Bill Klaproth (host): This is Today in Nursing Leadership, a podcast from the American Organization for Nursing Leadership. I'm Bill Klaproth. And with me is Brandy Matthews, Chief Nursing Officer at UK Healthcare for Good Samaritan Hospital and Emergency Services, and Joni Watson, Senior Director of Professional Practice at AONL, as we discuss the Economic Value of Nursing: Insights from the AONL Value and Impact Panel. Brandy and Joni, welcome.

Brandy Mathews: Good morning, Bill. Thanks for having us.

Joni Watson: Thank you so much, Bill. Looking forward to today.

Host: Yeah, thank you both for your time. This is going to be great. So, AONL has a member-led workforce committee. And within that, the Nursing Value and Impact, or NVI, subcommittee supports nurse leaders in the economic value of nursing. So in December 2025, AONL hosted an invitational CNO/CFO dyad dialogue with support from the Healthcare Financial Management Association, HFMA.

So, I just wanted to kind of set the ground rules there. So Brandy, let me start with you. What problem were you trying to solve through this CNO/CFO dyad dialogue, and why was this conversation so necessary right now?

Brandy Mathews: Well, we know that today's healthcare landscape is ever-evolving and constantly changing, and that organizations are facing pressures to not only deliver high-quality care for their patients, but to have a really engaged team and also high-quality patient care outcomes while maintaining that financial stability and sustainability. And that can be really, really challenging. So, that's the problem that we were trying to work on now. But before we get into that, I wanted to give also the group a little bit of background on this committee and its previous work.

So nearly two years ago, AONL was really focused on the role of the nurse manager and their span of control. And as we were going through that work, we actually realized in our thinking that we need to change that language from span of control and really focus more on the nurse manager span of accountability, given the breadth and the depth of the nurse manager's responsibilities.

So through that work, we created a psychometrically tested assessment tool and a process that nurse leaders can use to evaluate their nurse manager's span of accountability. And this tool can help nurse leaders to identify maybe where their spans are appropriate. But in some cases, they're going to realize that the span of control or span of accountability is too large, and that tool will help to point them into areas where improvements can be made or small adjustments maybe need to be made.

Sometimes those improvements are going to lead them to make a request for additional resources. And so in order to do that, we created a second tool called the Return on Investment Calculator, and we created that tool also in collaboration with the HFMA. And that tool has really helped to design to help nurse leaders have a collaborative discussion with their business partners and create agreed-upon accountabilities and expected outcomes that they will achieve by making this additional investment maybe in additional resources for nursing.

So as we concluded that work, it really reinforced the need for us that nurses and nurse leaders have to have a strong business acumen, and they have to be able to speak in financial terms, especially if there's going to be a situation where they're advocating for resources.

And so, through that, we kind of realized that dyad partnerships in other areas in healthcare, such as the chief nursing officer and the chief medical officer for managing clinical outcomes had been a really effective model. So, we wanted to look at ways to apply those principles and learnings to clinical and financial partnerships. So, we wanted to learn from nurse leaders who had done that well in their organizations. So, that's what led us to convene a group of nurse executives along with their financial partners, and we hosted that CNO and CFO dialogue.

The goal of the dialogue ultimately was really to create some guiding principles on how you can build and sustain a strong and effective relationship between the CNO and the CFO, really formalize that as a dyad partnership. And so, that really kind of brings us to where we are in this work today.

Host: That is really interesting. So, it sounds like really this is a push to build awareness and recognize the value of having financial skills, if you will. So then, you were mentioning you came up with some guiding principles, Brandy. Joni, I wonder if you can tell us more about those guiding principles.

Joni Watson: The Nursing Value and Impact Subcommittee of the AONL Workforce Committee has really been working on these foundational guiding principles for a while now. And so, everything that Brandy just mentioned has really been building and scaffolding up to these five guiding principles.

