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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?”

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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

Preparing Millennial Charge Nurses To Be Successful Leaders

In a busy and stressful nursing unit, the first-level supervisor nurse is very important. The Charge Nurse is responsible for care delivery and ensuring procedures are running smoothly. They look for outcomes, think about success indicators, and are responsible for a team. Clinical knowledge alone is not enough for a nurse to fulfill this role. Charge Nurses need to be prepared to lead teams and manage different viewpoints, personalities, and motivations.

As Baby Boomers retire and younger generations fill in more of these roles, there can be a talent crunch in many U.S. health systems. Older nurses leaving means years of insight and experience is lost, and this hurts an organization’s performance and efficiency. Talent loss is one of many barriers which young Charge Nurses need to overcome as they manage teams. For more information on this subject, see our article 9 Leadership Barriers Charge Nurses Face.

How can U.S. healthcare organizations set up the Millennials, our younger generation of nurses, for Charge Nurse success?

Prepare Young Charge Nurses! Provide Leadership Courses with Actionable Content Built Directly for that Role

The best way to set up millennial nurses for leadership success is to directly teach Charge Nurse situational leadership in your organization. Role uncertainty or ambiguous job responsibilities leads to confusion, so build defined job responsibilities for the first-level supervisory nurse and teach to it. Prepare Charge RN’s with the behavioral skills they will need, including communications, critical thinking, switching from peer to leader, supervisory skills, and financial awareness. Early preparation for the Charge RN role will also boost retention and encourage your next wave of leaders to apply for Nurse Manager roles in the future. If a nurse has a bad first leadership experience, they are often unlikely to pursue further management roles, or could even pursue other employment.

Consider a curriculum like NCharge®: “Nurses Learning to Lead” to prepare nurses with the leadership and behavioral skills they will need to be successful. Courses like Charge Nurse Fundamentals, Critical Thinking for Charge Nurses, and Supervisory Skills for Positive Outcomes will help boost behavioral skill learning. These courses also teach business objectives in nursing, like using critical thinking to make informed decisions, the financial implications of value-based purchasing, and implementing strategies to improve staff productivity. Another course, Managing Multigenerational Conflict, can help young Charge Nurses to understand other generations’ work tendencies, and how to apply a 3-step framework to communicate effectively and motivate high performance on work teams.

Teach Conflict Resolution and Communication

When Catalyst Learning surveys Nurse Directors and VPs about skills they need from a Charge Nurse, we see that dealing with conflict is usually top of list. Conflict is unavoidable and problematic, so nurses with strong conflict resolution skills are better able to deal with challenges quickly and reduce potential errors stemming from it. Teach young nurses how to gain trust before conflict arises, how to separate the person from the problem, and how to demonstrate empathetic listening. Conflict resolution will help young nurse leaders to be more successful. See our article, “Nurse Conflict Resolution Strategies.”

Also encourage (or teach) communication skills to new Charge RNs. This will help with decision-making and will help that nurse build trust with a team. Part of communication is delivery of information; delivering bad news to a team is part of the job, so doing so without ruining team morale is critical to the role. Plus, if the team leader can effectively communicate information, the team will follow her example. Teaching nurses how to communicate and resolve conflict is very important in setting up Millennial nurses for leadership success.

Ease Transitions to New Leadership Roles

The experience for a new nurse leader in past decades may have felt a little bit like a “sink or swim.” But with growing demands on Charge Nurses, plus with Millennials craving more feedback than prior generations did, health systems should find ways to ease the transition to leadership. One way to do that is help new Charge Nurses to find a mentor who can offer support and encouragement. The mentor can be another Charge Nurse or manager within the organization. They do not need to be in the same specialty, but should be someone who can provide support and help build leadership ability, emotional intelligence, and confidence.

Another way to ease transitions to leadership roles is a nursing residency program. This can help create the nursing workforce pipeline needed to provide experienced and quality care. These longer-term programs enable participants to hit-the-ground running, and build a solid foundation for future leadership roles.

Set up Realistic Expectations, and Plan for Success

A first time Charge Nurse can fail if an administration does not give clear goals and role expectations. Sit down with a first time nurse leader and discuss issues that can arise, ask what concerns a new Charge has about the role, and set up any applicable goals that are necessary. One part of setting up realistic expectations may just be talking about delegation and how a leader is not expected to take on all the work themselves. See our article, “Charge Nurses & Delegation.”

