Major Challenges for Chief Nursing Officers in 2016

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. The following is a list of current nursing challenges from 27 Chief Nursing Officers from healthcare organizations primarily in South Florida interviewed in 2016:

Recruitment and retention of staff – the shortage is back
A laser focus on performance metrics
Patient safety with skill mixes that include a significant percentage of new graduates
Turnover of C-suite colleagues
Maintaining staff and leadership alignment with organizational initiatives in an environment of relentless change
Less control at the local level – more centralized corporate decision making and mandates
Increasing issues with behavioral health in the patient population – limited mental health resources and referral networks
Declining reimbursement under the Affordable Care Act – cost versus quality is always an issue
Rising labor costs and use of contract labor to fill vacancies
Very high turnover of millennial nurses in the first two years of practice
Professional disengagement of nursing staff
Being asked by the executive team to make tough decisions that the CNO does not always agree with
Bundled payments specifically concern about the cardiac bundles that are coming in 2017
Preceptor burnout
Staffing is a growing challenge – sign on bonuses a new norm
Avoiding leader burnout – both for the managers and executive leadership team
Maintaining performance above the national benchmarks – the goalpost keeps moving
Assuming risk for what patients do at home after discharge
An increasing number of Baby Boomer Nurse Retirements – their loss of their knowledge
A complex patient population – more empowered, demanding
Maintaining excellent customer service scores in an era of increasing expectations
Nursing staff resistance and lack of knowledge about changes in the healthcare environment

Many of these challenges are unchanged from 2015 but there is a notable increase in the number of Nurse Executives now reporting recruitment and retention issues.