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Reshape the Nurse Leadership Role

Analysis  |  By Jennifer Thew RN  
   September 27, 2019

Reshaping healthcare delivery means reshaping nursing leadership. Enter the chief nursing optimization officer role.

Betty Jo Rocchio, MS, BSN, CRNA, CENP, chief nursing optimization officer at Mercy in St. Louis has long been ahead of the curve when it comes to the nursing profession.

"As an undergraduate, I did a dual degree. I did a bachelor's in nursing as well as a bachelor's in business administration at the same time. My mother was a nurse and she told me the only way she'd let me go into nursing is if [I also had] a business background," she says. "She really pushed me to do that. It was probably one of the best things I did. It set me on that dual track—healthcare as a business, but also taking care of patients and driving toward outcomes."

After graduating from nursing school, Rocchio used those healthcare optimization skills—which she describes as eliminating barriers in order to achieve high-quality outcomes—while starting wellness programs at a business that helped employers with healthcare needs and health promotion. She later became a certified nurse anesthetist and worked with orthopedic surgeons who eventually started an orthopedic hospital. There Rocchio helped build the anesthesia department, and eventually became chief nursing officer of that hospital. Once the hospital was sold to a health system, she became the system's perioperative director. Later, a colleague who had joined Mercy asked Rocchio to come on board to do perioperative work at the St. Louis–based organization.

"I learned to optimize the perioperative space, focusing on the lowest cost for the best outcomes for our patients," she says of the opportunity.

After Mercy's CNO left about three years ago, leaders realized they had an opportunity to reshape its nurse leader position.

"I believe our senior leaders saw that nursing was changing and becoming more operationally minded. They came up with a fantastic title: 'chief nursing optimization officer,' and that's how I got here," she says.

In addition to her current role, Rocchio continues to work a few days a month at Mercy as a CRNA.

Rocchio recently spoke with HealthLeaders about the chief nursing optimization officer role, the future of nursing leadership, and how her continued clinical work informs her leadership decisions. 

Following is a lightly edited transcript of that conversation.

HealthLeaders: What is your definition of the term optimization?

Rocchio: Optimization basically means we're driving the best outcomes with the best performance of our coworkers with a minimal amount of friction in daily processes. So: an easy process for people to be able to do the right thing for patients. That's basically how I define it.

HL: What were the goals and outcomes that Mercy was hoping for when you came into this position?

Rocchio: We have been focusing on three paths: cost, quality, and service. I split my work up into those buckets on a daily basis. We hit each of those kind of pillars in Mercy and we're doing it in nursing. Now everyone is aligned underneath me from a nursing perspective. Peri-op reports up through me, cath labs, all of nursing. I have all of that structure underneath me, [and I'm] trying to make sure that we are able to stay optimized and bring all those specialties and nursing with us.

In the cost sector, we're all about delivering the best care with the least amount of resources. That is exactly where we want to be. I think the government is pushing us that way as well as the payer. We are concentrated on trying to manage our cost structure while keeping our quality the same or better.

HL: Tell me a little bit more about your role and title. How does it differ from a CNO or a CNE?

Rocchio: Changing out that chief nurse executive role for my title really signifies the operational work that needs to go on in nursing.

I would say the biggest difference is the way the work gets done. The CNE works through a strict process and nursing structure. The chief nursing optimization officer is freed up to do work through innovation. Everything we do has a creative slant to that nursing structure that most other CNOs are working on like Magnet Recognition status or NDNQI. We're … becoming innovative in the ways that we're looking to accomplish the same things that they're looking to accomplish.

Part of that innovation is having a technology slant as well as an analytics slant. I like to say the technology is how we get the work done. It gives our providers that extra something they're going to need [in order] to spend more time with their patients at the bedside.

HL: Can you give me an example of innovation in action?

Rocchio: One of the technology platforms that we're working on right now is called Epic Rover. It gives the nurse the ability to have a hospital-issued smartphone to do their work. Now instead of being tied to a computer, they can do most everything through the smartphone. One of the things that makes Mercy innovative is we're tagging on to voice-activated charting through that. No longer does the nurse do their assessment and have to go back to a workstation to be able to chart it. [Instead], they're voice activating the entire assessment while they're [completing it]. Your phone is logged in for you and you'll say, 'Pull up the adult neuro assessment,' and then you start charting.

[The technology] does more than just give back time to the nurse. It allows for communication with the patient as the nurse does the assessment. …We explain to [patients]: 'We're going to be talking to the phone, but we're going to be charting while we're talking, and feel free to ask questions.' It also allows the nurse to chart in real time.

HL: Would you suggest other organizations create a similar role of chief nursing optimization officer?

Rocchio: Yes, but I would caution against having a CNO and a chief nursing optimization officer because you want to pick one structure to go with. I'm not saying your CNO can't have an innovation focus, but, if you create both [roles], it becomes redundant in your organization.

Their basic fundamental philosophy is going to be completely different. If you put two of them in there, you're going to have some head butting going on. Your CNE may be focusing on retention while your chief nursing optimization officer is focusing on new and inventive ways to get people hired quicker, oriented faster, and up on the unit taking care of patients.

What I would do if you want to stick with your typical CNO structure, is to partner them with a chief nursing informatics officer that's highly innovative and who understands analytics. I would get that analytics function in there because the way to get things done is through innovation and technology.

HL: How does your continued work as a CRNA inform your ideas and the decisions that you make as a chief nursing optimization officer?

Rocchio: I [work as a CRNA] about a couple of times a month when I can fit it in.

While I'm working, I go up to the ICU and I meet those nurses. I'm interested in what goes on at the frontline from an operational and innovation standpoint [to understand] how we can reduce friction and make things better.

HL: Any advice or insights that you have for other hospitals, health systems, or nurse leaders?

Rocchio: Really listen to what the frontline staff and patients are saying. I would say that's an aggregated voice, not just one versus the other. [Rather it's] knowing what your patients are experiencing and what your nurses are delivering and experiencing together, not separate.

Jennifer Thew, RN, is the senior nursing editor at HealthLeaders.

Photo credit: Photo of Betty Jo Rocchio provided by Mercy.


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