Knowledge and skills for chief nurse executives : a survey of practitioners

• Main Author: Donaldson, Sheetal
• Language: English
• Published: 2008
• Online Access: http://hdl.handle.net/2429/1771

Since the late 1800s the role of the chief nurse executive (CNE) has evolved in response to changes within both health care and nursing. Whereas, historically, the responsibilities were diverse (clinical, supervisory and teaching) now they are focused in administration. Generally, the educational preparation of CNEs has also changed to reflect the role. The most recent study which examined the knowledge, skills and education of CNEs was conducted by Sorrentino in 1992. Moreover, the most recent Canadian study to examine these issues was the Canadian Health Administrators Survey (CHAS) (Hastings, Mindell, Brown, & Barnsley, 1981). More recently, nurse leaders noting dramatic changes within health care and nursing, have suggested that the CNE may require a new complement of knowledge and skills in order to face the challenges and exploit the opportunities. The education of prospective CNEs should therefore be re-evaluated. The purpose of this study was to survey CNEs of selected acute care hospitals in British Columbia (100 beds or more) to determine the following: the knowledge and skills perceived to be important to the role in the present and future; the time spent using specific knowledge and skills; and recommendations regarding formal educational preparation for future CNEs. Data were gathered by means of a mailed questionnaire, adapted from two previous studies, the Ontario Health Administrators Survey (Hastings,1976) and the CHAS (Hastings et al. 1981). The questionnaire listed 48 primary KSs which were combined into seven knowledge/skill groups (KSGs). The KSGs included Communication Skills, Social Science Skills, Management Functions, Knowledge of the Organization, Nursing Knowledge, Analytical Methods and Skills, and Health Services Knowledge. A section on time demand and course recommendations was also included. Questionnaires were mailed to 41 acute care hospitals and 20 usable responses were received. A mean score was calculated for each KS, KSG and course recommendation and they were then ranked accordingly. The mean percentage time demand was also calculated for each KSG. The data were analysed within the managerial classification scheme as proposed by Katz (1974). The major findings of the study include the following. The CNEs worked in hospitals ranging in size from 100 to more than 400 beds. Most held a masters degree, were responsible for nursing as well as other patient care areas and were in their mid to late 40s. All were women and a significant proportion had extensive administrative experience. Communication skills had ranked highly in the earlier studies and continued to do so for the present and future in this study. They also ranked highly in time demand indicating that they have played and will continue to play a significant role in the CNE position. Several middle management skills, termed technical skills in Katz's classification scheme, were also seen as critical to the role, figured prominently in the educational recommendations and were allocated a large proportion of time. These included problem-solving and decision making methods, budget preparation and analysis, and management theories and methods. Within this group of skills, evaluation and planning methods and computers increased in rank in terms of future needs while personnel administration and labour relations were seen as less important. Managing change within the organization was very highly ranked as a need for both the present and the future. The CNEs saw specific knowledge areas as important and felt they should be formally taught. These included knowledge of general acute hospitals, ambulatory care programs and regional services, government health policy, and health services policy and planning issues. Although the CNEs appeared to understand the provincial context of health care and the forces which have an impact on it, knowledge of the Canadian healthcare system or of international health care trends was not deemed important to the role. Generally, the need for nursing knowledge per se was ranked low in the present and even lower in the future in comparison with the other KSGs as it was in the course recommendations and time demand. However, the KSs, nursing theories and issues and trends in nursing, were ranked of moderate importance.