“Clinical Nurse Managers are the Linchpins of their Organizations”

Beth Oliver serves as Vice President of Cardiac Services for the Mount Sinai Health System. She oversees clinical cardiology operations and is responsible for ensuring delivery of quality patient care to cardiology patients.  She previously served as Vice President of Clinical Operations for Mount Sinai Heart, a position she holds in addition to Vice President of Cardiac Services for the health system.

From 2010-2012 Oliver served as associate executive director of Nursing and Cardiovascular Services at Lenox Hill Hospital, and prior to that she held a number of leadership positions at Mount Sinai, including director of interventional cardiology nursing services, and senior director of nursing services. Oliver earned a BSN from the University Of Massachusetts School Of Nursing, an MS from Columbia University School of Nursing and a DNP from Case Western Reserve University. This year, she received the 2014 Distinguished Alumni Award from Columbia Nursing.  She is a member of Sigma Theta Tau Nursing Honor Society, the American College of Cardiology, and the American Heart Association, where she is the only nurse on the board of directors of the New York Chapter. She is the chairperson of the American Heart Association’s My Heart, My Life campaign which aims to improve the cardiovascular health of all Americans by 20 percent by 2020, and co-chairs its annual Heart Walk fundraiser.

Q: You were the lead author of a recent study finding that the recruitment and retention of clinical nurse managers (CNMs) is crucial to the future of quality care in health care institutions. Your recommendations include onsite leadership development programs for CNMs, greater transparency and communication from nursing divisions, and more opportunities for mentorship from clinical directors. Why hasn’t this been done before and what are the impediments to empowering CNMs?

Historically, nurse administrators picked the best clinical nurses to become managers. While it is unquestionably crucial that clinical nurse managers be expert clinicians, their role has evolved into a very different position from that of head nurse, and additional skills are required.   In today’s health care environment, CNMs must also be able to access, evaluate and interpret data on quality measures, patient satisfaction and other areas that reflect the changes in the health care delivery system.  The ability to understand and be comfortable with financial data is also a growing concern of CNMs. The role of the CNM has been evolving rapidly, however CNMs have not always been provided with the education and skills required to fulfill this role.  This is true of formal education programs as well as hospital based orientations.  Nursing leaders within academia should consider adding core courses to their programs that address these needs, just as they have modified curricula to respond to the expansion of the roles of case managers and nurse practitioners.   Ideally, academic program leaders should collaborate with hospitals to determine the nature of the needs of CNMs, who are important figures in clinical operations.

A large reduction in the number of CNMs is predicted by 2020, presenting a crisis for the profession, however this issue has not yet been fully addressed.  Clinical nurse managers are the lynchpins in their hospitals. In a 35-bed unit, for example, they round on all the patients, report on financial and quality metrics as well as patient satisfaction, handle payroll and overtime, manage the budget, and deal with personnel issues.

Q: As health care becomes more interdisciplinary and team based, what more can be done to educate nurses to work in an increasingly complex environment?

Inter-professionalism is an important concept and as the health care environment becomes more complex, with more and different types of providers contributing to the overall care of the patient, interdisciplinary collaboration and team work will become increasingly important to coordinating care, achieving quality outcomes, and providing safe patient care.  The environment is simply too complex for one provider or service to be effective alone. Since most doctors, nurses, physical therapists and other care delivery team members are educated in profession-specific programs, they may lack education in functioning as part of a well integrated team.  Perhaps education can be modified to include shared curricular content that relates to inter-professionalism, teamwork and prepares providers to function effectively as a team.

Q: This year, Mount Sinai Hospital expanded to create the largest hospital system in New York City. Health care organizations across the country are also expanding as they move away from a fee-for-service model toward accountable care organizations. What challenges do nurses face as a result of this expansion of large health systems?

A big challenge for clinical nurses with growing standardization will be the transition of care across the continuum of care settings: between hospitals, clinics, rehabilitation facilities and home.  Nurses need to become empowered to do more than simply following discharge orders: They must collaborate with case managers and care navigators and communicate effectively with providers and patients to make sure that follow up care and strategies are in place, as well as avoid medication errors.  Patient follow up will become even more critical to avoid readmissions. I foresee more nurses and nurse practitioners working together in community health; specifically in promoting wellness, educating patients on medications, as well as partnering with patients to promote  smoking cessation,  exercise and healthy eating.  Nurses can make an important contribution to helping monitor patient’s management of chronic diseases such as  diabetes, heart failure and COPD.

Q: During your tenure as a nurse leader at Lenox Hill Hospital, you helped expand the role of ambulatory nurses. How will their role grow with the implementation of the Affordable Care Act?

The role of nurses will surely expand as a result of the Affordable Care Act.  Nurses will be instrumental in making sure that patient care plans and treatments are successfully transitioned and implemented across the continuum of care settings. For example, they will need to work more closely and partner with long term care facilities, community health organizations and home health care vendors.  For example, when discharging a heart failure patient to a long term care facility, the nurse will need to work with the personnel who will care for this patient by educating them about their treatment and care plan to insure continuity of care, and to avoid readmission.

Q: Heart disease is the number one killer of women and it’s even deadlier than breast cancer. What more can nurses do to promote cardiac wellness with female patients?

Nurses, along with all health care providers, must raise their awareness of heart disease in women, as it's different than heart disease in men. Nurses must know risk factors for heart disease, know patient targets, and have the knowledge and expertise to coach patients toward reaching those targets. But just as important, nurses must take stock of their own cardiovascular health, become aware of their own risk factors, and be exemplars of risk factor management, for their own well being and for the well being of their patients.

Like other Americans, health care providers must address their own rising rates of obesity and hypertension. Nurses need to lead the way on health promotion: exercise, diet, stress reduction, smoking cessation, diabetes screening— and to do that most effectively, they must take care of their own health.