Leadership in systems: the role of the corporate nurse

Major changes have taken place in health care. The small "Mom and Pop" organizations have been replaced by merged and consolidated entities to become more efficient. It is difficult to find a physician in solo practice now and difficult to find a nonaligned hospital, home health agency, or nursing home. Managing in large complex consolidated integrated networks is very different and requires different structures and competencies. The history of nursing started with the Chief Nurse not being apart of the executive team. Through many strides, and even regulatory conditions emanating from organizations such as the Joint Commission for the Accreditation of Healthcare Organizations, the CNO now is expected to develop and be accountable for the budget and be considered apart of the executive team in an egalitarian position. The same process is now taking place in the large consolidated organizations. It is as important for the voice of patient care to be present strategically at the executive level of the new structures as it has been to have that person well positioned in the smaller organization. We in nursing have met the challenge by preparing CNOs to operate at the executive level through education and membership in organizations such as the American Organization of Nurse Executives and the American College of Healthcare Executives. Strategically, we need to think through the educational programs and mentoring experiences that will help more CNOs step into these positions easily. Programs such as the Johnson & Johnson Wharton Program for Nurse Executives have been invaluable for helping individuals make the transition into strategic, executive roles. Our challenge is to determine how these opportunities can be made available to more people as the times demand greater expertise.