overview...overview several years ago, the american organization of nurse executives (aone)...

Overview

Several years ago, the American Organization of Nurse Executives (AONE) published its paper on the role and function of nurses in executive practice. This document outlined the transitions occurring in health care leadership and the dimensions and processes that were instrumental in executive success. The AONE Board of Directors determined that it was time to update this work with a more in-depth description of the competencies integral to the practice of nurse executives.

The turbulent, ever-changing world of health care continues to present new challenges. With the mission statement: “To shape health care through innovative and expert nursing leadership,” AONE recognizes that excellent leadership is essential to ensure excellent patient care.

The competencies listed on these pages describe skills common to nurses in executive practice regardless of their educational level or titles in different organizations. They are presented as information for both nurse leaders and those who employ or work with them. Executives can use these competencies as a self-assessment tool, useful in the identification of possible areas for growth. Aspiring nurse leaders can use them in planning personal preparation for their careers. Health care organizations may see them as a guideline for job descriptions, expectations and evaluations of nurse leaders. Nurse educators can utilize them as a curriculum guideline for the educational preparation of nurses seeking expertise and knowledge in executive practice.

The AONE Nurse Executive Competencies

Leadership skills include:• Foundationalthinkingskills• Personaljourneydisciplines• Theabilitytousesystemsthinking• Successionplanning• Changemanagement

Professionalism includes:• Personalandprofessionalaccountability• Careerplanning• Ethics• Evidence-basedclinicaland management practice• Advocacyfortheclinicalenterprise and for nursing practice• Activemembershipin professional organizations

Business skills include:• Understandingofhealthcarefinancing• Humanresourcemanagement and development• Strategicmanagement• Marketing• Informationmanagementandtechnology

The following discussion provides an in-depth description of the skills needed for competency in the five AONE leadership domains.

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The competencies are captured in a model developed by theHealthcareLeadershipAlliancein2004.MembersoftheAlliance include AONE, the American College of Healthcare Executives,AmericanCollegeofPhysicianExecutives,HealthcareFinancialManagementAssociation,HealthcareInformationandManagementSystemsSocietyandMedicalGroupManagementAssociation. This graphic model is being used in ongoing work to identify a common core set of competencies for leadership executives in healthcare.

AONE believes that managers at all levels must be competent in:I. Communication and relationship-buildingII. A knowledge of the health care environmentIII. LeadershipIV.ProfessionalismV. Business skills

While all nursing leaders share these competency domains, the emphasis on particular competencies will be different depending on the leader’s specific position in the organization.

Communication and relationship-building competencies include:• Effectivecommunication• Relationshipmanagement• Influenceofbehaviors• Abilitytoworkwithdiversity• Shareddecision-making• Communityinvolvement• Medicalstaffrelationships• Academicrelationships

Knowledge of the health care environment includes:• Clinicalpracticeknowledge• Patientcaredeliverymodelsandwork design knowledge• Healthcareeconomicsknowledge• Healthcarepolicyknowledge• Understandingofgovernance• Understandingofevidence-basedpractice• Outcomemeasurement• Knowledgeof,anddedicationtopatientsafety• Understandingofutilization/casemanagement• Knowledgeofqualityimprovement and metrics• Knowledgeofriskmanagement

The vision of the American Organization of Nurse Executives (AONE) is “to shape the future of health care through innovative and expert nursing leadership. Innovative nursing leadership requires that nurses in leadership positions are competent.

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1. Communication and Relationship-Building

a. Effective Communication•Makeoralpresentationstodiverseaudienceson

nursing, health care, and organizational issues

•Producecogentandpersuasivewrittenmaterialsto address nursing, health care and organizational issues appropriate to the audience

•Resolveandmanageconflict

b. Relationship Management•Buildtrusting,collaborativerelationshipswith: Staff Peers Other disciplines and ancillary services Physicians Vendors Community leaders Legislators Nursing and other educational programs

•Deliver“badnews”insuchawayasto maintain credibility

•Followthroughonpromisesandconcerns

•Provideservicerecoverytodissatisfiedcustomers

•Careaboutpeopleasindividualsanddemonstrateempathy and concern while ensuring that organizational goals and objectives are met

•Accomplishobjectivesthroughpersuasion,celebrate successes and accomplishments and communicate a shared vision

•Assertviewsinnon-threatening, non-judgmental ways

c. Influencing Behaviors•Createandcommunicateasharedvision

•Rewardappropriatebehaviorsandconfrontandmanage inappropriate behaviors

•Develop,communicateandmonitor behavior expectations

d. Diversity•Createanenvironmentwhichrecognizesand

values differences in staff, physicians, patients and communities

•Assesscurrentenvironmentandestablishindicatorsof progress toward cultural competency

•Definediversityintermsofgender,race,religion,ethnicity, sexual orientation, age, etc.

