Nurse Executive Competencies

Nurse Leaders in executive practice set the vision for nursing practice in the delivery of safe, timely, efficient, equitable and patient-centered care. Working within a collaborative and interprofessional environment, the nurse in executive practice is influential in improving the patient experience of care (including quality and satisfaction), improving the health of
populations and reducing the per capita cost of health care.
The AONE Nurse Executive Competencies detail the skills knowledge and abilities that guide the practice of nurse leaders in executive practice regardless of their educational level, title or setting. The competencies are captured in a model developed in 2004 by the Healthcare Leadership Alliance1 that identify the common core set of competency domains for health care leadership: communication and relationship management; knowledge of the health care environment; leadership;
professionalism; business skills and principles.

1 Members include American Organization of Nurse Executives, The American College of Healthcare Executives, American Association for Physician Leadership, Healthcare Financial Management Association, Healthcare Information and Management Systems Society, and Medical Group Management Association.

Reliability and validity for the AONE Nurse Executive competencies is established by periodic job analysis/role delineation studies. These competencies are based on A National Practice Analysis Study of the Nurse Executive (2014).

A. EFFECTIVE COMMUNICATION
 Make oral presentations to diverse audiences on:
» Nursing
» Health care topics
» Organizational issues
 Produce written materials for diverse audiences on:
» Nursing
» Health care topics
» Organizational issues
 Facilitate group discussions
 Demonstrate skill in interpersonal communication

B. RELATIONSHIP MANAGEMENT
 Build collaborative relationships
 Exhibit effective conflict resolution skills
 Create a trusting environment by:
» Following through on promises and concerns
» Establishing mechanisms to follow-up on commitments
» Balancing the concerns of individuals with organizational goals and objectives
» Engaging staff and others in decision- making
» Communicating in a way as to maintain credibility and relationships

C. INFLUENCING BEHAVIORS
 Assert views in non-threatening, non- judgmental ways
 Create a shared vision
 Facilitate consensus building
 Inspire desired behaviors and manage undesired behaviors

 Achieve outcomes through engagement of stakeholders
 Promote decisions that are patient-centered
 Apply situational leadership skills

D. DIVERSITY
 Establish an environment that values diversity (e.g. age, gender, race, religion, ethnicity, sexual orientation, culture)
 Establish cultural competency in the workforce
 Incorporate cultural beliefs into care delivery
 Provide an environment conducive to opinion sharing, exploration of ideas and achievement of outcomes

E. COMMUNITY INVOLVEMENT
 Represent the organization to non-health care constituents within the community
 Serve as a resource to community and business leaders regarding nursing and health care
 Represent the community perspective in the decision-making process within the organization/system
 Represent nursing to the media
 Serve on community-based boards, advisory groups, and task forces

F. MEDICAL/STAFF RELATIONSHIPS
 Build credibility with physicians as a champion for patient care, quality and the professional practice of nursing
 Confront and address inappropriate or disruptive behavior towards patients and staff
 Represent nursing at medical executive committee and other department/medical staff committees

 Collaborate with medical staff leaders and other disciplines in determining needed patient care service lines
 Collaborate with physicians and other disciplines to develop patient care protocols, policies and procedures
 Collaborate to determine patient care equipment and facility needs
 Use medical staff mechanisms to address physician clinical performance issues
 Address and model appropriate conflict resolution
 Create opportunities for physicians and nurses to engage in professional dialogue

G. ACADEMIC RELATIONSHIPS
 Determine current and future supply and demand for nurses to meet the care delivery needs
 Identify educational needs of existing and potential nursing staff
 Collaborate with nursing programs to provide required resources
 Collaborate with nursing programs in evaluating quality of graduating clinicians and develop mechanisms to enhance this quality
 Serve on academic advisory councils
 Collaborate in nursing research and translate evidence into practice
 Collaborate to investigate care delivery models across the continuum
 Create academic partnerships to ensure a qualified workforce for the future

