Chief Nursing Executive/Chief Nursing Officer Governance and Leadership Initiative
Frequently Asked Questions (FAQs)
These questions have been developed based on the input of Chief Nursing Executives and Chief Nursing Officers in Ontario in response to the passage of the Excellent Care for All Act (Bill 46). While they are largely focused on the implications to the Chief Nursing Executive role, we will post further questions in relation to both the Chief Nursing Executive and Chief Nursing Officer role as they arise. We welcome your suggestions for such questions. Please e-mail your questions to Melissa Aziz at firstname.lastname@example.org . Responses will be prepared and posted as they are received.
1. What Chief Nursing Executive role and responsibility changes can be expected with the passage of the Excellent Care for All Act (Bill 46)?
a. Non-voting Board membership – The Chief Nursing Executive is now a non-voting member of the hospital Board. Similarly, the hospital administrator, president of medical staff, chief of staff, chair of MAC are all non-voting members of the board. No employee of the hospital can vote on the hospital Board.
b. Quality Committee membership – The Chief Nursing Executive is now a member of the Quality Committee of the hospital.
2. What does it mean to be a non-voting member of the Board?
Board members – voting and non-voting – are responsible for passing by-laws to provide for the management and administration of the hospital , monitoring hospital activities for compliance with the Public Hospital Act, regulations and by-laws and taking such measures as are necessary to ensure compliance with the Act, regulations and by-laws. While non-voting members cannot vote, which includes moving and seconding motions, they can probably vote on committees, count towards a quorum and perform other functions of a Board member. Non-voting directors, as directors, owe fiduciary duties to the organization.
3. As a member of the Quality Committee, does the Chief Nursing Executive have voting privileges?
Regulations under the Excellent Care for All Act specify the members of the Quality Committee, including the Chief Nursing Executive. However, the Act and regulations are silent on who has, or has not, voting privileges on the Committee. The Registered Nurses’ Association of Ontario’s (RNAO) practical conclusion that membership of the committee includes voting privileges seems to be supported by the Ontario Hospital Association. It also was the intention of the Minister’s Office as communicated clearly to the RNAO both verbally and in writing.
4. What are the implications of being an employee of the hospital in voting (Quality Committee) and non-voting (Board) positions?
No employee of the hospital can vote on the hospital Board. Members of the Quality Committee can vote on the Quality Committee (see Q.3 above).
5. In the past, the Chief Nursing Executive was the senior support for the Quality Committee and the Board on quality issues. How do Chief Nursing Executive responsibilities change in these new roles as a non-voting member of the Board and as a voting member of the Quality Committee?
At times the same person who provides senior staff support will also sit as a voting member of the Quality Committee and as a non-voting member of the hospital Board. There is no indication in the legislation nor the regulations that the Chief Nursing Executive cannot have both roles.
6. What is the difference between the Chief Nursing Executive, the Chief of Staff, and the Chief Executive Officer with respect to voting privileges on the hospital Board?
None. No employee of the hospital can vote on the hospital Board.
7. What is the reporting relationship of the Medical Advisory Committee to the Quality Committee and to the Board?
The Quality Committee’s mandate is to “monitor and report to the Board on quality issues and on the overall quality of services provided” in the hospital. It is suggested that reports from the Medical Advisory Committee identifying and making recommendations with respect to systemic or recurring quality of care issues should be directed to the Quality Committee and through the Quality Committee to the hospital Board. Further, taking an expansive view of the Quality Committee’s mandate to drive the quality agenda, it has also been suggested that the Medical Advisory Committee’s role in reviewing professional staff appointments and re-appointment should also report through the Quality Committee. There is no doubt that the role and understanding of the Quality Committee will evolve and grow.
8. What are the roles and responsibilities of the Quality Committee?
It is the role of the Quality Committee to drive the quality agenda of the hospital. Its responsibilities, as set out by the Excellent Care for All Act, include:
• To monitor and report on quality issues and on the overall quality of services provided in the hospital, with reference to appropriate data.
• To consider and make recommendations regarding quality improvement initiatives and policies.
• To ensure that information on best practices as supported by scientific evidence is distributed to employees and persons providing services within the hospital and to monitor the use of that information by those persons.
• To oversee preparation of annual quality improvement plans.
9. Which health sectors are affected by the new Excellent Care for All Act and regulations?
The Excellent Care for All Act only applies to hospitals within the meaning of the Public Hospitals Act. In time, the government can extend the Act’s application by regulation to other health care organizations.
10. Does the Medical Advisory Committee retain jurisdiction over the quality of care provided by nurse practitioners employed by hospitals?
No. The Medical Advisory Committee can no longer make recommendations to the hospital Board regarding the quality of care provided in the hospital by nurse practitioners who are employees of the hospital.
11. If the Chief Nursing Executive is not a member of the senior executive committee, how can she/he contribute effectively to Board discussions when she/he is not aware of discussions that have occurred at the executive meeting, particularly discussions in preparation for upcoming Board meetings?
Under the Excellent Care for All Act, 2010 regulations, the following people are “executives” with respect to a public hospital: members of the senior management group of the hospital who report directly to the hospital’s chief executive officer, the chief of staff of the hospital (where there is one) and the chief nursing executive of the hospital. By definition,
therefore, the Chief Nursing Executive is senior executive staff and has the same responsibilities as other senior executives.
