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Changes in Hospital Leadership

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Women make up about half of the U.S. population. But they far outnumber men in the nursing workforce. Women account for nearly 90% of all registered nurses (RNs) in the U.S. Still, women continue to be underrepresented in hospital leadership.

RNs are being called on to become leaders at all levels in the healthcare system, from the bedside to the boardroom. Earning a Master of Science in Nursing (MSN) can put RNs on a leadership path.

The MSN – Nursing Administration online program at the University of Alabama in Huntsville (UAH), for example, prepares RNs with leadership competencies that align with the American Organization of Nurse Executives (AONE). RNs can graduate with their MSN in as few as 12 months, ready for a wide range of leadership roles.

What Does Hospital Leadership Look Like?

The majority of nurses are women. In fact, as the Advisory Board put it, “The health care industry is powered by women.” Still, women are a minority in healthcare leadership.

According to Healthcare Dive, women make up about a third of senior leadership positions in healthcare. But they account for only 13% of Chief Executive Officer (CEO) roles.

Hospital boards are an area for growth when it comes to diversity. However, as a 2018 American Hospital Association (AHA) healthcare governance survey shows, there is some progress.

  • 58% of respondents reported at least one racial/ethnic minority on their board, up from 53% in 2014
  • 30% of board members were female, an increase from 23% in 2005 (gender diversity remained unchanged between 2011 and 2014)

While results of the survey represent advances, they also point to persistent problems. For example, women have made notable gains. But that 7% increase mentioned above took 13 years to achieve.

What Are the Benefits of Diversity on Hospital Boards?

The U.S. is becoming more diverse. The Population Reference Bureau projects that, by 2020, only one-half of children in the U.S. will be non-Hispanic White. Healthcare organizations need to keep pace in order to provide culturally competent care to a diverse patient population.

There are multiple benefits to becoming a culturally competent healthcare organization, according to the Institute for Diversity in Health Management:

  • Reduced healthcare disparities
  • Increased community participation
  • Improved health outcomes
  • Lower costs

Cultural competence begins with understanding a hospital’s community and patient population.

Training and education for cultural competence can help nurses meet the needs of their diverse patients. Increasing diversity on hospital boards and executive teams is also key.

As one example, the AHA survey report notes that the patients coming through a hospital’s doors are evenly split between men and women. It follows, then, that hospital boards should mirror that in their membership.

Similarly, findings of the AHA survey call attention to the need for increased racial and ethnic diversity on boards.

  • According to the Census Bureau, Hispanic and Latino Americans make up 18% of the U.S. population. Yet they fill only 3% of board membership.
  • Likewise, African Americans comprise 13% of the U.S. population. But they fill only 6% of board seats.

Age diversity is another priority. Boards typically have low turnover, and there is a growing gap in membership age. The AHA survey showed that 12% of board members were 71 and older, compared with 9% in 2005. Only 22% were 50 or younger in 2018, down from 29% in 2005.

When it is time to fill an empty seat, younger nurses can take heart. Hospital boards do better than system boards when it comes to filling new seats with Millennials. Getting started on an MSN can help RNs position themselves for these opportunities.

For example, the MSN in Nursing Administration at UAH is designed to prepare nurses for leadership roles in healthcare organizations. Coursework emphasizes management, business and leadership competencies, such as:

  • Executive-level budget management and business planning skills
  • Strategic planning, such as tracking current trends and forecasting
  • Quality, safety and risk management concepts, including the use of data to evaluate and promote quality outcomes
  • Health assessment and health promotion for individuals and populations
  • Resource allocation and management, including recruitment, selection, retention, development and labor relations

The demand for RNs is expected to grow 12% from 2018 to 2028, according to the U.S. Bureau of Labor Statistics. This is more than double the average job growth for all occupations. The career outlook for nurse leaders is even stronger — with 18% job growth for the same period.

Earning an MSN in nursing administration can help RNs achieve their leadership potential. Whether managing a team of nurses or overseeing an entire department or healthcare facility, nurse leaders can influence decision-making in healthcare right up to the executive level.

RNs who aspire to the highest levels of leadership can earn an MSN to put themselves one step closer to a doctorate, the highest level in nursing education.

Learn more about The University of Alabama in Huntsville online MSN – Nursing Administration program.


U.S. Bureau of Labor Statistics: Labor Force Statistics from the Current Population Survey

NCBI: The Future of Nursing: Leading Change, Advancing Health

American Organization for Nursing Leadership

Advisory Board: Women Make up 80% of Health Care Workers – but just 40% of Executives

HealthcareDive: Women Make up Only 13% of Healthcare CEOs

American Hospital Association: National Health Care – Governance Survey Report 2019

Population Reference Bureau: What the 2020 U.S. Census Will Tell Us About a Changing America Becoming a Culturally Competent Health Care Organization

United States Census Bureau: Quick Facts – United States

U.S. Bureau of Labor Statistics: Occupational Outlook Handbook – Registered Nurses

U.S. Bureau of Labor Statistics: Occupational Outlook Handbook – Medical and Health Services Managers

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