Senior nursing officers have assumed more executive responsibilities in recent years and will be better prepared than their predecessors to graduate to hospitals' executive ranks, according to a survey released to Modern Healthcare by Ballein Search Partners and the American Organization of Nurse Executives.
In the past five years, 91% of the nurses surveyed had experienced a change in responsibilities, with 79% of that group taking on additional duties. Also, 61% of all respondents said they have responsibilities that are comparable to those of a traditional chief operating officer. The respondents held the top nursing positions at their hospitals and oversaw nursing operations.
"Their role is expanding," said Kathy Ballein, president of the Oak Brook, Ill.-based search firm, which oversees the survey that is conducted every three years. "That is the desire of the nurse executive. These are bright people who are able to contribute at the executive table."
Although the survey did not ask for reasons behind the increased duties, Ballein speculated that senior nursing officers now oversee other clinical areas, such as laboratory work, outpatient departments, radiology and social services.
At a time when nursing shortages are reported nationwide (See Special Report, p. 20), Ballein said the results of the survey show that nurses who enter the field have the opportunity to climb their way to the executive ranks. "If you are on the rise in your career, you see the opportunities," she said.
Of those surveyed, 95% said they had support from their executive teams to implement needed changes. With the added responsibility came a rise in compensation for senior nursing officers, according to the survey. In 2002, the average total compensation, including benefits, was $161,657, up 19% from the 2000 survey.
"This demonstrates the value of how important the role of the nurse executive is where the primary product is providing patient care," Ballein said. "It is important they are being recognized."
The nurses surveyed were responsible for budgets that averaged $90 million, and 70% of respondents said they had been given increased budget responsibilities in the last five years. The average size of the hospitals where they worked was 431 beds. With more clinical departments under their belts, the senior nurses managed bigger budgets. "Any department that has direct patient care comes under nursing," Ballein said.
Peg Sebastian, a senior nursing officer at Mercy Health System, Janesville, Wis., said the increased budget responsibilities began in the mid-'90s when systems saw funding drop. "Chief executive officers began looking for chief nursing officers who were visionaries with fiscally sound skills," Sebastian said. "This gave the CNO an opportunity to demonstrate added value." Sebastian, who has changed and expanded her role three times since 1999, said senior nursing officers now have "the ability to strategically focus, plan for the future and lead staffs to a goal."
The nurses surveyed said their greatest career successes included balancing the quality and cost of daily operations; mentoring and developing teams; developing new programs or services; and reporting patient, physician and employee satisfaction.
According to the survey, nurses said they were frustrated with the difficulties of staff retention, relationships with physicians, lack of resources and bureaucracy. The senior nursing officers said their biggest challenges were recruiting and retaining enough nurses, providing good leadership and working on Medicaid reimbursement issues.
The joint survey by Ballein and the nurse executive organization was mailed last fall to 1,000 senior nursing officers at hospitals throughout the country. The response rate was 11%.