Seven Steps to Financial Health.

Physicians and dentists have a very limited exposure to personal financial management and yet find themselves in the top 10% of earners in the United States of America. Education loans, practice expenses, and high standards of living obligate them to be good financial stewards to succeed financially. Anecdotal personal experience and review. The article establishes seven steps to implement as medical/dental students, interns, residents, or practicing doctors to move towards financial health and security. The steps include (1) saving enough; (2) good debt management; (3) being tax savvy; (4) obtaining the correct insurance; (5) making wise investments; (6) if choosing to marry, avoid divorce; and (7) keeping track with periodic progress assessment. Each of these steps contains several components that can aid and guide physicians and dentists in their financial arc of development over their professional career and into retirement, considering generational wealth transfer or charitable donation as ultimate goals. This brief guide is based on my own financial journey to achieve long-term financial independence: start early, use simple tax deferred investments without chasing trends while keeping fees down, live within your means, and adequately insure your income.

Healthcare employers' policies on nurse education.

The 2010 recommendation that the proportion of registered nurses with BSN (bachelor of science in nursing) degrees in the nursing workforce should increase from the current 40% to 80% by the year 2020 has shifted the focus on nurses educational progression from state legislatures-where changes in entry-level requirements were debated for decades-to the executive suites of large healthcare providers. The recommendation, contained in the report titled The Future of Nursing: Leading Change, Advancing Health, by the Robert Wood Johnson Foundation Initiative on the Future of Nursing at the Institute of Medicine, suggests that human resources policies for nurses have the potential to double the rates of college degree completions (IOM, 2010). We surveyed 447 nurse executives in hospitals, nurse-led clinics, and home and hospice companies to explore the current practices of healthcare employers with regard to this recommendation. Almost 80% of respondents reported that their institution either preferred or required newly hired nurses to have a bachelor's degree, and 94% of the facilities offered some level of tuition reimbursement. Only 25%, however, required their nurses to earn a BSN or offered salary differentials on the basis of educational attainment (9%). We conclude that if employers are serious about wanting a more highly educated nurse workforce, they need to adopt requirements for degree completion and wage differentials in the coming years. The likelihood that such policies will be widely adopted, however, is dramatically affected by the dynamics of nursing supply and demand.

The American Organization of Nurse Executives System CNE task force: a work in progress.

Health care is a complex industry, consequently requiring a diverse group of health care executives leading initiatives for efficiency and effectiveness in patient care delivery. Value-based purchasing and pay for performance are at the top of the list for indicators of success, and many hospitals are merging into health care systems. The role of the system chief nurse executive is an evolving role to lead health care systems in clinical, operational, patient safety, and patient satisfaction processes and outcomes. The American Organization of Nurse Executives, being the voice for nursing leadership, convened a group of system chief nurse executives to address the role, function, and competencies needed for this significant and emerging role in health care. This article describes the role statement and system chief nurse executive competencies needed for success in the role. In addition, the next steps for addressing the needs of this group will be outlined in this article.

Chief nursing officer turnover and the crisis brewing: views from the front line.

OBJECTIVE: This American Organization of Nurse Executives study examined perceptions of staff nurses, nurse managers, and nurses in other organizational roles as part of an initiative examining CNO turnover. Here, we report findings that complete the 3-phased effort to better understand how nurse executive turnover affects the work environment and patient care. BACKGROUND: The CNO plays a key role in promoting nurse satisfaction and improving quality, safety, and effectiveness in healthcare organizations. However, little is known about the impact of nurse executive turnover on staff, managers, or patient care delivery. METHODS: An online survey was used to gather participants' views. RESULTS: Approximately 1,277 nurses employed in hospitals across the United States responded to this survey. They reported that their CNO listened and responded to staff and backed up staff in decision making, even when doing so involved conflicts with physicians. However, they also perceived that the CNO was not always visible on units and accessible to staff and had less power and authority than other top-level hospital executives in the organization. CONCLUSION: Strategies are needed to address the concerns of staff nurses and managers who are left behind when CNO turnover occurs.

Chief nursing officer turnover: chief nursing officers and healthcare recruiters tell their stories.

Chief nursing officers (CNOs) develop environments in which quality patient care is delivered and nurses enjoy professional practice. Because of the growing turbulence in this vital role, the American Organization of Nurse Executives conducted a study to examine CNO turnover as described in interviews with CNOs and healthcare recruiters to inform the development of strategies to improve CNO recruitment and retention and ease transition for those who turn over. The authors present the findings from this research and describe American Organization of Nurse Executives' initiatives to address the identified needs.

Key challenges facing American nurse leaders.

What are the key challenges facing nurse leaders in the United States? To find out, I asked 20 prominent nurse leaders to respond to that question and tell me their top three issues. Their voices tell a compelling story on challenges faced by the nurse leaders in American healthcare. The focus is no longer just on the process of how care is delivered, but on the outcomes of that care. More attention is being given to documenting that the care is provided according to specific standards associated with better outcomes. Many of the standards are directly related to the care given by nurses, including some indicators that are specifically sensitive to nurse intervention. There is also a new focus on federal reporting of patient satisfaction with the services provide. Producing quality outcomes, high patient satisfaction and effective measurements of both are now a central theme for the entire hospital administrative team. For the nurse leader, however, it represents explicit accountability for managing and leading the staff responsible for providing the patient care. Safety and quality issues are directly linked to financial pressure. Reimbursement for hospital is being whittled away as financial accountability for services receives greater scrutiny from the federal government and private insurers. Close on the heels of the financial challenge is the ever present workforce shortage. The most troublesome challenge identified by these nurse leaders is the absence of an adequate pipeline for nursing leaders. It is an exciting time for nursing in the United States. Challenges to be sure, but these nurse leaders have identified the priorities that will create a successful future.

Chief nursing officer retention and turnover: a crisis brewing? Results of a national survey.

Anecdotal evidence suggests growing concerns about chief nursing officer (CNO) dissatisfaction, intent to leave, and turnover. However, little evidence documents the magnitude of the problem or whether CNO turnover requires direct action. This article reports the results from the first phase of a three-phase study examining CNO turnover and retention in U.S. hospitals. CNOs were invited to complete an online survey to gather data about their experiences with turnover and to identify CNO retention issues. Our sample includes responses from 622 CNOs employed in hospitals and healthcare systems across the United States. Approximately 38 percent of the respondents reported having left a CNO position-13 percent within two years before the survey and 25 percent within five years before the survey. Of these, approximately one-quarter had been asked to resign, had been terminated, or had lost their jobs involuntarily. When asked about the context of their departure, a high percentage reported leaving their position to pursue another CNO position (50 percent) or for career advancement (30 percent); approximately 26 percent reported leaving because of conflicts with the chief executive officer. Of great concern is the finding that approximately 62 percent of respondents anticipate making a job change in less than five years, slightly more than one-quarter for retirement. Respondents clearly indicated that CNO turnover is a problem that requires attention. The knowledge gained from this study can be used by healthcare leaders to develop strategies and policies aimed at recruiting and retaining CNOs and easing the transition for CNOs and others in the organization when CNO turnover does

Patient safety: the four domains of nursing leadership.

The role of the nurse leader in patient safety can be characterized as follows: to establish the right culture; to infuse that culture with shared leadership so that the expert voice at the bedside is really defining the work; to possess the competencies necessary to coordinate and advance this complex initiative; and to forge both internal and external partnerships, because we will not be able to do this work alone. To further the work on this topic, nurse leaders who participated in the Nursing Leadership Congress are committed to identifying additional resources to help nurse leader colleagues drive patient safety efforts throughout their organizations.