By Diana Mason, editor-in-chief emeritus

Ann Keen

Ann Keen

First, the necessary throat-clearing about who and where: I recently attended a public session held by the Institute of Medicine Initiative on the Future of Nursing. Chaired by University of Miami president and former secretary of Health and Human Services Donna Shalala and chief nurse for Cedar Sinai Medical Center Linda Burnes Bolton, the session began with presentations by two nurses involved in the Prime Minister’s Commission on the Future of Nursing and Midwifery in England: Ann Keen, Member of Parliament and Parliamentary Undersecretary for Health Services, who chairs the British commission; and Jane Salvage, the lead secretariat for the commission and a former contributing editor for AJN.

Now the point: During the formal session, Keen noted that various countries in the UK each have a chief nurse officer (CNO) who is responsible for developing a national nursing strategy. Afterwards, I interviewed Keen and Salvage, who both said they didn’t understand why American nurses were not supporting the call for a CNO for the United States, one who would be charged with developing and overseeing a national nursing strategy for this nation. In their eyes, a CNO who is on par with the surgeon general could help the nation to develop approaches to ensure an adequate nursing workforce, identify barriers to their full utilization, identify new models of care to better promote the health of the public, and develop strategies for removing the barriers that impede forward movement.

Opposition from nursing groups. In the U.S., organized nursing has largely opposed the efforts of a group of grassroots nurses who are calling for the establishment of an Office of the National Nurse. They argue that the American CNO is the assistant surgeon general. But President Obama refers to Mary Wakefield, PhD, RN, FAAN, the head of HRSA, Health Resources and Services Administration, as “the nation’s top nurse.” Yet Wakefield is not responsible for a national nursing strategy. Her portfolio is a broader one. Another argument against a CNO office is that it could divert resources away from important federal nursing initiatives. Sounds like a fear-based reaction to me.

Our colleagues across the pond are convinced that it makes a difference to have a national CNO who is visible, proactive, collaborative, and savvy. Keen urged nurses to “have courage and take your agenda forward.” While our current priorities should probably be ensuring that Congress passes health care reform legislation this year and that any legislation includes enabling language to improve access to advanced practice nurses, we’ll soon need to focus on how to transform the care we provide to emphasize health promotion and care coordination. Let’s do it with courage and include the notion of a national chief nurse.

Do you think we need a national chief nursing officer in the U.S.?