Why Doesn’t the U.S. Have an Office of the National Nurse?

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.?

Senior editor/social media strategy, American Journal of Nursing, and editor of AJN Off the Charts.


  1. 7 Resolutions for the Nursing Profession July 27, 2017 at 10:20 pm

    […] role that heads up nursing initiatives and the focus of our practice going forward. Having a National Nurse for Public Health would not only strengthen our profession, but it could do great things for healthcare as a […]

  2. […] role that heads up nursing initiatives and the focus of our practice going forward. Having a National Nurse for Public Health would not only strengthen our profession, but it could do great things for healthcare as a […]

  3. Susanne Arbogast October 19, 2009 at 8:38 am

    The Office of a National Nurse would provide cohesiveness and visibility of the nursing profession. There are many grassroot health/wellness and prevention programs being provided by nurses to address the body, mind, and spirit needs of the communities in which we live. Many nurses are providing their expertise to improve the communities in which they live as volunteers because the community needs are great. Parish nursing as a speciality is growing because it addresses the needs of the community on an individual level and enhances the efforts of the public health services. The efforts are volunteer more than paid because of lack of visibility of the knowledge,expertise, and the nurses role in providing health care services. Nursing leadership by the Office of a National Nurse would provide the visibility and education platform for the expertise and contributions nursing provides to build a healthier tomorrow.

  4. Susan Sullivan RN MSN October 15, 2009 at 12:52 pm

    While the US does not have a national health system, we do have an excellent US Public Health Service where several thousand nurses and other public health professionals make it their life career to serve and protect our nation’s health. Formally designating the Chief Nurse Officer of the USPHS as The National Nurse will enhance visibility of the critical role nurses play in Public Health and the many contributions nurses continually make to our society.

  5. Teri Mills October 15, 2009 at 11:33 am

    Thanks for raising a very valid point. You are absolutely right. As Dr. Beverly Malone, CEO of the NLN, pointed out to me a couple of years ago, we have a decentralized system of nursing in America.
    That is why we have crafted the Office of the National Nurse initiative carefully, incorporating the feedback of Dr. Malone and others.
    In order to avoid duplication of services and unnecessary cost, our proposal is to simply elevate the CNO of the U.S. Public Health Service to a full time position and ranked equally with other CNO’s in government (8.0 grade). Subsequent CNOs would be appointed by the Secretary in accordance with guidelines spelled out the the Public Health Service to avoid politicizing the position.
    Duties would remain the same as they are for the current CNO with an added and enhanced focus on prevention, particularly engaging health professionals including nurses to participate in proven successful health promotion programs.
    The National Nurse therefore, is not being proposed to be the “nurse” over all nursing, but to elevate the nursing profession and highlight its important role in health promotion and prevention of chronic disease.
    Hope this explanation is helpful.
    Teri Mills RN, MS, CNE
    President National Nursing Network Organization

  6. Brenda RN October 15, 2009 at 11:15 am

    Just a comment that CNOs in other countries derive much of their power by serving a national health system.

  7. Cathy Coleman October 1, 2009 at 12:51 pm

    RIGHT ON! America needs an Office of the National Nurse and CNO NOW….
    Our international nursing leaders are correct. I remember with pride the first time I met Mr. Robert Tiffany in London at the first international nursing conference on oncology nursing in 1978. What a leader he was. Nursing is respected around the world when our leaders emerge and collaborate.
    Nursing should not be a “house divided against itself”. I strongly support a CNO for the USA and actually would like to nominate Judith F. Karshmer
    Dean and Professor of the school at the University of San Francisco where I am enrolled in the new MSN Clinical Nurse Leader program. She embodies all of these skills that you mention “a national CNO who is visible, proactive, collaborative, and savvy.” And she has the courage and charisma and leadership style to pull it off. Thank you. Cathy Coleman, RN, OCN, CPHQ, MSN (c)

  8. […] National Nurse is going strong, and now Diana Mason over at AJN’s blog Off the Charts wonders Why Doesn’t the U.S. Have an Office of the National Nurse? Why, […]

  9. Lily Gonzalez September 30, 2009 at 11:35 pm
  10. Lily Gonzalez September 30, 2009 at 11:33 pm

    Yes – and the title should be “National Nurse.” That title is unique enough to help the public understand that nurses do not work for doctors. Nurses have their own licenses separate from but complimentary to physician’s roles. Another “Chief Nursing Officer” is too confusing, as many hospitals have these titles. The title, National Nurse, distinguishes the nursing role as separate from yet complimentary to the Surgeon General’s role.

    OMG – Finally! Thank you, Ms. Mason, for bringing light into an issue that I feel is the single-most important issue for nurses of our generation – the establishment of an Office of the National Nurse.

    In 2004, I testified before Nevada Legislators in favor of nurse-to-patient ratios. In preparing for my testimony, I turned to the ANA for support. The door was not only slammed in my face, but I was also scolded because I dared to testify of my own accord, rather than as a representative to some larger nursing establishment.

    The ANA’s motives behind their actions opposing the ONN are dubious to say the least. I concur with the previous sentiments that their actions are “fear-based.” They fear that the ONN will take the spotlight away from them. But their actions characterize them as egocentric, petty, and unprofessional. Because the nursing profession continues to be overwhelmingly dominated by females, it is especially crucial that petty, girly, cattiness be put aside, if not for the good of nursing which is reason enough, then for the good of the our nation’s health and well-being.

