TL - Transformational Leadership

TL4: Advocacy and Influence. Describe and Demonstrate:

The process(es) that enable the CNO to influence organization-wide changes

The Chief Nursing Officer, Rita Smith DNP, RN, NEA-BC answers directly to the Chief Executive Officer, Joe Scott FACHE of the organization and is one of four Senior Vice Presidents in the organization. She works collaboratively with the CEO and senior leadership and functions as the voice of nursing in all executive senior administrative meetings. She maintains collegial working relationship with all senior executives and actively participates in weekly Senior Leadership meetings which are chaired by the CEO and attended by the Senior Vice President of Quality and Safety, Brenda Hall MS, RN, NE-BC the Chief Financial Officer, Paul Goldberg, the Vice President of Human Resources, Mary Cataudella, the Chief Medical Officer, Dr. Kenneth Garay MD, and the Vice President of Support Services, Kirat Kharode. This is a core planning group who discusses operational issues, plan goals and determine priorities for action and use of resources. The CNO is viewed hospital-wide as an influential leader and maintains a strong influence in all areas of the organization. She is an integral part of senior management and exerts a strong influence in the decision-making process at Jersey City Medical Center. She is involved in the strategic planning process along with the other senior leadership. She maintains a strong voice and is a strong advocate for nursing.

The Chief Nursing Officer has a voting position on the Board of Trustees of the Medical Center, which is the highest decision-making body in the organization Appendix TL4-A. This is a prestigious position and allows her to bring a perspective of nursing and patient care issues to this governing body. She serves as a resource person on nursing issues for the Board of Trustees and lobbies for resources, such as, equipment, supplies and budgetary needs that may impact on patient care. A good example of this is the recently purchased cardiology management system from McKesson. She explained the purpose of the system to the Board and importance in processing Cardiac Catheterization Laboratory information such as electrocardiogram tracings, echocardiogram tracings and storage of data. The CNO discussed the merits and need of having this system and its ultimate impact on patient care.

The CNO is also a member of key councils/committees hospital-wide. One committee reviews pending contracts. The CNO, Hospital Attorney and the Vice President of Information Technology (IT), Stephen Li participates in this process. Every open project is reviewed as to timeliness and allocation of resources. She recently reviewed the contract for a new education system to be purchased by the hospital, Elsevier-MC Strategies and insured that this system would be available for nurses to utilize (SE5). This is an internet based education system used to facilitate competencies of nurses. It allows nurses to learn in a variety of venues and ties into Best Practice and Evidence-Based learning.

The Medical Executive Committee is the governing body comprised of elected members of all divisions of the Medical/Dental staff and Executive Leadership. This Committee is largely comprised of physicians. The CNO is a Standing Guest of this council; she fully participates but does not have voting privileges Appendix TL4-B. Prior to the actual Medical Executive Committee meeting, a pre-meeting is held with the Chief Nursing Officer, Chief Executive Officer, Chief Medical Officer and the Chief Safety and Quality Officer and the President of the Medical/Dental staff. This committee presents a forum to discuss all issues that need to go for approval or that impact change in clinical practices in the organization. The actual meeting is chaired by the President of the Medical/Dental staff and all issues relating to nursing/physician practice are presented first to the Nurse Practice Council. The CNO discusses the need for change in policy/practice and then serves as a resource person on the clinical operations in the organization. All practice changes affecting nursing are presented to this committee by a clinical member of the Nursing Department (Clinical Nurse Leader, Nurse Practitioner and/or Nursing Director). This committee is accountable to the Board for the overall quality and safety of the patient care delivered.

The CNO, as part of her function as a voting member of the Board, Chairs the Quality Assessment and Oversight Committee Appendix TL4-C. This is an Executive level council that the CEO, CMO and Chiefs of Clinical Services, for example, Cardiology, Emergency Department, etc., and other Board members participate. The purpose of this meeting is to review all quality and safety initiatives and outcomes and provide oversight of exception reports for those areas not meeting projected targets. All adverse and reportable events are discussed in this meeting.

The CNO participates on the Strategic Planning Council whose membership consists of all the Vice Presidents. The purpose of this committee is a monthly review on the progress of all strategic planning initiatives that are developed and approved by the Board. This committee insures that targets are appropriate and they review tactics on a monthly basis. This committee provides recommendations regarding change and/or an action plan may be submitted for approval. An “end-of-year” Report is generated which establishes a process/plan for the coming year and reports on the success/failure to the Board.

