Open Forum

Hello, 

Happy Friday.  I am curious to learn how you have structured your ambulatory nursing services in your organization. My organization is an Integrated Delivery System with Health Service Areas (Acute Services + Medical Groups + Clinically Integrated Networks + other Ambulatory Services) in 22 states. Our Ambulatory Nursing section includes RNs, LPNs, LVNs, and Medical Assistants (as unlicensed assistive personnel).  A large majority of our colleagues work in our Medical Groups. We have Regional CNOs who are accountable for nursing practice (dotted line) across the Health Service Area with solid line reporting structure to practice managers (mostly non-clinical).  I am following the thread on nurse supervision.  We are exploring implementing Ambulatory CNOs/ Ambulatory Nursing leaders in each of our Health Service Areas. Is there any guidance you can provide on organizational structure: are you organized in your structure by number of colleagues, by geographic spread, by something else?  Any wisdom you can provide is helpful.  Thank you in advance. 

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Sheila Johnson MBA RN
VP Population Health Clinical Operations
Trinity-Health
Livonia MI

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Hi Sheila,

This is Kevin from the University of Michigan. In our institution, we follow a triad leadership model with nursing, administrators (typically non-clinical), and physicians work together on the individual clinic level all the way to the top. 

As a result, we are split into 3 areas each with their own CNO

1. Children and Women's
2. Hospital and Cardiovascular
3. Ambulatory Care

I am not sure about the other two areas, but in ambulatory care we have senior nursing directors followed by supervisors like myself, that are organized more by specialty rather than geographic spread. My clinics are spread over 9 sites and they are not at all close together! 

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Kevin La RN
Nursing Supervisor
University of Michigan
Windsor, ON
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