The CMO and the Chief Nursing Officer: Creating Synergy

To analyze the roles, responsibilities and scope of current government chief nursing and midwifery officers or equivalent senior leaders in the Region of the Americas. This was a descriptive observational study. All government chief nursing or midwifery officers or equivalent senior leaders from 35 countries in the Region of the Americas were considered eligible to participate. An online survey was conducted that included items on demographic variables, the officer's roles and responsibilities, and a self-assessment of competencies. Data were analyzed using descriptive statistics, disaggregated by role, subregion and country income level. Content analysis was used for responses to open-ended questions. Twenty eight officers from 28 countries participated in this study, representing 80% of the 35 countries in the Americas. About 82.1% (23/28) of the officers or equivalent leaders were exclusively responsible for nursing issues. Most of the participants had the job title of chief nursing officer (53.6%, 15/28), were female (92.9%, 26/28) and were aged 55-64 years (46.4%, 13/28). Regarding leadership roles, 57.1% (16) of participants reported that their countries had an executive model, with the officer having line authority over nursing or midwifery, or both. The responsibilities of these officers were mainly related to leadership, influence and policy advice. In the self-assessment of competencies, participants rated themselves as less skilled in global health priorities and management. Although the role of a government chief nursing officer or midwifery officer exists in most countries in the Americas, there is a need to further strengthen it. It is important for governments and stakeholders to create a policy environment conducive to empowering these leaders, recognizing their strategic role in the human resources for health agenda, and in expanding the contributions of nursing and midwifery towards achieving more resilient and equitable health systems.

As hospitals expand their roles within transforming health systems, their governance structures must adapt to changing demands, with novel leadership structures evolving to meet new challenges. This review aims to provide a comprehensive overview on the evidence of the influence of hospital C-level positions on key organisational performance parameters. It maps key concepts from the existing literature relating to hospital performance and leadership and identifies mediators and moderators of top management team impacts based on the Upper-Echelons-Theory. The scoping review was conducted according to the Joanna Briggs Institute methodology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews, covering studies from 1990 to the present. Eligible studies addressed at least one identifiable hospital C-Suite role and one hospital-wide leadership effect. Out of 5430 articles identified, 60 were included. The analysis covers seven distinct C-Suite roles and their effects on six performance dimensions: quality of care, structural quality, patient satisfaction, work satisfaction, financial performance, and process efficiency. The findings suggest that the influence of C-Suite positions on hospital performance is multifaceted, with the Chief Executive Officer's influence extending beyond financial performance to shaping the quality of care. Additionally, the impact of newer roles such as the Chief Quality Officer, as well as leadership roles like the Chief Medical Officer and Chief Nursing Officer, appear to depend on a collaborative approach and alignment with the Chief Executive Officer. From a policy perspective, the findings emphasise that hospital governance, shaped by regulations, determines key performance indicators and strategic priorities.

Coaching on the Run: Building Capacity and Capability for the Future

The International Council of Nurses confirmed that as of October 2020, more than 1,500 nurses died from COVID-19 in 44 countries (ICN, October 2020). Policies and guidelines were required for effective patient care delivery and staff protection. As government Chief Nursing Officers, the responsibility rest on their portfolio to manage the nursing workforce during a pandemic which was new to them. Significance: Research on the experiences of Chief Nursing Officers in CARICOM as they grapple to manage and lead the nursing during the pandemic is not available. This study provides information which will aid in the development of strategies for leading in a pandemic. Methodology: A descriptive quantitative design was utilized. Chief Nursing Officers of CARICOM who were in the post since the inception of the COVID-19 pandemic in 2019 were included. Each Chief Nurse was contacted via email. And a questionnaire was submitted via google doc. Analysis: Pearson’s correlation showed a direct positive relationship between knowledge and motivation. When knowledge was inadequate, motivation was also low. Pearson’s Correlation Coefficient (r- 0.371) between motivation and knowledge shows a moderate negative linear relationship. The Chief Nurses found that. “During the pandemic, nurse leaders felt excluded from planning for COVID-19. Conclusion: When staff is involved at the policy level, patient outcome is satisfactory. The support shared among nurses in CARICOM, aided in their ability to manage and to remain resolute as champions of new innovations in health.