And we held the CNO/CFO dyad dialogue in December 2025. We then had several sessions that were happening simultaneously at HFMA conferences, at AONL Inspiring Leaders Conference. And then, the Nursing Value and Impact Subcommittee has really vetted the foundational guiding principles through this field-informed work, as well as looking at the overall nursing and financial evidence.

And I'll just pause and let our listeners know that there really is a paucity of evidence in this regard. And we're working to fill the evidence alongside others. So as nurse leaders and finance leaders who are listening today, as you're working on joint efforts, I would encourage you to write that into a manuscript, submit it for scholarly publication or professional presentation at a national conference, because there is a paucity of evidence on this important relationship. These relationships certainly change patient and care outcomes in our organizations.

But we have five foundational guiding principles that are in the final stages of vetting and formatting, and they'll be available on the AONL website probably by the end of June 2026. And so, they are, number one, build and sustain high-trust relationships through structured collaboration and shared leadership behaviors. Number two, practice reciprocal cross-disciplinary learning to understand each other's realities, pressures, and priorities. Number three, establish shared language, unified data, and jointly developed metrics. Number four, honor distinct roles while advancing an integrated enterprise financial and clinical strategy. And number five, operationalize shared accountability for enterprise performance through joint ownership of goals.

Host: You've put a lot of work into this, and I can see where this is really important, all of this work that you've put in. I love those five guiding principles. And we've been talking about this CNO/CFO dynamic, if you will, this dialogue partnership. So Brandy, can you describe to us what a strong CNO/CFO partnership actually looks like in practice beyond just meeting together or reviewing budgets? What does that relationship look like in the real world?

Brandy Mathews: So in addition to the guiding principles, you know, we intend to have practical tactics and tools that nurse leaders can use to establish that relationship. But I think what it really looks like on the day-to-day is, first and foremost, you have to be intentional about creating a relationship with your CFO or whomever your financial business partner is.

And that might simply look like having a cup of coffee on a regular basis or grabbing lunch on occasions where you can really get to know each other, and understand each other's roles and backgrounds and experiences. You have to create some opportunities for shared visibility, and that can look like rounding on the clinical units, taking your finance partner out into the world, if you will, so they can see healthcare happening at the bedside. And ideally, that'll give them a little bit of a better understanding of what's going on in our clinical environments.

Joni Watson: Brandy, I love how you're saying, our financial partner, because, you know, while we certainly have conducted the CNO/CFO dyad dialogue, and we are talking a lot about nurse and finance executives, these relationships really happen all throughout our organizations. And so even, you know, nurse managers who are working with financial analysts, nurse directors and above, as we work with VPs of finance and our colleagues across all of our financial departments, we all have partners. And so, I appreciate that perspective of it's not solely the nurse executive and the finance executive. We really have finance partners in whatever role we are in as nurses.

Brandy Mathews: Yeah, absolutely. And I think we want these guiding principles and all of these resources to be applicable and usable for nurse leaders, really regardless of the role that they're in. Obviously, they'll have to be tweaked a little bit if it's not applicable to your particular setting or organization, but we hope they will be meaningful tools for everybody.

And the last thing that I will say is that one of the other, guiding principles talks about creating a shared language and some jointly developed metrics. And that's going to be important too. I think we have to clearly define and agree on those definitions in some of the words and the language that we use.

I think one thing that comes to mind, as I mentioned earlier, we were talking about nurse manager span of accountability. And often, we talk about that in terms of FTEs. But from the leader's perspective, we really need to be focusing on head count because those two measures can be vastly different. But that you have to agree upon when you go in, in having these discussions.

Joni Watson: I wholeheartedly agree, Brandy. You know, I made an intentional decision to get both nursing and business degrees in my career, and I've spent a large part of my career translating between departments, because we all have the same goals to make sure that patients are well taken care of, that our organizations are financially sustainable and can continue long term, that our teams are well taken care of.

We often talk in different terms across clinical departments and financial departments, and it's only when we come together that we can identify, "Oh, yeah, that's exactly what I'm talking about," or, "No, I'm talking about something that's a little bit different, but I can totally see your perspective, and then let's try and reconcile some of these pieces."