Make sure your new leader is comfortable with policies and procedures. Discuss with her how to communicate with Nurse Managers, and what success looks like from management’s eyes. Discuss with your new leader how her unit supports the larger goals of the organization, and what internal resources are available to her if needed.

“Charge nurse: What’s in a name?” Beckers Hospital Review, Nich Chmielewski and Larry Faulkner, May 17, 2018

“Staffing challenge: How to manage a new generation of nurses” Beckers Hospital review, Marcia Faller, June 2017

“The best strategies to engage millennial nurse leaders,” Beckers Hospital Review, Laura Dyrda, February 2016

Tips to BOOST your Nurses’ Confidence

No one said nursing was easy. There are days when your nurses will be stressed out and possibly feel hesitant about their own abilities. Nurses may ask themselves “Is this something I can handle?” or “Can I really do this my entire career?” New nurses straight out of school may acknowledge that they have the clinical know-how, but don’t feel ready to face real life challenges or high acuity patients.

While executives are working on higher-level system initiatives like nurse retention planning and staff development, are there simpler ways to keep nurses happy and engaged? Here are some tips to help boost your nurses’ confidence:

Teach Personal Boundaries

Encourage your nurses to have personal boundaries; this is code for you cannot please everyone. Teach nurses, especially young ones, to be selective about what personal information they share with other nurses and staff. Teach your nursing staff the fundamentals of Emotional Intelligence, most notably keeping emotions professional. Boundaries are important in successful nurse-patient relationships as well. Teach your nurses where their responsibilities begin and end and how to assert those boundaries when tested.

See our related article, “Emotional Intelligence in Nursing – Six Key Traits.”

Build Bully-Proof Nurses

Lateral violence is no longer the hidden secret of the profession, and being bully repellant is sadly necessary. Physicians can also bully nurses; nasty workplace behavioral practices exist. But if nurses have a strong sense of self and know what they stand for, they can make themselves less likely to be a target for a bully. Bullies are attracted to low self-confidence and nurses with timid communication styles, so teach nurses to be assertive. Also teach your nurses the more subtle forms of bullying to watch out for. While physical violence is an obvious form of workplace bullying, there are other bullying techniques: peers setting peers up for failure, sabotaging work, gossip, or giving misleading/false information. If your nurses know these patterns, they can better prepare themselves to deal with it and possibly even combat it.

See our related article, “The Nurse Bullying Phenomenon.”

Teach Nurses NOT to Compare Themselves to Others

Unfortunately, we live in a culture where everyone seems to care about what others are up to. But there is little that can shatter confidence faster than comparing oneself to others. It is good for young nurses to have senior nurses/administrators to serve as inspiration for a career path, but teach your staff not to look down on their own abilities by comparing to others. You can also teach senior nurses not to inflate their own ego just because they are superior in some competencies. Even very experienced nurses can see their confidence get shaken at times.

Set Your Nurses Up with a Mentor

A career mentor is important in any career, but especially in nursing. A mentor can encourage nurses when frustration sets in, and give new perspectives. Start a nurse mentor program at your facility, whether formal or informal. For nurses, knowing that they have someone in their corner can give confidence. If a mentor program isn’t possible, encourage your supervisors, instructors, and directors to build stronger relationships with nursing staff. Have these senior staff members take nurses out for coffee or get some 1×1 moments in a judgment free mindset.

If there is anyone who knows the ins and outs of a facility, it’s the people who have been there the longest. Teach your nurses to model their work ethic after someone who is excelling in their role.

Teach Nurses that Perfection Isn’t Real

When in small groups with nurse staff or at 1×1’s, remind your staff that no one is perfect. It is better to admit a mistake or flaw than it is to make an excuse for it. Confident nurses are able to admit when they are wrong. By acting defensively after a mistake, it hurts confidence instead of boosting it. Possibly share mistakes or flaws that you had as a bedside nurse, and assure staff that all great nurses had moments they wish could be taken back.

Let your nurses know they do not have to personally know everything. Giving great care doesn’t mean nurses are on an island; teach nurses to flip the script. For example, when they don’t know what to do with a patient in distress, teach them to leverage the collective knowledge of the nursing team around them. Let the group figure out next steps. Having the ability to gather information and consensus is more important than the personal clinical knowledge to figure it out solo.