•Analyzepopulationdatatoidentifyculturalclusters

•Defineculturalcompetencyandpermeateprinciplesthroughout the organization

•Confrontinappropriatebehaviorsandattitudestoward diverse groups

•Developprocessestoincorporateculturalbeliefs into care

e. Shared Decision-Making•Engagestaffandothersindecision-making

•Promotedecisionsthatarepatient-centered

•Provideanenvironmentconduciveto opinion-sharing

f. Community Involvement•Representtheorganizationtonon-healthcare

constituents within the community

•Provideconsultationtocommunityandbusinessleaders regarding nursing and health care

•Beaneffectiveboardmemberforcommunity and/orprofessionalorganizations

g. Medical / Staff Relationships•Buildcredibilitywithphysiciansasachampionfor

patientcare,qualityandnursingprofessionalism

•Confrontandaddressinappropriatebehaviortowards patients and staff

•Representnursingatmedicalexecutivecommitteeand other medical staff committees

•Collaboratewithmedicalstaffleadersindetermining needed patient care services

•Collaboratewithphysicianstodeveloppatientcareprotocols, policies and procedures

•Collaboratewithphysicianstodeterminepatientcareequipmentandfacilityneeds

•Utilizemedical/staffmechanismstoaddressphysician clinical performance issues

•Facilitatedisputesinvolvingphysiciansandnursesor other disciplines

h. Academic Relationships•Determinecurrentandfuturesupplyanddemand

for nursing care

• Identifyeducationalneedsofexistingandpotentialnursing staff

•Collaboratewithnursingprogramstoprovide requiredresources

•Collaboratewithnursingprogramsinevaluatingqualityofgraduatingcliniciansanddevelopmechanismstoenhancethisquality

•Serveonacademicadvisorycouncils

•Collaboratewithnursingfacultyinnursingresearchand incorporate nursing research into practice

2. Knowledge of the Health Care Environment

a. Clinical Practice Knowledge•Maintainknowledgeofcurrentnursingpractice

and the roles and functions of patient care team members

•Articulatepatientcarestandardsaspublishedby theJointCommission,CMS,andprofessional nursing literature

•Understand,articulateandensurecompliancewiththeStateNursePracticeAct,StateBoardofNursing regulations, regulatory agency standards and policies of the organization

•Ensurethatwrittenorganizationclinicalpoliciesandprocedures are reviewed and updated in accordance with evidence-based practice

•Rolemodellifelonglearning,includingclinical subjects such as disease processes, pharmaceuticals and clinical technology

b. Delivery Models/Work Design•Maintaincurrentknowledgeofpatientcaredelivery

systems and innovations

•Articulatevariousdeliverysystemsandpatientcaremodelsandtheadvantages/disadvantagesofeach

•Serveaschangeagentwhenpatientcarework/workflow is redesigned

•Determinewhennewdeliverymodelsareappropriate, and then envision and develop them

c. Health Care Economics•Articulatefederalandstatepaymentsystemsand

regulations, as well as private insurance issues which affect organization’s finances

•Understandandarticulateindividualorganization’spayermix,CMIandbenchmarkdatabase

d. Health Care Policy•Articulatefederalandstatelawsandregulations

that affect the provision of patient care, e.g., tort reform,malpractice/negligence,reimbursement

•Participateinthelegislativeprocessconcerninghealth care through membership in professional organization and personal contact with public officials

•Educatepatientcareteammembersonthe legislative and regulatory processes and methods for influencing both

• Interpretimpactofstateandfederallegislationonnursing and health care organizations

e. Governance•Articulatetheroleofthegoverningbodyofthe

organization in the following areas: Fiduciaryresponsibilities Credentialing Performancemanagement•Representpatientcareissuestothegoverningbody•Participateinstrategicplanningandqualityinitiatives

with the governing body• Interactwithandeducatetheorganization’sboard

members regarding health care and the value of nursing care

•Representnursingattheorganization’sboardmeetings

f. Evidence-Based Practice/Outcome Measurement

• Interpretinformationfromresearch•Utilizeresearchfindingsfortheestablishmentof

standards, practices and patient care models in the organization

•Disseminateresearchfindingstopatientcare team members

•Participateinstudiesthatprovide outcome measurements

•Allocatenursingresourcesbasedonmeasurementofpatientacuity/careneeded

g. Patient Safety•Supportthedevelopmentandimplementationofan

organization-wide patient safety program

•Designsafeclinicalsystems,processes,policies and procedures

•Monitorclinicalactivitiestoidentifybothexpectedand unexpected risks

•Supportanon-punitivereportingenvironmentandareward system for reporting unsafe practices

