So You Want to Be a Chief Nursing Officer?

Laura A. Stokowski, RN, MS


March 26, 2015

In This Article

Systems Level Nurse Executives

Nurse executives are increasingly being positioned at the helm of entire consolidated hospital networks. Systems differ from traditional hospital-centric organizations.[4] Within a system, the acute care facility is no longer the only player; it is but one component of a larger network that can incorporate, for example, ambulatory care, surgery centers, post-acute care, chronic disease care, home care, rehabilitation, and hospice.[4]

Systems-level CNOs have responsibility for nursing and other patient care services, integrating care and aligning and standardizing nursing practice across the entire continuum of facilities in the network.[4] This role is relatively new to nursing but has become more prevalent as one-time independent hospitals have expanded or consolidated into networks of as many as 10 or more inpatient and outpatient facilities.

The American Organization of Nurse Executives (AONE) has developed a list of competencies for systems-level CNOs providing a sense of the level of responsibility of these nurses[3]:

  • Convenes and aligns all system-wide elements of nursing and the patient experience at the macro-system level;

  • Promotes standardization and assists in the reduction of variation by the dissemination of evidence-based practice while maintaining innovative practices;

  • Develops innovative strategic efforts to achieve the system's vision of the patient experience across the continuum;

  • Exemplifies professional nursing practice;

  • Leads efforts to define the role of professional nursing in patient care delivery and the patient experience;

  • Engages all stakeholders in the development of workforce strategy for future system needs;

  • Understands and influences policy and regulatory issues on behalf of the system;

  • Plays a lead role in ensuring accessibility and affordability in care delivery;

  • Remains patient-focused and represents the patient voice in system governance, strategic planning, and operations; and

  • Leads and manages large-scale change.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as: