Building a Stronger Healthcare System: The Case for a Chief Nurse and Midwife Officer in the HSE

I’d like to dive deeper into why we need a Chief Nurse and Midwife Officer (CNMO) in Ireland's Health Service Executive (HSE) as part of a Triumvirate governance model.

What is the ‘Triumvirate’ in Healthcare Governance?

The Triumvirate model is gaining momentum in healthcare leadership, moving away from the traditional dominance of the medical profession. Research shows that high-performing healthcare organizations have executive nurses and midwives working alongside CEOs and medical leaders to ensure nursing and midwifery perspectives are part of strategic decision- making. This collaborative approach leads to more inclusive, effective healthcare governance.

Globally, countries like the UK, Australia, the US, and Canada have adopted this model to improve healthcare outcomes. By forming a Triumvirate with the CEO, Chief Medical Officer (CMO), and Chief Nurse and Midwife Officer (CNMO), healthcare systems can leverage diverse expertise for better decision-making.

The 3 ‘P’s’ of the Triumvirate Model:

1. Patients: Ensures patient-centered care by integrating the perspectives of nursing, midwifery, and medical leaders, improving health outcomes.

2. Professionals: Elevates nursing and midwifery leadership, promoting professional autonomy, job satisfaction, and interdisciplinary collaboration.

3. Providers: Enhances organizational performance by balancing clinical efficacy, operational efficiency, and patient satisfaction.

Why We Need a Chief Nurse and Midwife Officer (CNMO)

Ireland's healthcare system is undergoing reforms, with six new Regional Health Authorities (RHAs) focusing on integrating nursing and midwifery services across regions. But to ensure consistent, high-quality care, we need a national CNMO to oversee these structures.

A CNMO would:

• Ensure nursing and midwifery perspectives are included in executive decision- making.

• Advocate for workforce development, standards, and collaboration across providers.

• Improve service delivery, equity, and access to healthcare nationwide.

• Despite nurses and midwives being the largest group in the healthcare workforce, they currently don’t hold positions at the executive level to influence national patient care and safety. The lack of a national CNMO hinders cohesive, high-quality care.

The Role of the CNMO

A Chief Nurse and Midwife Officer (CNMO) would operate at the executive level of the HSE, bridging policy and practice to ensure that national nursing and midwifery strategies are implemented across all healthcare settings. This role would:

• Standardize care across HSE-owned and funded hospitals.

• Address staffing shortages and workforce issues.

• Ensure consistent, high-quality care regardless of hospital ownership.

Addressing Healthcare System Challenges

Ireland’s healthcare system includes public hospitals directly owned and funded by the HSE, public hospitals funded by the HSE but privately owned, and private hospitals. The governance and funding structures vary, which can lead to inconsistencies in care.

How a CNMO can help:

• Governance: A CNMO would help unify governance across different hospital types, ensuring adherence to national standards in public healthcare.

• Funding and Access: The CNMO can advocate for equitable care across public and private sectors, ensuring consistent access to quality services.

• Operational Influence: While the CNMO wouldn’t have direct control over private hospitals, their leadership could foster collaboration, encouraging private hospitals to align with national standards.

Conclusion

The Triumvirate governance model in healthcare – with a Chief Nurse and Midwife Officer at the executive level – is a crucial step toward integrated, patient-centered care in Ireland. By empowering nursing and midwifery leadership, we can ensure better outcomes, higher safety standards, and a more equitable healthcare system for all. At ArrowHealth, we believe that nursing and midwifery leadership should not only be heard but actively shape the future of healthcare in Ireland. Whether you're a patient in need of clinical care at home or a nurse who believes in a more visible, empowered profession — we’d love to connect.

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