•Supportsafetysurveys,respondingandactingon safety recommendations

•Ensurestaffisclinicallycompetentandtrainedontheir role in patient safety

•ArticulateandtakeactiontosupporttheJointCommissionNationalPatientSafetyGoals

h. Utilization/Case Management•Articulateorganizationdecision-makingforthe

criteria model adopted by the organization

•Communicatekeypointsofthemodeltoavarietyof audiences (nursing, financial, medical staff)

• Involvephysiciansinon-goingutilization management practices

•Designcontinuumofcareoptionsformanagingpatient throughput (long term care units, urgent carecenters,admission/dischargeunits,etc.)

i. Quality Improvement/Metrics•Articulatetheorganization’sQIprogramandgoals

•Determinepatientcarequalityimprovementgoals and objectives

•Definemetricsasrelatedtoprocessimprovement

•Explainandutilizemetricsasaunitofmeasure for any process

•Articulatethelinkbetweenmetricsandgoals

•Articulatethelinkbetweenorganizationmetricsandnationalqualityinitiatives/metrics

•Targetoutcomesthatareevidence-based(comparison data benchmarking)

•Definequalitymetricsby:

Identifyingtheproblem/process

Measuringsuccessatimprovingspecificareasof patient care

Analyzing the root causes or variation from qualitystandards

Improving the process with the evidence

Controlling solutions and sustaining success

j. Risk Management• Identifyareasofrisk/liability

•Ensurestaffiseducatedonriskmanagementandcompliance issues

•Developsystemswhichencourage/requirepromptreporting of potential liability by staff at all levels

•Envisionandtakeactiontocorrectidentifiedareasof potential liability


3. Leadership 4. Professionalism

a. Foundational Thinking Skills•Addressideas,beliefsorviewpointsthatshouldbe

given serious consideration

•Recognizeone’sownmethodofdecisionmakingand the role of beliefs, values and inferences

•Criticallyanalyzeorganizationalissuesafterareviewof the evidence

•Maintaincuriosityandaneagernesstoexplorenewknowledge and ideas

•Promotenursingleadershipasbothascienceandan art

•Demonstratereflectiveleadershipandanunderstanding that all leadership begins from within

•Providevisionarythinkingonissuesthatimpactthehealth care organization

b. Personal Journey Disciplines•Valueandactonfeedbackthatisprovidedabout

one’s own strengths and weaknesses

•Demonstratethevalueoflifelonglearningthroughone’s own example

•Learnfromsetbacksandfailuresaswellassuccesses

•Assessone’spersonal,professionalandcareergoals and undertake career planning

•Seekmentorshipfromrespectedcolleagues

c. Systems Thinking•Promotesystemsthinkingasavalueinthe

nursing organization

•Considertheimpactofnursingdecisionsonthehealth care organization as a whole

•Provideleadershipinbuildingloyaltyandcommitment throughout the organization

•Synthesizeandintegratedivergentviewpointsforthe good of the organization

d. Succession Planning•Promotenursingmanagementasadesirable

specialty

•Conductperiodicorganizationalassessmentstoidentify succession planning issues and establish action plans

•Serveasaprofessionalrolemodelandmentortofuture nursing leaders

•Establishmechanismsthatprovideforearlyidentification and mentoring of staff with leadership potential

•Developasuccessionplanforone’sownposition e. Change Management•Utilizechangetheorytoplanfortheimplementation

of organizational changes

•Serveasachangeagent,assistingothersinunderstanding the importance, necessity, impact and process of change

•Supportstaffduringtimesofdifficulttransitions

•Recognizeone’sownreactiontochangeandstriveto remain open to new ideas and approaches

•Adaptleadershipstyletosituationalneeds

a. Personal and Professional Accountability

•Createanenvironmentthatfacilitatestheteamtoinitiate actions that produce results

•Holdselfandothersaccountableforactions and outcomes

•Createanenvironmentinwhichothersaresettingexpectations and holding each other accountable

