OO4 The administrative and nursing organizational chart(s). Describe the CNO's structural and operational relationships to all areas in which nursing is practiced.
CNO’s structural relationship
Nancy Gail Gordon, MSN, RN, NEA-BC, is the vice president and chief nursing officer (CNO) of Homestead Hospital. She has held this position for the past 22 years. She is one of three vice-presidents who directly reports to Chief Executive Officer (CEO) William Duquette. (OO4 01 Homestead Hospital Organizational Chart) The CEO is accountable to the hospital Board of Directors and reports to the Baptist Health South Florida (BHSF) President. The Board of Directors, composed of community, medical staff and BHSF board volunteers, directs the organizational strategic direction and provides quality, financial and CEO oversight. Gordon is a non-voting member of the hospital Board of Directors, Medical Executive, Credentials and Medical Staff Quality committees. She is a standing member of the Performance Improvement Steering Council which oversees hospital-wide quality plan and initiatives.
Gordon is part of the senior leadership team. She represents the voice and interests of nursing in their monthly meetings, strategic planning sessions and annual board retreats. Additionally, she is a member of the Patient Care Leadership Council (PCLC) composed of CNOs from 6 BHSF hospitals, corporate office, and outpatient services. This group directs corporate-wide nursing strategic goals and initiatives.
Though Homestead Hospital Nursing Services department is decentralized, Gordon has the chief authority and accountability for professional nursing practice in the organization. These services include Medical, Surgical, Telemetry, Emergency, Critical Care, Ambulatory Care, Endoscopy, Perinatal and Pediatric (inpatient and emergency) Services. (OO4 02 Homestead Hospital Plan for Patient Services) Gordon provides executive coordination of nursing care within the services by developing a common framework for nursing practice and generic standards for care delivery. This includes assessment of needs; program development and evaluation; coordination of plan to deliver nursing care services; system implementation to measure nursing care outcomes and data utilization for performance improvement activities. There are 30 cost centers and approximately 450 RNs across all levels that report to her. Areas where nursing is practiced that do not report to her such as corporate departments have indirect reporting relationships (represented by the dotted lines in the nursing organizational chart). (OO4 03 Homestead Hospital Nursing Organizational Chart) Gordon periodically attends staff meetings or schedules on-on-one meetings with these indirect-report departments to facilitate communication and coordination of nursing care.
As CNO, Gordon is responsible for ongoing evaluation of nursing practice quality and ensuring delivery of competent, evidence-based care. She accomplishes this by approving all nursing job descriptions, reviewing nursing-related policies, procedures and standards; and overseeing the on boarding, annual competency validation and education activities. Furthermore, she spearheads the development of the annual nursing strategic goals in alignment with organizational goals and the integration of the professional practice model in all areas of nursing practice.
Gordon also endorses participative shared decision-making through the establishment of the shared governance model. The main purpose of this model is to provide a structure for staff across all levels input into organizational decision-making and to facilitate the communication flow and sharing of ideas. This is realized through the creation of hospital-wide and unit-based councils as follows: (OO4 04 Shared Governance Model)
- Nurse Leadership Council – meets monthly and serves as the ultimate decision-making body regarding all matters pertaining to the professional practice of nursing. Membership consists of: The Vice President of Nursing, Assistant Vice Presidents, Nurse Managers & Directors, Clinical Learning Coordinator, Nursing Supervisors, Patient Care Supervisors, Risk Manager, Palliative Care Manager, Infection Control Practitioner, Performance Improvement Director and Clinical Informatics Specialist.
- Nurse Governance Council – serves to oversee the implementation of professional nursing practice throughout the organization and develops an environment that promotes and enhances the practice of professional nursing and the promotion of shared governance. Membership includes Patient Care Managers and Directors; Present Chairs of Unit Practice Councils, Clinical Practice Council, Professional Development Council, Evidenced-Based Practice and Research Council, Nursing Quality Council; and the Nurse Scientist.
- Clinical Practice Council - Serves as a resource to the Unit Practice Council and defines and approves all issues, products and activities related to quality care and nursing practice. Membership includes one Unit Practice Representative from each unit, Clinical Nurse Educator, Patient Care Manager/Director, Nursing Peer Review Representative, Patient Safety Officer, Pharmacist, Radiology Nurse, Respiratory Therapist and Interprofessional Staff as needed.
- Evidence - Based Practice and Research Council - Defines and directs all research and evidence - based activities related to clinical practice. Membership includes Unit Practice Council Representatives, Clinical Nurse Educator, One Patient Care Manager/Director, National Database of Nursing Quality Indicators (NDNQI) Coordinator, Nurse Scientist, Center for Excellence in Nursing Representative and Interprofessional Staff as needed.
- Professional Development Council - Defines and directs education, clinical competency and professional advancement activities. Membership includes a Unit Practice Council Representative from each unit, Clinical Nurse Educator, One Patient Care Manager/Director and Interprofessional Representatives as needed.
- Unit Practice Council - Serves as a communication network. Receives input and feedback from staff and addresses patient care issues at the unit level. Membership includes representatives of staff from each caregiver role including RNs, Care Partners (CP), Unit Clerks and Monitor Technicians. Non-nursing disciplines are invited as needed for issue resolution.
- Nursing Peer Review Council – assesses the performance of individuals and overall staff performance using the results for continuous quality improvement of patient care. Membership includes Evidence-Based Practice Council Chair, A Patient Care Manager/Director; Patient Care Supervisor; Medical Surgical and Specialty Clinical Nurse Educators; Risk Manager; Performance Improvement Nurse; and Staff Nurses from Med/Surg Telemetry, Oncology, Surgery, Emergency, Critical Care and Perinatal Services. The CNO, Performance Improvement Director, Chief Medical Officer, Infection Control Practitioner, NDNQI Coordinator, Magnet Project Director and Risk Manager are ex-officio members.
CNO’s operational relationship
Gordon meets one-on-one with her direct and indirect reports (OO4 05 CNO 1 to 1 meetings). She collectively meets with her directors and managers during the weekly “Operations” meeting to keep abreast of important issues. She heads the monthly Nursing Leadership Council (NLC) meeting attended by nursing directors, patient care managers, patient care supervisors and indirect report nurse leaders. Furthermore, Gordon conducts an annual nursing leadership retreat that includes frontline patient care and nursing supervisors to facilitate direct communication and discussion of strategic priorities and significant initiatives.
Gordon is the liaison and advocates for Clinical RN representation in corporate-wide meetings. To maintain operational channels of communication for nurses across all levels, she attends hospital-wide shared governance council meetings and volunteers as executive sponsor for various interprofessional and system-wide committees. She also participates in the credentialing and privileging of advanced practice nurses and attends the Allied Health Practitioner committee meeting.
To promote visibility and accessibility among staff, Gordon participates in senior leadership rounding, attends nursing departmental meetings monthly through her “Roundtable with Gail” program, conducts 90-day meetings with new hires and operates an “open door” policy. She is easily accessible by staff through her email. Additionally, she conducts “state of nursing” forums to update direct and indirect reports on nursing strategic goal outcomes, quality and financial metrics and strategic priorities for the upcoming year. To maintain personal connections with staff, she sends an average of 10 notes monthly in the form of thank you cards, congratulatory or sympathy letters.
Summary of Attachments/Hyperlinks/Evidences
OO4 01 Homestead Hospital Organizational Chart
OO4 02 Homestead Hospital Plan for Patient Services
OO4 03 Homestead Hospital Nursing Organizational Chart
OO4 04 Shared Governance Model
OO4 05 CNO 1 to 1 meetings
Exhibit OO4a: Homestead Hospital Shared Governance Model