And so, we can only do that, I think, to your earlier point, when we have trust and a solid relationship. And we can come together to talk about the shared language and how we can have unified data and our metrics that finance doesn't "create for nursing," and nursing doesn't "create the metrics for finance," but that we actually do that together as colleagues because we really do have the same goals.

Brandy Mathews: Absolutely. And while we create those things together, I think we also need to display them and monitor them together. You're talking about your organizational goals or your unit goals. We need to have a dashboard or a scorecard, whatever it is that you use in your setting that includes both the financial aspects of the organizational performance as well as the clinical outcomes.

So if we're talking about productivity or staffing costs, those need to be displayed in the same scorecard, if you will, as patient outcomes and your fall rates and your hospital-acquired conditions so that we can track those things together and identify any trends or opportunities. And then, each group held equally accountable for achieving high performance in those areas.

Joni Watson: Yeah, it really does take all of us to take care of patients. Absolutely.

Host: I love the back and forth that you two are having here. This is really an important discussion. And I really am enjoying how you're talking about these relationships, these partnerships. So, it seems like it's not just having a transactional relationship. It seems like you're really working hard to have a deeper relationship, like a long-term partnership, if you will, when you talk about building an intentional relationship. I really love what you're saying there.

And Joni, where do you see the biggest opportunities for nursing and finance leaders? So, you've got the short-term financial pressures, right? But then, you've got to think about the long-term investments. How do you do that? How do you make better shared decisions around workforce models and span of accountability, as you were talking about earlier, and more?

Joni Watson: It's interesting because you used the word transactional, Bill. And sometimes we think about nursing leadership as being transactional or transformational. Transactional kind of being focused on the short term and the here and now. And then, transformational, we tend to think of it more long-term and more strategic. And sometimes that gives a stronger positive connotation to transformational leadership. And maybe transactional leadership gets maybe a little bit more of a negative connotation.

But as we think about nursing leadership, we absolutely want to think long-term. We also have to think short-term and make sure that today is okay, you know? Nobody really cares about making tomorrow better if today is on fire. And so, we have to be able to think as nurse leaders in both terms, both the short-term and the long-term. And sometimes as nurse leaders, we can kind of look to one over the other.

But this idea and this tension of short-term and long-term clinical and financial pressures is not new at all in healthcare. It certainly feels a little bit more applicable today because we feel the pressures and the tensions, I think, more often. But again, not something new, because healthcare is inherently a complex adaptive system. And it's that pressure and the tension between two things that feel completely dichotomous to one another that actually helps us spur transformation within nursing. And so, we have to be able to think both and in regards to these things.

And so, when we think about both the short-term and the long-term clinical and financial outcomes, we have to have the right resources at all times. And this often requires a financial investment. And there's mounting evidence to show that we have to reframe our ways of thinking about the workforce, that it's not solely the workforce, it's actually human capital.

And so if we think about capital in terms of what nurse and finance leaders typically think of as capital, things like machines and large equipment and buildings and those sorts of things, you have to continually invest financially in the capital so that it will have the financial return. Well, the same is true with our people, with our workforce. This is human capital. It requires an investment, and we expect to see a return on that investment that we can certainly project. And it's our responsibility, and we're accountable to show that actual ROI after we complete an intervention.

And so, as such, we need clinical and financial leaders really to jointly make decisions on these investments and to share the accountability. And what we've learned from high-performing dyads through the dyad dialogue, through the field-informed conference sessions, is that when those colleagues are aligned, that really the rest of the team has permission and agency and opportunity to also be more clearly aligned in these joint efforts.

So, Bill, I would say that the biggest opportunity for nursing and finance leaders is really to be aligned both for short-term and long-term pressures and tensions so that we can invest and then share those outcomes together.

Host: So when both are aligned like that, that's when you really create a high-performing workforce and environment. Would that be right?

