Chief Nursing Officers – who are they and what do they do?
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<ul><li><p> 2002 International Council of Nurses</p><p>Chief Nursing Officers who arethey and what do they do?</p><p>The majority of governments around the world</p><p>have nurses who work within them, but not all are</p><p>identified clearly as nurses. One nursing role that</p><p>does identify as a nursing role and as a senior public</p><p>servant is that of the Chief Nursing Officer (CNO).</p><p>Many nurses and other health leaders throughout</p><p>the world have little knowledge of the complexities</p><p>of the role of the senior nurse in government. Even</p><p>now many countries today do not have the Chief</p><p>Nursing Officer (CNO) role in their governments. I</p><p>am often asked by others, both within and outside</p><p>New Zealand, what is the Chief Nursing Officer</p><p>role? And what value does it add?</p><p>My response is simple: what profession com-</p><p>prises the largest workforce group in health care?</p><p>who provides the majority of professional health</p><p>care services? Why would governments not want</p><p>policy to benefit from a nursing perspective, a per-</p><p>spective that reflects that reality of health care provi-</p><p>sion? (Hughes 2001). The following quote from a</p><p>Pan American Health Organization and World</p><p>Health Organization report says it well:</p><p>There can only be a single rational argument for</p><p>the existence of a government chief nurse: that</p><p>the nursing professional makes a major contribu-</p><p>tion to the health care of people and is therefore</p><p>an integral and vital asset to the health care</p><p>system (PAHO et al. 1996; p. 43).</p><p>Those of us who are CNOs must bridge many</p><p>domains civil or public servant, policy analyst,</p><p>translator of clinical research, manager of projects</p><p>and nursing leader. The CNO role is one which</p><p>influences health policies and government health</p><p>officials, and can create opportunities for nursing </p><p>to influence health policy agendas. The CNO is</p><p>expected to provide high level expert advice, leader-</p><p>ship, and guidance on nursing and health policy.</p><p>It is at times a position you love to hate. The role</p><p>of CNO is demanding, vulnerable, stressful, fraught</p><p>with conflicts between interest groups, and yet ful-</p><p>filling and rewarding. It requires an innate sense of</p><p>Guest Editorial</p><p>129</p><p>ICN</p><p>Frances Hughes RN, BA, MA, FCON, FANZCMHN is the Chief Nursing Adviser for the Ministry of Health,New Zealand.</p></li><li><p>130 F. Hughes</p><p>judgement and an element of elasticity as you walk</p><p>the paths with politicians, consumer groups,</p><p>researchers, nursing organizations and stay true to</p><p>yourself and the values of public service.</p><p>The CNO role is clearly influenced by the</p><p>national political structures and systems. Like </p><p>other nursing roles it too has been affected by the</p><p>reforms and restructuring that have occurred in</p><p>health and public sectors around the globe. Because</p><p>the CNO role is closer to the centre of government,</p><p>politics, policy and politicians, it is even more</p><p>exposed.</p><p>It is sad that this role has had so little written</p><p>about it over the past century. Research is minimal</p><p>and if it were not for the work in the early 1990s by</p><p>Splane and Splane of Canada, we would have very</p><p>little information about this role (Splane & Splane</p><p>1994). We need more research and more literature</p><p>on the complexities and contributions of this role as</p><p>a way of understanding and engaging in policy</p><p>making.Dr Salmons article on page 136 provides an</p><p>excellent and insightful analysis of the key issues</p><p>facing CNOs today.</p><p>Last October a unique event occurred when</p><p>CNOs from many countries gathered in Atlanta,</p><p>Georgia, USA. Normally CNOs only meet by chance</p><p>at international nursing or country events, and a</p><p>purposeful event like this had not occurred for</p><p>several decades.</p><p>The time we had with each other in Atlanta was</p><p>precious to us all. It allowed us to reflect upon and</p><p>discuss our roles and the issues facing not only</p><p>nursing within our countries but also the wider</p><p>context of health within the political context of gov-</p><p>ernments. It also provided an important environ-</p><p>ment of support. It is difficult for all of us in this</p><p>position to access support and advice in our every-</p><p>day work, without compromising our positions or</p><p>the governments we work for.</p><p>In Atlanta, we celebrated the 100 years anniver-</p><p>sary of the first Chief Nursing Officer in the world,</p><p>my fellow countrywoman, Grace Neil of New</p><p>Zealand. She was a strong determined woman, who</p><p>fought for nursing to be an educated and regulated</p><p>profession. Neil formulated strategies with politi-</p><p>cians, nurses, hospitals and consumer groups to</p><p>bring out positive changes in nursing, and also in</p><p>public health care in New Zealand (Neil 1961). In</p><p>1901 New Zealand became the first country to have</p><p>separate nursing legislation.</p><p>It is with fondness and respect for her energy,</p><p>passion and strength that I remember Neil today. I</p><p>believe that CNOs throughout the world today are</p><p>following in her footsteps and yet walking a more</p><p>complex path.</p><p>Frances Hughes RN, BA, MA, FCON, FANZCMHN</p><p>is the Chief Nursing Advisor for the Ministry of</p><p>Health, New Zealand. For the past year she has been</p><p>based in the USA, on a Harkness Fellowship in</p><p>Health Care Policy, funded by the Commonwealth</p><p>Fund in New York City, located at the University of</p><p>Pennsylvania Center for Health Outcomes and</p><p>Policy Research with Dr Linda Aiken.</p><p>References</p><p>Hughes, F.A. (2001) Health Policy and Nursing: Closer</p><p>Relationship Required. Nursing Praxis New Zealand,</p><p>17(3), 2327.</p><p>Neil, J.O.C. (1961) Grace Neil: The Story of a Noble</p><p>Woman. Christchurch, N.M. Peryer Ltd., New </p><p>Zealand.</p><p>Pan American Health Organization (PAHO), World</p><p>Health Organization (WHO) and Ministry of Health</p><p>of Cuba. Regional Meeting: The Role of Government</p><p>Chief Nurses in the Countries of the Region of the </p><p>Americas. Havana, Cuba, 1012 September 1996.</p><p>Splane, R. & Splane, V. (1994) Chief Nursing Positions in</p><p>National Ministeries of Health: Focal Points for Nursing</p><p>Leadership. University of California, San Francisco.</p><p> 2002 International Council of Nurses, International Nursing Review, 49, 129130</p></li></ul>
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