12. What initiatives is the RNAO currently involved in to advance the leadership agenda in public health nursing?
The RNAO is involved in moving public health nursing leadership forward through various working groups and advisory committees:
1) Public Health Nursing (PHN) Advisory Committee (Sponsored by RNAO)
This committee of PHN leaders, consisting of Chief Nursing Officers, public health researchers, public health educators, and policy advisors, was established expeditiously to plan for the first PHN Summit co-hosted by RNAO and Public Health Ontario (formerly the Ontario Agency for Health Protection and Promotion), in April, 2010. Following the PHN Summit, this same committee advised RNAO on how best to respond to the many recommendations identified at the Summit. The need to develop public health nursing leadership through the establishment of a PHN leadership academy and a CNO leadership role gave the committee a defined and motivating purpose. Promoting social determinants of health by providing feedback on RNAO policy submissions, survey responses, and action alerts is a responsibility highly valued by all committee members as well as the RNAO.
2) Public Health Nursing (PHN) Professional Development Advisory Group (co-sponsored by RNAO and Public Health Ontario)
This subcommittee of the PHN Advisory Committee was established November, 2010 in partnership with Public Health Ontario (formerly the Ontario Agency for Health Protection and Promotion). The purpose of this group was to implement – with the addition of two front-line public health nurses – the Community Health Nursing Standards and Public Health Nursing Discipline Specific Competencies into every day practice. This group met initially before the Chief Nursing Officer announcement and plans to resume activity again in the fall of 2011.
3) Chief Nursing Officer Working Group (sponsored by the MOHLTC and RNAO)
Established at the request of the MOHLTC, this ministry working group is defining the roles and responsibilities of the Chief Nursing Officer; a position required by the organizational standards to be implemented in all health units by January 1, 2013. This working group consists of members from RNAO, the Association of Nursing Directors and Supervisors in Official Health Agencies in Ontario (ANDSOOHA), business administration, Chief Nursing Officers, Medical Officers of Health, Chief Executive Officers, the Ministry of Health Promotion and Sport, the Ministry of Children and Youth Services, MOHLTC, and the Nursing Secretariat. For the MOHLTC communiqué on the Chief Nursing Officer Working Group, please click here.
5) Chief Nursing Executive / Chief Nursing Officer Advisory Committee (Sponsored by RNAO)
Established by the RNAO in response to the passage of the Excellent Care for All Act (Bill 46) legislating that the Chief Nursing Executive is now a non-voting member of the Board and a member of the Quality Committee of the hospital, the Advisory Committee provides advice and direction on matters related to the RNAO’s Chief Nursing Executive/Chief Nursing Officer Governance and Leadership Initiative. In particular, the Advisory Committee provides a senior nurse executive perspective to the development, implementation, and dissemination of a CNE/CNO Governance and Leadership Toolkit. The Advisory Committee consists of representatives from public health associations, including the Association of Nursing Directors and Supervisors in Official Health Agencies in Ontario and the Community Health Nurses’ Initiatives Group, as well as the Council of Academic Hospitals of Ontario and the Nursing Leadership Network.
6) Chief Nursing Executive / Chief Nursing Officer Knowledge Exchange (Sponsored by RNAO)
The Knowledge Exchange is an RNAO-sponsored forum, recommended by the CNE/CNO Governance and Leadership Initiative Advisory Committee, that has been established to facilitate open dialogue and information sharing about achievements, innovations, successes, and challenges related to CNE/CNO role implementation, responsibilities, and scope; recommend strategies for enhanced and effective role influence and impact; and to contribute to the development of resources to support CNEs and CNOs in their roles at hospital and public health boards.
The Knowledge Exchange is open to all senior nurse executives (CNEs and CNOs) of hospitals and public health units in the province of Ontario, who are members of the Board of Directors or members of the executive-level, decision-making management team of the organization.
i Public Hospitals Act, R.R.O. 1990, Reg. 965, s.2(1.1) (2).
ii Excellent Care for All Act, 2010, Ontario Regulation 445/10, s.1(3)3.
iii Public Hospitals Act, R.R.O. 1990, Reg. 965, s. 4(1).
iv Public Hospitals Act, R.R.O. 1990, Reg. 965, s.2(3).
v Ontario Hospital Association. (2011). Guide to Good Governance: Quality and Patient Safety Governance Toolkit. (2nd edition).
vi Public Hospitals Act, R.R.O. 1990, Reg. 965, s.2(1.1) (2).
vii Public Hospitals Act, R.R.O. 1990, Reg. 965, s.2(1.1) (2).
viii Excellent Care for All Act, 2010, S.O. 2010, c.14, s.4.
ix Ontario Hospital Association. (2011). Guide to Good Governance: Quality and Patient Safety Governance Toolkit. (2nd edition). 1.
x Ontario Hospital Association. (2011). Guide to Good Governance: Quality and Patient Safety Governance Toolkit. (2nd edition).2.
xi Excellent Care for All Act, 2010, S.O. 2010, c.14, s.4.
xii Excellent Care for All Act, 2010, S.O. 2010, c.14, s.1.
xiii Public Hospitals Act, R.R.O. 1990, Reg. 965, s.7(2.2).
xiv Excellent Care for All Act, 2010, Ontario Regulation 444/10, s.1(2).