    After what the ANA put me through some 5 years ago, I can only imagine the resentment their leadership must have felt when they discovered that some “ordinary” working nurse practitioner and nurse educator from the State of Oregon, conceived the ONN on her own and dared to get her brilliant thoughts published in the New York Times WITHOUT first consulting with the ANA.

    It is obvious that the ANA does not speak for nurses (as evidenced by the positive ONN comments in this blog) they speak only for themselves.

    Kudos to Teri Mills for daring to have an opinion, and an opinion that has struck a positive cord within the nursing community – despite the various attempts by the ANA to misinform the public about the ONN initiative.

    Ms. Mason, had I seen more support for the ONN by leaders such as yourself, then it is quite possible that I would not have left the nursing profession. I left because I do not have the stomach to deal with the politics that prevent nurses like me to give good nursing care to patients in need. The obstacles to pursuing good patient care were too overwhelming for any reasonably sane and caring person. And the politics occur at the bedside and permeate to the ANA.

    For the sake of the nation and the nursing profession, I hope the ONN is established in our lifetime.

  11. […] emeritus, just wrote a post for AJN’s blog, Off the Charts The title of her post says it all: Why Doesn’t the U.S. Have an Office of the National Nurse? Diane attended a meeting held by the Institute of Medicine Initiative on the Future of Nursing. Two […]

  12. Tafi Vista RN CM September 29, 2009 at 11:38 am

    In today’s environment of healthcare reform, A National Nurse could and would represent nursing views and galvanize Nurses as the back bone of healthcare. Nurses provide the care let our views be known. Where do I sign up to support this endeavor?

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    […] Why is there no national nurse? […]

  14. Peggy September 28, 2009 at 11:18 am

    There is no time the like present to accomplish this. I am in full support and would be happy to help in any way I can.
    Thank you for an update on this important project.

  15. Anne Llewellyn September 27, 2009 at 4:02 pm

    I support the creation of the Office of the National Nurse. All of the project to reform health care call for prevention, education and empowerment of our citizens. Who better to educate than nurses.

    There has been a great deal of work done on this subject and it is ready to go; we just need the acceptance of the US Congress or do we??

  16. Teri Mills September 23, 2009 at 10:52 am


    It would be wonderful to include your statement of support on our website, and also to list you as an official endorser of the Office of the National Nurse initiative. Is it possible for you to drop me an email at teri@nationalnurse.info so that we may connect.

    Teri Mills MS, RN, CNE
    President National Nursing Network Organization

  17. Jane Salvage September 23, 2009 at 6:36 am

    Thanks for raising this very important issue. I’ve worked in a number of countries helping nursing leaders to develop their strategies, and I’ve always found that having a Government Chief Nurse position makes a huge difference. The nature and scope of the role varies enormously, but in all contexts the Chief Nurse can provide stewardship: bringing together nursing leaders from health services, academia and elsewhere to agree together their vision and action plans. The World Health Organization strongly endorses this approach.

  18. Lori Graber, RN September 22, 2009 at 1:23 am

    Of course we need a National Nurse! A visible, recognizable leader for issues regarding healthcare prevention and education~~to elevate an existing position with a updated title of National Nurse and a focus on prevention, education, and volunteerism in healthcare the current CNO, Carol Romano would be an excellent choice!

    Cheers to ONN Initiative!

  19. Mother Jones rn September 21, 2009 at 6:12 pm

    Thank you Ms. Mason for spotlighting this timely issue. I am at a loss to understand why the ANA is resisting change, as well as why they are still misrepresenting the ONN initiative on their website. It’s unfortunate that their fear based opposition is hurting the nursing profession as well as the American people.

  20. Kathy Quan RN BSN September 21, 2009 at 5:11 pm

    For almost a decade this country was convinced we had huge evils to fear and we allowed ourselves to be controlled by that fear agenda. Now the minority party is trying to continue that fear agenda with all sorts of inaccuracies about health care reform instead of looking at the realities of our current broken system that we should indeed fear.

    That fear has been allowed to spread and work to defeat the grassroots efforts to keep us from establishing an Office of a National Nurse which would do so much towards raising awareness of the educational and professional issues we all face everyday. It would help to drive home the need for more nurses and more nurse educators far more than it would cost.

    To paraphrase President Obama, we need to stop fearing the future and work to shape it. I am thrilled to see someone at AJN take a positive stand on this issues and to have taken the time to discuss the successes with those who enjoy the option of a National Nurse. Thank you!

    We must have national leadership and visibility in order to deal with all of the health care issues that face us in the future.

  21. Susan Sullivan September 21, 2009 at 4:23 pm

    The grassroots group of nurses that has been working for over 3 years to establish an Office of the National Nurse in the US remains focused and determined. They continue to be optimistic because support for having a National Nurse is overwhelming when the vision is shared with nursing organizations across all areas of practice.
    Opposition arose based on misinformation on the role and details of the proposal. The excellent work done by ANA and other professional nursing organizations will be supported and enhanced by having a National Nurse. Surely support for enhancing nursing’s role in improving the nation’s health would not be adversarial to any group familiar with the issues of nursing advocacy. Nurses, unite, and support having a National Nurse, because both the nursing profession and the nation will benefit.

  22. Janet RN September 21, 2009 at 1:38 pm

    Yes! And I would run for the office!!!

Comments are moderated before approval, but always welcome.

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