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The ties that bind
The Nurse Executive
The Ties That Bind HERE IS MUCH stress and distress as hospital organizations follow new directions to adapt to T changes in health care. Many organizations are structuring around product lines or service lines (such as cardiovascular), hoping to better understand a particular business segment and provide comprehensive care while monitoring service-specific costs. As these service lines are organized, they may not be administered by nurses and may not follow the existing nursing department organizational chart. This may render the nursing department organizational chart obsolete. Nurses who work in a service-line entity may report to a nonnurse administrator rather than to a nurse administrator in the nursing department. Some nurses find this prospect discomforting. However, in many organizations the role of chief nursing officer is emerging. This individual may not have line authority for the nursing department but is expected to assure comparable standards for nursing practice and patient care within the organization or system. How can this be accomplished without line authority? Some nurses doubt that it can be done. We must give serious consideration, however, to this new organizational pattern because it is becoming more common, and we need some assurance that it will work and that standards can be maintained. Do we in fact define ourselves only by our line authority for the nursing budget, or can we be comfortable finding another way to maintain the integrity of the professional discipline of nursing? As we organize more by networks and systems, we need to define the links that hold nursing together. What are the ties that bind us? One hypothesis is that we have been creating the foundation for maintaining nursing
SUEELLEN PINKERTON, PHD, RN VicePresident~ChiefNursing O~cer Shands at the UniversityofFlorida PO Box 100335 Gainesville,FL 32610-0335 Copyright © 1998 by W..B.Saunders Company 8755-7223/98/1402-0003503.00/0
66
integrity within a service-line structure since the early 1980s with the development of shared governance. As nursing departments implemented shared governance to support staff nurses in making practice decisions, many nursing departments made paradigm shifts to shared governance as a way of thinldng--a transformation--not just an organizational structure (Krejci & Malin, 1989). Nurses in organizations that have shared governance models will be better equipped to maintain their professional discipline. Most shared-governance-based nursing departments have councils organized around patient care (standards), quality, research and evaluation, management systems, and nursing staff development. These main themes for councils have persisted for nearly 20 years. Are these the ties that bind us? The integrity of the discipline lies in having (1) the requisite knowledge to evaluate the quality of patient care and nursing care and (2) having the management systems to support them. No matter where nurses report in the organization, the profession grows and thrives by having councils attentive to the themes cited. Advanced shared governance implementations have become multidisciplinary and systemwide, building on what has been successful in a single department. The argument may be made that this approach cannot be successful if nurse administrators do not control the nursing budget. However, support for nursing from top administration, or lack of it, is a key element to success and affects resources and the deployment of them, no matter where nursing reports. Many hospitals have been successful in maintaining the integrity of the nursing profession without nurse administrators responsible for nursing budgets. This has resulted from a commitment to shared governance councils that focus on professional nursing practice. This becomes the main role of the chief nursing officer without line authority: to support comparable standards through the work of the councils. These are the ties that bind us; the hope for the future; the impetus to reach new levels of professional practice. Reference Krejci, J.W., & Malin, S. (1989). A paradigm shift to the new age of nursing. Nursing Administration Quarterly, 13(4), 40-45.
JournalofProfessionalNursing, Vol 14, No 2 (March-April), 1998: p 66
The Ties That Bind HERE IS MUCH stress and distress as hospital organizations follow new directions to adapt to T changes in health care. Many organizations are structuring around product lines or service lines (such as cardiovascular), hoping to better understand a particular business segment and provide comprehensive care while monitoring service-specific costs. As these service lines are organized, they may not be administered by nurses and may not follow the existing nursing department organizational chart. This may render the nursing department organizational chart obsolete. Nurses who work in a service-line entity may report to a nonnurse administrator rather than to a nurse administrator in the nursing department. Some nurses find this prospect discomforting. However, in many organizations the role of chief nursing officer is emerging. This individual may not have line authority for the nursing department but is expected to assure comparable standards for nursing practice and patient care within the organization or system. How can this be accomplished without line authority? Some nurses doubt that it can be done. We must give serious consideration, however, to this new organizational pattern because it is becoming more common, and we need some assurance that it will work and that standards can be maintained. Do we in fact define ourselves only by our line authority for the nursing budget, or can we be comfortable finding another way to maintain the integrity of the professional discipline of nursing? As we organize more by networks and systems, we need to define the links that hold nursing together. What are the ties that bind us? One hypothesis is that we have been creating the foundation for maintaining nursing
SUEELLEN PINKERTON, PHD, RN VicePresident~ChiefNursing O~cer Shands at the UniversityofFlorida PO Box 100335 Gainesville,FL 32610-0335 Copyright © 1998 by W..B.Saunders Company 8755-7223/98/1402-0003503.00/0
66
integrity within a service-line structure since the early 1980s with the development of shared governance. As nursing departments implemented shared governance to support staff nurses in making practice decisions, many nursing departments made paradigm shifts to shared governance as a way of thinldng--a transformation--not just an organizational structure (Krejci & Malin, 1989). Nurses in organizations that have shared governance models will be better equipped to maintain their professional discipline. Most shared-governance-based nursing departments have councils organized around patient care (standards), quality, research and evaluation, management systems, and nursing staff development. These main themes for councils have persisted for nearly 20 years. Are these the ties that bind us? The integrity of the discipline lies in having (1) the requisite knowledge to evaluate the quality of patient care and nursing care and (2) having the management systems to support them. No matter where nurses report in the organization, the profession grows and thrives by having councils attentive to the themes cited. Advanced shared governance implementations have become multidisciplinary and systemwide, building on what has been successful in a single department. The argument may be made that this approach cannot be successful if nurse administrators do not control the nursing budget. However, support for nursing from top administration, or lack of it, is a key element to success and affects resources and the deployment of them, no matter where nursing reports. Many hospitals have been successful in maintaining the integrity of the nursing profession without nurse administrators responsible for nursing budgets. This has resulted from a commitment to shared governance councils that focus on professional nursing practice. This becomes the main role of the chief nursing officer without line authority: to support comparable standards through the work of the councils. These are the ties that bind us; the hope for the future; the impetus to reach new levels of professional practice. Reference Krejci, J.W., & Malin, S. (1989). A paradigm shift to the new age of nursing. Nursing Administration Quarterly, 13(4), 40-45.
JournalofProfessionalNursing, Vol 14, No 2 (March-April), 1998: p 66