The study explored factors leading to chief nursing officer (CNO) sustainment in the professional practice of nurse executive leadership. CNOs are expected to lead adaptations in care delivery in this current era of healthcare reform, requiring a multitude of new leadership skills. Exploration is needed to understand barriers to longevity, which prevent consistency of leadership and execution of vision. Twenty CNOs were interviewed to determine the lived experience related to the phenomena of role sustainment. An interpretative phenomenological analysis approach was used. Six themes emerged describing sustainment. These are as follows: loving the profession, having a broader impact, reflecting on one's own work, learning to manage conflict, maintaining work/life balance, and working with supportive leaders. The desire and passion for nurse executive leadership must be enhanced through education and competencies that emerged in this study and include strategic processing, mindful reflection, and resiliency training.

On the eve of the flu vaccination season, Liam Benison reviews the guidance from the Chief Medical, Nursing and Pharmaceutical Officers for the 2006/2007 season

Recently, the Chief Medical and Nursing Officers for England issued a joint letter highlighting the need to diagnose more HIV infections in specialties such as thoracic medicine [1]. The aim of this study was to determine minimum estimates for the HIV coinfection rate and the prevalence of new HIV diagnoses in patients admitted to hospital with pneumococcaemia. Patients with Streptococcus pneumoniae isolated from blood cultures were identified at King George Hospital, Barking, Havering and Redbridge Trust between June 2003 and December 2006. Information was prospectively collected on patient demographics, sites of infection, HIV serostatus, haematology and biochemistry results and 30-day mortality. Ninety-seven patients had pneumococcaemia. Five (5.2%) patients were known to be HIV seropositive at presentation. Nine additional patients were tested for HIV: four (44.4%) tested positive and five negative. Among the four newly diagnosed patients, mean CD4 counts and viral loads were 263 cells/mL and 108 551 genomic HIV-1 RNA copies/mL, respectively. Compared with patients with unknown or negative HIV serostatus, HIV-positive patients were significantly more likely to be aged 16–30 years (P5 0.015), to have been born in sub-Saharan Africa (P5 0.004) and to have elevated globulins (Po0.001). Overall, 30-day mortality was 14/97 (14.4%) and there was no significant difference in mortality between the two groups. Within the UK, this is the first study to estimate a minimum HIV coinfection prevalence for patients admitted to hospital with pneumococcaemia. Five thousand patient episodes of pneumococcaemia are reported to the Health Protection Agency each year and, based on our findings, HIV testing of all patients with pneumococcaemia could result in an additional 250 new HIV diagnoses per annum. In view of limited testing, a larger study to estimate the true prevalence of HIV infection in patients with pneumococcaemia is required.

The purpose of this study was to determine gap areas where North Carolina should implement strategies to promote the Institute of Medicine's recommendation of an 80 percent bachelor of science workforce. The North Carolina Action Coalition sought information about the nursing BSN and higher degree workforce and about human resource policies/strategies that promote BSN and higher degree education. An electronic survey was used to query 120 acute care hospital chief nursing officers over a four-year period and 100 public health chief nursing officers over a two-year period. A majority of acute care and a minority of public health institutions had policies promoting BSN education. Barriers included lack of tuition reimbursement, scheduling/staffing issues, lack of local universities, and a perceived lack of value for nurses. A minority of respondents reported an 80 percent BSN workforce. Strategies are needed statewide to support nursing academic progression.

Person- and family-centered care (PFCC) is a philosophy that has been espoused for decades and yet is rarely embedded in health care organizations. Difficulties dispelling the numerous myths about what PFCC is, as well as daunting challenges to designing and implementing it, have hindered progress. The chief nurse officer is well-positioned to assume organizational leadership in successfully navigating this effort. This article provides 9 specific steps a chief nurse officer should take to create a culture, with supportive systems and an environment, to ensure authentic PFCC.

Doctors' leaders have condemned the UK government's decision to give nurses and pharmacists virtually unlimited prescribing powers. James Johnson, the BMA's chairman, has called for an urgent meeting with the...

