- Email: [email protected]
The role of the system chief nurse executive
The Role of the System Chief Nurse Executive Vicki M. George, RN, PhD, FAAN
Peter Drucker states, “Leaders should always ask: ‘What in my organization could I do that would truly make a difference? How can I truly set an example? How can I motivate followers to do the right thing, thereby accomplishing results?’”
Leadership gurus of our time would agree that, for success to occur in today’s knowledge-driven, service-orientated, and customer-focused world, organizations must change the rules of hierarchical decision making to include the grassroots opinions of employees. Creating an organizational framework of inclusiveness in decision making is a key to success. Most leadership academics view health care as a complex service delivery system with knowledge workers from August 2005
many professional disciplines. These professionals must work in a team approach to delivering patient care, always focusing on doing the right thing, in the right place, by the right person, and for the right purpose. Agreement also exists that it is the leader’s role to create this team-oriented infrastructure, to engage the knowledge workers around a common goal, and to deliver great, quality-driven, and fiscally sound results. Organizations that have achieved great results speak to Nurse Leader 45
a common set of behavioral attributes in their leaders. Their leaders can: • Create a shared long-term vision for the future • Focus the daily work on the needs of the customer • Show passion for the work • Know that with fundamental change comes conflict and noise • Find the courage to stay the course in challenging times • Manage the conflict, not ignore it • Develop a team and hold them accountable to results • Make the call on team members who cannot create results And finally, the leader must communicate, communicate, communicate. The health care arena has many different organizational models, from standalone community hospitals to large, integrated health care systems. The customer base for health care workers could be seen as patients, families, physicians, insurance companies, and consumers and providers of goods and services to the organization. Health care systems of the past have organized themselves around the business principles of supervision. The new work of health care leadership is to create a different supervision infrastructure that moves away from the model of subordinate workers carrying out the decisions of a few bosses at the top of the pyramid to an organization structure whose top leaders require management and professional staff to work together in process redesign and in creating a common focus around personalized patient care delivery. In the organizational structure of large systems, a new position called system chief nursing executive (CNE) is emerging. This role involves both clinical leadership and advocacy for nursing. The role of nursing advocate represents over 60% of the labor force. The role of clinical leader focuses on teamwork and building partnerships with medicine, pharmacy, and other members of the interdisciplinary team. Because the CNE is both a professional nurse and a senior manager, it is important that he or she articulate the purpose of the two roles for all health care team members. The CNE in a health care system is uniquely positioned to help organizations achieve the great results they desire. By using the leader attributes previously described and what the CNE knows about the attributes of a professional, he or she can focus the structure, processes, and outcome goals of the nursing communities at large with the goals of the organization as a whole. Nursing leadership, as should all clinical leadership, should work toward developing an organizational structure that gives each individual practitioner the freedom to act and solve issues around the client/clinician partnership. The leaders should endorse the autonomy of clinicians to act on evidence-based practices, principles, and protocols to accomplish clinical excellence through a personalized approach to patient care. By facilitating structure and process design, the CNE empowers clinicians at the point 46 Nurse Leader
of service to create an implementation strategy that promotes an organizational climate of accountability. The ultimate outcome is the provision of service, quality, and financial excellence. By achieving these outcomes, the organization ensures its future and the loyalty of its customers. Not only will the organization retain a loyal customer base, but it will facilitate the engagements of its knowledge workers toward a common purpose. This marriage of professional goals with organizational goals produces the excellent outcomes that all health care organizations are striving to achieve, no matter how large, how system focused, or how geographically dispersed they are.
STRUCTURE The CNE must be able to articulate that this partnership can and should exist. As stated earlier, the size of the nursing community is at critical mass. As it moves, so moves the organization as a whole. Size does not always mean more value to the organization, but it does mean more structure and financial excellence. In the past, this structure has been designed as formal and bureaucratic. The new role of the new leader is to facilitate the design of a structure where practicing professionals meet practicing managers at the policy table. In the professional role, the CNE must ensure that this structure is grounded in the ethics of the discipline and fosters the autonomous role of the professional nurse. Finding equitable ground on which to build a decisional structure based on mutual trust can be guided by the following principles for all health care team members. It must be communicated through a shared vision of the system’s CNE and the professional community of nursing. • Knowledge is a powerful force and a key production tool in the health care service industry. • Each clinical discipline comes to the workplace with a unique knowledge base grounded in professional education. • Advancing clinical knowledge does not rest in the hands of management but is owned by the professional discipline. • Clinicians from different disciplines must come together in partnership around a common goal of patient care excellence. • Information collected by the organization concerning quality, service, and financial outcomes must be made transparent to the clinician at the point of service. • For the CNE, trust is built when the structure and process are designed so that leading professional staff means letting go of the authority for clinical decision making, not just delegating it. The CNE and other system leaders must collaborate in resource allocation, both human and fiscal, to accomplish the design of this structure. The purpose of the structure is to produce and transfer evidence-based patient care practice to the bedside and to the expectations of the bedside practitioner. A system’s only goal should be to ensure August 2005
Empowerment comes when each organization in the system reviews its processes and outcomes in relation to these standards and makes recommendations for change.
