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Chief nursing officers (CNOs) develop environments in which quality patient care is delivered and nurses enjoy professional practice. Because of the growing turbulence in this vital role, the American Organization of Nurse Executives conducted a study to examine CNO turnover as described in interviews with CNOs and healthcare recruiters to inform the development of strategies to improve CNO recruitment and retention and ease transition for those who turn over. The authors present the findings from this research and describe American Organization of Nurse Executives' initiatives to address the identified needs.

Background: Access to personal health information through the electronic health record (EHR) is an innovative means to enable people to be active participants in their own health care. Currently this is not an available option for consumers of health. The absence of a key technology, the EHR, is a significant obstacle to providing patient accessible electronic records. To assess the readiness for the implementation and adoption of EHRs in Canada, a national scan was conducted to determine organizational readiness and willingness for patient accessible electronic records., Methods: A survey was conducted of Chief Executive Officers (CEOs) of Canadian public and acute care hospitals., Results: Two hundred thirteen emails were sent to CEOs of Canadian general and acute care hospitals, with a 39% response rate. Over half (54.2%) of hospitals had some sort of EHR, but few had a record that was predominately electronic. Financial resources were identified as the most important barrier to providing patients access to their EHR and there was a divergence in perceptions from healthcare providers and what they thought patients would want in terms of access to the EHR, with providers being less willing to provide access and patients desire for greater access to the full record., Conclusion: As the use of EHRs becomes more commonplace, organizations should explore the possibility of responding to patient needs for clinical information by providing access to their EHR. The best way to achieve this is still being debated.

The role of the healthcare system chief nurse executive is complex, daunting, risk-laden, and exciting, and provides unprecedented opportunities to influence the care of patients in a very broad context. Creating a unified vision, mission, and culture is a challenging task that can be personally and professionally rewarding. At first glance, the role can appear impersonal and distant, with little opportunity for meaningful interaction with staff. However, with thoughtful consideration, the system chief nurse executive can establish effective relationships that have far-reaching outcomes.

Few publications have reported empirical findings regarding the measurement of nursing group power. This article reports the confirmatory factor analyses of the Sieloff-King Assessment of Group Power Within Organizations (SKAGPO) for instrument and middle-range theory development. Secondary analyses were conducted using cross-sectional data collected in 1999. The target population of the initial research was the chief nurse executives (CNEs) of all hospitals within the United States (including Alaska and Hawaii). A sample of 600 hospitals from across the United States was selected through a stratified random sampling process. A total of 350 executives comprised the final sample. Second-order confirmatory 8-factor analysis revealed factor loadings ranging from .43 to .89. The overall fit of the proposed model was: X2 = 1,360, df = 586, p < .00, GFI = .82, CFI = .86, and RMSEA = .06, indicating an acceptable fit with the data. Statistical support was found for the proposed model with the subsequent development of an alternate model that better fit the data. The study results indicated that the SKAGPO has acceptable psychometric properties.

Chief nurse officers seek leaders who'll guide practice transformation to meet clinical and educational challenges. Do you have what it takes?

This bimonthly department, sponsored by the American Organization of Nurse Executive (AONE), presents information to assist nurse leaders in shaping the future of healthcare through creative and innovative leadership. The strategic priorities of AONE anchor the editorial content. They reflect contemporary healthcare and nursing practice issues that challenge nurse executives as they strive to meet the needs of patients.

*Two in three commissioning directors and 44 per cent of chief executives don't know if they will use FESC. *More than 70% of chief excutives and commissioning directors would rather get other help in commissioning. *More than half of chief executives and commissioning directors think FESC will at best be 'a little' successful.

This article discusses management practices in public hospitals (general hospitals with emergency services) in the city of Rio de Janeiro, Brazil, based on a psychosociological approach to organizational analysis. Of the 12 existing hospitals, 8 were included in the current study, conducted from July 2003 to April 2004. The research, drawing on hospital directors' narratives, identified three management models. The first focuses on processes of change, highlighting symbolic and imaginative elements for building a vision of the future for the hospitals. The second concentrates on specific projects, which absorbs all the management efforts. A third pattern (predominant in the study) is marked by the struggle to keep the hospital working, with the image of urgency as the driving force. The imposition of continuous action leaves no room for reflection. The crisis in Rio de Janeiro's public hospitals has led to a "wartime" environment and thus the dissemination of the urgency-based model.

