gggg

Top CNO Worries: A Fall 2020 Update

2020 sparked what will forever be looked at as the year of the nurse. Our nation’s frontline health heroes answered the call when the world started changing in early March. Chief Nurse Officers had to push aside competing internal priorities and get to the root of their leadership role: advocating for the nursing profession. As we prepare for an end to summer, what are the top concerns of our nation’s CNOs?

Gauging the Impact of COVID-19 on Nurse Staff

Even before the pandemic, healthcare organizations were facing growing challenges in finding the nurses they need to compete and provide great care. But not CNOs really need to gauge the impact on staff. How did this event affect nurse stress and resiliency? What can be done to make positive steps to coping as a system/team. Nurse Directors and CNOs will likely spend months or years helping to give emotional first-aid to nurses who were on the front lines, as they process what has happened.

Prioritizing Nurse Resiliency from the Top-Down

Nurses are stressed! With the pandemic, recent nursing furloughs that led to employee financial issues, political unrest, or stress from children not being in school, nurse stress management and resiliency is more important than ever. How will CNOs help RNs feel prepared to tackle challenges the job throws at them?

CNOs will be encouraging nurse emotional breaks and stress management techniques. When huddling with work teams, nurse leaders will worry about how to teach self-awareness and how to teach nurses to recognize what they can and cannot control. CNOs know they desperately need to prioritize nurse satisfaction, productivity, and stress management, but it is an uphill climb.

At Children’s Hospital and Medical Center in Omaha for example, managers are trained to listen and provide safe spaces for nurses to talk through work stressors. Omaha Children’s early intervention program began with a need to address secondary trauma, then saw there was also a need to reduce workplace stress. CNOs across the U.S. are looking for the right resiliency strategies for their own organizations.

Preparing Staffing Models for a COVID-19 and Influenza Surge in Fall/Winter

No one knows what will happen in late Fall or Winter, but history shows that a non-vaccinated virus can have secondary spikes, more probable in cooler weather. CNOs are figuring out how to expand the acute care workforce as much as possible before this possible surge starts. Organizations are relocating staff from a variety of other care sites such as outpatient procedural areas, ambulatory care sites, and low volume clinics. CNOs are also increasing temporary staffing options: recruiting from pools of retired nurses, independent NP’s under temp contracts, student nurses, and recruiting faculty from academic partners.

After workforce expansion actions are taken, the next priority is to optimize deployment of this expanded workforce. CNOs are figuring out how best to ensure staff are prepared and that potential learning needs are addressed, and worried about how to best deploy staff to optimize staff experience and clinical competency.

Once staffing volume for a virus resurgence is addressed, preparation evolves to figuring out the stressful details of how to support that staff. For example, is the 12-hour shift excessive while staffing this pandemic? Can staggered shifts be supported? How can nurse leaders best leverage preceptors and nurse mentors? How is hazard pay addressed? How are new nurse graduates prepared? How can leadership best prepare ICU space and equipment/supply issues? And how can emotional support and stress-mitigation strategies be put in place before any surge hits? These are all questions our nurse executives are hoping to find answers for.

There are a lot of questions that have no answers for CNOs this winter that will affect staffing models. Will it be a bad flu year? Will populations, tired of distancing and putting off leisure activities, let their guards down near the holidays and cause mass viral outbreaks? Will a COVID-19 vaccine come, and will high-risk populations have adequate access to it? Or will they even trust it? Will pent up demand for non-essential/preventive care in Spring and Summer cause spikes in care volume needed later in the year? And how will a divisive election season affect population health?

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 cited 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. Some sources are showing that understaffing nurses can degrade the work environment and HCAHPS scores. Nurse recruitment is becoming more 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. Read our related article, “Millennial Nurse Retention Strategies.”

 Changing Technologies/Processes, plus Training to Manage it

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 challenging, 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 increase efficiency in 2020, but there are growing pains as this happens. And what new technologies or processes will arise because of the pandemic? Will some of the restrictive new rules from long-term facilities make it to acute care hospitals?