Help Your Nursing Staff to Engage in Lifelong Learning

Learning new skills and acquiring new experience contributes to both confidence and competence. As your nurses learn and develop, they will become more effective nurses. They will also be more confident nurses and better leaders. While knowledge is power and well-educated nurses will naturally be more confident, tell your nurse staff not to limit education to just clinical learning. “Soft Skills” like communication, conflict resolution, and leadership can help nurses stand out on the team and boost confidence.

NCharge®: “Nurses Learning to Lead” is a set of leadership courses built for the first-level supervisory nurse, the Charge RN. NCharge is an evidence-based curriculum that gives nurses the insights, interpersonal skills, and business knowledge they need to more effectively manage, inspire, and lead. NCharge helps U.S. health systems to build a nurse leader pipeline, impact financial awareness and results, and increase nurse engagement and retention. For instance, the Supervisory Skills For Positive Outcomes course teaches communication strategies to confidently communicate practice concerns, conflict management, time management strategies, and appropriate delegation while maintaining accountability.

Click Here to have one of our team members reach out to you about NCharge. Give us the opportunity to hear your skill gaps in nurse confidence and allow us to make a course recommendation!

 

Sources

“4 Ways to Build Confidence as a Nurse,” AHS Nurse Stat, Cade Webb, January 24 2019

“Boost your confidence to reach the stars,” The Nursing Times

“7 Things Nurses Can Do to Feel More Confident at Work,” Nursing CE, Keith Carlson, RN, BSN, NC-BC, March 20, 2019

“How Nurses Can Build Their Confidence,” The Gypsy Nurse, February 20, 2018

“Tips Nurses Can Use To Build Confidence,” Diversity Nurse Blog, Erica Bettencourt, July 26 2019

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

Encouraging Your Nurses’ Career Path?

Nurses make up the largest employee category in U.S. health systems. More than ever, healthcare leaders are advocating for the need to retain confident nurses who can lead, and be ready for change and complexities in managing patient populations. Nurses are on the front line of patient care and are crucial for advancing health. When the Robert Wood Johnson Foundation and the Institute of Medicine built the report “The Future of Nursing: Leading Change, Advancing Health,” the key recommendation was for nurses to be full partners with doctors and other professionals in redesigning the country’s healthcare system.

As a nurse leader or executive, are you empowering your nurses on staff to navigate and build careers? As competent nurses on your team are beginning a professional career, are you helping them find the right career trajectories? Here are steps you may want to pursue:

Coaching
What nurses expect from their leaders has changed. Young nurses today are not looking for authoritarian leadership. In light of today’s tight job market, gone are the days when staff are expected to be grateful to even have a job – it’s beginning to be an employee’s market and nurse shortages are seen to correlate. Today’s nurses, especially the Millennial workforce, want their leaders to be coaches who help them to learn and grow as professionals. Retaining nurses requires adjusting styles to adapt to this new generation.

Do you know characteristics of an effective coach? Are you facilitating change and helping staff to embrace change? To help identify your personal nurse coaching style, feel free to playback Catalyst Learning’s on-demand webinar with Dr. Rose Sherman, “Develop A Coaching Mindset.” (must have Adobe Connect Installed to View)

Develop Your Nurses Leadership Potential
During individual development conversations with staff nurses, especially younger ones who may be earmarked for future leadership, discuss their development. Be sure to go over effective leadership styles and characteristics – discuss positive communication skills, how to manage conflict, and delegation techniques. Give nurses tips on how to cope with change, manage stress and improve time management. The best way to help a young nurse to develop leadership potential may be to tell her how a leadership path was rewarding for you. Help nurses envision themselves leading teams. If nurses seem interested, encourage them to develop a personal plan for developing their leadership potential.

Nemours Children’s Hospital (Orlando FL) was built in 2012 and has quickly become a premiere children’s hospital in the Southeast U.S. When Nemours’ leaders decided to add charge nurses to every shift on every unit, they sought out a training program that would give their emerging leaders the development needed to effectively manage a nursing team. Nemours chose NCharge™: “Nurses Learning to Lead.” Nemours is on a Magnet journey, and strives for a cultural transformation in nursing by developing nurse leaders. Read more about Nemours Children’s Hospital.

