ROLES AND RESPONSIBILITIES OF A CHIEF NURSE

The following framework is intended to illustrate the Chief Nursing Officer (CNO) role and
responsibilities in the context of membership and participation at the senior management and board
table. This framework assumes that the CNO is responsible for nursing activities throughout the
organization and reports directly to the Chief Executive Officer or Medical Officer of Health/Senior
Management Team as a senior member of executive-level, decision-making management.

1. Strategic Visioning, Organizational Decision Making & Practice Innovation

Governance.

 Participate as an active member of the Board/Senior Management Team.

 Identify relevant emerging local, regional (e.g., Local Integrated Health Network), provincial, and
national issues and draw these to the attention of the Board/Senior Management Team
 Contribute to a vision for the delivery of client care/service, including a statement of values,
mission, standards of practice, and outcomes.
 Contribute to organizational decision making that is consistent with the values, vision, mission
and standards of practice and quality outcomes
 Ensure respect for nursing services is conveyed in the strategic plan and Board/ Senior
Management Team operations.

Leadership.

 Disseminate the strategic vision for the delivery of client care/service within and across the
community of practice/ organization/constituency.
 Inspire new levels of creativity and innovation within the organization to positively impact
client/service outcomes
 Participate in the planning and implementation of programs and services by establishing a clear
sense of service priorities to pursue and the necessary resources to fulfil those priorities
 Participate in the evaluation of programs and services by identifying relevant quality
improvement indicators for client/service outcomes, nursing practice, and organizational
structure
 Ensure that a forum exists for decision making for nursing professional practice (e.g., Nursing
Professional Practice Council) with strong engagement from direct care nurses Understand,
develop, and exercise political acumen in internal and external relationships to strengthen the
contribution of nursing

Practice.

 Guide practice based on the shared vision across the facility/organization /community
 Lead the nursing research agenda focusing on research conduct, research utilization, and
research capacity building in partnership with relevant stakeholders
 Foster and sustain academic partnerships to advance nursing research for quality client care /
service Identify, appraise, and apply evidence to understand and participate in clinical and
management decision making Create and promote evidence-based nursing practice

2. Quality Care and Client Safety

Governance

 Advocate for senior nurse executive representation on and contribution to the Operational
Quality Committee
 Champion policies and protocols that promote effective health care delivery evidence-based
practice, and service quality Assume accountability for meeting quality and safety
performance targets set by the Board
 Provide recommendations regarding quality improvement initiatives by translating
information from quality-related reports into knowledge development
 Advocate for the inclusion of structure, process and nursing-sensitive outcome indicators in
the quality improvement plan of the organization
 Provide input and assessment of the organization’s quality improvement plan

Leadership

 Propose, lead, and direct strategies to improve quality outcomes and advance evidence-
based care
 Oversee and report on risk management strategies, including identification and monitoring
of nursing-sensitive quality and safety indicators
 Participate on task forces working quality and safety committees as necessary and
appropriate
 Establish and utilize a network to provide on-going support and guidance for client
care/service initiatives and improvements
 Ensure a practice environment that enables the implementation of evidence-based nursing
best practices that are consistent throughout the organization and aligned with the
organization’s broader quality improvement plan

 Role-model vigilance in ensuring high quality care

 Assess variability in nursing practice within the organization to determine areas in which to
improve client care/ service outcomes, quality, or efficiency
  Evaluate nursing practice and client care/service excellence from a structure, process and
outcomes framework.
 Select and monitor evidence-based nursing-sensitive client care/service, provider, and
system outcomes, and measure progress toward organizational health care delivery goals
 Develop and establish mechanisms for continuous monitoring of organizational processes
and change, including evaluation of the impact of clinical and healthy work environment
best practice guidelines on client/service outcomes and nursing practice
 Ensure sustained use and spread of nursing best practice guidelines within the organization

3. Collaboration

Governance

 Develop and maintain collaborative relationships with senior nurse executive colleagues
within and across organizations, sectors, and regions to collectively advance the nursing
governance and leadership agenda
 Encourage the Board/Senior Management Team to work towards common service
improvement goals
 Promote inter-organizational, crosssectoral, and regional synergy to optimize client
care/service across the continuum of care
 Promote an interdisciplinary approach to client care/service and the coordination of
care/service across health disciplines
 Establish credibility with the senior executive team as the expert on nursing and nursing-
related matters for the organization

Leadership

 Unite health professionals from across the system by using shared vision, values, and
understanding to build mutual respect, bridge territories, and unify agendas
 Demonstrate commitment to and respect for the profession of nursing, its values,
knowledge, contributions, and achievements
 Represent the nursing profession externally by maintaining membership and active
participation in relevant regulatory and professional nursing organizations
 Ensure that there is a system for collaboration with schools of nursing to facilitate
appropriate clinical placements and shape curriculum and effective teaching/learning
experiences for nursing students and staff

Practice

 Champion inter-professional collaboration among nursing, medical, and allied health

professionals to achieve optimal client care/service outcomes and effective integration of
care
 Role model inter-professional relations for quality care and management practices
 Support, coach, and mentor others to succeed with change
  Establish tools and processes for communicating and collaborating with direct care nurses

4. Professional Accountability

Governance

 Assume accountability for obtaining and implementing leadership skills and knowledge for
effective participation on the Board/Senior Management Team and for obtaining knowledge of
how legislated governance and management requirements impact and support Board/Senior
Management work generally, nursing services in particular
 Bring forward to the senior executive team the nursing perspective, and provide expertise on
the nursing practice environment
 Advocate for nursing practices that enhance the delivery of client care/services, including
healthy work environments
 Create shared understanding of both current and anticipated demands for clinical and
program/service performance
 Accept responsibility for accountability of specific targets agreed upon by the Board that are
within the direct nursing portfolio
 Monitor, interpret, and report performance of nursing service delivery against nursing-sensitive
quality and safety indicators and broader organizational indicators
 Profile examples of nursing leadership within the organization to senior leaders of the
Board/Senior Management Team