A. CLINICAL PRACTICE KNOWLEDGE
 Demonstrate knowledge of current nursing practice and the roles and functions of patient care team members
 Communicate patient care standards as established by accreditation, regulatory and quality agencies
 Ensure compliance with the State Nurse Practice Act, State Board of Nursing regulations, state and federal regulatory agency standards, federal labor standards and policies of the organization
 Adhere to professional association standards of nursing practice
 Ensure that written organizational clinical policies and procedures are reviewed and updated in accordance with evidence-based practice
 Integrate bioethical and legal dimensions into clinical and management
decision-making
 Ensure protection of human subject rights and safety in clinical research

B. DELIVERY MODELS / WORK DESIGN
 Demonstrate current knowledge of patient care delivery systems across the continuum
 Describe various delivery systems and age- appropriate patient care models and the advantages/disadvantages of each
 Assess the effectiveness of delivery models
 Develop new delivery models
 Participate in the design of facilities

C. HEALTH CARE ECONOMICS AND POLICY
 Understand regulation and payment issues that affect an organization’s finances
 Describe individual organization’s payer mix, CMI and benchmark database

 Align care delivery models and staff performance with key safety and economic drivers (e.g., value-based purchasing, bundled payment)
 Take action when opportunities exist to adjust operations to respond effectively to environmental changes in economic elements
 Use knowledge of federal and state laws and regulations that affect the provision of patient care (e.g., tort reform, malpractice/ negligence, reimbursement)
 Participate in legislative process on health care issues through such mechanisms as membership in professional organization and personal contact with officials
 Educate patient care team members on the legislative process, the regulatory process and methods for influencing both
 Interpret impact of legislation at the state and federal level on nursing and health care organizations

D. GOVERNANCE
 Use knowledge of the role of the governing body of the organization in the following areas:
» Fiduciary responsibilities
» Credentialing
» Performance management
 Represent patient care issues to the governing body
 Participate in strategic planning and quality initiatives with the governing body
 Interact with and educate the organization’s board members regarding health care and the value of nursing care
 Represent nursing at the organization’s board meetings
 Represent other disciplines at the organization’s board meetings

E. EVIDENCE-BASED PRACTICE/OUTCOME MEASUREMENT AND RESEARCH
 Use data and other sources of evidence to inform decision making
 Use evidence for establishment of standards, practices and patient care models in the organization
 Design feedback mechanisms by which to adapt practice based upon outcomes from current processes
 Design and interpret outcome measures
 Disseminate research findings to patient care team members
 Allocate nursing resources based on measurement of patient acuity/care needed
 Monitor and address nurse sensitive outcomes and satisfaction indicators

F. PATIENT SAFETY
 Support the development of an organization-wide patient safety program
 Use knowledge of patient safety science (e.g., human factors, complex adaptive systems, LEAN and Six Sigma)
 Monitor clinical activities to identify both expected and unexpected risks
 Support a Just Culture (non-punitive) reporting environment, supporting a reward system for identifying unsafe practices
 Support safety surveys, responding and acting on safety recommendations
 Lead/facilitate performance improvement teams to improve systems/processes that enhance patient safety

G. PERFORMANCE IMPROVEMENT/METRICS
 Articulate the organization’s performance improvement program and goals
 Use evidence-based metrics to align patient outcomes with the organization’s goals and objectives
 Apply high reliability concepts for the organization
 Establish quality metrics by
» Identifying the problem/process
» Measuring success at improving specific areas of patient care
» Analyzing the root causes or variation from quality standards
» Improving the process with the evidence
» Controlling solutions and sustaining success

H. RISK MANAGEMENT
 Identify areas of risk/liability
 Facilitate staff education on risk management and compliance issues
 Develop systems that result in prompt reporting of potential liability by staff at all levels
 Identify early warning predictability indications for errors
 Correct areas of potential liability
 Ensure compliance by staff with all required standards

A. FOUNDATIONAL THINKING SKILLS
 Address ideas, beliefs or viewpoints that should be given serious consideration
 Recognize one’s own method of decision making and the role of beliefs, values and inferences
 Apply critical analysis to organizational issues after a review of the evidence
 Maintain curiosity and an eagerness to explore new knowledge and ideas
 Promote nursing leadership as both a science and an art
 Demonstrate reflective practice and an understanding that all leadership begins from within
 Provide visionary thinking on issues that impact the health care organization

