An Integrative Review of 21st-Century Roles, Responsibilities, Characteristics, and Competencies of Chief Nurse Executives

Abstract

Executive nursing practice is experiencing "head-snapping change." Health care has transitioned from the managed care era to the disruptive innovation era. As chief nurse executives (CNEs) navigate evolving care delivery models, they must consider retooling their roles and responsibilities related to emergent models. This integrative review's purpose was to examine evidence for the roles, responsibilities, characteristics, and competencies of CNEs and system CNEs to better guide future generations of nurse executives. Ganong and Cooper's integrative review methodology was chosen to guide the evidence synthesis. Seventeen articles were identified that pertained to the clinical inquiry. The evidence is inconsistent for specific CNE roles, responsibilities, characteristics, and competencies due to many areas of overlap and an absence of definitions. The evidence does describe who CNEs are, what they do, and how they articulate executive practice. Embedding evidence regarding emerging roles, responsibilities, characteristics, and competencies into the personal journeys of nurse executives helps articulate shifting paradigms and the CNE's role in transforming health care. Review results have the potential to create a blueprint for the recruitment, development, and retention of the next generation of nurse executives. New knowledge for the ever-changing worlds of CNEs is needed by robust research studies and other evidence.

The strategic leadership of nursing directorates in the context of healthcare system reform

“…Secondly, we found that following the reform, the nursing directorates had to quickly reposition their responsibilities in relation to the quality of nursing care with the other directorates of the new institutions, so as not to be excluded from projects. This is in line with what other authors found about the lack of clarity regarding the roles of nursing directorates in their organizations 3 as well as the limited place given to quality of care in management committees of various hospitals elsewhere. 9 In this regard, our research suggests that nursing directorates need to rethink their roles and responsibilities in the governance structure introduced by the reform, develop a more strategic role, and measure their contribution in terms of quality of care.…”

“…1 This law requires that a nurse be appointed as director of nursing in each health institution, under the authority of the Chief Executive Director (CEO), but provides no specific information on how the nursing directorates should carry their quality of nursing care mandate within the institutions. Consequently, it has been observed that 2,3 : (1) responsibilities attributed to the directors of nursing vary significantly, depending upon the recognition of their legitimacy within the institutions, (2) lack of clarity concerning the roles and responsibilities of the nurses in leadership positions limits understanding of the director of nursing function, (3) nursing directorates' participation in strategic decisions is not reflecting their real potential, and (4) nursing directorates are often ill-prepared to act strategically at this level of responsibility in the new institutions.…”

“…In the context of reform geared toward improvement of organizational performance, nursing governance needs to use strategic leadership, 4 due to the major impact of nursing care on the overall quality of care and services in the organization. 3 This article reports the major findings of a doctoral study 5 which focused on the Quebec nursing directorates' exercise of strategic leadership. The following research questions guided the study:…”

Nurse Manager Core Competencies: A Proposal in the Spanish Health System

“…The experts agreed that competencies should be developed at "competent" (this was considered to have been reached when there is a strong demonstration of competency), "very competent" (level reached when there is a significant demonstration of competency) and "expert" level (level reached when it demonstrates the behavior of the competency model). This proposal is in agreement with AONE, who use the levels competent, proficient and expert for the development of competencies, emphasizing how these levels are reached through master's degree studies or a Ph.D. [62,63]. In contrast, in other studies such as "Nurse manager competencies", the focus is on the degree to which the competencies contribute to the nurse manager's work (minimally, moderately, significantly and essentially) [48].…”

La transformation du réseau québécois de la santé : une opportunité de repositionnement stratégique des soins infirmiers

“…La nouvelle structure du réseau venait modifier la mission et les niveaux d’intervention de la DNSSI. C’est ainsi qu’une réflexion 1 –5 orientée autour de trois questions , suivie d’une journée de concertation avec les DSI du RSSS ont permis d’y répondre.…”