CNE/CNO Top Concerns Going Into 2023

It is no secret that nursing today is challenging to say the very least. The gap for trust between direct care teams and executive leadership seems be growing along with the competition for workforce. We can take action to move forward in an effective and meaningful way.

I interviewed 20 CNEs and CNOs to get a pulse check on their most current top-of-mind concerns.?Not every CNE/CNO shared the same challenges, but very clear themes emerged.?As nursing leaders, it is imperative that we all lean on each other for support and leveraging of ideas.?We are not alone and the interviews certainly highlighted this.?

A recent study by Deloitte notes that less than half of frontline workers trust their organization’s leadership to do what is right for patients and even fewer, only about 23%, trust their leadership to what is right for workers.?As we look to move the needle on metrics and change management initiatives, we must first put the time in to ensure we have the trust of the team.?Trust is the foundation with which most sustainable work is built upon.?Without it, we have poor change management, lost productivity, high turnover and low morale.?

The top 4 Challenges noted by the CNEs and CNOs that were interviewed:

a.????Workforce.?Uniformly the top issue to no surprise.?The shortage in multiple disciplines as well as discussions around transforming the traditional care models that most utilize today.?

b.????Shared/Professional Governance engagement.?Most noted that they were struggling with shared governance or revamping the old structure and functions.?

c.?????Lack of follow through.?The majority of CNEs and CNOs interviewed generally felt their leadership teams were accountable, but “stuck”.?Many noted a transactional leadership style being seen in both experienced and novice leaders. Leader overwhelm was also a common theme.

d.????Approximately 2/3 of those interviewed noted largely novice leadership teams or leaders who were new their current roles.

Workforce Challenges

Now more than ever, retention is a priority. ?According to NSI Solutions, Inc, 25% of nurses are leaving their hospital position.?This number continues to climb since publication of the report in 2022.?The average cost of turnover for one bedside Registered Nurse is greater than $46k.?Additionally, hospitals are spending on average $4.2 million for every 20 travel RN positions.?The competition and gap between supply and demand is sure to widen.?The current statistics are unsustainable.

Professional Governance

Nurses widely note a lack of trust in leadership to carry out decisions made in professional governance councils coupled with moral injury or pure fatigue as reasons to disengage from participation in councils.?As we seek to increase autonomy and improve engagement, looking at ways of incorporating participation on councils to be included in their worked FTE may be necessary.?As leaders, we must also say yes whenever feasible and assist in removal of barriers for decisions made in our councils.

“Being Stuck” or Lack of Follow Through

Getting results is fundamental for the work of a leader whether the results are a product of organizational initiatives or the product of decisions made in professional governance councils.?Without making progress or achieving goals, our teams lose trust in our abilities as a leader.?Follow through is part of increasing or maintaining a high degree of trust.

Novice Leaders or Leaders New to Their Role

When leaders feel overwhelmed or are novice and still want to feel they are adding value and contributing, they often default to transactional leadership.?This “checking boxes” and crossing off lists type of leadership leaves teams feeling a lack of engagement and uninspired.?Now more than ever, it is crucial for our nursing leaders to be confident, emotionally and socially intelligent and have the complex skillset to navigate hardship and change.?Research shows that nurses working with transformational leaders report higher job contentment and lower intent to leave the profession.?

With the challenges posed in solving staffing, fostering a thriving professional governance, becoming unstuck, and leading to at our highest potential, how do we move forward??The foundation of inspirational and transformational leadership is trust.?

4 key areas of focus can shift teams from stuck and uninspired to thriving and collaborative.?When our leaders are strong and functioning to connect through trust with our teams they are more likely to remain in their current positions.?People do not leave jobs, they generally leave leaders that they do not align with.?

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Focus area #1.?Self-transformation

How are we individually viewing the current state of the union??What thoughts and feelings are being triggered for us and how is this impacting our attitude and behaviors??Improving how we process the inner work (our thoughts and feelings) and how this translates into our outer work (behaviors) is the first step.?Self-awareness takes energy and a deep openness to allowing for feedback to be analyzed and insights to develop.?

We know through research that we have improved memory recall when we learn through insights versus classroom style, structured learning.?Making the connection with how new information personally applies to us increases our chances of being able to recall and apply the new behaviors in the long term.?

Focus area #2 Team Transformation

How do we unite our teams to function as a greater interdependent team??Interdependence occurs when teams rely on one another rather than competing as individual islands.?When we trust enough to rely on each other our ability to collaborate and think critically is improved.?When we are in a threat state or lacking trust, we are more likely to experience impaired problem solving, poor critical thinking and a lack of collaboration. Leading from a coaching standpoint pulls the strengths of the team forward and creates the container for resolving blocks to optimal team function.?Coaching through barriers specific to individual teams allows them to create insight and better understand how to apply new learning to their current situation.?This in turn sustains the learning and allows for compounding improvement throughout the journey. Team development leads to greater ability to navigate future hardship. Oftentimes, classroom style learning can generate excitement, but misses the mark for implementation in real world application or long term sustainability. ?

Focus area #3 Adaptability

Looking at the previously noted statistics, the staffing challenges will continue as 64% of hospitals are planning to increase their RN workforce in the near future.?We will be required to be adaptive and innovative in finding long term solutions to care delivery models.?Adaptability requires us to be able to lead through hardships, manage conflict, and create an environment of ownership vs buy in.?Understanding various change model implementation and having a thoughtful execution will greatly increase the chances of sustained success.?A change management plan is key to any roll out and is frequently underestimated.?Choosing the correct change management model for the initiative adds to the likelihood of success. A staggering statistic notes that 70% of change initiatives fail. 70%!!!! A strong leadership team with a keen skill set to lead change is a must. Teams fully understanding how to operate as a unified team versus islands of teams is the ultimate goal in reaching interdependence.?Professional governance to include inter-professional disciplines supports the road to interdependence.?

Focus area #4-Results and recognition

Regardless of the current work that needs to be done or is in process, we must keep an ever laser focused eye on outcomes and results. Trust is eroded when decisions are made in councils and unable to be implemented. If it isn't feasible to implement a decision, it is vital to help the team understand the why behind the barrier and to work with them to find an alternate solution. Coaching leaders to lead from behind instead of dragging their teams along improves the chances of long term success. When leaders take a coaching approach to leading their teams they create ownership vs buy in. Through ownership, teams feel a great sense of connection to the work and they are more likely to support the process and end goal. Coaching for the skill set of peer accountability has also been shown to increase success rates. Accountability cannot fall on the shoulders of the leader alone. Teams depend upon one another and peer accountability is part of that. Proper coaching and guidance around how to implement peer accountability is necessary. To poorly roll out peer accountability would create the anthesis of the desired outcome.

The number one reason at the epicenter of all that we do is to take excellent care of the patient. How do we make the most of the current state to protect them and to do what is right??How do we learn as we navigate to create a better future state??In order to take the best care of the patient, we need to take the best care of our teams.?

Recognition is valued by teams.?How do individuals and teams like to be recognized??Not everyone likes public recognition, yet recognition is important none-the-less.?Perhaps a quite 1:1 or smaller group recognition would be better suited for some.?Personalizing recognition is of the utmost importance, especially now.?People want to know that they work they are doing is making a difference and that they are valued for their contributions.?Do not underestimate the deep meaning and significance of recognition.?

The endless list of areas that we are accountable for as leaders can be overwhelming at times.?Taking a moment to reflect on your strategy, options and who to partner with is key.?We are not in this alone and leveraging our collective strengths will take us where we want to be.?