Thirty years ago, I was a young nurse leader with the title "Vice President for Nursing." Today, I'm a not-quite-as-young executive called the "Senior Vice President and Chief Nursing Officer" for a health care system. Then, I had operational responsibility for a single-community hospital. Now, I am accountable for the practice of nursing in a multiorganizational system with facilities in 18 states. Then, I was challenged to find time to make rounds on each of the nursing units every week. Now, I tell colleagues that I still make rounds. It just takes me 3 years.

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Not every nursing leader will choose the career path that I did. But, as the articles in this issue underscore, very few (if any) will remain nurse leaders in single, independent hospitals. The majority of us will be employed by systems, whether these are local, regional, or national. These are, or soon will be, corporations that include at least some (if not all) parts of the continuum of health care services. Acute care hospitals will probably (but might not be) one of the care delivery sites included in the organization. The articles assembled in this issue by Guest Editor Tim Porter-O'Grady are meant to help us all understand the revolutionary changes this will bring to our work.

Health care systems are the reality of the next era of health care. As systems thinkers, nurses can intuitively understand the benefits this will bring to our patients and communities. Systems bring with them the potential to decrease fragmentation in care and to decrease costs through reduction of service duplication. They can conceivably increase quality by providing an infrastructure to improve communication among various caregivers. This is likely to improve customer service, as users of health care begin to perceive a more seamless experience from virtually connected care delivery locations. For nursing, this improved connection between sites of care will make it imperative that we practice evidence-based nursing at every site. Standardized nursing procedures across the continuum will not only increase quality but also increase patient confidence in that quality.

This positive move from single institutions to ever-more-complex systems brings new demands to executive nursing roles. Although nurse executives will increasingly come from all parts of the care continuum, the majority of current system chief nursing officers have lived our careers in the acute care arena. We are less familiar with the operations of employed physician practices, outpatient clinics, home health, long-term care facilities, and other emerging sites of care. As system chief nursing officers, many of us are finding ourselves accountable for nursing care in parts of the system where we may have never personally practiced. On the surface, this may seem like an overwhelming task.

This challenge is not as daunting when we remind ourselves that, even in the acute care world, nursing leaders have historically been responsible for nursing across a variety of specialties. Nurse executives have been able to serve as formal leaders for nurses with very different competencies because nurses have a core identity as nurses. Wherever it is practiced, the profession has core theories, principles, standards, and processes. In this new era, we need to take our knowledge of this core along with our leadership competencies to new models of care, as we learn more about the world of nursing care outside of the hospital.

Systems will evolve with different structures. In some, the chief nurse executive will, as he or she does in the hospital world, have both operational and professional accountabilities. In others, he or she will work in a matrix, primarily accountable for the practice of nursing, wherever it occurs, whereas other leaders take the operations role. In either case, as leaders of a profession that will continue to engage the users of health care across the continuum, we have a responsibility and privilege to take part in changing health care for the better.

Thank you for choosing to lead.

-Kathleen D. Sanford, DBA, RN, CENP,

FACHE

Editor in Chief

Nursing Administration Quarterly