Top Worries of CNOs in 2020

CNOs have a stressful role – it is tough being the biggest advocate for nurses in a healthcare organization, when up to 35% of the staff are nurses. There is a lot at stake and a lot of associates to lead. CNOs are responsible for quality, safety, patient satisfaction, labor, regulatory, compliance, budgets and the professional advancement of the members of their team. So as we peek into the new decade, what are the top concerns of CNOs?

Nurse Shortages and Attrition Leading to Erosion of Patient Care and Staff Morale

Healthcare organizations are facing growing challenges in finding the nurses they need. According to the AMN Healthcare Study “Worsening Shortages and Growing Consequences: CNO Survey on Nurse Supply and Demand,” many CNOs are citing that the nurse shortage at their organization is moderate to severe, and most say that this problem will become worse instead of better in the next five years. CNOs see shortages negatively affecting key components of care delivery: patient satisfaction, quality, and staff morale. And CNOs say the two greatest challenges to nurse recruitment are the lack of access to high-quality talent and the location of their organization; neither of those factors can be changed from within the organization itself. Some sources show that understaffing nurses can degrade the work environment and HCAHPS scores.

Nurse recruitment is really competitive now too, with salaries rising higher and higher. Nurses demand more perks, like flexible schedules. Hospitals are seeing nurses leaving for easier 9-5 shifts in outpatient settings, and jumping from system to system in pursuit of sign-on bonuses. Even in geographies where a nurse shortage is not as big of an issue, the nurse pipeline is primarily graduate nurses. Nearly 4 million millennials will enter the nursing profession from now until 2030 according to a recent Health Affairs study, which is a good thing. But there will be issues with dwindling workplace clinical and leadership experience on staff.
Read our related article, “Millennial Nurse Retention Strategies.”

Changing Technologies and Associated Training to Manage it

Nurse executives have been feeling technology fatigue lately, because of all the staff training involved. EHR, automated IV pumps, portable monitors, medication bar code scanning, smart beds, and centralized command centers are just a few recent tech upgrades. Besides just frustrations with scheduling constant training sessions, health IT can contribute to nurse burnout, as it demands more of nurses’ time. Work interruptions from constant alerts and alarms is hard, and if nurses see added IT processes with no measurable impact, it leads to more frustration. Systems are looking to technology to streamline work and make it more efficient in 2020, but there are growing pains as this happens.

Risk Pushed to Systems, Changing Politics, Changing Landscape

The Centers for Medicare and Medicaid Services (CMS) is accelerating risk-based payment models onto health systems, tying more Medicare payments to quality metrics. CMS got the ball rolling with its value-based programs and commercial insurers have followed behind. This leaves the strategic apex of health systems to manage the added uncertainty and risk associated with being reimbursed for outcomes. According to a recent survey by KPMG LLP, the U.S. audit, tax and advisory firm, a majority of healthcare providers expect their organization’s finances to suffer with the moves to value-based care. There is also uncertainty over what will happen in the upcoming big election in late 2020, and what that will mean for health delivery and payment. Some political candidates are campaigning against private insurers in lieu of paying providers CMS-level rates, which are lower margin or even below margin for services. While this may keep a hospital CFO up at night more than a CNO, uncertainty in the short-run is frustrating for all executives.

Disengaged Staff

A high-stress work environment can cause nurse burnout, which leads to disengagement on the job. Improper staffing levels caused by the nurse shortage is a factor in creating a stressful work environment. Professional growth and proper staffing levels are required to avoid disengagement.

Turnover Within the C-Suite

Continuous consolidation of healthcare organizations and retiring Baby Boom leaders are influencing these executive turnover rates. Constant change in the apex of an organization negatively affects care planning, and can lead to frustration and confusion on where the organization is headed.

Lack of Transformational Nurse Leaders – Young Nurses Not Pursuing Leadership

As Baby Boom nurses are retiring or cutting back hours, there is a void in leadership and experience. It makes sense that young nurses should apply and fill these leadership voids, but often times they do not. Finding good Nurse Managers is especially tough. Managers are responsible for staff, overseeing patient care, scheduling, meetings, and personnel and budget decisions. It comes with stress and work-life balance issues. See our related article, “Why Are Many Young Nurses Not Applying For Manager Roles?”

Another reason for young nurses not filling manager roles is that they had a bad first leadership experience, in the Charge RN role. If a nurse had a bad first leadership experience, his/her willingness to try another managerial position could be low. Some research shows that fear of failure is especially prevalent with Gen Y nurses.

There are many reasons why your young nurses may not be applying for management roles. In order to do more effective succession planning, pay attention to environmental factors in your unit that hinders willingness to accept leadership responsibilities. A program likeNCharge®: “Nurses Learning to Lead can help prepare your Charge Nurses for their first role in management. Courses like Charge Nurse Fundamentals, Critical Thinking for Charge Nurses, and Supervisory Skills for Positive Outcomes help young nurses practice skills like managing conflict, collaboration, delegation, and critical thinking. These courses learning objectives are also tied to business skills like learning about hospital financial indicators and how nursing work ties to VBP. NCharge® also helps participants understand financial indicators of success, and prepares nurses for higher level conversations to assist the Nurse Manager.

See related article, “6 Reason to Budget for Charge Nurse Development in 2020”



“Healthcare News: Nurse Leaders Say Nurse Shortages Erode Patient Care and Staff Morale,” AMN Healthcare
“Worsening Shortages and Growing Consequences: CNO Survey on Nurse Supply and Demand,” AMN Healthcare
“10 things keeping health system CEOs up at night,” Beckers Review, Molly Gamble/Ayla Ellison
“Top CNO Concerns,” Kristin Whitehead, HealthLinx
“Worries of the health system CEO,” Medi Leadership, September 27, 2019
“Nurse burnout? Try telehealth, clinical decision support and analytics tools, experts say,” Healthcare IT News, Bill Siwicki