You are a new nurse executive at a community-based hospital system in the southeastern region of the United States. The system is not-for-profit and serves five rural counties. The system comprises one flagship hospital, three smaller critical access hospitals, and a number of clinics and urgent care centers. The health care system serves a diverse population of insured, Medicare, Medicaid, and uninsured patients. The hospital is Joint Commission accredited and for three years in a row has been rated as a Top 100 Hospital.
Historically, the hospital system has been physician-centric, meaning that the physician staff have had the power to influence change, policy, and protocol. The current chief executive officer (CEO) was recently hired from a large university-affiliated hospital system. The chief medical officer (CMO) started the organization’s orthopedic program (one of the most lucrative service lines) and has been with the organization for more than 25 years. He is well respected in the local community and serves on a number of community boards. In light of this strong influence from the department of medicine, nursing has struggled over the past five years. You are the second chief nursing officer (CNO) in four years. The hospital board is applying pressure to seek Magnet designation, which was recently lost due to poor leadership by your predecessor.
The hospital has recently adopted the hospitalist model to cover all in-patients. The hospitalist group was developed by physician leaders in the organization and operates as a separate department within the organization. The hospitalist group desires to become a limited liability corporation (LLC) to maximize benefit offerings but needs a larger staff to make this happen. They have presented a proposal to executive leadership to transfer all advance practice registered nurses (APRNs) working in the organization (there are more than 50) to the hospitalist group, which is housed under the department of medicine. The CMO is spearheading this initiative. Traditionally, ARPNs were hired and managed by the department of nursing.

As the new CNO, you have been approached by a group of 15 APRNs who are against the transition as it will severely impact their scope of practice, in addition to affecting their paid time off, salary, and work hours. The CMO has offered to make APRNs eligible for the annual physician hospitalist bonus structure, as an incentive. At the same time, the CMO has informally proposed that a new policy be created for APRN hospital privileges. If the APRNs choose not to join the hospitalist group, they will not be eligible for hospital privileges. In the state in which the organization is located, a supervising physician is required for APRN practice.
Instructions
Analyze the organization’s political landscape. Examine formal and informal power structures at play and how they affect organizational culture, policies, and communications at all levels.
Lessons learned from your analysis of the organization’s political landscape will provide useful insight into important contextual factors for consideration as you work through Assessments 2, 3, and 4.