that all patients, regardless of organizational size or geographic area, receive coordinated care based on evidencebased knowledge. To ensure progress on this goal to the board of trustees, the CNE must have a systematic way to access data outcomes and share that information with practitioners in the field. By creating a structure like a system-wide practice council—where practicing nurses are elected to the decision-making table to review data and establish guidelines of care—the CNE can reassure the board that evidence-based practice will be delivered in a timely and ethical manner and implemented effectively. For example, a system-wide practice council may decide to adopt the American Nurses Association Scope of Standards for care and practice. There is power in a unified August 2005
voice of care delivery. Empowerment comes when each organization in the system reviews its processes and outcomes in relation to these standards and makes recommendations for change. In so doing, system issues can be identified and corrected while individual practitioners are held accountable for the outcomes. The willingness of a system CNE to bring professional practicing nurses to the table where policy is formulated is a power message for engagement and empowerment of autonomy in clinical practice.
PROCESS Conflict management, not conflict avoidance For fundamental change to occur, conflict will exist. The Nurse Leader 47
CNE must manage conflict from organizational hierarchy that resists the concepts of new structure. Reviewing and communicating the fundamental accountability of the professional is not unique to nursing; the CNE could engage support from other members of the administrative team, especially the chief medical officer. By acting collaboratively with members of the medical staff, nurses can function autonomously. Without collaborative practice agreements that empower the nurse to act immediately to provide safe and timely care, research has shown that patients can suffer great harm. A common goal for nursing and medical staff is that “failure to rescue” never happen. Before the CNE can create such a structural change, he or she must communicate the principles of the change to all stakeholder groups. In hospital structures, as in larger system structures, all professional ancillary staff have many lateral interdependencies. They need to work through methods of horizontal communication in a cooperative context to deliver patient care on an hourly/weekly basis. If the organization has a high degree of central control, where the authority for decision making rests in the hands of a few, the speed at which decisions can occur must logically be slowed down. Models like these interfere with the individual professional’s use of specialized knowledge to solve a client/family issue and can spell either a clinical or a service disaster. There are many organizational concerns around the impact of silos of decision-making authority. It is the CNE and his or her senior management team’s responsibility to ensure that each professional discipline is respected and valued for the unique perspective it brings to the decision-making table. When conflict does occur, it is the leader’s job not to allow compromise but to encourage breakthrough learning. This can occur by always putting the patient/family at the center of every decision made. Conflicts also can occur over the professional’s desire for autonomy in carrying out the work of the discipline and the manager’s need to support the organization’s directives (such as budget management). One could envision a structural way to manage this conflict that creates a process of shared decision-making whereby management and staff sit at the same table to decide the results they need to achieve. This could be supported by the common belief and trust that when information is transparent to all involved in the decision-making process, all members of the team will come to basically the same conclusion. This discussion is always better than one made by a single discipline. In this case, engagement occurs because the designers are the implementers of the change and vice versa. As system nursing leaders, it is important to communicate that the interrelationship of leadership roles for professionals and staff needs changing. The key to unlocking the leadership question “What does it take to create excellence in a professional practice environment?” rests in the CNE’s personal belief and trust that autonomy and interdependence can coexist for the worker and the workplace. It requires a formalized, sustainable structure that fosters a 48 Nurse Leader
process of shared decision making and is led by managers who have learned the principles of shared leadership.
