1. Adams, Cindy PhD, RN, ANP-BC
  2. Browning, Mary DNP, RN, NE-BC
  3. Woodward, Romma M. MSEd, MSN, RN-BC


This bimonthly department, sponsored by the American Organization of Nurse Executives (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.


Article Content

The 2010 Institute of Medicine (IOM) report, The Future of Nursing: Leading Change, Advancing Health,1 was a call to action for nurse leaders and the nursing profession as a whole. Community Health Network (CHNw), an integrated nonprofit health system with more than 200 sites of care and affiliates throughout Indiana, has answered the call by integrating many of the IOM recommendations into their complex network nursing strategy. Community's network includes physicians, specialty and acute care hospitals, surgery centers, home care, and behavioral and employee health. Strategies include the following:


* creating collaborative improvement efforts through formation of a leadership triad at each acute care hospital,


* developing a partnership with 3 nurse practitioner (NP) programs to design a consistent approach to clinical experience for NP students,


* forming an educational partnership with Indiana University to provide on-site MSN education classes allowing nurses in the program to be paid to attend classes, and


* designing a professional development program to hardwire ongoing development of nursing leadership skills and competencies for leadership roles across CHNw.



Network Strategy

Creation of Interdisciplinary Leadership Triads

In the spirit of engaging interdisciplinary talent in full partnership to reengineer healthcare processes and outcomes, we created the concept of leadership triads in the acute care hospitals in our network. In previous years, the separate hospitals functioned as distinct entities[forms light horizontal]using varied methodologies in uptake and execution on emerging evidence-based practices (EBPs) and process improvements (PIs). A key role in the implementation of EBP is the clinical nurse specialist (CNS). Throughout CHNw, the staff of 10 CNS practitioners report centrally to the network chief nursing officer. They focus on clinical areas of expertise and drive change using influence and expertise across the 5 regional hospitals. Historically, CNS practices involved rounding in the various hospitals interacting with leadership and staff with the hope of influencing practice. However, barriers affecting success including a lack of authority to initiate change based on chain of command, limited ability to change physician behavior, the inefficiency of traveling to all locations to be visible and supportive, and lack of infrastructure in nursing practice to execute changes in process and practice. Hospital-based personnel perceived a lack of support with the system and requested to hire a local CNS instead. Sporadic and inconsistent ownership of clinical and experience outcomes was also problematic in driving improvement.


As work escalated to transform CHNw into an integrated health delivery system, nursing leadership engaged in redesign to create a reliable structure in the acute care services where EBP and PI initiatives could be efficiently and reliably deployed. Redesign involved a deployed CNS at each hospital to serve as the gatekeeper for advanced practice nursing resources. They would serve as the go-to person for clinical issues and questions and access their content-expert counterparts as needed depending on the clinical issue at hand.


More importantly, the CNS at each facility was engaged in a triad leadership relationship with the vice president of patient services/chief nurse executive and the vice president of medical affairs. These relationships were charged with oversight of the surveillance and management of clinical and experience outcomes at the facility level. By creating these triad leadership teams, barriers to success were eliminated, such as lack of authority to drive change, ability to influence physician behavior change, perceived lack of visibility and support by centralized CNS staff, and inconsistent ownership of outcome measures.


The triad teams were implemented in July 2011, and the 1st global (network-wide) intervention delegated to the teams was improved effectiveness of purposeful rounding. Success of the triad leadership teams included the creation of a reliable infrastructure for nursing facilitating execution of practice changes and PI. The design of a new nursing governance structure was created for future implementation. Our belief is that this highly functioning, interdisciplinary leadership team with the accompanying engagement of an effective nursing practice infrastructure across CHNw will lead to assurance that best practices are hardwired into practice and superior clinical and experience outcomes will result.


Partnership With Nurse Practitioner Programs

Several factors led to a partnership with schools including increased need to place NP students, growing enrollment in the programs, and need for clinical preceptors for NP students. Partnership outcomes included the development of guidelines for the program delineating student and preceptor roles and responsibilities, a universal preceptor tool to be utilized by all schools, and the designation of an individual from human resources to coordinate the placement of NP students providing a single entry point for clinical placement for both students and faculty.