Joni Watson: Absolutely, Bill.

Host: I love your analogy too about other businesses and the investment they have to make in parts or machines, if you will, sort of. We have to do the same thing with human capital as well to get that ROI. You can't just set it and forget it. You have to keep nurturing and cultivating a great environment and doing work here and there, et cetera, to get the most out of the employees. And they appreciate that too. They want a healthy, strong work environment too, and they appreciate it when leaders pay attention to them and do those things too. So, I think that's really important.

I'd love to ask you both this last question before we wrap up. Brandy, let me start with you. If listeners take away just one action from the CNO/CFO Guiding Principles, what is the first thing you would want them to do differently on Monday morning?

Brandy Mathews: Well, I think the first thing on Monday morning is if you don't have a finance business partner, you need to figure out who that person is. And if you do have one, you probably need to have a quick meeting with that person and really check in and see what is the status of your relationship. And then, otherwise do the work to make that a stronger and more collaborative relationship.

And I think if you don't know who that person is or you don't have a strong relationship, the intention is for those guiding principles to be able to be used so that you can create one. They really serve as a roadmap, I think, to creating that strong and collaborative relationship.

Host: I love that. Find that person, do the work, and then follow the guiding principles. And then, Joni, let me ask you same question. What is the first thing you would want someone to do differently on Monday morning?

Joni Watson: I wholeheartedly agree with Brandy. Find your person, find your colleague, that you can build a relationship and share responsibility with. If I take it one step further, I would also just remind nurse colleagues that we have the shared same goals as our finance colleagues. And oftentimes, we can come to the table thinking that our finance colleagues are solely focused on perhaps saying no to our financial request. But we need to be mindful that they have a responsibility and an entire education and training and professional responsibility to steward the financial resources of the organization for financial sustainability. And so, they are not experts in clinical care, and they are growing in understanding clinical care, just like we are not always experts in business and financial pieces, and we're growing in that domain.

But when we come together, we get the opportunity to teach one another, and that takes humility on our part and also some grace for our finance colleagues. Because, you know, like Brandy mentioned, it's great to bring a colleague and round with a colleague, but we do have to be mindful that that might be an uncomfortable scenario for our finance colleagues. And so, just remembering that we're all still learning and that we all have the same shared purpose to take great care of people in our communities and to make sure that our organizations are here for a really long time. So, wholeheartedly agree with Brandy.

Brandy Mathews: Yeah, absolutely. And, you know, Jodi, hearing you talk about that, there have also been times too in my career where my finance partner has actually been helpful to me in order to make that business case if it's needed. So, there are going to be times where get that person on your team and then your ask will be stronger and they can help us to articulate it better, perhaps than sometimes, you know, we can with just the clinical story alone. You have to be able to tell both parts of the story. But I think if we put our minds together, our backgrounds and our expertise, then our story and our ask, if you will, will be stronger. And then, ultimately, our outcomes will be better too.

Host: Yeah, great point. And I love what you both said there. And Joni, we've been looking at this from the lens of the CNO, if you will, but you kind of reversed it and said, you know, the CFO is looking for this as well as they can learn things from you. So, this actually helps them out too. Beause if you're like, "Hey, let me tell you how our department runs and what's important to us," and they may go, "Oh, I didn't know that. Okay, this helps me." So, that is a great point, turning it around and looking at it from their lens. So, what a great discussion.

Brandy and Joni, thank you so much for your time today. This has been great.

Brandy Mathews: Bill, thank you so much for the opportunity.

Joni Watson: Agreed, Bill. Thanks.

Bill Klaproth (host): You bet. And once again, that is Brandy Matthews and Joni Watson. And if you found this podcast helpful, please share it on your social channels. And please make sure you check out the full podcast library of topics that we have for you at aonl.org/nursing-leadership-podcast. There is just a ton, a wealth of information and education waiting for you on that page. Once again, this is Today in Nursing Leadership. Thanks for listening.