Help If Nurses Are Looking For Career Change (Or Pivots)
Advancing through a leadership route is not for every nurse out there. For some nurses, maintaining a long-term nursing career trajectory may mean changing to a different role. The challenge for today’s nurses who want to pivot careers isn’t lack of opportunity, the challenge is actually choosing from so many opportunities. There is a growing list of new nursing and health disciplines. Many nurses may only pivot towards urgent care or behavioral health, for instance, to obtain a more favorable work schedule. Others may fully pivot into roles within information management or nursing research, while others still may transition into being wellness coaches, healthcare writers, or pharmaceutical sales representatives.

If you have a nurse who is contemplating a career pivot, encourage them to do a self-assessment of what makes them light up and feel fulfilled. Ask them to be critical, and think these things through:
• Why do you want to change specialties?
• Are you making a change for the right reasons, or do you just want to get away from  challenging colleagues or other short-term issues?
• Do you want to move out of a hospital setting?
• Are you ready for additional training or certifications?
• Do you want more or less contact with patients?

Talk to your nurses about how to make their personality characteristics work for them by considering correlated nursing specialties and environments they might enjoy more than others.

Show Nurses Career Navigation Tools Available To Them
In encouraging career growth for your nursing staff, show your nurses where HR (or other?) tools are and how to access them. But don’t lean just on HR to perform this navigation role. Many nurses may not understand how to use navigation tools, and end up leaving an organization instead of navigating it, just from not knowing what professional growth or complimentary roles are available to them.

Encourage Continuous Learning
Lifelong learning offers nurses the opportunity to keep current skills up to date, and to pursue a wide variety of interests. Healthcare is a constantly changing field with advances in medicine, expansion of evidence sources, new treatments and care model/regulation updates. For nurses who want to blaze an intentional path for their career trajectory, encourage new learning challenges. In such a dynamic industry, future leaders should: Attend conferences, obtain certifications, take management courses, and stay current on regulations and care model delivery changes. So be sure to advocate for your staff to be continuous learners, even if it is another clinical area. Of course we cannot ignore that most positions in advanced practice, leadership, teaching and research require obtaining Master’s or Doctoral degrees. But not all nurses will go this route, so be ready to point to alternative learning sources or credentials.

Encourage Building Networks & Join Professional Organizations
Meeting new people, with whom nurses can exchange ideas and work experience, is one of the best ways to encourage your staff to build new perspectives. Networking within a nurses’ own organization is important of course, but encourage your nurses to gain information from the industry by networking outside of it too. Nurses can build a network and make friends by attending workshops, conferences, or participating in webinars with colleagues and people with similar interests. Being a member of a professional organization looks good on your staffs resume and offers nurses the chance to learn from peers, who also want to improve their perspectives and build strong interpersonal connections. Many nurses get into the profession to help people, and outside organization “networking” doesn’t sound comfortable to some nurses. But tell these nurses that networking is to the benefit of both parties as they learn from each other. If your nurses still seem reluctant, tell them doctors do it all the time! Why does it seem normal for doctors to seek outside-the-organization networks, but not nurses?

Teach Nurses About Emotional Intelligence
Teach your nurse staff about key components of nursing professionalism: being honest, maintain confidentiality about patients, be respectful, cultivate strong interpersonal skills, keep a positive attitude, maintain competency and keep up to date in one’s work.

But professionalism and EI apply to off-the-job too. Nurses have been cut for consideration for leadership roles because of improper personal Facebook pages or hurting their personal brand by gossiping or causing conflict. Urge nurses to see themselves as leaders and to personally cultivate and promote their leadership skills and abilities.

See our related article, “6 Traits of Nurses With High Emotional Intelligence.

Encourage Nurse Staff To Find A Mentor
Having a nurse role model who gives wisdom to younger nurses can be very helpful to young nurses starting a career journey. There is nothing in a textbook that can replace real-life experience of a seasoned nurse who has navigated a full career. If your health system doesn’t already have a mentor/mentee program, maybe it is time to start an official career advice and guidance program.

Stanford Healthcare (Palo Alto, CA) started a Nurse Mentorship Program back in 2004. The program was originally designed to help new graduate nurses succeed in their first nursing positions. First-year nurses are statistically more inclined to leave the nursing field than more established peers, so it is a great time for early mentor interventions. New nurses learn from established nurses, as they integrate nursing theory into practice over time. The program also helps new nurses understand the organization culture. The goals of Stanford’s program are to have a culture of mentoring, professional development, teamwork, and high retention.

