Issue link: https://beckershealthcare.uberflip.com/i/1468749
58 NURSING SPOTLIGHT NP practice authority by state By Mackenzie Bean T wenty-six states and Washington, D.C., grant nurse practitioners full practice authority as soon as they earn their licenses, according to the American Association of Nurse Practitioners. Another 13 states reduce the ability of NPs to perform at least one practice element inde- pendently and require they have a career-long regulated collaboration with another healthcare provider. The remaining 11 states restrict NPs' ability to perform at least one practice element inde- pendently and require career-long supervision by another healthcare provider. Is it time for more nurse CEOs? By Mackenzie Bean, Erica Carbajal and Cailey Gleeson W ith nearly one-third of registered nurses considering leaving their current roles amid historic workforce shortages, healthcare exec- utives nationwide are scrambling to better understand and meet nurses' needs. is task may come easier for hospital and health system CEOs with hands-on nursing experience, but so-called "nurse CEOs" are few and far between. "We're still unicorns in healthcare administration," said Nancy Howell Agee, MSN, BSN, CEO of Roanoke, Va.-based Carilion Clinic. Ms. Agee started her career as a surgical nurse at Carilion Clinic and became CEO in 2011. Since then, Ms. Agee said she has not seen an increase in the number of healthcare CEOs with nursing backgrounds. "It may even be fewer … because of mergers and acquisitions and the changing industry," she said, noting that nurse CEOs have historically run smaller healthcare facilities. e true proportion of nurses who are healthcare CEOs is unclear due to a lack of data. e American Organization for Nursing Leadership and the American College of Healthcare Executives told Becker's they do not track the number of hospital and health system CEOs with nursing backgrounds. An analysis of the CEOs leading U.S. News & World Report's top 20 hospitals reveal just two have nursing backgrounds: Johnese Spisso, RN, president of UCLA Health and CEO of the UCLA Hospital System; and Regina Cunningham, PhD, RN, CEO of the Hospital of the University of Pennsylvania in Philadelphia. Becker's spoke with three nursing leaders to understand why there are not more nurses in CEO roles and whether CEOs with nursing backgrounds could bring a competitive advantage to health systems aiming to create a better envi- ronment for these clinicians. What's holding nurses back Nurse CEOs' scarcity is likely linked to broader issues surrounding female representation in healthcare leadership, Ms. Agee said. Although federal data shows 76 percent of the healthcare workforce and 87 percent of nurses are female, women represent just 15 percent of industry CEOs. Nurses also do not have much representation on hospital and health system boards, which appoint CEOs. Data from the American Hospital Association in 2017, for example, showed just 5 percent of U.S. hospitals had a nurse as a trustee or serving on a board. "Nurses are not always given a seat at the table," Loressa Cole, DNP, RN, the American Nurses Association Enterprise CEO, told Becker's. Dr. Cole said the ANA has sied through data to look at how the number of nurses serving on hospital or system boards has changed over the years. "We've really not made much progress in that regard, even though the Amer- ican Hospital Association itself says that there is significant value to having nurses on boards," she said. Nurses' absence on boards means leadership might not fully grasp the skill set or value a nurse leader could bring to the CEO role, as nurse members would be best suited to communicate that. "A lot of boards are filled with people with strong financial backgrounds and strategic backgrounds, and it doesn't seem natural that the boards begin to look for a nurse as a CEO," Ms. Agee said. Full practice authority Alaska Arizona Colorado Connecticut Delaware Hawaii Idaho Iowa Kansas Maine Maryland Massachusetts Minnesota Montana Nebraska Nevada New Hampshire New Mexico New York North Dakota Oregon Rhode Island South Dakota Vermont Washington Washington, D.C. Wyoming Reduced practice authority Alabama Arkansas Illinois Indiana Kentucky Louisiana Mississippi New Jersey Ohio Pennsylvania Utah West Virginia Wisconsin Restricted practice authority California Florida Georgia Michigan Missouri North Carolina Oklahoma South Carolina Tennessee Texas Virginia n