The emergence of health systems as a dominant structure for organizing healthcare has stimulated the development of chief nurse executive (CNE) positions. These positions have large spans of control, requiring CNEs to balance a wide range of responsibilities, making them accountable for fiscal management, quality of care, compliance, and contributing to organizational growth. Relying on an influence-based model of management, these CNEs are challenged to establish themselves as organizational leaders in complex matrix organizations. They are required to establish a nursing agenda that delivers value to the corporate entity, member hospitals, hospital-based nursing leaders, practicing nurses, physician colleagues, and most important patients and their families.1
This issue focuses on the role of nurse executives at the corporate or system level. There are unique characteristics for these roles, and the responsibilities for practice, policy, research, and academic affiliations demand special attention. Requirements for nursing administration have evolved significantly over recent decades against the ever-changing backdrop of the healthcare industry. Relationships between corporate headquarters and affiliated entities are examined by experts in roles with systemwide responsibilities.
Each topic carries a message of importance to all nurse executives with an emphasis on understanding the application to senior nursing positions in healthcare systems of multiple entities at a regional or national level. There are varied organizational structures to be considered: affiliated models with corporate guidance or corporate partnership, integrated models with a corporate umbrella for oversight and policy setting, nonprofit, for profit, microsystems within a corporate macrosystem, county, state, and federal systems. Innovative concepts and practical advice are offered by seasoned colleagues who have dealt with these issues "up close and personal."
Chief nursing officers holding various system-level positions will gain insights on shared responsibility, relationships and accountability, information management, intergenerational workforce, strategic planning, mentoring, evidence-based leadership, quality measurement, effective organizational structures, group power within organizations, and leadership competencies.
It is important to recognize that nursing priorities across elements within a healthcare system must be aligned to achieve efficiency and effectiveness across all clinical domains. Chief nursing officers understand the work of nursing and each chief nursing officer must be equipped to design and describe the essential contributions of nursing in the context of the whole as we partner to shape the healthcare systems of the future.
Cathy Rick, RN, CNAA, FACHE
Guest Editor, Chief Nursing Officer, Veterans Health Administration
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