•Answerfortheresultsofone’sownbehaviors and actions

b. Career Planning•Developowncareerplanandmeasureprogress

according to that plan

•Coachothersindevelopingtheirowncareerplans

•Createanenvironmentinwhichprofessionalandpersonal growth is an expectation

c. Ethics•Articulatetheapplicationofethicalprinciples

to operations

• Integratehighethicalstandardsandcorevaluesintoeveryday work activities

•Createanenvironmentthathasareputationforhigh ethical standards

d. Evidence-Based Clinical and Management Practice

•Advocateuseofdocumentedbestpractices

•Teachandmentorotherstoroutinelyutilizeevidence-based data and research

e. Advocacy•Rolemodeltheperspectivethatpatientcareisthe

core of the organization’s work

•Assurethattheclinicalperspectiveisincludedinorganizational decisions

•Ensurethatnursesareactivelyinvolvedindecisionsthat affect their practice

f. Active Membership in Professional Organizations

•Participateinatleastoneprofessionalorganization

•Supportandencourageotherstoparticipateinaprofessional organization


5. Business Skills

a. Financial Management•Articulatebusinessmodelsforhealthcare

organizations and fundamental concepts of economics

•Describegeneralaccountingprinciplesanddefinebasic accounting terms

•Analyzefinancialstatements

•Managefinancialresourcesbydeveloping business plans

•Establishprocedurestoassureaccurate charging mechanisms

•Educatepatientcareteammembersonfinancialimplications of patient care decisions

b. Human Resource Management•Participateinworkforceplanningand

employment decisions

•Championadiverseworkforce

•Usecorrectivedisciplinetomitigateworkplace behavior problems

• Interpretandevaluateemployeesatisfaction/qualityof work surveys

•Createopportunitiesforemployeestobeinvolvedin decision-making

•Rewardandrecognizeexemplaryperformance

•Formulateprogramstoenhancework-lifebalance

• Interpretlegalandregulatoryguidelines

•Managecollectivebargainingenvironmentsorimplement programs to avoid the need

• Identifyandeliminatesexualharassment,workplaceviolence, and verbal and physical abuse

• Implementergonomicallysoundworkenvironmentsto prevent worker injury and fatigue

•Developandimplementbioterrorism,biohazardanddisaster readiness plans

• Identifyclinicalandleadershipskillsnecessaryforperforming job-related tasks

•Selecttoptalent,matchingorganizationalneedswith appropriate skill sets (assess job candidate skills sets)

•Manageperformancethroughrewards,recognition,counseling and disciplinary action

•Providementorshipandcareercounselingtoaspiring clinicians and leaders so they may develop requiredskillsets(successionplanning)

• Identifyfutureskillsetsneededtoremaincompetitive

•Analyzemarketdatainrelationtosupplyand demand and manage resources to ensure appropriate compensation

•Developandimplementrecruitmentand retention strategies

c. Strategic Management•Analyzethesituationandidentifystrategicdirection•ConductSWOTandgapanalyses

•Formulateobjectives,goalsandspecificstrategiesrelated to mission and vision

•Understandwhatorganizationsshouldmeasureinorder to “balance” the financial perspective

•Measureandanalyzeperformancefromthelearningand growth, business process, customer and financial perspectives

d. Marketing•Analyzemarketingopportunities

•Developmarketingstrategies

• Integratemarketingandcommunicationsstrategies

•Usepublicrelationsandmediaoutletstopromote your organization

e. Information Management and Technology

•Demonstratebasiccompetencyine-mail, common word processing, spreadsheet and Internet programs

•Recognizetherelevanceofnursingdatafor improving practice

•Recognizelimitationsofcomputerapplications

•Usetelecommunicationdevices

•Utilizehospitaldatabasemanagement,decisionsupport, and expert system programs to access information and analyze data from disparate sources for use in planning for patient care processes and systems

•Participateinsystemchangeprocessesand utility analysis

•Participateintheevaluationofinformationsystemsin practice settings

•Evaluateandrevisepatientcareprocesses and systems

•Usecomputerizedmanagementsystemstorecordadministrativedata(billingdata,qualityassurancedata, workload data, etc.)

•Useapplicationsforstructureddataentry(classification systems, acuity level, etc.)

•Recognizetheutilityofnursinginvolvementintheplanning, design, choice and implementation of information systems in the practice environment

•Demonstrateawarenessofsocietalandtechnological trends, issues and new developments as they apply to nursing

•Demonstrateproficientawarenessoflegaland ethical issues related to client data, information and confidentiality

•Readandinterpretbenchmarking,financialandoccupancy data

This document is not intended to be an exhaustive list of all areas of expertise for individual nurses in executive practice. It does, however, illustrate how complex and important their roles have become. Nursingleadership/managementisasmuchaspecialty as any other clinical nursing specialty. Assuch,itrequiresproficiencyandcompetentpractice specific to the executive role. The AONE Nurse Executive Competencies sets the standard for that practice.

Special thanks to the AONE 2004 Education Committee for its extensive work on this project: Patricia Conway-Morana, Rosemary Roth, Rose Sherman, Kathy Harris, Janice Wharton, Beth Brooks, Pamela Thompson and Veronika Riley (staff liaison).

Conclusion


overview...overview several years ago, the american organization of nurse executives (aone)...

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