¶ … civilians think of the nursing department in any well-run hospital, they often don't consider all the structure, organization and guidance which is required to make this department run as smoothly as it needs to be and to achieve the highest level of patient-centered goals. One position at the top of the pyramid of the nursing department is the position of Chief Nursing Officer or CNO. The Chief Nursing Officer is the person who is responsible for overseeing the crux of the entire nursing operation, ensuring that the entire team runs like a well-oiled machine and that all members are responsible for pulling their weight, following policy and engaging in the most proactive and balanced measures for patient centered goals (Dickson, 2008). This is without a doubt an extremely demanding job and absolutely requires a person who truly enjoys working with patients and other nurses, and thrives on the challenge of offering up the highest available level of healthcare to patients. However, when one looks at the statistics and retention rates of individuals in these positions the rates are actually quite low: there is a tremendous amount of turnover in this position (Monroe, 2008). This points to a tremendous and nuanced problem: a high amount of turnover in this position indicates that there's an aspect of the job which is incredibly demanding -- so much so that it's unmanageable. The evidence indicates that real changes need to be made to nursing departments and the environment they create, in order for CNOs to desire to stay in such jobs (Austin, 2010) (Figley, 2013) (O'Brien, 2010). The high amount of turnover in this position also points to the fact that there's something about the structure and environment of the job which is hard to maintain for many people. The high levels of turnover also suggest that there's an aspect to this job which creates a strong amount of burnout, which can be debilitating, but which can be fixed (Reese, 2008). This paper is going to take a more invasive look at the problems presented by the low rate of retention with CNOs and why those problems exist and how they can best be countered and prevented.

Background of the Problem

Chief Nursing Officers (CNO) refer to registered nurses that guide the nursing tasks in professional healthcare facilities all over the United States. The Chief Nursing Officer is depended upon by the entire nursing department to demonstrate fairness and leadership in an ever-changing field (Strommer, 2011). One of the most important elements of this job is that the CNOs work in conjunction with other chief executive officers to help push forth decisions for the healthcare agency at large: this is so crucial because CNOs generally have a better sense of what's essential for patient care, and what the real needs and priorities of patients actually are. These are certain decisions which can truly improve the level of care that patients receive, and the overall satisfaction of the staff. CNOs all over the nation are exhibiting a disturbing trend, of leaving their current positions as a result of career changes and personal commitments (Salmon, 2002).

This study will discuss and scrutinize all the elements which influence this trend in decision-making of chief nursing officers and all the interlocking factors which foster this abrupt career path.

Recent relevant research suggests that a problem is brewing in the works when it comes to the retention and turnover of CNOs. The marked lack of longevity in the profession as a whole is something to consider and for all involved parties to take active steps. A study conducted by Jones and colleagues looked at the CNO turnover using 622 CNOs from America who were all engaged in an online survey. One of the main findings was that "close to 40% of CNOs reported leaving a position as CNO during their careers. The majority (77%) left voluntarily with approximately 50% choosing to take another position as CNO and 30% pursuing other opportunities to advance their careers"(Jones et al., 2008). One of the more perplexing aspects of this survey was that many CNOs reported a high level of satisfaction, with just about half of all participants reporting satisfaction, and 37% asserting that they were very satisfied with their jobs. Regardless, over half of all CNOs involved in this survey asserted that they had the absolution intention to actively pursue other job opportunities within the next half of a decade (Jones et al., 2008). Thus, the problem clearly becomes even more aggravated than imagined. The data demonstrates that even though the bulk of CNOs who were satisfied with their jobs...

The problem becomes even more aggravated than before when one considers that nearly all of the CNOs who participated reported excellent relationships with their staff team members. "The majority of CNOs reported good or excellent relationships with staff nurses (78%), nurse managers and directors (94%), senior organizational leaders (87%), and CEOs (79%)" (Jones et al., 2008). This clearly demonstrates that there absolutely needs to be more compelling policies in place to make retention and longevity in this field more organic. Thus, there needs to be a greater examination of the leadership process within the CNO work/practice environment. The findings from this study also point to the fact that there need to be conscious and real adjustments in the process by which CNOs are recruited. There need to be conscious efforts to recruit CNOs who have an active and passionate desire to promote patient care (Kompier, 1999).
One reason why CNOs are so incredibly vulnerable to high turnover and so consistently desire new careers after just a few years in their current positions is likely a result of the fact that these positions have dual sources of stress. One source of stress comes from the intensive administrative, bureaucratic and organizational issues that CNOs are responsible for (Alsop, 2008) (Dogbey, 2008) (Bern-Klug, 2013). They have to oversee the smooth execution of all actions within the nursing department, while circumventing some of the more robust landmines in care and effectiveness that can occur in the high-stakes world of professional nursing where life and death hangs in the balance each day. Another source of stress originates from the fact that there's so much emotional drain that comes with this job, even if CNOs don't have as much direct contact with patients. They are still directly in an environment which can be quite debilitating, and they directly oversee nurses who are often quite drained themselves. "Nurses care for ill, wounded, traumatized, and vulnerable patients in their charge. This exposes them to considerable pain, trauma, and suffering on a routine basis (Coetzee & Klopper, 2010; Hooper, Craig, Janvrin, Wetzel, & Reimels, 2010). While many nurses perceive their work as a calling, few anticipate the emotional implications and sequelae that come from their close interpersonal relationships with patients and families" (Boyle, 2011). Thus, both nurses and CNOs have to be able to exhibit high amounts of compassion when privy to the distress and suffering of those among them, while being able to nurture these individuals. If compassion fatigue is something which can negatively influence nurses, than it can no doubt have an effect, though a less understood one, on CNOs. If nurses are vulnerable to a minimized ability to nurture, as a result of the intense stress and fatigue that they're subjected to, it's quite possible that CNOs will also experience the heavy weight of environmental stressors, such as expanding workload and long hours, coupled with the need to respond to complex patient needs, including pain, traumatic injury, and emotional distress, resulted in nurses feeling tired, depressed, angry, ineffective, apathetic, and detached" (Boyle, 2011). In fact, it's quite possible that CNOs suffer from this type of emotional and mental damage, also suffering from somatic complaints, headaches and gastrointestinal issues. In fact, if nurses find that their symptoms escalate over time, it's quite possible that CNOs experience the same adverse affects. This is quite possible as both positions are jobs which require the professionals within them to ignore their own emotional needs, given the demands of the job and the situations they are constantly put under.

Statement of the Problem

The crux of the issue revolves around the consistent trend of CNOs around the nation continue to ask for early departures from their current positions. The general timeframe of departure rests at between two and five years of working in the position. CNOs generally hold their tenure for at least two years, but no more than five, on average. According to Jones (2008), over 66% of Chief Nursing Officers have been terminated, ask to resign, or voluntarily left the Chief Nursing Officer position. On the other hand, many of these professionals abruptly decide to engage in a career change when leaving this high-stress and demanding position. This trend is so disturbing as it suggests that there's an inherent issue with maintaining this position.…