PROFESSIONAL DEVELOPMENT All clinicians come to the decision table to represent the interests of their disciplines. It is why conflict or silo mentality can occur. Without a focus on continuous learning and growth, the conflict will not be managed appropriately, will result in either apathy or anger. Group work takes effort on behalf of every member of the team. In health care, we say we cannot care for patients without a team approach, yet how much education and attention do we pay to developing clinical leaders into good team players? Each discipline is expert in their clinical knowledge, and since nursing is usually the biggest volume player at the table, it is no wonder acronyms like SPONGE (The Society for the Prevention of Nursing Getting Everything) have arisen in some, if not most, organizations. It would seem that professional staff development could teach critical thinking skills through both the patient care and the team experience. Clinicians need to be taught the skill sets of facilitation, negotiation, conflict management, and systems thinking. Such courses have been shown in nursing to increase leadership abilities of the staff and, more importantly, produce outcomes of higher levels of professional autonomy.
OUTCOMES Peer review/accountability for action = Results Once the CNE has secured both human and fiscal support for the structure and process redesign, the work on outcomes management begins. The structure has already decided on the process of shared decision making to produce desired results; now the new work of the CNE is to support the resources necessary for peer review design, data collection, and outcomes reporting. The model of accountability must incorporate, as it should for all professionals, a monitoring of the care provided and the practitioner providing it. Through this model of peer review, accountability for meeting the organizational goals can also be incorporated. The peer review process must be managed by the practicing experts in the field. Organizational citizenship issues and accomplishing goals are manager responsibilities and can be combined or separated, depending on how the organization evaluates and rewards the remaining members of the team. As the organized body of nursing moves toward systemwide application of evidence-based professional nursing practice, a system of measurement outcomes and process expectations must be developed. Although outcomes are usually reported by aggregate patient population, it is necessary to also create a data system that can report feedback to the individual practitioner based on real time feedback. The CNE should support a collaborative arrangement between information technology and nursing practice to esAugust 2005
tablish a mechanism to gather the resources necessary for purchase and implementation. Peer review in an organization is not an easy task to implement, but if a system wants to hold its members accountable for achieving results, both clinically and financially, it must invest in a system that can aggregate data reports of the balanced scorecard for the board, but also for the discipline involved. The individual practitioner carrying out the work must receive timely feedback if fundamental behavioral change is to occur. As practitioners receive needed feedback, they also need a structure of consultation around growth and development opportunities for those who are accountable to advance the practitioner (ie, clinical nurse specialist). Developing a system of coaches, preceptors, and developers of people is essential to get to innovative levels of care delivery.
Kotter J. On what leaders really do. Boston: Harvard Business Review Books; 1999. Porter-O’Grady T. Whole systems shared governance. New York: Aspen Publishers; 1997. Quinn JB, Anderson P, Finkelstein S. Managing professional intellect – making the most of the best. In: The Harvard Business Review of knowledge management. Boston: Harvard Business School Publishers; 1998. p. 181.
Vicki M. George, RN, PhD, FAAN, is CEO of VMG Consulting in Milwaukee, WI. She can be reached at [email protected]. 1541-4612/ $ See front matter Copyright 2005 by Mosby, Inc. All rights reserved. doi:10.1016/j.mnl.2005.07.011
CONCLUSION As a nurse in a senior leadership role, the CNE understands the professional discipline of nursing and its professional accountability. Creating a professional practice environment that links nursing to other members of the health care team means the CNE must display all the attributes of a leader in the system and an advocacy master for the needs of the professional. Working in an organizational setting, his or her role is to ensure that relationships can be created and thrive in an environment of constant change. The discipline of nursing has a unique body of knowledge developed through research. An organizational structure must exist within the health care system to promote, grow, and change the practice of nursing based on that knowledge. It must be dynamic, fast, fluid, and flexible. It must create links to all other health care team members to whom it owes collaborative interdependence. As a professional leader, the CNE needs to ensure that the professional practicing clinician is given the power and authority over peer review for both the care provided and the care provider. All members of the discipline must hold each other accountable to the quality outcomes in a fiscally responsible way. Nursing as a professional discipline is not unique in its desire for autonomy at the point of service, yet nurses are the largest single group of knowledge workers in health care today and thus will have a significant impact on the changes in quality outcomes for patient care. A system that supports this effort by designing and supporting the CNE role will be one step closer to clinical and financial excellence. Bibliography Drucker PF. The coming of the new organization. In: The Harvard Business Review of knowledge management. Boston: Harvard Business School Publishers; 1998. George VM. The role of chief nurse executive in fostering excellence in the professional practice environment. In: Heitman B, editor. The clinical practice development model. New York: Aspen Publishers; 1999.
