The nurse who calls the shots: as CEO of a major health-care system, Valinda Rutledge says she is still taking care of patients--just on a broader scale.

• Author: Martin, Edward
• Position: COVER STORY

At dawn, they will come with the gurney the door will slowly open, and light from the hallway will stream in. Someone will ask his name, and the long night will end. Until then, there is darkness, the soft hum of machines and pumps, the tangle of translucent tubes and the dull ache where needles stick into his arms. The surgeons and family have gone, and the clock above the bed is dim in the pale glow of monitors. He is alone with his fear--and the nurse on the midnight shift.

This, in the 1970s, is the realm of Valinda Rutledge. She is young, and Detroit's formidable Henry Ford Hospital is the first stop in her nursing career. The years will add experience and credentials. She will specialize in oncology nursing, working with kids suffering with what then was the nearly certain death of childhood leukemia, while earning advanced degrees. She will meld passion and compassion, on occasion baby-sitting her patients overnight to spell their parents.

She particularly remembers those awaiting operations. "You'd go into the rooms of patients who couldn't sleep because they were worried about their surgery and what the morning would bring. You'd hold their hands and let them talk about how scared they are." Some-times, the darkest fear became reality. "You would have to go to a family and tell them that, no matter how much you'd done, their loved one had passed away."

In the decades since, Rutledge, now 57, has moved from the nurses station to the executive suite. For nearly two years, she has been president and CEO of CaroMont Health Inc., the Gastonia-based health-care system that is in five counties in the Carolinas, anchored by the 435-bed Gaston Memorial Hospital. An anomaly in her field, she's the only nurse, and only woman, running an independent health system in North Carolina. (Another nurse, Kevin Sowers, is president of Duke University Hospital in Durham; Sharon Tanner heads Albemarle Health in Elizabeth City, which is affiliated with Greenville-based University Health Systems of Eastern North Carolina Inc.) With 3,800 employees, 44 medical practices and 133 physicians, CaroMont is the largest of the second tier of health systems, which often consist of an anchor hospital and multiple medical clinics and practices. Most are affiliated with one of the nine multiple-hospital systems, based in Charlotte, Winston-Salem, Greensboro, Greenville, Raleigh, Chapel Hill, Asheville, Wilmington and Pinehurst.

Now, rather than comforting solitary patients, she's confronting upheaval in the delivery of care to tens of thousands, much of it driven by the sweeping provisions and uncertainties of national health-care reform and the heated competition among health systems in the Piedmont. She's moving toward once-unthinkable precepts. Among them: that those who deliver medical care will be held financially responsible for its results and that medical procedures can be bundled--list-priced--like a car or washing machine. Ultimately, her system's independence could be at stake. CaroMont, with net operating revenue of $483 million in the fiscal year that ended in June, posted an operating margin of about $23 million, about 5%.

Facing such hurdles while working to bridge the frosty aloofness that once characterized relations between administrators who run hospitals and doctors and nurses whose hands fall directly on the patients, she feels she has an advantage. On a gray, snowy day in Gastonia, a town where empty mills from the decades-long decline of textiles seem to mirror the collapse of the auto industry in Detroit, she takes stock. "When you move from the patient's room into the boardroom, you leave a part of you back in the patient's room. You never lose that."

"A CEO that has a clinical background and has worked with physicians certainly has an asset in their tool kit that will be more valuable as we move even deeper into health-care reform," says Don Dalton, a vice president of the 130-member North Carolina Hospital Association. More than a mere matter of personnel management, it's a gulf that must be spanned if the next generation of medicine is to succeed.

Smart but shy, she grew up a bookish kid in Baltimore and other places General Motors Corp. made its cars and their parts. "My dad worked for GM and was transferred several times. My parents married young and were not well-to-do in their background at all."...