< Previous48 American Nurse Journal Volume 15, Number 3 MyAmericanNurse.com Why CNOs care about compliance It’s a matter of ethics. By Leah Curtin, RN, ScD(h), FAAN From Where I Stand W HY do chief nursing officers (CNOs) care about compliance? From a purely pragmatic viewpoint, hospitals will quickly go out of business if they don’t meet standards. Receiv- ing payment from the Centers for Medicare & Medicaid Services (CMS) requires complying with CMS Conditions of Participations (CoPs); since 1965, accredited hospitals were auto- matically deemed compliant with CoPs. More recently, The Joint Commission, DNNV, and other accrediting entities must apply to CMS for the hospital deeming authority required of all accrediting organizations. Although ac- creditation by these organizations is volun- tary, CMS isn’t. CMS closes hospitals it finds to be seriously jeopardizing patient safety. From a historical and humanitarian view- point, all those who allocate public monies for the public good have additional responsi- bilities. History richly documents an enduring belief that ethical stewardship is the key to producing economically relevant services and goods. For centuries, scholars have directed their ethical reflections, concerns, and princi- ples to the formation of upright men and women who can be entrusted with the bur- den of decision-making that will lead to the general prosperity of the people—the com- mon good. The common good is the result, outcome, blessing, advantage, and reward of ethical ad- ministration. So, for the administrator, the ob- ligation to act for the common good expands the demands of honesty to include account- ability for the outcomes of those decisions. Therefore, business ethics have, by and large, been teleological, or outcome-oriented; all is- sues and actions are analyzed through the prism of results, aims, and purposes. As nurses, CNOs have additional ethical and professional obligations. Like all their predecessors and models, CNOs derive their political and social advantages from their power to allocate the limited resources as- signed to their discretion. And nursing lead- ers derive their moral authority to allocate resources from their clinical knowledge and professional commitments, which are ex- pected to moderate a purely outcome-orient- ed ethic with one that also incorporates nursing’s obligations to patients and the public. As both nurses and administrators, CNOs are concerned about nursing ethics and business ethics. Although these two are not inimical, they are derived from different traditions that, in some cases, may lead to different conclusions. Professional ethics derive from quite liter- ally the “public promises” (from the Latin profiteer, the root of professional) that com- prise the profession’s social contract to do no harm, to act in the patient’s best interests, to keep in confidence all private matters entrust- ed to one, to maintain competence, and to advocate for the patient’s needs. In other words, CNOs incur ethical obligations from their professional commitment to meet vul- nerable patients’ needs and their stewardship of public investments entrusted and allocated to them. Their core ethical responsibility is to ensure safe patient care, the common good, and the fiscal viability of their organization. And this is why CNOs not only should care about compliance but actually partner with CMS, The Joint Commission, and other agen- cies concerned with ensuring patient safety. Leah Curtin, RN, ScD(h), FAAN Executive Editor, Professional Outreach American Nurse Journal PRACTICE MATTERS CNOs’ core ethical responsibility is to ensure safe patient care, the common good, and the fiscal viability of their organization.Next >