August 2005
Nurse Leader 49
Peter Drucker states, “Leaders should always ask: ‘What in my organization could I do that would truly make a difference? How can I truly set an example? How can I motivate followers to do the right thing, thereby accomplishing results?’”
Leadership gurus of our time would agree that, for success to occur in today’s knowledge-driven, service-orientated, and customer-focused world, organizations must change the rules of hierarchical decision making to include the grassroots opinions of employees. Creating an organizational framework of inclusiveness in decision making is a key to success. Most leadership academics view health care as a complex service delivery system with knowledge workers from August 2005
many professional disciplines. These professionals must work in a team approach to delivering patient care, always focusing on doing the right thing, in the right place, by the right person, and for the right purpose. Agreement also exists that it is the leader’s role to create this team-oriented infrastructure, to engage the knowledge workers around a common goal, and to deliver great, quality-driven, and fiscally sound results. Organizations that have achieved great results speak to Nurse Leader 45
a common set of behavioral attributes in their leaders. Their leaders can: • Create a shared long-term vision for the future • Focus the daily work on the needs of the customer • Show passion for the work • Know that with fundamental change comes conflict and noise • Find the courage to stay the course in challenging times • Manage the conflict, not ignore it • Develop a team and hold them accountable to results • Make the call on team members who cannot create results And finally, the leader must communicate, communicate, communicate. The health care arena has many different organizational models, from standalone community hospitals to large, integrated health care systems. The customer base for health care workers could be seen as patients, families, physicians, insurance companies, and consumers and providers of goods and services to the organization. Health care systems of the past have organized themselves around the business principles of supervision. The new work of health care leadership is to create a different supervision infrastructure that moves away from the model of subordinate workers carrying out the decisions of a few bosses at the top of the pyramid to an organization structure whose top leaders require management and professional staff to work together in process redesign and in creating a common focus around personalized patient care delivery. In the organizational structure of large systems, a new position called system chief nursing executive (CNE) is emerging. This role involves both clinical leadership and advocacy for nursing. The role of nursing advocate represents over 60% of the labor force. The role of clinical leader focuses on teamwork and building partnerships with medicine, pharmacy, and other members of the interdisciplinary team. Because the CNE is both a professional nurse and a senior manager, it is important that he or she articulate the purpose of the two roles for all health care team members. The CNE in a health care system is uniquely positioned to help organizations achieve the great results they desire. By using the leader attributes previously described and what the CNE knows about the attributes of a professional, he or she can focus the structure, processes, and outcome goals of the nursing communities at large with the goals of the organization as a whole. Nursing leadership, as should all clinical leadership, should work toward developing an organizational structure that gives each individual practitioner the freedom to act and solve issues around the client/clinician partnership. The leaders should endorse the autonomy of clinicians to act on evidence-based practices, principles, and protocols to accomplish clinical excellence through a personalized approach to patient care. By facilitating structure and process design, the CNE empowers clinicians at the point 46 Nurse Leader
of service to create an implementation strategy that promotes an organizational climate of accountability. The ultimate outcome is the provision of service, quality, and financial excellence. By achieving these outcomes, the organization ensures its future and the loyalty of its customers. Not only will the organization retain a loyal customer base, but it will facilitate the engagements of its knowledge workers toward a common purpose. This marriage of professional goals with organizational goals produces the excellent outcomes that all health care organizations are striving to achieve, no matter how large, how system focused, or how geographically dispersed they are.
STRUCTURE The CNE must be able to articulate that this partnership can and should exist. As stated earlier, the size of the nursing community is at critical mass. As it moves, so moves the organization as a whole. Size does not always mean more value to the organization, but it does mean more structure and financial excellence. In the past, this structure has been designed as formal and bureaucratic. The new role of the new leader is to facilitate the design of a structure where practicing professionals meet practicing managers at the policy table. In the professional role, the CNE must ensure that this structure is grounded in the ethics of the discipline and fosters the autonomous role of the professional nurse. Finding equitable ground on which to build a decisional structure based on mutual trust can be guided by the following principles for all health care team members. It must be communicated through a shared vision of the system’s CNE and the professional community of nursing. • Knowledge is a powerful force and a key production tool in the health care service industry. • Each clinical discipline comes to the workplace with a unique knowledge base grounded in professional education. • Advancing clinical knowledge does not rest in the hands of management but is owned by the professional discipline. • Clinicians from different disciplines must come together in partnership around a common goal of patient care excellence. • Information collected by the organization concerning quality, service, and financial outcomes must be made transparent to the clinician at the point of service. • For the CNE, trust is built when the structure and process are designed so that leading professional staff means letting go of the authority for clinical decision making, not just delegating it. The CNE and other system leaders must collaborate in resource allocation, both human and fiscal, to accomplish the design of this structure. The purpose of the structure is to produce and transfer evidence-based patient care practice to the bedside and to the expectations of the bedside practitioner. A system’s only goal should be to ensure August 2005
Empowerment comes when each organization in the system reviews its processes and outcomes in relation to these standards and makes recommendations for change.
