Nurses in executive roles like Chief Nursing Officers (CNOs) build bridges between various members of the healthcare team, between healthcare team members and patients, and also between the legislative environment and organizational practices. In a position of leadership, the CNO also sets the tone for organizational culture. An interview with CNO Oakes reveals some of the most pressing trends and issues impacting the role of CNO and also the healthcare organization as a whole in a dynamic environment. Themes include those related to recruitment and retention of healthcare staff, managing organizational change, collaboration and communication with various members of the healthcare team, workplace incivility, emotional intelligence, team-based communication strategies, regulatory demands, and learning environments. Recruitment and Retention of Staff

Employee turnover is one of the most pressing issues for nurse leaders and administrators today (Oakes, 2018). Research even shows that turnover rates are high among nurse leaders in executive roles including CNOs themselves (Havens, 2008). Jones (2008) in fact claims that high rates of turnover signals a “crisis brewing,” placing the responsibility upon nurse leaders “to develop strategies and policies aimed at recruiting and retaining” top talent in their organizations (p. 89). Organizational culture and related issues such as workplace environment and managerial practices are generally cited as the primary reasons for high turnover rates or the inability to attract the type of nursing staff the CNO would otherwise prefer (Jones, 2008). Oakes (2018) pointed out that the organization she operates dramatically transformed its organizational structure and culture five years ago, yielding promising results such as a lower rate of turnover among nursing staff, increased pathways to promotions and positions of leadership for minorities, and increased recruitment of nursing staff in key areas of specialization including geriatrics.

Managing Change

The CNO serves in multiple roles at once, sometimes with seemingly competing or conflicting objectives (Oakes, 2018). Managing change within the organization is one of the primary functions of the CNO, who often conducts data-driven needs assessments that drive change or assessments of change strategies and interventions (Stamps, McCormack, Lovetro, et al., 2017). Resistance to change is a serious concern among nurse leaders, including many members of Oakes’s staff (Oakes, 2018). Managing change can involve seemingly simple procedural changes in nursing practice based on emerging evidence-based guidelines, and yet even then, nursing staff may resent the intrusion on their habitual practices and lack the foresight or knowledge to implement the recommended or required changes. Change within the organization can also be drastic, as the structural changes that took...

Structural changes involved a wholesale reassessment of each department: its function, its role, its relationship with other departments, and its budget. Organizational structure had been hierarchical prior to the change, whereas now the healthcare facility has flattened somewhat while still retaining the benefits of role clarity (Oakes, 2018). Change always needs to be initiated, implemented, and assessed according to organizational mission, vision, and values with patient outcomes, patient satisfaction, safety, and quality of care the primary issues (Stamps McCormack, Lovetro, et al., 2017).
Collaboration and Communication

One of the cornerstones of effective nurse leadership is the ability to foster interprofessional collaboration and communication. Research shows that poor communication between members of the healthcare staff is associated with poor patient outcomes (Foronda, MacWilliams, McArthur, 2016). At the very least, nurse leaders and CNOs should be considered about the ethical ramifications of allowing poor interprofessional collaboration and poor communication to become normative. To promote effective interprofessional collaboration and communicaiton, nurse leaders need to play an active role. Teams need to be formed, engaged, and formally trained to work together as a matter of course (Oakes, 2018). Research substantiates Oakes’s (2018) claims that training programs are important because “standardized tools and simulation are effective in improving interprofessional communication skills,” (Foronda, MacWilliams, McArthur, 2016, p. 36). When the ultimate goal of healthcare shifts to improving patient outcomes, patient communications, and the overall patient experience, nurse leaders can shift their entire approach towards managing staff and motivating nurses and physicians to work together. Oakes (2018) also points out that her goal as CNO is to inculcate a new model of healthcare governance in her organization, under the rubric of shared leadership distributed among various members of the healthcare team. When nurses are empowered to be team leaders more often, patients experience improved communication and transparency and report better impressions of staff and overall quality of care (Oakes, 2018).

Workplace Incivility and Violence

Workplace violence and incivility is a shockingly commonplace problem, with over 75% of all nurses reporting some type of incivility including verbal abuse and physical abuse (Speroni, Fitch, Dawson, et al., 2014). Healthcare environments can cause tremendous stress for patients and their family members, requiring a compassionate and empathetic approach to situations like these (Oakes, 2018). Patients, but also their family members, can perpetrate verbal or physical abuse out of frustration, fear, or anger (Oakes, 2018). However, it is also important to…