The System Chief Nursing Officer: An Evolving Role

The first large wave of healthcare system and hospital consolidation occurred in the 1990s as organizations responded to the specter of managed care. As mergers occurred, there was not always a perceived immediate need to standardize operations, systems, and care processes. A number of organizations recognized the value of a system chief nursing officer (CNO) in promoting professional nursing practice, standards, and outcomes, but these initial roles typically focused on the acute inpatient care settings. Phrases such as meaningful use, accountable care organizations, and pay for performance were not part of day-to-day discussions. Fast forward to our current healthcare environment, and it is clear that the role of the system CNO is changing and rapidly evolving to meet the many challenges inherent in this era of decreasing reimbursement and healthcare reform. There are as many configurations of the system CNO role as there are healthcare systems, yet the changes sparked by the current environment highlight common themes that have emerged. The system CNO continues to focus on overall quality of care, patient safety, patient and family experience, nursing practice and standards of care, leadership development and succession planning, and fiscal responsibility. This article will focus on a few of the evolving priorities: standardization, cross-continuum care, and organizational strategy.