Nurse Leaders Expand Responsibilities in High-Level Management

Executive nurse leaders are increasingly filling the highest levels of hospital management, engaging a much wider range of responsibilities on top of clinical duties, according the AMN Healthcare Nurse Executive Survey.

The survey of 141 nurse executives was completed in July 2017 by AMN Healthcare and The Center for the Advancement of Healthcare Professionals to assess nurse leaders’ attitudes and behaviors regarding staffing and recruiting, along with their general roles and responsibilities.

The survey found that nurse executives spend most of their time on culture and operations, and are valued for their ability to utilize nurse resources to achieve organizational and clinical goals. Approximately 68% report directly to the CEO, and 91% are members of a senior management team.

Evolution of the CNO

When asked how the Chief Nursing Officer, or CNO, role has evolved over the years, 56% of nurse executives mentioned the word “more”: More metric-driven, more responsibilities, more involved in decision-making, and more strategic planning, particularly to meet financial goals.

“In our organization I think it has evolved from just staffing the nursing department to a key player in setting and achieving organizational goals and part of the decision making team for major changes within our organization,” one survey respondent said.

Nurse leaders say that they utilize their time in the following:

• Relationships and culture – 35%
• Operations – 32%
• Strategy – 19%
• Finance – 14%

Growing Value to Organization

The Nurse Executive Survey looked beyond functional duties to probe the contributions today’s nurse leaders deliver their organizations. Asked what value they believed their CEOs and boards ascribed to their roles, respondents listed:

• Developing and executing strategy
• Bringing perspective on how decisions impact patient care
• Utilizing nurse resources to meet organizational goals

AMN Healthcare has extensively covered the evolution of executive leadership roles as organizations undergo care delivery transformation.

Such positions reflect what one respondent summarized as the evolution “from just staffing the nurse department to being a key player in setting and achieving organizational goals and decision-making for major changes.” This shift from tactical to strategic has multiple facets. Survey respondents noted involvement in:

• Financial performance: “Continued emphasis on finance” and “greater need to work with tighter margins.”
• Quality outcomes: “Huge focus on quality and safety.”
• External relations: “Must be a visible leader” able to “partner with CNOs of other institutions.”

The new orientation is accompanied by changes in skill requirements. One leading executive sees “five crucial evolving competencies for nurse leaders: influencing innovation, spanning boundaries, collaboration, expanding the accessibility and use of technology and, perhaps particularly important, courage.”

Expansive Responsibilities

Most nurse leaders oversee nursing and clinical, including all patient care including medical-surgical, cardiac, acute/critical care, and trauma, among others. Many oversee pharmacy, radiology, quality/risk management, case management, volunteer services, and behavioral health. A few even include finance and payroll as part of their responsibilities.

“The role has gained respect for ability to coordinate nursing care while working with or directing operational areas,” another survey respondent said. “There’s much more involvement with financial and strategic goals.”

Estimates place the number of chief nursing officers at over 3,800 in 2017, up 10% in just the past two years. Nurse leaders claim a wide variety of titles. Among the survey respondents:

• Chief Nursing Officer or Executive: 60%
• Director of Nursing: 23%
• Vice President: 11%
• Senior Vice President: 2%
• Chief Operating Officer: 2%
• Clinical Nurse Leader, Clinical Administrator, Hospital and Healthcare Consultant or other title: 2%

The past few years have witnessed the emergence of new nurse/clinical leader titles such as:

• Nurse Informatics Executives
• Chief Patient Experience/Rights Officer
• Chief Integration Officer