Keys to avoiding a high rate of CNO turnover

Article Outline

• Copyright

• 
  • View Large Image
  • Download to PowerPoint

Turnover among chief nursing officers (CNOs) is a continuing concern in the current hospital marketplace because of the enormous impact on both the organization and the individuals involved. The reasons for turnover are multiple and can be connected with either the choice of the individual, complex internal and external politics, or a combination. There are times when the change is actually good for both parties and enhances the growth of the nurse executive.

Whether the turnover is a choice or a forced decision, there are important skills and techniques that can enhance the nurse executive's success and prepare her for the next opportunity. After conferring anecdotally with both CNOs and chief executive officers (CEOs), there was remarkable similarity in what a CEO expects from a successful nurse executive and what makes the nurse executive want to remain in the position.

Developing a plan for excellent nursing care and executing that plan through the recruitment and retention of qualified nursing personnel was seen as essential by the CEOs. At the same time, all of the nurse leaders indicated that having a strong nursing team, mentoring, and making a significant difference in the improvement and enhancement of nursing care are high motivators. This requires not just nursing support but also the support of the hospital's executive team. Nurse leaders see this as key to obtaining respect, support, and assistance in implementation to achieve the nursing agenda. The skills required to build teamwork, plan, modify, communicate, and ensure implementation are essential in achieving success. These skills are highly regarded by the CEOs, while the outcomes of a supportive organization are valued by the nurse executive.

CNOs want to be accepted as the experts in nursing. Nurse execs often choose to stay in their positions because of organizational support, and it is the wise CEO and board of directors who create the right climate to enhance and maintain both the CNO and a positive environment for care delivery.

Another significant area that requires consistent attention is the development of financial skills and knowledge. CEOs expect nursing executives to be fiscally accountable and at the very least demonstrate knowledge about the nursing budget, understand and control unplanned variances, and be able to talk the lingo with other executives. Being savvy in reading and understanding both accounting and financial reports and the impact nursing services have on the organization is highly valued.

Regardless of whether a hospital is for profit or nonprofit, its ability to maintain a black bottom line is critical. The stress of not doing so often leads to turnover of the top executives.

Nurse executives in particular come under the gun because of their high visibility and the fact that nursing care often leads to turnover of the top executives, which consumes 50% or more of the expense budget, exclusive of capital. The expense is not surprising because hospitals basically exist to provide nursing care. The quest to provide high-quality care, high staff satisfaction, and low turnover can cause expenses to exceed both budget and planned variance. This situation can be justified as having a positive effect on the organization if the chief nursing executive forms a plan and executes it with a clearly defined bottom line outcome, specifying the expected return on investment to the organization.

As an example, an investment in a well-defined, evidence-based practice program can go over the planned expense budget; however, if the outcome is improved patient safety and satisfaction validated through consistent, regular measurement, the ultimate impact on the organization is often positive. We do manage what we measure.

In this situation, measuring and calculating increased unreimbursed expenses that would have occurred from complications, infections, and so forth can produce a positive net effect for the organization and achieve the support of the board and executive staff. This is particularly important in presenting new programs and being able to answer key questions about the impact on net profit for both the nursing areas and the organization.

Presentations to justify new or changed expenditures and programs should be financially clear as to cost, potential outcomes, and clinical improvements that are measurable and reportable on a regular basis. Presentations and questions during financial reviews such as budget variance meetings should be knowledgeable and use terminology understood by the executive team, the board, and particularly the CFO. Learning and practicing good financial skills are paramount for the successful nurse executive. Having a financial person on the team can assist a nurse executive, but obtaining the skills through multiple resources that exist is important. Even individual coaching is available as necessary; it does take practice.

Personal issues also come into play. Nurse executives stated that liking the area they live in, making friends, and being near family were important. Good benefits, particularly pensions, and a competitive salary were also critical. A spouse who has a good job in the area is also a consideration, but generally the CNO was free to move if the right circumstances were in place.

The issues seem clear: the organizational culture and values have to mesh with those of the CNO. Sometimes those change in midstream due to various circumstances. Changing with the environment is acquiring the skill of adaptation as long as the new organization remains consistent with personal values.

CNO turnover can be devastating to an organization. Mentoring and training staff and establishing a plan with clear goals, objectives, and systems of measurement can minimize the impact of a CNO vacancy and enhance the reputation of the one who is leaving. If a unique opportunity presents itself, competent succession planning can avoid major disruptions in morale and programs that are producing the desired outcome. It is the insignia of a great leader. When a nurse executive decides to leave for a better opportunity, what better reward can there be than leaving a legacy of continuity?