Date of Award


Degree Name

Doctor of Nursing Science

Dissertation Committee

Janet K. Harrison, EdD, RN, Chair; Mary Jo Clark, PhD, RN; Susan M. Zgliczynski, PhD


Chief Nurse Executive Officers, integrated healthcare systems, managed care, nursing


The healthcare industry is undergoing radical transformation. Healthcare's transformation is characterized by new patterns of organization, alliance, management, administration, and governance. Traditional fee-for-service reimbursement strategies are rapidly dissolving and managed health care is proliferating. Managed care and managed competition are forcing hospitals and healthcare providers to reduce expenses and identify improved methods for healthcare delivery. Integrated healthcare delivery systems (IDSs) and networks are at the center of healthcare reform. Chief Nurse Executive Officers (CNEOs) are increasingly finding themselves in roles within complex IDSs located within highly managed care markets (HMCMs). This new work environment is altering old and mandating new CNEO role expectations. The purpose of this study was to identify present-day and future role expectations for CNEOs employed in IDSs located within HMCMs and determine the level of consensus between CNEOs and CNEO supervisors on present-day and future CNEO role expectations. The research methodology employed was a Delphi process. A 25 member expert panel, 15 CNEOs and 10 CNEO supervisors, completed three iterative survey rounds. The panel retention rate was 83%. The panel reached consensus on 59 present-day and 59 identical future role expectations for CNEOs working in IDSs in HMCMs. Three major categories of CNEO role expectations were identified: leadership role expectations, clinical role expectations, and system/organizational improvement expectations. Mean importance ratings for the CNEO role expectations revealed all but one present-day and two future CNEO role expectations to be important. Stratification of CNEO role expectations by CNEO and CNEO supervisor sub-groups revealed a high level of consensus between CNEOs and CNEO supervisors on present-day CNEO role expectations and a moderately high level of consensus on future CNEO role expectations. Study implications relate to successful CNEO role enactment; increased CNEO job satisfaction; decreased CNEO turnover; and development of graduate curricula, educational offerings, position descriptions, and performance standards. Further study was recommended to validate study findings, explore more fully future CNEO role expectations, and determine how study findings are communicated, operationalized, and evaluated in the work setting.

Document Type

Dissertation: Open Access



Included in

Nursing Commons