Skip Navigation LinksHome > September 2011 - Volume 41 - Issue 9 > Perspectives on Executive Relationships: Influence
Journal of Nursing Administration:
doi: 10.1097/NNA.0b013e31822a717d
Departments: AONE: Leadership Perspectives

Perspectives on Executive Relationships: Influence

Keys, Yolanda DHA, MSN, RN, NE-BC

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Author Information

Author Affiliation: Assistant Professor, College of Nursing and Health Sciences, Texas A&M University, Corpus Christi.

The author declares no conflict of interest.

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Correspondence: Dr Keys, Texas A&M University, 6300 Ocean Dr, Corpus Christi, TX 78412 (

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This department, sponsored by AONE, presents information to assist nurse leaders in shaping the future of healthcare through creative and innovative leadership. The strategic priorities of AONE anchor the editorial content. They reflect contemporary healthcare and nursing practice issues that challenge nurse executives as they strive to meet the needs of patients. In this article, the author presents the views of 6 Magnet® hospital chief nursing executives regarding their relationships with executive-level colleagues.

The emergence of large hospital systems has led many organizations to designate a system chief nursing executive (CNE). Although the role of specific CNEs can vary, a consistent responsibility is that the CNEs serve as the representatives for nursing at the executive level. In working to create positive nurse work environments and support optimal patient outcomes, CNEs must be adept at managing relationships with other executives.1-3 The ability of nursing leaders to influence and build relationships is a strong determinant of success.1,3 In a study of CNEs in the United Kingdom, poor relationships with members of the executive team "were seen as an important failure, as they made it difficult to contribute across a wider agenda."3(p960) In addition, CNEs not successful in this area were considered by colleagues "to have failed to take personal responsibility for improving poor relationships."3(p960) Having responsibility for nursing across multiple facilities requires that CNEs promote a strong agenda for nursing, remain alert to changes that impact patient outcomes, and manage relationships with executive-level colleagues.

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Adams Influence Model

The importance of executive-level relationships may seem obvious, but strategies to nurture such relationships can be elusive. This is especially true when nursing leaders are focused on a pure nursing agenda or are immersed in conflicts regarding scarce resources.1 Six Magnet® hospital CNEs were interviewed to obtain insight into their relationships with executive colleagues. Initial content analysis revealed the importance of influence within the context of these crucial relationships. The Adams Influence Model (AIM) was used to guide a second content analysis.4

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Factors From the AIM

Using the AIM to understand CNE influence "provides CNEs with a road map for understanding the factors, attributes, and process of influence and can be used by nurse leaders as a guide to maximizing their individual influence and that of the profession."5 The AIM outlines 5 main influence factors (authority, communication traits, knowledge-based competence, status, and use of time and timing) and identifies attributes of each factor.4 Because this inquiry is focused on influence in the specific context of executive relationships, not all attributes of the AIM are addressed.

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One of the 3 attributes of the AIM authority influence factors is access to resources. Access to executive-level colleagues is an important element of an organizational structure that participant CNEs described. Access to executive colleagues occurred in formal meetings or informal interactions.

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Communication Traits

The influence factor of communication was especially relevant with respect to message articulation. Chief nursing executives described spending considerable time preparing themselves to communicate their agenda to non-nursing colleagues. Using quality as a rallying point for garnering cross-departmental support for nursing initiatives was not uncommon.1

The communication attribute of emotional involvement included effort on the part of participants to distance themselves from their own emotional reactions in order to view situations objectively. In addition, participants described efforts to understand the emotional involvement of others relative to a specific situation or issue.

Persistence was another attribute of communication that was noted in participant responses. Persistence was evident in keeping specific agenda items on the radar screen for future funding or in ensuring message articulation across multiple constituencies. Presence and confidence were attributes that were not specifically mentioned but were implicit in participant descriptions of relationships and interactions with executive-level colleagues.

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Knowledge-Based Competence

The knowledge-based competence influence factor was most evident in the context of sociopolitical knowledge. Sociopolitical knowledge "causes the nurse to question taken for granted assumptions" and think outside of traditional nursing silos.6(p83) Whereas some nursing leaders may be focused on nursing specific issues, Magnet hospital CNEs in this inquiry managed a paradigm shift from a strict patient or nursing focus to a focus on a healthy organization that demonstrates good patient outcomes. This paradigm shift also helped them to appreciate the need to speak the language of business and/or finance to promote mutual understanding and respect among executive-level colleagues.

Health system executives rely on their nursing colleagues to manage resources.1 By investing time to develop relationships with these colleagues and speaking in terms of finance or business, nurse executives described experiences that aligned their nursing agenda with those of the health system, thus positioning their constituencies for success.1 Participants were clearly adept at message articulation that demonstrated respect for the sociopolitical environment in which nursing care occurs.6

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The AIM places key supportive relationships under the influence factor of status, which is understandable inasmuch as status provides access to key personnel because of hierarchical position. Status may also be viewed in the sociopolitical context because, according to White, "nurses must be both articulate about what they know and do and be recognized by others as having something to contribute."6(p85) This is true in the context of influencing organizational decisions where key personnel are the targets of influence.

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Time and Timing

The final influence factor of the AIM is time and timing. It was evident from participant responses that timing can be a key component in building relationships and message articulation. Investing time to prepare facts to be able to demonstrate organizational, business, or financial knowledge is also an important use of CNE time and timing. One of the strategies mentioned by almost all participants was taking informal opportunities (timing) to secure 'buy-in' from key personnel or coalition building.

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Focus on Coalition Building

An element of executive relationships that was noted among participant responses includes behind-the-scene work to garner support for nursing agendas. In working through executive-level relationships, participant CNEs worked to build coalitions for their initiatives. Coalition building has been described as a common influence tactic used by female nursing leaders.4 This work took place via conversations walking across the hospital campus or having designated afternoons without meetings but where executive team members had an informal agreement to be working in their offices. This dedicated time allowed for impromptu meetings to discuss pending issues, projects, and even work through conflicts. Participant CNEs described these informal interactions as key opportunities to influence executive relationships toward a common action.

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Influence factors from the AIM provide a useful tool to identify areas where current or aspiring nurse leaders can improve. By focusing on authority, communication traits, knowledge-based competence, status, and use of time and timing, nurse executives can identify areas of deficiency and strengthen their skills. These skills are especially important to not only create positive relationships with executive colleagues but also build coalitions that favor initiatives that promote positive nurse work environments.

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1. Arnold L, Drenkard K, Ela S, et al. Strategic positioning for nursing excellence in health systems: insights from chief nursing executives. Nurs Adm Q. 2006;30(1):11-20.

2. Englebright J, Perlin J. The chief nurse executive role in large health care systems. Nurs Adm Q. 2008;32(3): 188-194.

3. Kirk H. Factors identified by nurse executive directors as important to their success. J Nurs Manage. 2009;17:956-964.

4. Adams J. Validation of the Adams Influence Model (AIM) [dissertation]. Chestnut Hill, MA: Boston College Connell School of Nursing; 2009.

5. Adams J, Erickson J. Applying the Adams influence model in nurse executive practice. J Nurs Adm. 2011;41(4):186-192.

6. White J. Patterns of knowing: review, critique, and update. Adv Nurs Sci. 1995;17(4):73-86.

© 2011 Lippincott Williams & Wilkins, Inc.