CNO for a Day: What 8 Nurses Would Do Differently

Nurse retention and happiness are top of mind for many leaders among an increase in strikes and nurses leaving the profession.

Becker’s recently asked nurses what they would change or do if they were chief nursing officer for a day.

Note: Responses have been lightly edited for length and clarity.

Sanju Anand, RN. Memorial Hospital West (Pembroke Pines, Fla.): I’d spend time each day, if possible, with each nursing unit to familiarize myself with what they’re doing, what they need, and how they feel about the care we’re delivering, understanding the patient is always our top priority.

As an advocate for our teams, I’d make sure to communicate and collaborate with them to implement policies that improve efficiency.

Lindsey Causey, DNP, APRN. Cone Health (Greensboro, N.C.): One opportunity for growth exists for our advanced practice nurses who work as certified registered nurse anesthetists, nurse practitioners and certified nurse midwives. As CRNAs, NPs and CNMs transition to delivering care differently, it can be easy to depart from the dynamic core of nursing to practice in more of a medical model. This unintentionally disconnects our highly educated APNs from opportunities to use their nursing foundation in addition to their provider perspective to innovate care delivery, improve patient outcomes and transform the healthcare system. As the healthcare paradigm shifts to a value-based model, now is the perfect time to get started on this initiative.

First, I would partner with our already embedded CNSs to identify opportunities to engage our CRNAs, CNMs and NPs in systemwide nursing committees. I would also design intentional transition-to-practice pathways to embed our highly trained APNs as unofficial leaders within our nursing department. These changes would allow our APNs to continue their practice but also establish a commitment to incorporate their unique expertise in improving our communities’ health by increasing involvement in APN research, improving mentorship opportunities for our APN students, engaging in advocacy around healthcare policy, and leveraging their perspectives and relationships to further interprofessional practice.

Joanne Christophers, RN. Northwell Wellness Center (Roslyn, N.Y.): I’d have more integrative medicine everywhere. And I would change how nurses take care of themselves. Self-care is not optional; it is absolutely necessary. We found this out more than ever during COVID-19. There are holistic nurses in the Northwell system that helped nurses get through the awful beginnings of COVID. How can you get through all of that if you don’t take care of yourself?

Krista Elkins, RN, a nurse based in Bozeman, Mont.: If I were chief nursing officer for a day, I would give the nurses a raise, guarantee lunch breaks for every nurse, make sure that every department is well staffed, reduce the nurse-to-patient ratio and make sure that the nurses felt supported in doing their jobs.

Nurses are underpaid for their work, so a raise would be welcomed. Nurses are often unable to stop and eat for 12 hours sometimes; my lunch break is as good for me mentally as it is physically. Healthcare departments are often understaffed, putting extra strain on the nurses, and the nurse-to-patient ratio then increases, putting even more strain on the nurses and reducing high-quality patient care capabilities. Making sure that staff feels supported, whether a manager needs to jump in and help with patient care, a nurse gets requested time off to spend with their families, they have the equipment and education they need to do their job, or they are supported mentally and emotionally are all essential things.

Fabiola Rodriguez, BSN, RN. Memorial Hospital Miramar (Fla.): I would prioritize strategies that improved the nurses’ well-being and enhanced patient care. Reviewing the current staffing ratios and workload would be the first step to understanding how to help nurses efficiently provide quality patient care and provide a supportive and manageable work environment. I would encourage nurses to share research, evidence-based projects, and their own personal experience to demonstrate why we need funds for more nurses and better staffing ratios.

I’d also implement more interdisciplinary care so nurses aren’t stuck doing tasks outside our scope of practice because other providers claim not to have the time for a task that’s part of their job description. Better interdisciplinary communication between nurses and other healthcare professionals can deliver better patient-centered care.

Lastly, it would be important for me to incorporate wellness events and offer incentives to help nurses feel they chose an appropriate career. We bend over backwards to make sure patient needs are met, but we also have to take care of ourselves to effectively attend to someone else.

Cinthia Rogers, BSN, RN. Memorial Hospital Pembroke (Pembroke Pines, Fla.):

My primary focus would be on connecting with and understanding the needs of the front-line staff who tirelessly dedicate themselves to healing others. It’s in the moments of vulnerability that humanity renders itself visible, and I’d commit to unwavering support, compassion, and being an ear for our team as they stand alongside patients in moments of desperation.

I’d also empower staff to vocalize their thoughts and concerns to ensure we foster an environment of trust and collaboration. By effecting meaningful internal change, we can create a ripple effect that transcends the walls of our institution and embodies the mission of Memorial Healthcare System to heal the body, mind and spirit of those we touch.

Ashley Smith, RN. UAB Medicine (Birmingham, Ala.): Leadership is the key factor in creating a successful organization. A chief nursing officer sets the mood and direction that nursing staff will carry through in their actions and patient care. Making a priority in caring, communicating, and being present for staff will build trust and collaboration that will be beneficial for employee morale. Having resources, support, and proper training for staff will connect patients with the best possible care options. Recognizing and rewarding employees and being open to feedback will improve and raise staff retention rates. All measures will set a firm foundation and lead the way for high nursing performance that delivers the values, mission and vision of the organization. This will ensure high quality care is given and thus improve safety and patient outcomes. This type of strong leadership will encourage and inspire better nursing care, which in turn will positively impact patients and care they receive.

Cassidy West, MSN, RN. UAB Medicine (Birmingham, Ala.): If I were a CNO for a day, I would spend time on all the nursing units. The CNO cannot effectively advocate for nurses unless there is an understanding of patient care workflow and possible barriers to successful outcomes. I would engage with the team and encourage feedback. One of the American Organization for Nursing Leadership core competencies is communication and relationship building. Multiple research studies show successful CNOs invest in their nurses and ensure their voices are heard. I think it’s extremely important that nurses know they are valued, which ultimately affects the number one goal of quality patient care.

(This story originally appeared in Becker’s Hospital Review.)

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