Turnover Within the C-Suite

Continuous consolidation of healthcare organizations and mass retirements of Baby Boom age leaders increase executive turnover rates. Churn in the C-suite can have a negative impact on financial performance, organizational development, and employee engagement. C-suite turnover creates a toxic environment of competing priorities that can distract organizations from providing high levels of patient care.

As the nation gets up from this gut-punch in 2020, will it lead to an even larger mass exodus in our systems’ C-Suite? That is uncertain, but we do know that hospital CEOs are taking pay cuts as COVID-19 financial losses mount, and capital projects are being terminated or postponed. With some bans on high margin non-emergency surgeries, workers being furloughed, and soon-to-come regulatory changes looming to prepare for future pandemics, it would not be unprecedented to see turnover within the C-Suite later this year.

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. Hopefully when we look back in time, we’ll see that the COVID-19 pandemic helped CNOs identify leadership potential where they had not yet seen it in junior staff (and perhaps the converse, re-evaluate where they thought senior leadership potential was present). One way to prepare young nurses is to equip them with leadership development opportunities. Making sure a first-time Charge RN has a good leadership experience is crucial for filling future Nurse Manager roles. 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?”

—–

BONUS – All About Nursing with Dr. Joyce Batcheller

Dr. Joyce Batcheller is an Executive Nurse Advisor with The Center for the Advancement of Healthcare Professionals for AMN Healthcare and is responsible for the development and delivery of two Chief Nursing Officer Academies: CNO Academy I, which was developed for new and aspiring CNOs and CNO Academy II, which was developed for experienced CNOs. Having served as a Chief Nursing Officer for more than 19 years in one of the largest healthcare providers in Central Texas, she has extensive experience in leading large system changes within a complex multi-hospital organization.

Dr. Batcheller’s podcast, “All About Nursing” explains how nurses play a significant role in providing healthcare in multiple care settings. You will be able to hear from some of these key nurses who work in practice, academia and other practice settings. You will hear about challenges nurses are engaged in as healthcare continues to experience an unprecedented need to decrease costs and improve outcomes. Recently, Dr. Batcheller interviewed Robyn Begley CEO of AONL and Kim Glassman who is leading work in NYC related to COVID-19. Listen to the podcast here.

Sources

“Dealing with COVID-19 Anxiety & Stress on the Front Lines,” Wolters Kluwer Podcast, April 13 2020

“Key actions CNOs should take now to staff for a Covid-19 surge,” Advisory Board, Carol Boston-Fleischhauser, JD, MS, BSN, CNO and Managing Director

“Healthcare News: Nurse Leaders Say Nurse Shortages Erode Patient Care and Staff Morale,” AMN Healthcare

“Hospital CEOs take pay cuts amid COVID-19,” Modern Healthcare, Stephanie Goldberg, May 11, 2020

“Working without a Playbook,” Emerging RN Leader, Rose O. Sherman, April 2, 2020

“The backbone of healthcare: 3 CNOs on what COVID-19 has taught us about nursing,” Beckers Healthcare, Mackenzie Bean, Gabrielle Masson, Anuja Vaidya, May 11 2020

“Maintaining hospital culture through C-suite leadership turnover,” Beckers Healthcare, Brian Hudson, April 23, 2018

“Second Victim Syndrome and COVID-19,” Emerging Nurse Leader, Rose O. Sherman, April 30, 2020

“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

“COVID-19 Hits Some Health Care Workers With Pay Cuts and Layoffs,” NPR, Martha Bebinger, April 2, 2020

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”

 

Sources

“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

3 Ways NCharge® Supports Magnet Applications

Transformational leadership is a key ingredient in establishing a nursing environment that achieves Magnet designation. Gradually, a transformational mindset should take root in the organization and become even stronger as other leaders adopt this way of thinking. Nurses in charge need to be developed, directed, and empowered to find the best way to accomplish the organizational goals and achieve desired outcomes. Where Transformational Leadership meets the Structural Empowerment domain is where Magnet nurses will shape dynamic change in healthcare and the nursing profession as a whole.