Partnership to Provide MSN Classes

Community Health Network developed a partnership with Indiana University (IU) to facilitate nurses returning to school for MSN degrees in preparation for advanced clinical roles and faculty positions. This proactive stance supports the IOM report1 as well as responding to future predicted shortages of nursing faculty.2 Informational sessions were conducted to inform network RNs of the opportunity for advanced education. Following the sessions, interested nurses chose 1 of 3 tracks of study: administration, CNS, or education. Twenty-five nurses enrolled with IU and attended core classes together on site at the hospital. Core courses were taught by IU faculty, with the majority of the clinical courses supervised by CHNw preceptors. Most of the students' projects and research benefited CHNw by using the facilities as clinical sites.


Given the need for faculty and new criterion for the hospital's nurse educators to be MSN prepared, those who chose the education track were eligible to apply for a special scholarship program. Eighteen employees applied, and 10 were chosen. All MSN students were eligible for tuition assistance, and the scholarship program included an additional $10 000 for full-time status. Students in the MSN program worked 20% of their full-time shifts, but received full salary. In return for the hospital's investment in them, each student made a 4-year commitment to teach as needed either in the hospital or the university. Financial support facilitated 8 RNs graduating in 24 months.


Other positive outcomes resulted from the CHNw/IU partnership including the following:


* The joint classes/experiences provided support and decreased apprehension in returning to school.


* IU faculty commented that students were exceptionally motivated.


* Eighty-seven percent of the 25 students in the cohort graduated as planned.


* Students and preceptors bonded and voiced an increased appreciation for the other's role and contributions.


* Students expressed appreciation to CHNw for the opportunity to earn their MSN.



Professional Development Program

The CHNw team created a professional development program to hardwire ongoing development of nursing leadership skills and competencies for leadership roles across CHNw. Aging of the nursing workforce within leadership magnified the need for continued development among clinical leader ranks, the establishment of a leadership brand, and standardized leadership practices so promotion from within would be a priority as a network. Three programs were developed to strengthen the overall CHNw nursing leadership strategy. These are leadership in action (LIA), leadership effectiveness, and leadership identification and pipeline growth. Aside from determining the individuals chosen to become part of succession planning as either interim or potential permanent successors, the program focuses on enriching the depth and breadth of potential successors via pipeline growth. Potential leaders who were identified were invited to participate in a 24-month LIA accelerated development program with a senior leader preceptor as a partner. After completion of the program, these new leaders are considered to have high potential for senior positions in the CHNw.


To assess leadership effectiveness, inventories are conducted network-wide for both directors and managers. The goal of this program is to minimize variation by establishing a leadership brand. The brand clearly defines the leadership skills, behaviors, and knowledge needed to sustain the culture in CHN and drive strategic plans. It also identifies competencies that support the development and measurement of leadership practices and teaches leaders how to develop other future leaders.


To address leadership identification and pipeline growth, an emerging nurse leader program will be implemented in the future. A pathway known as the emerging nurse leader pipeline (ENLP) was created for staff nurses to explore nursing leadership positions. The ENLP pathway encompasses a robust and comprehensive submersion into what leadership entails-what it means to be a CHNw leader, as well as fundamental skills and network expectations. The objectives for creating ENLP include building a reservoir of potential nurse managers that will support CHNw in responding more quickly to opportunity and needs requiring leadership, prime our nurse leadership pipeline and proactively strengthen and enhance personal growth of those that participate, sustain our culture and accelerate readiness, and reduce costs associated with onboarding new managers. Emerging nurse leaders will be identified by current nurse leaders through a formalized inventory and selection process.


CHNw Creating a Bright Future for Nurse Leaders and Patients

By utilizing the IOM report1 as a strategic guide, CHNw nursing leadership continues to answer the call for action. The future has never been brighter for nursing to meet the dynamic changes required in healthcare. Engaging nurse leaders to make the changes outlined in the IOM report1 will refocus nursing's energy on the future while advancing the well-being of patients across the care continuum.




1. Institute of Medicine Report. The Future of Nursing: Leading Change, Advancing Health. Available at Accessed November 10, 2010. [Context Link]


2. American Colleges of Nursing. White Paper: Faculty Shortages in Baccalaureate and Graduate Nursing Programs: Scope of the Problem and Strategies for Expanding the Supply. Available at Accessed January 16, 2007. [Context Link]