Major Challenges in Executive Nurse Leader Roles Today

By Rose O. Sherman

“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 ten, 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 21 Chief Nursing Officers interviewed in 2012.

Expectations are high and resources are limited.
Maintaining my energy level to lead through the multiple initiatives that nurse executives are now accountable to monitor.
The impact of Medicare cutbacks on our agency.
Maintaining the level of customer service that our patient expect.
Achieving a balance between quality nursing care and financial responsibilities of the institution.
20% of our current patients are uninsured unpaid care is having a dramatic impact on our budget.
Achieving the right level of staffing in the face of declining resources.
Adjusting to the rapidly changing health care environment.
Implementation of a fully electronic medical record.
Helping staff remain engaged with their work.
Managing a diverse, multigenerational nursing workforce with many different needs.
Doing more with less and being asked to continually improve efficiency.
Achieving high scores on all the various performance measures.
Improving our 30 day patient readmission rates.
Maintaining quality and avoiding variability.
My own work-life balance.
Justifying resources to continue the professional development of our staff.
Cutting back where we can on our labor costs.
Managing my own time.

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. The cost of care in the United States has skyrocketed to an average cost of over $8000 per year per person. Left unchecked, we could spend over $13,000 per person by 2018. Whether we like it or not, health care is a business and under tremendous pressure to reduce costs. This has been the focus of the recent health care debates. Historically, providers and hospitals have been paid by the volume of care given. This system changes with the Affordable Care Act. Payment incentives are quickly moving away from volume toward a greater focus on value of services and health outcomes, including fewer hospitalizations.

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.