Health services administration

The highly complex role of the Chief Nursing Officer (CNO) requires the refinement of a multitude of competencies and leadership skills in this unprecedented time of healthcare reform. As the senior most patient advocate in our medical centers the CNO is responsible for translating research into practice, policy development and implementation creating value based patient-centric strategies to transform health care.
The ability to sustain and thrive in this role is essential in repositioning nursing as a
knowledgeable discipline actively contributing to the redesign of healthcare. This exploratory descriptive phenomenological study was designed to explore and
describe the elements that contribute to the sustainment of CNOs in their practice of
nurse executive leadership. Ray’s (1989) Theory of Bureaucratic Caring, Authentic
Leadership Theory (Wong & Cummings, 2009), and Resiliency Theory (Earvolino-
Ramirez (2007) provided the theoretical lens through which this study was grounded. Semi-structured telephonic interviews were conducted with twenty CNOs all with
two consecutive years experience in their current role. Six themes emerged after thorough content analysis which describes the lived experience of sustainment. Each theme was supported by several subthemes. Themes emerged as: Loving the Profession, Having a Broader Impact Reflecting on One’s Own Work, Learning to Manage Conflict, Maintaining Work/Life Balance Working with Supportive Leaders.

Tensions exist between the ideology of caring as a nursing practice ideal, and the corporately managed health care settings in which nurses work. The objective of this critical feminist ethnography was to understand these tensions by grounding them in nurses' experiences and perceptions. Data was gathered through ethnographic interviewing and participant-observations of a nurse key informant and her co-workers in the pediatric unit of a corporately managed acute care hospital. The data were analyzed according to the coding procedures and comparative method described by Strauss and Corbin (1990). Four characteristics of the corporate health care culture that conflict with nurses' practice ideals were identified: The Corporate Productivity Motive; The Priority of a Medical Regime Over Nursing Care; The Tolerance of Risk to Patient Safety; and The Hospitality Perspective. A critique of the patriarchal value structure that influences the health care system and recommendations for nursing practice, education, and research is provided.

References to accountability are common throughout public administration literature. However, a clear model to assess accountability in government programs is not fully developed. This research fills this gap and provides policymakers with a tool they can use to assess accountability in both public and contracted programs and enables them to make more informed contracting-out decisions. In addition, the Integrated Accountability Framework introduced in this research will serve as a guideline for how public administrators can improve accountability in the programs they administer and oversee. For the public and private health care programs analyzed in this study, the findings indicate that the publicly delivered programs provided more accountability to the vulnerable populations served than the contracted-out health care programs.