Reinventing the CNO

Carrie Vaughan, for HealthLeaders Magazine , February 5, 2009
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Batcheller says carving out time to think strategically amid daily operational concerns is critical to ensuring she is addressing her organization's most pressing issues. Currently, she is focusing on implementing information systems and "nursing business intelligence," which she explains as a color-coded system—red, yellow, green—so nursing units know where they stand against the budget. In her role as the co-patient safety officer with the chief medical officer, she spends a lot of time on clinical quality and safety issues, as well. "I'm hardwiring nursing units to be able to look at correlations between staffing and clinical outcomes," she says.

Coordinating care
CNOs are in a position to help foster a healthy working relationship between physicians and nurses. "Building that credibility with physicians is crucial to the success of an organization, and that does rest on the shoulders of the CNO," Swick says.

White says clinicians must work together "not just within the hospital but within the healthcare provider community to take care of patients along the continuum, not just when they are within our own specific jurisdictions." Being responsible for the continuum of care both inside and outside the hospital's walls will be one of the CNO's main responsibilities going forward, White adds.

To coordinate that care, however, CNOs will need effective communication skills across all levels of the organization. That means eradicating any misconceptions about their role in healthcare delivery (see "Biggest Misconceptions"). The challenge, Swick explains, is that CNOs have varying backgrounds. For example, Swick has experience developing service lines, but another CNO may have had experience running a very large cancer service program. That is why it is so important for the CNO to be visible and accessible to the staff, says Swick. "The more visible you are, the more the staff will understand what the role is."

Carrie Vaughan is leadership editor of HealthLeaders magazine. She can be reached at
Biggest Misconceptions

Even though the CNO's role has expanded in recent years, old perceptions about the position still linger in some healthcare organizations. Here are three:

1. CNOs only oversee nursing. The traditional image of a nurse executive is someone whose focus is the nursing department and staffing issues. That is no longer a fair representation of the position, says Maureen Swick.

Yes, staffing is a concern, but it is just one piece of what CNOs do today. "They are part of the strategic planning and part of the overall hospital budgeting process," she says. "It's more than just nursing. It is the entire patient care experience."

2. CNOs' only true priority is nursing. Employees may know that the CNOs role has expanded and they are now responsible for nontraditional nursing areas. Yet many of their new direct reports may believe the CNOs' true focus is still nursing issues. "It's not what's right for nurses. It's not what's right for radiologists. It's not what's right for pharmacists," Maureen White explains. "[The role] is what is right for the patient."

3. CNOs are only focused inside the hospital. Traditionally, people think that the CNO is only concerned with hospital matters that are in-house, says Swick. But care coordination means trying to create that seamless continuum of care for the patient, so that they receive the appropriate care in the appropriate place. "It is making sure they have the resources outside the hospital," Swick says.

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