Chief Nursing Officer Role: Key Trends and Leadership Issues

Introduction: The CNO's Bridging Role

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 between the legislative environment and organizational practices. In a position of leadership, the CNO also sets the tone for organizational culture. An interview with a practicing CNO reveals some of the most pressing trends and issues impacting the role of the CNO and the healthcare organization as a whole in a dynamic environment. Themes include 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. Research shows that turnover rates are high even among nurse leaders in executive roles, including CNOs themselves (Havens, 2008). Jones (2008) claims that high rates of turnover signal 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).

The interviewed CNO pointed out that her organization dramatically transformed its organizational structure and culture five years ago, yielding promising results: 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 Organizational Change

The CNO serves in multiple roles at once, sometimes with seemingly competing or conflicting objectives. 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 evaluate change strategies and interventions (Stamps, McCormack, Lovetro, et al., 2017). Resistance to change is a serious concern among nurse leaders and nursing staff alike. Managing change can involve seemingly simple procedural adjustments in nursing practice based on emerging evidence-based guidelines, and yet even then, nursing staff may resist intrusions on their habitual practices and may lack the foresight or knowledge required to implement the recommended or required changes.

Change within the organization can also be drastic, as was the case with the structural changes that took place in the interviewed CNO's organization five years ago. Those 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. 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 as the primary considerations (Stamps, McCormack, Lovetro, et al., 2017).

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