B. PERSONAL JOURNEY DISCIPLINES
 Learn from setbacks and failures as well as successes

C. SYSTEMS THINKING
 Use knowledge of classic and contemporary systems thinking in problem solving and decision making
 Provide visionary thinking on issues that impact the healthcare organization
 Recognize the contribution of mental models on behavior
 Promote systems thinking as an expectation of leaders and staff
 Consider the impact of nursing decisions on the healthcare organization as a whole
 Use resources from other paradigms

D. SUCCESSION PLANNING
 Develop a leadership succession plan
 Promote nursing leadership as a desirable specialty
 Mentor current and future nurse leaders
 Establish mechanisms that provide for early identification and mentoring of staff with leadership potential
 Develop a workforce analysis plan and implement strategies to ensure an adequate and qualified workforce

E. CHANGE MANAGEMENT
 Adapt leadership style to situation needs
 Use change theory to implement change
 Serve as a change leader

A. PERSONAL AND PROFESSIONAL ACCOUNTABILITY
 Hold self and others accountable for mutual professional expectations and outcomes
 Contribute to the advancement of the profession
 Participate in and contribute to professional organizations
 Demonstrate and promote leader and staff participation in professional organizations
 Promote leader and staff participation in lifelong learning and educational achievement
 Achieve and maintain professional certification for self
 Promote professional certification for staff
 Role model standards of professional practice (clinical, educational and leadership) for colleagues and constituents

B. CAREER PLANNING
 Coach others in developing their own career plans
 Seek input and mentorship from others in career planning and development
 Develop a personal and professional career plan and measure progress
 Solicit feedback about personal strengths and weaknesses
 Act on feedback about personal strengths and weaknesses

C. ETHICS
 Uphold ethical principles and corporate compliance standards
 Hold self and staff accountable to comply with ethical standards of practice
 Discuss, resolve and learn from ethical dilemmas

D. ADVOCACY
 Promote clinical perspective in organizational decisions
 Involve nurses and other staff in decisions that affect their practice
 Represent the perspective of patients and families
 Advocate for optimal health care in the community

A. FINANCIAL MANAGEMENT
 Develop and manage an annual operating budget and long-term capital expenditure plan
 Use business models for health care organizations and apply fundamental concepts of economics
 Interpret financial statements
 Manage financial resources
 Ensure the use of accurate charging mechanisms
 Educate patient care team members on financial implications of patient care decisions
 Participate in the negotiation and monitoring of contract compliance (e.g., physicians, service providers)

B. HUMAN RESOURCE MANAGEMENT
 Ensure development of educational programs to foster workforce competencies and development goals
 Participate in workforce planning and employment decisions
 Use corrective discipline to mitigate workplace behavior problems
 Evaluate the results of employee satisfaction/quality of work environment surveys
 Support reward and recognition programs to enhance performance
 Formulate programs to enhance work-life balance
 Interpret and ensure compliance with legal and regulatory guidelines
 Provide education regarding components of collective bargaining
 Promote healthful work environments
 Address sexual harassment, workplace violence, verbal and physical abuse
 Implement ergonomically sound work environments to prevent worker injury and fatigue
 Develop and implement emergency preparedness plans
 Analyze market data in relation to supply and demand
 Contribute to the development of compensation programs
 Develop and evaluate recruitment, onboarding, and retention strategies
 Develop and implement an outcome-based performance management program
 Develop and implement programs to re- educate the workforce for new roles

C. STRATEGIC MANAGEMENT
 Create the operational objectives, goals and specific strategies required to achieve the strategic outcome
 Conduct SWOT and Gap analyses
 Defend the business case for nursing
 Utilize the balanced scorecard analysis to manage change
 Evaluate achievement of operational objectives and goals
 Identify marketing opportunities
 Develop marketing strategies in collaboration with marketing experts
 Promote the image of nursing and the organization through effective media relations

D. INFORMATION MANAGEMENT AND TECHNOLOGY
 Use technology to support improvement of clinical and financial performance
 Collaborate to prioritize for the establishment of information technology resources
 Participate in evaluation of enabling technology in practice settings
 Use data management systems for decision making
 Identify technological trends, issues and new developments as they apply to patient care
 Demonstrate skills in assessing data integrity and quality
 Provide leadership for the adoption and implementation of information systems