Major Challenges for Chief Nursing Officers in 2014

By Rose O. Sherman, EdD, RN, FAAN

“Balancing optimism and realism, intuition and planning, faith and fact can be difficult. But that is what it takes to be effective in navigating leadership.” John Maxwell

Each year in my Introduction to Nursing Leadership graduate course, my students select a chief nursing officer in a health care agency to interview. The students have a list of questions that they ask and then add some of their own. I enjoy these reading these interviews because they highlight the changing challenges in today’s health care environment. Each year during the past twelve. I have had to opportunity to learn through the eyes of the CNO the major challenges that they face in their roles. Here is a list of current nursing challenges from 30 Chief Nursing Officers interviewed in 2014.

Maintaining performance above the national benchmarks.
Assuming risk for what patients do at home after discharge – managing their care across the continuum.
An increasing number of Baby Boomer Nurse Retirements – loss of their knowledge and loyalty.
A complex patient population – more demanding.
Finding competent nurse leaders to manage our frontline units.
Stimulating staff engagement.
Helping staff to understand that we are in a value-based care environment.
Lowering costs but maintaining quality.
Keeping adequate staffing ratios in a challenging economic environment.
Juggling all the balls and keeping my own stress level under control.
Promoting better teamwork among all staff.
Responding to an ever changing environment and the challenges – Ebola is a great example.
Regulatory compliance in an era of revenue compression.
Retaining our best and brightest – turnover is increasing.
Lack of Senior Leadership Appreciation of the Pending Shortages of Staff.
Maintaining excellent customer service scores because it impacts our bottom line if we don’t.
Nursing staff resistance to changes in the healthcare environment.
Keeping the workforce happy in a time of economic pressures.
Finding staff with the right set of competencies.
Encouraging staff to continue to be lifelong learners and to go back for their BSN and MSN

As we can see from these answers, many of today’s challenges identified by nurse executives are symbolic of a health care environment where there has been a clear mandate for change. With the implementation of health reform – there are more performance metrics that they are accountable and care is now value-based. This is the first year in the last five where recruitment and retention is again resurfacing as a challenge. Many CNOs mentioned the retirement of their baby boomer nurses as being very challenging. Younger staff come in with less experience and different ideas about organizational loyalty. Economic pressures in hospitals from decreased reimbursement have put pressure on staffing. CNOs are assuming responsibility for care across the continuum with the decreased reimbursement when a patient is readmitted within 30 days.

Bob Johansen in his book Leaders Make the Future has described today’s world as a VUCA environment characterized by volatility, uncertainty, complexity and ambiguity. Few nurse executives interviewed for this assignment would disagree with this assessment. Meeting these challenges involves a need for innovative thinking and the engagement of all staff. The business of caring and the work done by chief nursing officers is important perhaps today more than ever before.

Read to Lead

Johansen, B. (2012). Leaders make the Future: Ten New Leadership Skills for an Uncertain World. San Francisco: Berrett-Koehler.