Transforming nursing through knowledge

Professional Development: Governance

Governance - reflects an ultimate accountability for strategic decision making affecting the entire organization.
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    The Academy of Canadian Executive Nurses represents the voice of nursing leadership in Canada. Founded over thirty years ago, ACEN was created as a network of chief nursing officers of major teaching hospitals and deans and directors of Schools of nursing.


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    OBJECTIVE: The objective of this study was to identify the professional development topics that senior nurse leaders believe are important to their advancement and success.
    BACKGROUND: Senior/experienced nurse leaders at the executive level are able to influence the work environment of nurses and institutional and health policy. Their development needs are likely to reflect this and other contemporary healthcare issues and may be different from middle and frontline managers. A systematic review of assessing professional development needs for these nurse leaders is needed,


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    The Initiative on the Future of Nursing is rooted in the recommendations of the 2010 landmark report, The Future of Nursing: Leading Change, Advancing Health from the Institute of Medicine (IOM) and the Robert Wood Johnson Foundation (RWJF). Through the Initiative, RWJF continues to support the research agenda set forth by the report and implement the recommendations in the areas of nurse training, education, professional leadership, and workforce policy.
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    The American Organization of Nurse Executives (AONE) provides leadership, professional development, advocacy and research to advance nursing practice and patient care, promote nursing leadership excellence and shape public policy for health care nationwide. AONE is a subsidiary of the American Hospital Association.
    • Mission - To shape health care through innovative and expert nursing leadership
    • Vision - Global Nursing Leadership—One Voice Advancing Health
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    The following framework is intended to illustrate Chief Nursing Executive (CNE) and Chief Nursing Officer (CNO) roles and responsibilities in the context of membership and participation at the senior management and Board table. This framework assumes that the CNE/CNO is responsible for nursing activities throughout the organization and reports directly to the Chief Executive Officer or Medical Officer of Health/Senior Management Team as a senior member of executive-level, decision-making management.
    While it is acknowledged that CNEs and CNOs are involved in significant decisions dealing with the day-to-day operational management of the organization or institution, it is the purpose of this document to emphasize enhancements to governance and leadership functions of the Senior Nurse Executive role afforded by new legislation, specifically the passage of the Excellent Care for All Act, 2010 and the formal designation of the CNO role in Ontario public health units. 
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    Nurses running hospitals is not new. Florence Nightingale could be considered the first hospital administrator. What is changing is the growth of RN chief executive officers (CEOs), from 10% in 2004 to 18% in 2010. Furthermore, nearly 20% of chief nursing officers (CNOs) aspire to be CEOs. Is this a natural growth of CNO to vice president of patient care services to chief operating officer . . . to RN CEO?
    The research on RN CEOs is very small. Therefore, the author set out to obtain a journalistic snapshot of Arizona’s 12 hospital RN CEOs through interviews. Of the 12, 3 were corporate CEOs at the system level, they saw over several hospitals, and 9 were CEOs over 1
    to 2 hospitals. This article discusses some of the finding from these interviews.
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    Core competencies for public health in Canada require proficiency in evidence informed decision making (EIDM). However, decision makers often lack access to information, many workers lack knowledge and skills to conduct systematic literature reviews, and public health settings typically lack infrastructure to support EIDM activities. This research was conducted to explore and describe critical factors and dynamics in the early implementation of one public health unit’s strategic initiative to develop capacity to make EIDM standard practice.
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    In February 2011, the Ontario Public Health Organizational Standards were released requiring each board of health to “designate a Chief Nursing Officer to be responsible for nursing quality assurance and nursing practice leadership” and to "support a culture of excellent in professional practice for all regulated and unregulated health professions that ensures inter-professional collaboration and learning, and that staff are able to comply with professional regulatory body requirements where applicable. A range of models could be used, including the designation of professional practice leads.”
    In October, 2011, the Public Health Branch of the MOHLTC released the Public health Chief Nursing Officer Working Group Report, thereby clarifying the role and responsibility of the public health Chief Nursing Officer. This working group was co-sponsored by the MOHLTC, the Association of Nursing Directors and Supervisory of Official Health Agencies and RNAO.
    In order for public health Chief Nursing Officers to fully enact their newly mandated role and responsibility as well as implement this “culture of excellence” and authentic interprofessional collaboration, it is essential that public health program and staffing decisions be based on best practices. As such, RNAO proposes the following evidenced based Model of Public Health Nurse Executive Leadership as an initial point of dialogue to clarify the potential impact public health nurse executives can have on nurse / client, organizational and societal outcomes. 
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    Thunder Bay Regional Health Sciences Centre Slide Deck Presentation, February 2, 2011
    • What is the CNE Role? 
    • Overview of the Role 
    • What are the key roles, responsibilities and accountabilities of the CNE? 
    • Organizational Structure 
    • Recent Legislative Changes 
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    Objective: The purpose of this study was to examine how nursing is viewed by the nation’s decision makers and opinion leaders.

    Background: Nurses comprise the largest subgroup of the health and healthcareworkforce. The public recognizes nurses’ contributions, consistently ranking them highest in honesty and ethics. Yet, significant barriers remain in nurses achieving substantial leadership positions in health and healthcare delivery and policy.

    Methods: The study sampled a broad cross section of American opinion leaders in the public and private sector, academia, and trade organizations.More than 1,500 opinion leaders were interviewed by telephone interviewers.

    Results: The opinion leaders viewed government (75%) and health insurance executives (56%) as the groups most likely to exert a great deal of influence on health reform, compared with 14% for nurses. Government respondents were significantly different than all other respondents; 23%of these respondents said nurses have a great deal of influence in healthcare reform, compared with 14% of other individuals.