Leadership

 Establish a vision for nursing practice and client care/service that complies with ethical
standards and values
 Champion models of care delivery and nursing practice, work environments, and staffing
standards that are consistent with current research evidence, professional standards, and with
the mission, vision, and values of the organization
 Identify and leverage key initiatives to enable enhanced nursing practice and work environment
outcomes
 Evaluate nursing services against evidence-based standards set by Administration, Human
Resources, Nursing and Department policies and procedures Champion a Nursing Professional
Practice Council and ensure that it is positioned for influence and success
  Foster opportunities throughout the organization for staff to develop, enhance, and profile their
nursing leadership skills and contributions
 Develop strategies to promote nursing recruitment and retention and recognition of excellence
in nursing

Practice

 Champion safety, quality care, and evidence-based nursing practice

 Promote evidence-based models of nursing care delivery
 Promote clinical/service and frontline management decisions that are client-centred
 Monitor nursing outcomes related to nursing leadership, practice, education, and research
 Develop and support the Nursing Professional Practice Council (or other nursing decision-
making forums) to communicate, interpret, and assist with the application of professional
standards, competencies, expectations, and other legislative and regulatory requirements of
nurses
 Support the Nursing Professional Practice Council (or other nursing decision-making forums) to
implement and monitor the impact of clinical and healthy work environment best practices
 Create, support, and sustain a safe and healthy work environment in which nurses can provide
quality care
 Promote and inspire management practices that support nurses’ health, safety, and well-being
 Promote and achieve excellence in nursing care, education, and research through the
identification of success measures and reporting mechanisms that capture these successes
 Ensure a supportive environment and system for regular performance review and establish
metrics to determine success in deliverables

5. Professional Development

Governance

 Maintain awareness of the ever-changing health care environment and its potential impact on
the organization’s mission, vision, and values
 Assume confidence and competence in communicating the strategic vision to the Board/Senior
Management Team
 Demonstrate a clear commitment to advancing excellence and innovation in nursing practice
Conduct ongoing self-assessment of effectiveness as a Board/ Senior Management Team
member

Leadership

 Demonstrate active and visible leadership within the organization

 Conduct ongoing self-assessment of effectiveness as a nursing leader for the organization
 Request, accept, and learn from feedback provided by supervisors and direct reports
 Assume responsibility for learning and professional development by seeking mentors and
opportunities for growth
  Encourage, support, and enable staff to pursue professional development opportunities to
enhance skills, develop expertise, and advance their roles
 Facilitate rewarding and enriching teaching/learning experiences for nursing students by
encouraging staff-student partnerships, rewarding staff involvement in student education, and
recognizing student contributions to care

Practice

 Provide mentorship and guidance

 Create and support a professional learning environment to mobilize and enhance the clinical
expertise of staff
 Optimize nurses’ opportunities for autonomy and personal and professional growth
 Facilitate nurses’ access to and use of support, feedback, and guidance from superiors, peers,
and subordinates
 Enhance the meaningfulness of nursing work by facilitating nurses’ participation in decision
making Role model professional development and life-long learning

Nursing Duties
  A chief nurse is mandated by the hospital administration to maintain clinical and patient-
care standards. This includes ensuring that the patients are safe in the hospital and have
access to the right medical care. In order to do this, the chief nursing officer has to work
closely with the hospital management and stakeholders to acquire the right infrastructure
and resources. He also offers the best insights to the management on how they can
improve the quality of care in the facility. A chief nursing officer is also responsible for
formulating and implementing new nursing strategies. This requires extensive knowledge
of the nursing procedures, staff rules and patient policies.

Administrative Roles
 A chief nursing officer has a wide range of responsibilities, including administrative
roles. He sometimes performs the duties of a chief administrator or CEO of the hospital.
He plans and oversees the daily activities within the hospital and ensures everything runs
as planned. This includes organizing, directing and coordinating medical and health
services in compliance with the government regulations and policies set by the board of
trustees. He may also shortlist, evaluate and hire nurses and assist in educating them on
the best healthcare practices. In some instances, a chief nursing officer may help in
planning budgets and setting rates for the health services.

Leadership Roles
 A chief nursing officer is expected by the government and hospital management to
maintain high standards other staff members can follow. He inspires others based on what
he does and encourages them to uphold the best practices when handling patients. He
works towards establishing a conducive environment for other nurses by developing
strategies aimed at creating collaboration. His leadership duties may go beyond the scope
of nursing to serving as a spokesperson, representative or trainer at medical conferences
and seminars. A chief nurse may also review the certifications of other nurses to make
sure they comply with the existing professional regulations in the industry.

Advisory Roles
 Many hospitals in the US treat CNOs as chief advisers. They play a major role in helping
the hospitals run smoothly and observe the existing healthcare standards. They do this by
carrying out extensive research, evaluating results and preparing reports on the best
approach the hospital should take to streamline its operations. They also advise the
management on how to recruit new nurses and train them. Chief nursing officers working
in the public sector may also provide advice to the government.

Liaison with Physicians

 Many hospitals struggle to keep a perfect working relationship between physicians and
nurses. A chief nurse acts as the closest link between the physicians, nurses and hospital
administrators. He ensures that all the RNs and LPNs offer the best possible support to
the doctors in their respective departments. The support may include retrieving patient
information, observing the patients based on the doctors' instructions and providing the
right diagnostic tools. To achieve this, the nursing officer may need to review the policies
of the hospital and make changes where necessary.