that all patients, regardless of organizational size or geographic area, receive coordinated care based on evidencebased knowledge. To ensure progress on this goal to the board of trustees, the CNE must have a systematic way to access data outcomes and share that information with practitioners in the field. By creating a structure like a system-wide practice council—where practicing nurses are elected to the decision-making table to review data and establish guidelines of care—the CNE can reassure the board that evidence-based practice will be delivered in a timely and ethical manner and implemented effectively. For example, a system-wide practice council may decide to adopt the American Nurses Association Scope of Standards for care and practice. There is power in a unified August 2005
voice of care delivery. Empowerment comes when each organization in the system reviews its processes and outcomes in relation to these standards and makes recommendations for change. In so doing, system issues can be identified and corrected while individual practitioners are held accountable for the outcomes. The willingness of a system CNE to bring professional practicing nurses to the table where policy is formulated is a power message for engagement and empowerment of autonomy in clinical practice.
PROCESS Conflict management, not conflict avoidance For fundamental change to occur, conflict will exist. The Nurse Leader 47
CNE must manage conflict from organizational hierarchy that resists the concepts of new structure. Reviewing and communicating the fundamental accountability of the professional is not unique to nursing; the CNE could engage support from other members of the administrative team, especially the chief medical officer. By acting collaboratively with members of the medical staff, nurses can function autonomously. Without collaborative practice agreements that empower the nurse to act immediately to provide safe and timely care, research has shown that patients can suffer great harm. A common goal for nursing and medical staff is that “failure to rescue” never happen. Before the CNE can create such a structural change, he or she must communicate the principles of the change to all stakeholder groups. In hospital structures, as in larger system structures, all professional ancillary staff have many lateral interdependencies. They need to work through methods of horizontal communication in a cooperative context to deliver patient care on an hourly/weekly basis. If the organization has a high degree of central control, where the authority for decision making rests in the hands of a few, the speed at which decisions can occur must logically be slowed down. Models like these interfere with the individual professional’s use of specialized knowledge to solve a client/family issue and can spell either a clinical or a service disaster. There are many organizational concerns around the impact of silos of decision-making authority. It is the CNE and his or her senior management team’s responsibility to ensure that each professional discipline is respected and valued for the unique perspective it brings to the decision-making table. When conflict does occur, it is the leader’s job not to allow compromise but to encourage breakthrough learning. This can occur by always putting the patient/family at the center of every decision made. Conflicts also can occur over the professional’s desire for autonomy in carrying out the work of the discipline and the manager’s need to support the organization’s directives (such as budget management). One could envision a structural way to manage this conflict that creates a process of shared decision-making whereby management and staff sit at the same table to decide the results they need to achieve. This could be supported by the common belief and trust that when information is transparent to all involved in the decision-making process, all members of the team will come to basically the same conclusion. This discussion is always better than one made by a single discipline. In this case, engagement occurs because the designers are the implementers of the change and vice versa. As system nursing leaders, it is important to communicate that the interrelationship of leadership roles for professionals and staff needs changing. The key to unlocking the leadership question “What does it take to create excellence in a professional practice environment?” rests in the CNE’s personal belief and trust that autonomy and interdependence can coexist for the worker and the workplace. It requires a formalized, sustainable structure that fosters a 48 Nurse Leader
process of shared decision making and is led by managers who have learned the principles of shared leadership.