CEO turnover, although common, is expensive and disruptive for everyone involved. Both incoming and outgoing CEOs would welcome help in making the transition a painless experience. Through a 2005 nationwide survey of 805 current hospital CEOs, the authors obtained comments and suggestions in response to three open-ended questions about specific activities or processes that would help incoming and outgoing CEOs. Mostly, CEOs felt the need for a structured orientation process, succession planning, concrete peer and organizational support, training on recruitment and retention for the board, and an adequate separation package including continued healthcare coverage.

Peachtree Healthcare has major IT infrastructure problems, and CEO Max Berndt is struggling to find the right fix. He can go with a single set of systems and applications that will provide consistency across Peachtree's facilities but may not give doctors enough flexibility. Or he can choose service-oriented architecture (SOA), a modular design that will allow Peachtree to standardize incrementally and selectively but poses certain risks as a newer technology. What should he do? Four experts comment on this fictional case study, authored by John P. Glaser, CIO for Partners HealthCare System. George C. Halvorson, the chairman and CEO of Kaiser Permanente, warns against using untested methodologies such as SOA in a health care environment, where lives are at stake. He says Peachtree's management must clarify its overall IT vision before devising a plan to achieve each of its objectives. Monte Ford, the chief information officer at American Airlines, says Peachtree can gradually replace its old systems with SOA. An incremental approach, he points out, would not only minimize risk but also enhance flexibility and control, and would allow IT to shift priorities along the way. Randy Heffner, a vice president at Forrester Research who focuses on technology architectures for computer-based business systems, thinks SOA's modular approach to business design would best meet Peachtree's need for flexibility. He says that Peachtree's CIO sees SOA as a new product category but should instead view it as a methodology. John A. Kastor, a professor at the University of Maryland School of Medicine, questions the goal of standardized care. He argues that it would be difficult to persuade doctors, many of whom are fiercely independent, to follow rigid patterns in their work.

This article offers perspectives on the nursing shortage and how to deal with them from a variety of healthcare leaders.

Purpose: To define organizational culture in hospitals that have received quality certificates and to identify attitudes of healthcare personnel toward change., Methods: The population was all physicians and nurses (N=3,067) employed at four private hospitals that have received accreditation or the "ISO" certificate, and four public hospitals, all of which were located within Istanbul city limits. A proportional sample of 570 participants were selected from the eight hospitals. Data-gathering tools were information form, culture scale, and Attitude Against Change Scale (AACS). Data were evaluated by using descriptive statistics, Cronbach alpha coefficient, Chi-square test, and by t test for dependent groups, one-way variance analysis (ANOVA), and Tukey test., Findings: The lowest score averages on the AACS were found in those employed in public hospitals, in those who perceived top executives as autocrats, and in those who were unwilling to participate in quality studies. Participants in a power culture were least open to change., Conclusions: A collaborative culture was the most evident culture in private hospitals, but in public hospitals the most dominant culture was a power culture.

Background: It is important to assess rural health professions workforce needs and identify variables in recruitment and retention of rural health professionals., Purpose: This study examined the perspectives of rural hospital chief executive officers (CEOs) regarding workforce needs and their views of factors in the recruitment and retention process., Methods: A survey was mailed to CEOs of 28 Illinois rural hospitals, in towns ranging from 3,396 to 33,530 in population size. The survey addressed CEO perceptions of number of physicians needed by specialty, need for other health professionals, and variables important to recruitment and retention., Findings: Twenty-two CEOs (79%) responded to the survey. Eighty-six percent indicated a physician shortage in the community, with 64% reporting the need for family physicians. CEOs also indicated the need for physicians in obstetrics-gynecology, general and orthopedic surgery, general internal medicine, cardiology, and psychiatry. In terms of needs for other health professionals, most often mentioned were registered nurses (91%), pharmacists (64%), and nurses' aides (46%). Related to recruitment and retention, most often mentioned by the CEOs was community attractiveness in general, followed by practice and physician career opportunities., Conclusions: CEOs offer 1 important perspective on health professions needs, recruitment, and retention in rural communities. While expressing a range of opinions, rural hospital CEOs clearly indicate the need for more primary care physicians, call for an increased capacity in nursing, and point to community development as a key factor in recruitment and retention.

