1. Hill, Karen S. RN, MSN, CNAA, BC, FACHE

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Remember all those family dinners when you sat at the "kids table?" I do. Our family celebrations involved lots of people, and one dinner table was just not enough. The kids were sent to a second table to allow an adults-only table. As a seasoned nurse executive, I hate to complain in writing about the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO), but I can not resist making a public plea for changes to the newest modifications to the nursing standards (NR 1.10) to preserve a "seat at the table for nursing."


Effective January 1, 2007, JCAHO removed the recommendation from the nursing chapter requiring a nurse leader to be involved in the hospital by "participating with governing body, management, medical staff and clinical leaders in the decision-making structures and processes."1


I am so lucky! I have been employed at my hospital for over 24 years. I have developed collaborative relationships with the medical staff and have the support of my chief executive officer to participate in decision-making bodies affecting patient care. This is not because it is required, but because our chief executive respects my input and perspective enough to include nursing on committees and teams. Other nurse executives may not be so lucky. Some are new to the position, and struggling with difficult multidisciplinary issues like medication reconciliation, disruptive behavior, and the measurement of quality indicators. None of these initiatives will be solved without collaboration and support from a fully informed medical staff and administrative board. Will the nurse executive have to advocate for a position at "the table?" Often nurse leaders have been included in meetings such as the medical executive committee and the governing Board to meet regulatory guidelines. The outcomes of participation, in my opinion, have been positive for patients and for nursing. I can report that my board members and medical staff are supportive of nurse recruitment and retention largely because of their interactions with me. For example, our medical executive committee members have allocated a portion of their annual dues for the 3rd year for scholarships for staff members. They take great pleasure in "investing" in our staff.


I am disheartened to see the requirement for inclusion of the nurse executive eliminated from JCAHO standards. As nursing leaders committed to the health of our communities, I hope we can count on support for the nurse executive at the "table." I hope that the interpretation of the standards by the JCAHO surveyors will still evaluate institutions based on an expectation for active involvement of the nurse executive in collaboration with the decision-making bodies.




1. Joint Commission on the Accreditation of Healthcare Organizations. Revisions to Nursing Chapter. Available at: Accessed December 18, 2006. [Context Link]