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Reinventing the CNO

Carrie Vaughan, for HealthLeaders Magazine, February 5, 2009
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Service line development? Financial analysis? Pharmacy services? The role of chief nursing officer has morphed into much more than nursing.

When Maureen Swick, RN, PhD, began her job as chief nursing officer at Monmouth Medical Center 10 years ago, she was responsible primarily for nursing services. Then her role began to expand. She soon assumed responsibility for service line development for the Long Branch, NJ, hospital, including behavioral health, cardiology, and oncology. Now in her new role as the CNO and vice president of patient care services at Saint Peter's University Hospital, a 400-staffed-bed facility in New Brunswick, NJ, she continues her involvement in service line development. "The CNO by title is probably now more of a vice president of patient care services," Swick says.

Swick's story is an increasingly familiar one. Being the CNO at a hospital or health system used to mean you were in charge of nursing services. Period. But the title of CNO has evolved into perhaps the most misleading component of the C-suite. "It is the coordination of a multitude of departments that traditionally didn't report to or necessarily interact with the nursing department," says Maureen White, the senior vice president and CNO for the 15-hospital North Shore-Long Island Jewish Health System in New Hyde Park, NY.

The CNO's role has expanded into oversight of a broad range of pharmacy, respiratory, transport, central supply, and ancillary services. "The CNO role is becoming more important in a lot of hospitals," says Joyce Batcheller, RN, MSN, the CNO for Austin, TX-based Seton Family of Hospitals. Batcheller is charged with integrating and standardizing the care processes across the 10-hospital system, so that patients receive the same level of care regardless of which Seton hospital they visit. "If you look at what Medicare is doing in terms of not paying for never events and hospital-acquired pressure ulcers and other conditions related to hospital care, the spotlight is on nursing."

New skill sets
CNOs today must have a solid understanding of payers, case mix index, demographics, and reimbursement—areas in which CNOs historically haven't needed deep knowledge. Being able to analyze financial statements and accounting principles is certainly more important today, says Swick.

And CNOs can't afford to wait until such skills are required to learn them. "In the current healthcare environment, it is critical for the CNO to understand what is going on at a state and national level," says Swick, who is also a board member with the American Organization of Nurse Executives. "The days of learning on the job are gone. The expectation is that you maintain and develop yourself on an ongoing basis professionally."

Areas of focus
CNOs may still spend a good chunk of their time on staffing issues like recruitment, retention, and ensuring that they are managing staff resources effectively, but their focus also encompasses work force planning issues like mentoring and coaching future leaders. That emphasis is also not limited to nurses.

"A lot is focused on the people—not just on recruitment and retention—but bringing about the best in every staff member that we have," says White, adding that nurse leaders should be concentrating on being "very motivational, transformational, and forward thinking."

But perhaps the CNO's biggest role is to study the organization's strategy and determine how they can engage staff members to develop innovative solutions by ensuring employees have the forums to verbalize their ideas, White says. "It has become a people job focusing on the transformation versus the transactional."

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