1. Prestia, Angela S. PhD, RN, NE-BC


This column profiles Mary Jo Bulfin, MBA, RN, CENP, chief executive officer of St. Mary's Medical Center, West Palm Beach, Florida. Ms Bulfin began her career as a staff nurse in the organization where she is now the CEO and discusses her career path and lessons learned.


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Mary Jo (Joey) Bulfin, MBA, RN, CENP, is an example of a nurse who has leveraged options in her career path to move from staff nurse to chief executive officer (CEO) at the same facility, St. Mary's Medical Center. A 2016 survey substantiates the sentiment that currently employed millennials will seek other employment by the year 2020.1 Reasons for multiple employers may include personal expectations not being met, that is, work-life balance, and/or insufficient compensation.2 Career advancement opportunities are another reason nurse leaders leaving a role.3 With 85.9% of nurses in the United States in 2015 being women,4 differences with the grooming and mentoring of women for leadership and executive roles compared with men may be a factor. In nursing, women hold 43% of the nurse executive roles5 but only 11% of the CEO roles in the United States.2 The perception of a lack of fundamental business skills is reported as 1 reason holding women back from CEO roles.6

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Dr Prestia: Is nursing a good foundation to serve as a healthcare CEO?


Ms Bulfin: Nursing prepares you for the why of healthcare. Every day, there are distractions, but nursing brings you back. As you progress from chief nursing officer (CNO) to CEO, your nursing foundation provides you the unique perspective of compassionate care.


Dr Prestia: What did you do to prepare yourself for the transition from bedside to leadership in nursing and then from CNO to chief operating officer (COO) to CEO?


Ms Bulfin: At the beginning, I just wanted to take care of patients. Promotion to a leadership role was never a conscious thought. As your life changes, your career opportunities change. I began to understand that I enjoyed the challenge of learning and leading. From staff nurse to charge nurse, to nursing coordinator and then nurse manager, I was able to see myself in the next role. I began having a broader perspective.


Dr Prestia: What core competencies helped to make the transition?


Ms Bulfin: The most important competency for all roles is effective communication. The focus must be on the listening in understanding the perspective of others. This skill is critical for the development of collaborative teams. I believe specific competencies for each role include:


Nurse director/manager: the ability to develop staff competency and provide the most skilled clinician to patients. Conflict resolution skills are also critical.


CNO: the ability to develop leadership competencies among nurse directors/managers in preparation for CNO succession. A key relationship for the CNO is with the chief human resource (HR) officer. Together, they ensure nurse resource development.


COO: the ability to prioritize available resources and advise on the optimal allocation. Earlier in my career, I had recognized a deficiency in my knowledge of business and finance. I understood that I wanted to advance my career. I obtained my Master's in business finance. This degree provided me with the educational foundation to be a COO.


CEO: the ability to vision the future and move the team in unison toward goals is a key competency. This takes years to achieve; however, the skillful CEO understands the team's strengths and positions them for success.



Dr Prestia: Did you have a formal mentor, and can you share the best advice received?


Ms Bulfin: Judy Rich, RN, was the Director for Women's Services when I was promoted to my 1st nurse leader role. She took a chance with me, someone with minimal management experience. This was a big risk for both of us. Judy later became the President and CEO of Tucson Medical Center. She and other nurses who became CEOs served as my role models.


The best advice I received was a lesson in economics using a pie metaphor. "There is only one pie," a consultant told me, "and it must be divided up so that everyone gets some[horizontal ellipsis]. If I give you more, than someone gets less and perhaps someone gets none." Think about this: it works in every aspect of life-at home, at work, with time management and with money.


Dr Prestia: What has worked for you with respect to having a career at 1 facility?


Ms Bulfin: When I think back on my 36-year career, I have no regrets. Every job I held within the organization challenged me, each more difficult, and demanding. There were personal sacrifices. Young professionals must understand that they will not get every job or promotion they want. I certainly didn't. I may not have recognized it at the time, but I lacked the knowledge base required for some of these roles and would not have been successful. I support promotions from within and believe the historical perspective of an organization affords you a higher level of understanding of the people and culture. I knew the employees' joys and sorrows, and they knew mine. I was connected to them. When I was promoted to CEO, staff members approached me and shared how proud they were of me. My nursing background and longevity helped validate my worthiness as CEO.


Dr Prestia: What are the top 3 most impactful changes in healthcare over your career?


Ms Bulfin: I think they would be technology, pharmaceuticals, and DNA sequencing. These advances create opportunities that will improve healthcare.


Dr Prestia: What has not changed that you would like to see change during your career?


Ms Bulfin: I am very passionate regarding the female ambition gap described by Sandberg in her book Lean In.7 The disproportionate balance of female to male nurse leaders in a predominately female profession amazes me. I want to challenge female nurses to become leaders. Embrace these roles, as you have so much to offer. I know some incredibly talented bedside nurses want to continue to share their gifts at the bedside. However, for those who aspire to lead, "Lean-In!"


Dr Prestia: As a leader matures chronologically, how do you suggest they stay relevant to the next generation of healthcare workers?


Ms Bulfin: Learn to fully and honestly engage with our young professionals. Listen and take their suggestions. Don't be set in your ways.


Dr Prestia: Is there anything you would like to add?


Ms Bulfin: Career longevity is about realistic expectations, leaning in, hard work, and dedication. Find your passion; find your purpose.




1. Deloitte Consulting. The 2016 Deloitte millennial survey: winning over the next generation of leaders, January 2016. Accessed May 7, 2017. [Context Link]


2. A comparison of career attainments of men and women in healthcare executives, 2012. Executive summary. Accessed October 7, 2017. [Context Link]


3. Jones CB, Havens DS, Thompson PA. Chief nursing officer retention and turnover: a crisis brewing? Results of a national survey. J Healthc Manag. 2008;53(2):89-106. [Context Link]


4. National Council of State Boards of Nursing. National Nursing Workforce Study. Accessed October 7, 2017. [Context Link]


5. Diamond D. Women make up 80% of health care workers but just 40% of executives. Accessed October 14, 2017. [Context Link]


6. Matthews E, Collins KS, Collins SK, McKinnies RC. Chief executive officers in US hospitals: a reexamination of workforce demographics and educational issues. Health Care Manag. 2013;32(1):69-76. [Context Link]


7. Sandberg S. Lean in: Women, Work, and the Will to Lead.New York, NY: Alfred A. Knopf; 2013. [Context Link]