The CNO is a central figure in the negotiations of the nursing union contract. She works closely with union representatives and the Vice President of Human Resources, Mary Cataudella to determine the terms of the nursing contract. She works diligently with union delegates which enables her to have a stronger voice in the collective bargaining process. She is well versed in the negotiation process and is a powerful voice for nursing interests. Furthermore, she collaborates with the Vice President of Human Resources on

policies ranging from work related issues to employee dress code to hospital benefits. The CNO works closely with the Vice President of Human Resources regarding

Personnel issues and disciplinary actions. She also relies on the Human Resource Management team to determine market compensation for employees.

The CNO functions as an executive sponsor in the Pharmacy and Therapeutics Committee Appendix TL4-D. This committee is chaired by a physician and co-chaired by the Director of Pharmacy, Michael Curci Pharm D. This committee reviews physician’s requests for new medications, quality reports on adverse events, clinical pharmacists’ interventions and changes to the formulary and drug utilization.

The CNO is a participant of the Quality Management Steering Council on which Board members, physicians, the Chief Medical Officer, the Chief Executive Officer, and the Senior Vice President for Quality and Safety participate Appendix TL4-E. The goal of this council is to review safety and quality projects hospital-wide utilizing the Lean-Six Sigma and DMAIC (Define/Measure/Analyze/Improve/Control) process. Updates on projects are presented, for example, falls reduction, perinatal safety, sepsis and pain management, and progress on these projects is outlined. Overall strategies and tactics are discussed and analyzed as to meeting expected target dates. These measures/strategies/tactics are placed on a scorecard so that progress can be measured.

Ms. Rita Smith, DNP, RN, NEA-BC, CNO co-chairs the Engagement/Operational Process Council Appendix TL4-F. This Council’s specific focus is:

  • Work Force
  • Customer Focus (Patient, Employee, Physician)
  • Information Management
  • Marketing Communication
  • Life Safety
  • Throughput

This council reviews Patient Satisfaction reports as well as physician and staff satisfaction. Strategies are designed to improve overall scores and determine the best modalities to accomplish improvement in these areas.

Ms. Smith also participates in the Strategic Growth Council which provides strategies/tactics/measures to implement and/or improve new programs. This council reviews business plans and progress made towards the implementation of these new programs. Barriers to progress are addressed and resolved. The Hospital Attorney, Paul Murphy and the CNO frequently review service contract issues, particularly related to physician coverage and leadership. Education contracts are reviewed for legal compliance for hiring, for example, non-discriminatory. The attorney also approves the template for all nursing school affiliation agreements. They frequently consult on clinical aspects of physician contracts and incentive performance measures. Any issues pertaining to risk management and/or strategic plans that need legal input that may impact on patient care services are discussed between the CNO and the attorney. Any issues which may require reporting to the State Board of Nursing are discussed with the attorney first.

The CNO and the Senior Vice President of Quality and Safety, Brenda Hall MS, RN, NE-BC work closely on issues relating to quality and the patient care units. They collaborate closely on core measures to ensure that the hospital goals are met. The CNO, Clinical Directors and the Nurse Mangers participate in Root Cause Analysis (RCA) when necessary. Nursing is involved in every level of quality. The CNO and the SVP of Quality and Safety work hand-in-hand during Joint Commission preparation. The Vice President of Quality and Safety also has oversight of Regulatory Affairs, and is very involved with regulation changes and in all reporting to the State Department of Health and Senior Services. All plans for new services and/or new locations of services involve discussion with the SVP for Quality and Safety. A good example of this is the move of the Antenatal Testing Unit to the Medical Office Building, which is a joint venture located on the campus, from the hospital setting. This move required State intervention and approval.

The Chief Financial Officer, Paul Goldberg and the CNO meet routinely in order to discuss financial issues related to the nursing department. Issues reviewed frequently center on the number of FTEs, agency personnel and capital purchases. A business case is developed for new services/programs between the CNO and the CFO for presentation to the Board. An ideal example of their collaboration is the recent approval and purchase of PCA pumps. Our old pumps were not “Smart” pumps and did not have the safety parameters built into them that newer models had. The new pumps contain drug libraries which have built in dosing levels and drug concentrations. Our CNO advocated for these newer PCA models and prepared a presentation to the Board of Trustees Appendix TL4-G that highlighted the impact on pain management and patient satisfaction that this purchase would have.