Magnet requires dedication of the entire nursing staff; it is almost 2020, and it is time to think about developing the first-level supervisory nurse, the nurse at the beginning of her career path. NCharge®: “Nurses Learning to Lead” can assist organizations either considering the Journey to Magnet Excellence, or in a re-application for Magnet status, within these application sections:

 

1) ADVOCACY AND INFLUENCE:
The CNO advocates for organizational support for ongoing leadership development for all nurses, with a focus on mentoring and succession planning. TL6 (pg. 32)

How does NCharge® support?

  • Partners with CNO to assure content delivery is aligned with priorities of the organization.
  • Introduces first-level nurse leaders to Value-Based Purchasing principles and financial implications of their work. It raises awareness of the importance of adopting evidence-based care standards, eliminating occurrences of untoward outcomes and adverse events, and improving patients’ experience of care. For a reference case study, read “Nemours Children’s Hospital Teaches Charge Nurses Financial Implications of Success.”
  • Supports the development of an adequate pipeline of future leaders who understand the CNO’s vision and how to drive to positive outcomes.
  • Demonstrates the organization’s investment in helping to assure that staff have a positive leadership experience, and pursue further leadership roles.

Provide an example, with supporting evidence, of mentoring or succession planning activities for clinical nurses.

How does NCharge® support?

  • Provides education on how to be a first-level nurse supervisor; it provides education to assist an organization’s future leaders to think critically, supervise, and lead change.
  • Assists with clinical nurses transitioning from a peer to leader.
  • Assists with creation of multiple Personal Action Plans and topics, to aid in creation of ways to use information learned when back in the unit.
  • Reinforces exercises like the 5 Rights of Delegation Model to help prepare first-level nurses for planning to lead a team, which is key for succession planning. Classes prepare leaders for qualities they will need, like teamwork and collaboration, ego management towards self/staff, innovative thinking, adapting to rapidly evolving roles, and confidence with compassion. For a reference case study, read “East Alabama Medical Center Develops a Nurse Succession Plan.”

 

2) STRUCTURAL EMPOWERMENT DOMAIN – Commitment to Professional Leaders
Structural Empowerment processes developed by influential leadership to create an environment where professional practice flourishes. Staff need to be developed and empowered to find the best way to accomplish goals, and reference the Forces of Magnetism for pillars like the image of nursing and professional development.

How does NCharge® support?

  • It includes the development of the trainers and builds the pipeline of future leaders. Professional development includes:
    • Transitioning from peer to leader
    • Leading quality initiatives
    • Critical thinking integrated with the Charge Nurse role in driving process improvement
    • Change leadership integrated with the Charge Nurse role in leading compliance and other quality initiatives
    • Confident communication, conflict management, and delegation
    • Employee engagement strategies, led by nurses, integrated with patients’ experience of care

 

3) ACCOUNTABILITY, COMPETENCE, AND AUTONOMY: • EP14 (pg. 47)
Resources, such as professional literature, are readily available to support decision-making in autonomous nursing practice. How does your organization provide a dynamic learning environment that enhances the professional practice environment skills to build confidence and competence to manage common challenges Charge Nurses encounter?

How does NCharge® support?

  • NCharge® teaches keys of critical thinking for Charge Nurses. Courses teach evaluation and building initial analysis of making decisions, determining merit of information, and placing a judgment. It teaches deductive reasoning, inductive reasoning, and using these tools to apply towards decision-making and critical thinking concepts. One course, Critical Thinking for Charge Nurses, teaches essential traits of critical thinkers with situations that Charge Nurses encounter.

 

For more information on how NCharge supports the Magnet Application or Reapplication, CLICK HERE.

Are you attending the Annual ANCC Conference in Orlando in October? CLICK HERE to set up a quick meet and greet with our team.

Charge Nurse Traits Which Clinical Nurses Value Most

Every nurse early in their career has had a Charge RN they did not want to work under on a shift. Ineffective shift leaders may lead “reactive” instead of proactive, be pessimistic, unpredictable, poor under stress, or may even find it challenging to relate to other nurses viewpoint. This is why nurse leaders with high tenants of Emotional Intelligence (EI) are effective, as they are able to consciously align their behaviors toward a desired outcome.

