Q Our hospital is organized by service lines. Although there's a CNO to meet regulatory requirements, she doesn't have any operational control, authority, or responsibility. It seems as though nursing practice is often secondarily considered. What should be changed to ensure the benefits of both a service line and a traditional organizational structure?

Very few chief nursing officers (CNOs) exist in a freestanding hospital. Many healthcare organizations have some form of merger or agreement with a hospital system inclusive of service lines. Normally, the service line structure places all patients with like needs together. This is the opportunity for the CNO to assess the role of nursing within the service line structure and assume responsibility for the professional practice of nursing. The structure needs to be interdisciplinary, with the patient identified as the central focus. It's imperative that the service line has involvement of nurses at all levels in order to be successful. This should include representation at all critical meetings and involvement in decision making. Examples of the nurse's role within a service line include an identified nurse leader, oversight for policies and procedures, implementation of evidence-based practice, oversight of meeting quality outcomes, and ongoing research.

Service line strategies have the best opportunity to achieve quality outcomes, manage expenses, enhance revenue, and leverage these successes to grow in volume when nursing is very involved.1

REFERENCES