Transforming nursing through knowledge

Professional Development: Governance

Governance - reflects an ultimate accountability for strategic decision making affecting the entire organization.
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    Given that chief nursing officers (CNOs) play a critical role in hospital organizations and require a diverse set of executive leadership and professional competencies, what competencies are most critical? What kind of support is needed for a leader who is new to this executive role? What is needed to successfully on board an experienced leader who is new to the organization? How can a CNO demonstrate the unique value he/she brings to the executive BC[ suite? The author presents findings from on-boarding 6 new CNOs by using an in-depth 360-degree process to assess competency, an on-boarding development road map, and a CNO scorecard.

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    If today’s need for highly competent nurse leaders is urgent, and there seems to be no controversy about this fact, what will be the need in the next few years? And what will ensure the availability of
    these highly competent persons? Between the opportunities offered by the Accountable Care Act, and the IOM Report on the Future of Nursing’s recommendations, the consensus is that the need
    will be great. This is not a new concern:
    During the 1960s, the pendulum in graduate education in nursing swung from functional preparation in teaching, supervision, and administration to clinical specialization. While the change was a logical one, inadequate consideration was given to the preparation of people who would fill these roles in the real world. Consequently, Boston University School of Nursing held an invitational conference in 1978 to respond to the call for preparation of competent nursing leaders.
    The author interviews some of the leaders who attended and/or presented at this conference to see just how much we could learn for the past to apply today.
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    The roles and responsibilities of nurses are expanding, as they become more involved in administration and leadership within their field. Nurses are taking on executive positions, which have become a crucial part of hospital organizations. With this expansion, an executive development program is necessary to provide nurses with the knowledge and competencies that these executive positions require. Their focus must evolve from singular bedside practice to the greater scope of health care administration. Leadership skills are extremely important, in addition to interpersonal, management, mentoring, and interprofessional skills. A number of nursing associations have worked to develop a set of curricula for nurse executive education, but a consistent and specific set of academic requirements has yet to be agreed upon.
    With the importance of the chief nursing officer’s (CNO) role in the function of a hospital and the requirement of the knowledge of the changing health care system in the United States, it is essential that nurses are provided with proper education and training that will help them become successful nurse executives. Some
    suggestions include a dual MSN/MBA degree, a PhD in nursing, continuing education institutes, and mentoring programs. However, research must be done to clarify the best way to prepare CNOs for their roles.
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    Not-for-profit organizations (NPOs) are diverse and their expectations of directors can vary widely. In most cases, directors are volunteers who serve without compensation. They deserve respect and appreciation and should be encouraged to contribute effectively and with confidence. 
    This document explores the challenges faced by NPOs in recruiting the right people to serve on their boards, as well as the importance of director education and development and regular assessment of the board and its members. We hope that individual directors, boards, governance committees and CEOs will find it useful in developing effective, knowledgeable boards.


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    RNAO strongly supports the development of hospitals utilizing a patient/client centred care model, where Ontarians have access to continuity of care and continuity of caregiver from a primary nurse. RNAO also strongly endorses strengthening inter-professional care so all health disciplines work closely to support high quality patient care in all health care settings. 
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    Never has the NHS been a more diverse, complex or exciting place to work than now. Inevitably, this presents considerable challenges for newly appointed executives joining NHS boards. For nurse executives, who have a major role to play in ensuring excellence in the business of caring, effective clinical leadership at board level is essential and has never been more necessary.
    Caring for patients is the key ‘product’ of the business of health care, and we make no apology for describing it as such. Bringing the leadership of caring and the leadership of business together to improve people’s experience of health care was the central objective of the Who Cares, Wins report (2006) commissioned from the Office for Public Management by the Burdett Trust for Nursing.
    We are taking this work forward in partnership with The King’s Fund, and this handbook is the product of a joint programme of work to support nurse executives on NHS boards.We wanted to draw on 
    the experience of nurse executives who have already made the transition into an executive role, so that others could learn valuable lessons to enable them to fulfil their role as effectively as possible.The handbook is designed to enable all newly appointed nurse executives to approach their new role with confidence.