There have been many articles written about the relationship between high EI and effective leadership. Books like Emotional Intelligence 2.0 by Dr. Travis Bradbury and Dr. Jean Greaves gives a framework for why EI is especially important in healthcare. The more complex an organization is, the more it needs leaders who can navigate complex issues and work relationships. EI enables a nurse leader to gain trust and understand emotions. Cognitive skills are important too of course, but not as important as EI in complex healthcare systems.

While EI frameworks provide lists of skills and personality traits needed for effective leadership, what exactly are the top traits which clinical nurses cite looking for in their floor leader, the Charge Nurse? As Carol Holm identified in her presentation “Attributes in Leaders Most Desired by Clinical Nurses” at the AONE 2019 Annual Meeting, adaptability, stress management, empathy, and assertiveness are the EI attributes most desired by clinical nurses.

Adaptability
Adaptability is how a Charge Nurse shows potential for change management. It is the flexibility and willingness to adapt to new conditions. Here is a quick example: Recall a situation where bed capacity is an issue on the floor. A Charge is asked to put estimated discharge dates into records as well as likely beds to become available for patient placement. Charge Nurses may be asked to forecast throughput and document better practice. Charge RNs have to follow up with clinical nurses to be better at disclosing information for records. Some Charge RNs can engage clinical nurses to be better and get buy-in to processes, and some do not. Clinical nurses look for a leader to push towards doing their records better, and organizations rely on adaptable leaders to champion change and processes.

Stress Management
The next most important trait which clinical nurses desire for their Charge RN is the ability to handle stress. Clinical nurses have all been through situations where the team is short-staffed due to call-ins or other factors, and a floor leaders ability to rally a team is vital. Besides just morale, what about a stressed out patient or patient’s family member with unrealistic expectations for that shift? A Charge RNs ability to support co-workers during times of stress is critical and supports the entire team.

Empathy
Empathy in a first-level supervisory nurse is a top correlated trait with clinical nurse job satisfaction. It is the ability to stand in someone else’s shoes and see other viewpoints. When “life happens” to bedside nurses, they want to feel like the Charge Nurse is there for support. And when empathy is not demonstrated, it leads to low nurse job satisfaction. Especially during nursing shortages, this is a top personality trait, and is also a crutch pillar of high EI.

Assertiveness
This is the 4th highest rated trait which clinical nurses look for in a Charge RN. Nurses want a Charge RN who can stand up for the team and be forthright with leadership when appropriate to do so. This is the ability to say in a non-offensive way what needs to be said, and when to say it. For example, a Charge needs to be able to advocate for additional support in a particular shift, possibly due to the acuity on that shift. Having an assertive nurse leader is also linked with patient safety and quality of care.

While these are the top 4, other important traits which nurses look for in their first-level supervisory nurse are optimism, self-motivation, social awareness, and impulse control. In total, these eight traits are vital to having high EI and leading teams.

How can healthcare institutions encourage a culture of high EI?
• Promote nurses into leadership with identified traits of success – adaptability, stress management, empathy, and assertiveness.
• Use EI testing to screen nurse leader applications
• Encourage sharing of EI assessment scores among nurse co-workers. Have Charge Nurses find improvement areas by choosing a trait of impact focus based on their EI scores, and have them work with a colleague, mentor, or coach on that area of focus. There are many EI tests available for purchase.
• Purchase courses or libraries for EI education/training for Charge Nurses. Integrate Charge Nurse training into position descriptions, and use this nurse leadership development as a catalyst to start conversations on how to be an effective Charge RN.


Catalyst Learning offers its series NCharge®: “Nurses Learning to Lead.” Courses like Charge Nurse Fundamentals offer learning objectives like application of qualities for successful Charge Nurse leadership. It also teaches nurses to create an individual action plan to identify challenges and maximize opportunities faced in a complex hospital environment – a skill crucial to EI. A second NCharge course, Critical Thinking Skills For Charge Nurses, teaches nurses to apply critical-thinking skills to the decision-making process. Feel free to contact us to learn more.

“Attributes in Leaders Most Desired by Clinical Nurses”

Carol Holm at AONE 2019, Oregon Health & Science University and Academic Medical Center

How the CNO Drives Nurse Engagement

What is employee engagement? Gallup defines it as the level of commitment, passion and loyalty a worker has towards their work and their organization. CNOs can take action to drive nurse engagement; in fact Magnet hospitals are even graded on engagement metrics like leadership access/responsiveness and RN to RN teamwork and collaboration.

