Nurse Executive Leadership Roles

Will Chief Nursing Officers Hear the Call: A Reflection

The health care system has experienced rapid changes related to patient care and safety practices that had lead to multifaceted shift in patient care models and nursing leadership paradigm. These changes that include “transitioning from a traditional reimbursement models to new and innovative methods” (Patton & Pawar, 2012, p. 320). have greatly influenced the rapid transformation in the leadership role assumed by nursing executives in the healthcare organization in the past decade. In 2010, the Institute of Medicine (IOM) report, “The Future of Nursing,” discusses the vital roles and challenges chief nurse officers (CNO) faced while serving to bridge the gap between the business acumen

As expected to embody the executive tasks and functions referent to their positions, nurse leaders in the executive roles need to “move up in the reporting structure of their organizations to increase their ability to contribute to key decisions” (IOM, 2010, p.235). This essentially defines the roles and level of accountability the position entails. At West Palm Beach Veterans Affairs Medical Center (WPB VAMC), the local medical center executive leadership is composed of five executive members (also known as PENTAD); namely, Medical Center Director, Medical Center Associate Director, Nurse Executive/Associate Director of Patient Care, Chief of Staff, and Deputy Chief of Staff; with the Medical Director spearheading the local medical center. The Nurse Executive serving as one of the pillar of the PENTAD, represents the main core of health system - patient care. Reporting directly under the nurse executive is the CNO, whose role calls for the ability to influence organizational missions, healthcare changes, and redirection of institutional strategies as based on outcomes. Besides spearheading the resolution of complex clinical and ethical dilemmas, the CNO is first and foremost, a representation of the

As emphasized by Patton and Pawar (2012), the current healthcare system necessitates the need to efficiently handle “value proposition” in patient care; balancing “cost, quality, and patient experience” (p.324). As a result, CNO faces an interlocking compartmental dilemma, such as realignment of nursing academic preparatory learning to institution-based clinical specialization; integrating socio-political health system regulations and medical center operations; and efficiently directing funding availability, and multifactorial needs prioritization (needs vs wants) (Hughes, Carryer, & White, 2015). Being a proponent of evidence based practice and research contributors, CNOs serve as a valuable source in the formation of new caring knowledge and effective strategies in organizational management (Frederickson & Nickitas, 2011, p. 346). Besides forecasting trends and practice focus of regulating bodies, the CNO also needs to be able to deal with the different generations of nurses, the generation strengths, weaknesses, and effective learning approaches. In response to the challenge of the expanding demand of the executive nurse leader role and accountability to healthcare stakeholders, key organizations such as Robert Wood Johnson Foundations, Harvard University, and Johnson & Johnson, among a few, have designed competitive nurse executive curricula and fellowship that aims