 

Sources
“How to advance your nursing career path and create long-lasting job satisfaction,” Nightingale Blog
“Nursing Professional Development,” article, Stanford Healthcare website
“Lifelong learning strategies in nursing: A systematic review,” U.S. National Library of Medicine (National Institute of Health), October 2017
“Lifelong Learning,” Johns Hopkins Nursing Magazine, Mat Edelson
“Ready to change specialties?: Make sure you know yourself and what you really want”, American Nurse Today, Janet Boivin RN, BSN
“Five Tips For Advancing Your Nurse Career,” Megan Krischke, AMN Healthcare/NursingJobs.com

Top 10 CNO Resolutions for 2019

1) Improve your coaching mindset – Retaining nurses will require adjusting styles to adapt to a new generation of nurses
What nurses expect from their leaders is changing. Gone are the days of command control leadership when staff were expected to be grateful because they had a job. Today’s nurses, especially the Millennial workforce, want their leaders to be coaches who help them to learn and grow as professionals. Retaining nurses requires adjusting styles to adapt to this new generation. When nurses don’t receive the coaching and feedback they desire, they may be more likely to leave, as evidenced by high nursing turnover in many healthcare organizations. In 2019, think about how to create a competitive edge by adjusting your leadership style.

Self-reflection can be difficult, so feel free to playback Catalyst Learning’s webinar with Dr. Rose Sherman, as she discusses ways to create a coaching mindset with nurse staff. Viewers must have Adobe Connect installed.

2) Be a continuous learner, and encourage your staff to do the same
Lifelong learning offers individuals the opportunity to keep current skills up to date, and to pursue a wide variety of interests. Healthcare is a constantly changing field with advances in medicine, expansion of evidence sources, new treatments and care model/regulation updates. For CNOs, new challenges affecting the clinical workforce require leaders to take management courses, obtain certifications, attend conferences, and stay current on updated regulations and care model delivery to be effective.

Advocate for your staff to be continuous learners as well! A nurse may want to consider learning another clinical area and/or obtain a specialty certification to augment current knowledge; encourage staff to stay informed and share their learnings with the unit.

3) Prepare nurse staff to lead
In 2019, there is excitement and intention around preparing less experienced nurses for future leadership roles. While looming Baby Boom nurse retirements are on hospital leadership radar, C-Suite Nursing leaders are acknowledging the valuable role that first-level supervisory nurses play. Preparing inexperienced nurses to lead will help them have more informed conversations with Nurse Managers, will aid in nurse retention, job morale, and will set the stage for nurses to have a positive first experience as a leader. Nurses who have a bad first leadership experience (usually in the Charge RN role) often do not pursue future leadership roles.

See our related article, “6 Reasons to Budget for Charge Nurse Development in 2019.” 

4) Practice self-care, and realize you cannot do everything
This sounds like a no-brainer for busy executives. We know that self-care involves obvious health practices: physical activity, self-pampering, adequate sleep, quiet time for reflection, putting your phone down every now and then, and shutting your door sometimes so you can get work done.

While self-care as a stress management tactic is necessary, don’t forget to consider the root causes of the stress. Instead of accepting the explanation of “I have too much on my plate,” write down the key stressor(s). Is there an unrealistic deadline looming? Are the yearly goals you’re aiming for a moving target? Figure out how to fix the issue, rather than only managing the stress felt as a result. If too many tasks are the main stressor, think about a shared governance model to boost production, leading to group problem solving. Delegating scheduling to another person can help get back chunks of time during the week. Acknowledging that you cannot do this role alone is a great step in self-care.

Lastly, don’t be afraid to say “no.” Executives may tend to think they achieved their position by saying “yes” to every challenge that came their way. But don’t get trapped into that line of thinking, and don’t be afraid to set boundaries.

5) Encourage staff (and maybe yourself) to coach new nurse graduates
New graduates entering the workforce may not be ready for 12 hour shifts and the stress of their new role. These graduates often become frustrated as they experience the real world of healthcare. Many nurses will burnout and find new employment opportunities after only a few years. Successful coaching will make a significant difference in reducing frustration of novice nurses, and can help with retention. Some experienced nurses may feel burned out and not willing to make a commitment to coaching, but this year challenge these nurses to volunteer to coach. Remind your team that a coaching contribution could have a more profound effect than anything else they do as a professional.

