Addressing Top CNO Concerns for 2018

Kristin Whitehead
EVP Organizational Excellence
01/19/2018

The recent article in FierceHealthcare by Ilene MacDonald, Top 10 Concerns for Chief Nursing Officers, highlights the real struggles facing CNOs today.  Some of the top issues identified, and they are no surprise, are:

  • Staff engagement,
  • Recruitment/retention (local competition, allure of outpatient setting, and inexperienced nurses in the pipeline), leader turnover (C-Suite and nursing), and
  • Increasing demand for behavioral health nurses.

I certainly experienced these same issues firsthand as an Associate Chief Nurse in a medium/large community hospital and as a CNO in a specialty hospital. Additionally, through HealthLinx’s engagement with hospitals all over the country in their quest for nursing excellence, I see these very same CNO concerns rise to the top at many organizations.

So how does a CNO prioritize so many competing issues that have a very real impact on performance excellence across nursing and the entire organization? While there is no simple answer, integrating transformational leadership across the organization and creating well-aligned organizational and nursing strategic plans may be critical first steps.

Improved nurse engagement can aid with recruitment/retention and nurse leader turnover. Enhancing nurse engagement to produce truly satisfied nurses fixes many problems! The U.S. Bureau of Labor Statistics (2016) notes that roughly 43% of the hospital-based workforce is under the umbrella of Nursing Services.  That is a big chunk of your workforce, so creating and leveraging wins with this group is key. Promoting the shared governance structure, professional development, and low hanging fruit such as flexible scheduling are strategies used often in organizations today to bolster RN satisfaction.

However, I would argue that these things, while very important, are really baseline expectations of the nursing workforce. They are considered critical infrastructure within nursing services and are not seen as optional or particularly innovative. I am not making light of these things. They are foundational for nurse engagement, and there is no shame if your organization is struggling with any one of these issues. The take home point is to validate your barriers to nurse engagement with data (such as survey data, outcomes, etc.) and work to lay this critical foundation. Once the foundation is laid, you can start working on other strategies, such as cultivating the leader-nurse relationship, especially through transformational leadership, that will lead to sustaining a satisfied nursing staff over time.

One way to grow the leader-nurse relationship is through the practice of transformational leadership by all nursing leaders across the organization. Transformational leadership is a leadership style characterized by traits of charisma, mission-driven approach, care/development of the individuals within the ranks, and team orientation. It is especially important to grow your manager group’s transformational ability. We know from the literature that staff tend to ascribe TL attributes to administrative leaders more readily than to their direct managers (Andrews, Richard, Robinson, Cellano, and Hallaron, 2012), but it is the manager who has a more direct impact on staff satisfaction. Feather (2015) performed a review of the literature validating the notion of nurse manager influence on the employee, and notes that the nurse manager is potentially the person with the greatest impact on nurse job satisfaction. Grow this important group, and let them help you sleep better at night!

Finally, align the nursing strategic plan with the organizational strategic plan. This is one way to leverage wins in the nursing workforce and perpetuate them across the enterprise. To successfully align plans, the CNO must be integrated into the C-suite as an equal member of the team. Make sure strategic plans use common language, have complementary objectives, and provide expectations for innovation.

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