To help a nurse executive to be “visible” and lead organizations with dedicated nurses, here are a few tactics a CNO can use to drive nurse engagement:

Be Intentional About Nurse Recognition
One employment stat by Gallup shows that employees who receive senior-level recognition 3x or more in a quarter are twice as likely to stay with an organization. So recognize good work! Here are a few examples:
-Publish good works on the health system intranet, or even start a company/unit newsletter.
-Have contests tied to recognition received. Let the prize be “Be CNO for a Day!” Your nurses may even appreciate how hard it is to run a hospital.
-Celebrate your nurses’ certifications. Show that professional growth is noticed, valued, and contributes to long-term hospital success.

Enforce Patient Stories, Periods of Caring
Remind your nurses why they became a nurse, and give permission to spend time with patients, and collect stories from care and patient attention given. Let nurses know it is important to hold onto these moments and share if possible. A few examples:
-Redesign/Rethink the Care Delivery Model. In doing this, work in solutions to give nurses time at the bedside. Some nurse leaders adopt Swanson’s Caring Theory, which calls for nurses to take 5-minutes to get to know their patients. Ask nurses to share these stories from moments of caring.
-Give positive reinforcement to nurses for telling stories of caring. One CNO from Baystate Medical Center (MA) is so serious about enforcing stories of caring, that she passes out coffee shop gift cards at random intervals if a nurse can quickly tell her a unique patient story and how care delivered impacted the patient and nurse. This reinforces the importance of periods of caring, and shows nurses it is OK to spend a few moments just talking with patients and learning about them.

Increase Nurse Autonomy, and get Nurse Feedback
Think about a more collaborative shared governance model, and make sure your leaders buy-in. Shared governance will not work without the backing of managers and directors. Plus use a few of these tactics to show nurses you trust their judgment and ideas:
-Create nurse councils to address issues which leadership may not be noticing. For example, start a “night shift council” that meets monthly. Issues the night staff nurses face may be much different from other nurses. Night shift nurses may not deal with staffing issues for instance, they may have problems arising from Nutrition or Environmental Services which can more easily be fixed with attention and planning. And with a council, nurses will see that their input is being listened to.
-Increase the number and availability of nurse driven protocols.
-Use surveys to learn about nurse frustration points which may otherwise go unnoticed. You may not like what you hear, but you may also find out that untrue organization rumors are driving negative perceptions, giving you an opportunity to dispel rumors or false gossip. CNOs have enough on their plate without having to deal with issues that are imagined or perceived. And with surveys, don’t hand them out during busy periods and ask for them back in 5-minutes. Give your nurses a quiet moment to reflect off-the-floor, to help make answers meaningful.

Be Visible
Show your nurses that you are a part of the team and understand their issues:
-Consider doing a bi-weekly open coffee time, where nurses can come talk to you about issues they are facing.
-Be the first cheerleader when recognitions, certifications, or professional growth are achieved. Others will follow your lead and create a ripple effect.
-Since a CNO can’t be everywhere and cannot possibly “coach” every associate, assign a senior nurse resource for less experienced nurses. This will allow for discussions and mentoring without nurses feeling fear of retribution for speaking out or voicing concerns.

Organize a few “big deal” events
Plan fun outings or events to show nurse appreciation. Let nurses know that the organization doesn’t work without them! Feel free to tie “big deal” events to stories/periods of caring (previously mentioned):
-Don’t over think it here, have a “decorate an Easter basket contest,” a Yoga retreat, organize a dance class, go to a baseball game. Celebrate and recognize caring behavior as a group.
-Volunteer as an organization or get involved in the community somehow.
-Establish a few self-care practices or resources internally to help nurses build resiliency and work-life balance. Even if they do not participate it will show you value well-being.

Sources:
-AONE 2019 session, “Let’s Get Visible, and Drive Nurse Engagement;” Christine Klucznik, Baystate Medical Center
-“Tips from CNOs on Increasing Nurse Engagement in 2018;” Avant Health, Shari Costantini