6) Build nurse networks outside your organization
Unfortunately, social/work networking comes easier for most nurse executives than developing professional non-work networks. After all, most nurse leaders originally come to the nursing profession to help people, not to “schmooze” like a sales person. To make networking palpable, think of networking as a tool to “knowledge share”and help with mutual professional development. A network of nurse executives in other organizations can help you find information, give referrals, and offer someone to confide in for guidance and support. Remember- the best time to build your network is before you need it! Start with events to build your network. Leadership summits like CNO Academy can help you to network within smaller cohorts.

 

7) Seek and give timely feedback
This is truly a two-way street. It is important to not only give timely, specific feedback to your staff, but to also proactively seek feedback about your own performance. This is one of the best ways to continue career growth. Don’t hesitate to coach up nurses who are not performing as well as they could be, and let low performers go quickly when necessary. They can begin to drag on the organization quickly, so make sure to give timely feedback in 2019.

8) Nominate staff for recognition
When leaders fail to thank others, or take all the recognition for themselves, staff feel devalued. A key part of encouraging staff is to recognize contributions in a way that is valued by the person and celebrated by the team.When nurses in your organization make significant impacts that deserve recognition, be the first cheerleader to celebrate that contribution by letting the company know. Being the top advocate for the nursing profession at your health system means sharing recognition, whether internal or external. Be sure to attend recognition celebrations in person.

9) Build a nurse succession plan

In the coming year, top nurse executives are focusing on consistent development for nurses, including those nurses who are at the start of their leadership path. Systems don’t stumble on a strategic succession plan, it takes preparation and organization buy-in. So, in 2019, be intentional about identifying talent and teaching the next wave of leaders, especially young ones. Equipping Gen Y nurses with the leadership and business skills needed for advancement is an important step in developing nurse leader pipelines. Provide this generation of young nurses the ability to handle communication, conflict resolution, and challenges in managing change that they will face. To learn about NCharge: “Nurses Learning to Lead” please click here.

10) Up your game in technology – Be ready to advocate for it
A CNO should play a critical role in how an organization selects, implements, and adopts technology. In an ideal setting, the CNO creates a culture of shared decision making by asking others to participate in technology planning. However, technology implementation efforts can sometimes be unsuccessful and have unintended risks or issues. In 2019, embrace new technology, or work to simplify old tech processes. Be the first to volunteer to attend classes and serve as a champion for new technology or changes in practice. This could be the symbolic leadership gesture that gets buy-in needed from nursing staff.
  • “Develop a Coaching Mindset with your Nurses” November 3, 2018. Webinar with Dr. Rose Sherman and Catalyst Learning Company
  • “5 Ways To Practice Self-Care, Even as a CEO” Brian Wong, Inc.com magazine, August 31 2018
  • “The Value of Lifelong Learning Throughout a Healthcare Career,” HealthStream, Diane Hanson, CNO at EBSCO Health, October 11, 2018
  • “12 Networking Tips Executives Need for Success” by Louise Garver
  • “If I knew then what I know now: Advice for Nurse Leaders from a former CNO,” Studer Group September 2018
  • “Leadership goal setting for the New Year,” Rose O. Sherman, December 28 2017, Emerging RN Leader
  • “6 Reasons to Budget for Charge Nurse Development in 2019,” Catalyst Learning blog, January 2019
  • “Nurse leaders discuss the nurse’s role in driving technology decisions” American Nurse Today

Webinar with Dr. Rose Sherman: Develop a Coaching Mindset to Improve Millennial Nurse Retention

 

When: Thursday October 18, 2pm-3pmET. Catalyst Learning will send you a link, look for a calendar invite from our Office Manager, Claire Ballard.


SIGN UP HERE!

About the webinar
What nurses expect from their leaders is changing. Gone are the days of command control leadership when staff were expected to be grateful because they had a job. Today’s nurses, especially the Millennial workforce, want their leaders to be coaches who will help them to learn and grow as professionals.
 
Current research indicates that staff highly value managers who adopt a coaching style of managing performance.  When nurses don’t receive the coaching and feedback they desire, they may be more likely  to leave, as evidenced by high nursing turnover in many healthcare organizations. For many leaders this new expectation by staff nurses requires a change in leadership style.  Create a competitive edge by learning why a coaching style is important in today’s world and secrets of great coaching leaders.