Public Protection Is Everyone’s Responsibility

Background:At Chesapeake Regional Medical Center (CRMC), the Chief Nursing Officer (CNO) created the Professional Nursing Council (PNC), which is a governing body to help create more involvement from nursing when it comes to nursing practice. In the Fall of 2008, the PNC decided to adopt a nursing theorist to help guide their practice and with input of the bedside nurses, they chose Jean Watson's Theory of Caring.Jean Watson's theory was well-received, and nurses were eager to bring care back to the bedside but were struggling with how to incorporate the theory in an already overwhelming work environment. Our CNO went to a conference and met Robert Browning and found out about HeartMath. She thought this would be a good thing to bring to CRMC because the nurses have tremendous demands put on them and are feeling more stressed and overwhelmed than ever.A HeartMath steering committee was developed and created a plan to get as many nurses signed up for HeartMath as possible within a year. Several nurses were trained to teach the HeartMath workshop to accomplish this goal.As we presented HeartMath, we introduced it as a modality to the Jean Watson Theory of Caring. The motto was, “You have to take care of yourself before you can take care of others.” The first half of the workshop focused on the science and the HeartMath tools. We felt it was important to keep that as the foundation of the workshop. However, we felt it important to introduce Jean Watson's Theory of Human Caring and her 10 Caritas processes into the class and show how they are related.In October 2010, CRMC hosted the annual Caritas Consortium in Norfolk, Virginia. Two trainers taught HeartMath to a roomful of Caritas coaches as a pre-conference event. The trainers were then able to experience the consortium and realized even more how much HeartMath and the Theory of Caring are intertwined. At this time, it was decided that HeartMath and Jean Watson's Theory should be “married.”On November 17, 2010, the first HeartMath-Caritas Committee meeting commenced.Method:Quantitative, using Personal and Organizational Quality Assessment (POQA)Results:The first group to be taught HeartMath was the nursing leadership group in January 2009. POQA results appear in Figure 1. In phase two, we trained more than 850 employees (863 completed the pre-POQA, and 792 completed the post-POQA). The results are displayed in Figure 2.Figure 1POQA results from nursing leadership.Figure 2POQA results for the nursing department.Conclusion:As a result of incorporating Caritas processes into the HeartMath Workshop, the executive team at HeartMath has created a workshop called “Revitalizing Care,” which integrates the Caring Theory into the HeartMath concepts and tools. Care practice plans are built into the workshop to allow more time to have everyone work together to integrate the keys and skills into their work and personal lives, as well as to provide a chance to make connections with the Caring Theory.

Nursing executives' response to COVID-19 in Spain. An ethnographic study.

Cutting-edge Discussions of Management, Policy, and Program Issues in Emergency Care

BackgroundThe dearth of health personnel in low income countries has attracted global attention. Ways as to how health care services can be delivered in a more efficient and effective way using available health personnel are being explored. Task-sharing expands the responsibilities of low-cadre health workers and allows them to share these responsibilities with highly qualified health care providers in an effort to best utilize available human resources. This is appropriate in a country like Nigeria where there is a shortage of qualified health professionals and a huge burden of maternal mortality resulting from obstetric complications like pre-eclampsia. This study examines the prospect for task-sharing among Community Health Extension Workers (CHEW) for the detection of early signs of pre-eclampsia, in Ogun State, Nigeria.MethodsThis study is part of a larger community-based trial evaluating the acceptability of community treatment for severe pre-eclampsia in Ogun State, Nigeria. Data was collected between 2011 and 2012 using focus group discussions; seven with CHEWs (n = 71), three with male decision-makers (n = 35), six with community leaders (n = 68), and one with member of the Society of Obstetricians and Gynaecologists of Nigeria (n = 9). In addition, interviews were conducted with the heads of the local government administration (n = 4), directors of planning (n = 4), medical officers (n = 4), and Chief Nursing Officers (n = 4). Qualitative data were analysed using NVivo version 10.0 3 computer software.ResultsThe non-availability of health personnel is a major challenge, and has resulted in a high proportion of facility-based care performed by CHEWs. As a result, CHEWs often take on roles that are designated for senior health workers. This role expansion has exposed CHEWs to the basics of obstetric care, and has resulted in informal task-sharing among the health workers. The knowledge and ability of CHEWs to perform basic clinical assessments, such as measure blood pressure is not in doubt. Nevertheless, there were divergent views by senior and junior cadres of health practitioners about CHEWs’ abilities in providing obstetric care. Similarly, there were concerns by various stakeholders, particularly the CHEWs themselves, on the regulatory restrictions placed on them by the Standing Order.ConclusionGenerally, the extent to which obstetric tasks could be shifted to community health workers will be determined by the training provided and the extent to which the observed barriers are addressed.Trial registrationNCT01911494Electronic supplementary materialThe online version of this article (doi:10.1186/s12978-016-0216-y) contains supplementary material, which is available to authorized users.