PROFESSIONAL DEVELOPMENT All clinicians come to the decision table to represent the interests of their disciplines. It is why conflict or silo mentality can occur. Without a focus on continuous learning and growth, the conflict will not be managed appropriately, will result in either apathy or anger. Group work takes effort on behalf of every member of the team. In health care, we say we cannot care for patients without a team approach, yet how much education and attention do we pay to developing clinical leaders into good team players? Each discipline is expert in their clinical knowledge, and since nursing is usually the biggest volume player at the table, it is no wonder acronyms like SPONGE (The Society for the Prevention of Nursing Getting Everything) have arisen in some, if not most, organizations. It would seem that professional staff development could teach critical thinking skills through both the patient care and the team experience. Clinicians need to be taught the skill sets of facilitation, negotiation, conflict management, and systems thinking. Such courses have been shown in nursing to increase leadership abilities of the staff and, more importantly, produce outcomes of higher levels of professional autonomy.
OUTCOMES Peer review/accountability for action = Results Once the CNE has secured both human and fiscal support for the structure and process redesign, the work on outcomes management begins. The structure has already decided on the process of shared decision making to produce desired results; now the new work of the CNE is to support the resources necessary for peer review design, data collection, and outcomes reporting. The model of accountability must incorporate, as it should for all professionals, a monitoring of the care provided and the practitioner providing it. Through this model of peer review, accountability for meeting the organizational goals can also be incorporated. The peer review process must be managed by the practicing experts in the field. Organizational citizenship issues and accomplishing goals are manager responsibilities and can be combined or separated, depending on how the organization evaluates and rewards the remaining members of the team. As the organized body of nursing moves toward systemwide application of evidence-based professional nursing practice, a system of measurement outcomes and process expectations must be developed. Although outcomes are usually reported by aggregate patient population, it is necessary to also create a data system that can report feedback to the individual practitioner based on real time feedback. The CNE should support a collaborative arrangement between information technology and nursing practice to esAugust 2005
tablish a mechanism to gather the resources necessary for purchase and implementation. Peer review in an organization is not an easy task to implement, but if a system wants to hold its members accountable for achieving results, both clinically and financially, it must invest in a system that can aggregate data reports of the balanced scorecard for the board, but also for the discipline involved. The individual practitioner carrying out the work must receive timely feedback if fundamental behavioral change is to occur. As practitioners receive needed feedback, they also need a structure of consultation around growth and development opportunities for those who are accountable to advance the practitioner (ie, clinical nurse specialist). Developing a system of coaches, preceptors, and developers of people is essential to get to innovative levels of care delivery.
Kotter J. On what leaders really do. Boston: Harvard Business Review Books; 1999. Porter-O’Grady T. Whole systems shared governance. New York: Aspen Publishers; 1997. Quinn JB, Anderson P, Finkelstein S. Managing professional intellect – making the most of the best. In: The Harvard Business Review of knowledge management. Boston: Harvard Business School Publishers; 1998. p. 181.
Vicki M. George, RN, PhD, FAAN, is CEO of VMG Consulting in Milwaukee, WI. She can be reached at [email protected]. 1541-4612/ $ See front matter Copyright 2005 by Mosby, Inc. All rights reserved. doi:10.1016/j.mnl.2005.07.011
CONCLUSION As a nurse in a senior leadership role, the CNE understands the professional discipline of nursing and its professional accountability. Creating a professional practice environment that links nursing to other members of the health care team means the CNE must display all the attributes of a leader in the system and an advocacy master for the needs of the professional. Working in an organizational setting, his or her role is to ensure that relationships can be created and thrive in an environment of constant change. The discipline of nursing has a unique body of knowledge developed through research. An organizational structure must exist within the health care system to promote, grow, and change the practice of nursing based on that knowledge. It must be dynamic, fast, fluid, and flexible. It must create links to all other health care team members to whom it owes collaborative interdependence. As a professional leader, the CNE needs to ensure that the professional practicing clinician is given the power and authority over peer review for both the care provided and the care provider. All members of the discipline must hold each other accountable to the quality outcomes in a fiscally responsible way. Nursing as a professional discipline is not unique in its desire for autonomy at the point of service, yet nurses are the largest single group of knowledge workers in health care today and thus will have a significant impact on the changes in quality outcomes for patient care. A system that supports this effort by designing and supporting the CNE role will be one step closer to clinical and financial excellence. Bibliography Drucker PF. The coming of the new organization. In: The Harvard Business Review of knowledge management. Boston: Harvard Business School Publishers; 1998. George VM. The role of chief nurse executive in fostering excellence in the professional practice environment. In: Heitman B, editor. The clinical practice development model. New York: Aspen Publishers; 1999.
August 2005
Nurse Leader 49