The role of leadership in health care priority setting remains largely unexplored. While the management leadership literature has grown rapidly, the growing literature on priority setting in health care has looked in other directions to improve priority setting practices--to health economics and ethical approaches. Consequently, potential for improvement in hospital priority setting practices may be overlooked. A qualitative study involving interviews with 46 Ontario hospital CEOs was done to describe the role of leadership in priority setting through the perspective of hospital leaders. For the first time, we report a framework of leadership domains including vision, alignment, relationships, values and process to facilitate priority setting practices in health services' organizations. We believe this fledgling framework forms the basis for the sharing of good leadership practices for health reform. It also provides a leadership guide for decision makers to improve the quality of their leadership, and in so doing, we believe, the fairness of their priority setting.

Empirical evidence is scarce on chief executive officer (CEO) turnover in U.S. hospitals, with potentially serious implications for many of these organizations. This study, based on a nationwide survey of CEOs at non-federal general surgical and medical community hospitals conducted in the spring of 2004, reports the perceptions of hospital CEOs regarding the circumstances and impact of CEO turnover on U.S. hospitals. In the opinion of the respondents, the impact includes competitors taking advantage of turnover by luring employees and physicians away from the target hospital, significantly increasing the likelihood of other senior executives leaving the hospital, and many of the important strategic activities being delayed or cancelled altogether. Interestingly, the perceptions of CEOs regarding the effects of turnover do not seem to differ regardless of voluntary or involuntary circumstances of turnover. However, there is a notable bias in emphasizing the perceived negative implications of respondents' own departures and allegedly positive effects of their predecessors' departures.

Frontline RNs knowledgeable in the strategic objectives of their organization made a difference in the selection of an electronic medical record business partner for a large, complex healthcare system. Their impact was significant because of the chief nurse executive's personal articulation of the organization's strategic goals and of her investment in their education. These factors provided the frontline RNs with a foundational base of knowledge about a variety of electronic medical record systems. The preparation and exposure enabled the frontline RNs to make a valuable contribution to the selection of an electronic medical record business partner. The RNs were a major force in affecting philosophical change from the organization's original pursuit of "best-of-breed" interfaced systems to a fully integrated, "best-of-class" vendor business partner. The learning experiences of the frontline RNs are explored to answer the following question: Why must frontline RNs play a key role in this process?

Objectives: Following the events of 11 September 2001 in New York, planning for the deliberate release of chemical, biological, radiological and nuclear agents has intensified in the UK, with Department of Health recommendations for National Health Service and public health action. A consequence of this was to assess preparedness across the West Midlands region of England for mounting an effective response to a deliberate release of a biological agent., Study Design: Descriptive study., Setting: West Midlands, UK. This work involved key organizations and entailed obtaining information from those responsible for and likely to be involved in managing incidents via questionnaire surveys based around preparedness and planning arrangements., Results: Findings revealed that plans delineating action to take during an incident do exist. However, staff training (40%) in acute trusts and testing of plans in primary care trusts (45%) could be improved. Communication arrangements in hospitals require support., Conclusion: Work is ongoing but there is more to do. Trusts should provide staff training and engage in exercises to test plans and communication arrangements.

The health system chief nursing executive (CNE) is responsible for providing high-quality, service-oriented nursing care; delivering such care with disciplined cost management; leading and developing a group of nursing executives and managers at the facility level to establish nursing professional development programs and to build and maintain an effective supply of nurses; and advocating nurses and patients. This article provides insight into the strategies and priorities of large health system CNEs in balancing their obligations to their health systems, to patients and their families, and to the nurses they lead. It is hoped that these insights will provide perspectives that will support the ability of nursing educators to meet their own obligations to their schools of nursing, the faculty and students they represent, and to the profession. These insights will also set a context for further dialogue between two very important groups of nursing leaders-nursing executives and nursing educators.

In this article, the authors report on the results of the second phase of a three-part study of early managerial behavior in short-term, U.S. hospitals. The authors' objective in this phase was to identify important variables in the socialization process. Their analysis of these results was used as the basis for the development of a preliminary model of managerial socialization in short-term hospitals. The model incorporates individualized socialization factors and tactics and will be subject to empirical testing in Phase III of the study. An understanding of the strategic, tactical, political, and cultural approaches that short-term hospital CEOs have used should help lead to more successful transition outcomes and organizational change.