The Involvement of Chief Nursing Officers

This study employs a qualitative research approach with the view to identifying the extent to which chief executive officers and chief nursing officers in American health institutions are engaged in ensuring quality and patient safety at the leadership and governance level, and also how chief nursing officers can support board engagement in safeguarding quality health care services as well as patient safety.

The justification to undertake this study is embedded in the fact that there still exists a gap in the literature on how the interface between hospital boards of trustees, chief executive officers, and nurse leadership can be used to enhance quality treatment outcomes and patient safety (Mastal, Joshi & Schulke, 2007).

The findings of the study demonstrate that

  1. chief nursing officers should be provided with an avenue to play a key leadership role in closing the knowledge gaps and reshaping values about quality and patient safety in the boardroom,
  2. there is need for hospitals to adopt inclusive leadership practices and consistently invite chief nursing officers to all board meetings,
  3. chief nursing officers should be provided with the opportunity to not only apply leadership expertise to transform board members’ values, beliefs, and behaviors related to patient safety and quality, but also to use their knowledge base to enlighten board members about relevant measures of nursing quality and patient safety,
  4. board oversight of the quality of nursing care is limited to staffing concerns, with minimal attention given to quality indicators sensitive and specific to nursing performance and outcomes, and
  5. chief nursing officers have greater familiarity of milestone reports on quality and patient safety than hospital board chairs and chief executive officers (Mastal et al., 2007).

This study employs a quantitative research approach with the view to describing the scope and level of involvement of chief nursing officers in making executive decisions in the sampled acute care institutions in Canada. This study is informed by the need to fill the gap in the literature relating to the patterns of senior nurse leaders decision-making, particularly upon the realization that the decision making responsibilities of these professionals have expanded in the recent past (Wong, Laschinger, Cummings, Vincent, & O’Connor, 2010).

The findings demonstrate that

  1. chief nursing officers and other senior nurse leaders contribute to organizational processes in health care institutions that are significant for nursing professionals and patients through their active involvement in decision-making at the senior management level,
  2. the timing of involvement in decision-making, extent of content expertise, and the number of decision activities in which chief nursing officers are involved in predict their perception of influence in organizational decisions,
  3. the decision involvement of chief nursing officers (timing, extent of content expertise and number of activities) and influence in decision-making processes do not predict their perceived quality of institutional decisions,
  4. chief executive officers do not differentiate professional practice decisions from operational ones to the same degree as chief nursing officers, and
  5. the involvement of chief nursing officers in decision-making processes is critical and highly valued by chief executive offices owing to the fact that nurse leaders are more likely to understand the issues involved due to their expertise in healthcare settings (Wong et al., 2010).


Mastal, M.F., Joshi, M., & Schulke, K. (2007). Nursing leadership: Championing quality and patient safety in the boardroom. Nursing Economic$, 25(6), 323-330. Retrieved from PubMed. Web.

Wong, C.A., Laschinger, H., Cummings, G.G., Vincent, L., & O’Connor, P. (2010). Decisional involvement of senior nurse leaders in Canadian acute care hospitals. Journal of Nursing Management, 18(2), 122-133. Web.

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