Many hospitals have consolidated their resources in an effort to remain financially solvent and provide a broader range of care throughout the continuum. The economically competitive healthcare environment has prompted hospital executives and members of the governing board to make the decision to consolidate with other organizations. Mergers have given rise to large health systems in an effort to gain market strength, share services, and implement best practices between hospitals. One outcome of these consolidations is the creation of the corporate chief nursing officer (CCNO) role. What are the expectations of this role? How does the CCNO interact with chief nurse executives at the individual hospital campus? Will this role be sustained in the future? How will a CCNO's success be measured?
The complexity of large health systems requires that structures and processes be congruent to ensure that nursing care is delivered within the framework of evidence-based pratice, with an emphasis on delivering the best possible quality at the lowest possible cost. The primary role of the CCNO is to standardize, develop, and ensure the appropriate translation of evidence-based care into daily practice throughout the health system continuum.
There are virtually no studies or published literature on the scope and standards for this position because the CCNO role is relatively new. Many seasoned nurse executives are assuming this role and are charged with the task of creating position descriptions that delineate their responsibilities and measures for success. The primary responsibilities of this position should be strategic, not operational, to ensure sustained goal attainment.
Key characteristics of the CCNO
The CCNO should have extensive experience as a chief nurse executive in a hospital setting. The exceptional candidate is dynamic, educationally prepared with a minimum of a master's degree in nursing, and nationally certified as a nurse executive, with a proven track record of achieving goals in a highly matrixed organization. Because the role is strategically oriented, CCNOs should be transformational leaders who possess the skills to clearly articulate a vision, be innovative, inspire others, and set high expectations for achievement.
The CCNO will represent the nursing department at meetings of the governing body and periodically keep board members apprised of the work being accomplished by nurses throughout the health system. The CCNO will also represent nursing on other systemwide committees, such as finance, human resources, quality, and patient safety.
Ultimately, the CCNO should provide vision, establish a nursing governance structure, ensure quality, provide strategic nursing management, foster staff development, regulate nurse credentialing, foster open communication and collaboration, and provide financial oversight in budgetary formation and compliance.
Provide vision. The CCNO provides a vision and direction for nursing throughout the health system. The concise development and clear articulation of nursing's strategic imperatives must be agreed on by nurse leaders and staff. A strong sense of commitment must emerge, and the vision can only be achieved through the resilience of the CCNO to forge forward despite untoward obstacles.
Establish a nursing governance structure. To ensure that care is delivered in a consistent, scientific framework throughout the health system, a governance structure should be formed for nursing staff, nurse managers, nurse educators, and senior nursing leadership to discuss challenges, issues, and concerns that affect patient care and management activities. This type of forum will engage all levels of nursing leadership in joint planning of activities designed to enhance professional nursing practice, set annual strategic goals and initiatives, and provide final approval of policies and procedures. The CCNO should chair this congress to provide overall leadership, direction, and consistency in approach.
Ensure quality. Meeting the challenges set forth by healthcare reform, exceeding patient expectations, and financial solvency can only be achieved if the delivery of nursing care is at the highest level. The CCNO should identify systemwide nursing quality indicators, ensure the participation of the organization in the National Database of Nursing Quality Indicators,® and analyze and benchmark quality data to determine the overall level of nursing's clinical performance. This can be achieved through establishing a nursing strategic plan that targets quality performance, implementing a care model and monitoring its effectiveness, and simultaneously developing structures and processes that track and trend outcome measures.
Regulatory requirements established by the Centers for Medicare and Medicaid Services and The Joint Commission, as well as the American Nurses Credentialing Center's Magnet Recognition Program,® are excellent blueprints for the CCNO to follow when developing quality processes. The structure established will dictate the process to which all staff will adhere. Active participation of nurses at all levels will aid in the development of systemwide best practices and promote the development of new knowledge and innovation at the point of care.
Provide strategic nursing management. In contrast with the campus chief nurse executive whose primary responsibility is to lead operations, the CCNO provides strategic direction by establishing goals and clearly defined targets to achieve them. The CCNO must work in concert with nursing leadership at the individual campus level to ensure that goals are clearly articulated and easily understood. Nursing strategic priorities should be congruent with system goals and promote the participation of nurses in decision making.
The CCNO is in a key position to evaluate clinical and administrative processes and determine best practices. It then becomes incumbent upon the CCNO to work to adopt these practices throughout the health system. Internal benchmarking between hospital campuses will facilitate learning among practitioners and improve care delivery. Nurse-sensitive indicators, such as hospital-acquired infections, pressure ulcers, patient falls, vacancy rates, and hours of care per patient day, can easily be analyzed to determine the high performers. Incorporating successful strategies across the system will raise the performance level of the entire system.
Foster staff development. Ensuring the availability of a well-educated nursing workforce to meet the needs of an increasingly complex patient population is a driving force for CCNOs to actively identify, develop, and maintain strategic academic partnerships. Whether creating partnerships to support the pipeline for new nurses, building new mutually beneficial programs, working on solutions to key safety issues, or promoting clinical scholarship through research initiatives, the CCNO must ensure that the structure, processes, and substantial resources are in place to facilitate nursing education.
The CCNO should develop a system approach/model for the professional development of nursing staff by setting expectations and designing goals, structures, systems, and metrics for nursing staff development (such as a clinical recognition program and national certification). An infrastructure should be built that allows the system to offer a comprehensive orientation curriculum, continuing education, and in-service education to support professional development needs, regulatory requirements, and strategic initiatives.
Regulate nurse credentialing. Ensuring that nurses at all levels of the organization remain competent in the care they provide to patients is an essential component of the CCNO's role. The competency of nursing staff must be the same no matter where the care is delivered. Systemwide competency programs need to be established and maintained, and outcomes need to be reported through the systemwide nursing governance structure.
Foster open communication and collaboration. It's essential that the CCNO maintain positive relationships with campus nurse leaders. The CCNO must be careful not to get involved with individual campus operational issues, rather provide overall guidance, insight, advice, and mentorship. Structured communication processes should be in place to ensure appropriate information is exchanged and discussed.
Provide financial oversight. An infrastructure to uniformly determine nursing staff workload must be present throughout the system. The CCNO is responsible for using trended data to formulate the staffing plan and acquire necessary resources to ensure consistent application of the care delivery system. The trended data should be produced using a methodology so that like comparisons can be made throughout the health system. The data derived are the foundation for budget preparation and should be implemented in accordance with a standardized criterion that best supports patient acuity, volume, nursing skill, presence of support, and the use of technology.
What the future holds
The CCNO will be the driving link to ensure consistency of practice throughout clinically integrated networks and accountable care organizations. The delivery of competent, effective, and efficient nursing care needs to be strategically orchestrated to ensure the highest level of quality at the most prudent cost.