Chief Nursing Officer Research Articles

A Nurse Is Not Just a Nurse: The Challenges of Nursing During a Pandemic and Beyond

Summary The Executive Vice President and Chief Nursing Officer for CommonSpirit Health discusses challenges nurses are facing during the Covid-19 pandemic, predominantly in terms of staffing, burnout, and compassion fatigue and PTSD; how burnout has been a problem in nursing for decades; and involving nurses in the vision for the future of health care delivery.

Actions Taken by US Hospitals to Prepare for Increased Demand for Intensive Care During the First Wave of COVID-19: A National Survey

BackgroundThe COVID-19 pandemic placed considerable strain on critical care resources. How US hospitals responded to this crisis is unknown.Research QuestionWhat actions did US hospitals take to prepare for a potential surge in demand for critical care services in the context of the COVID-19 pandemic?Study Design and MethodsFrom September to November 2020, the chief nursing officers of a representative sample of US hospitals were surveyed regarding organizational actions taken to increase or maintain critical care capacity during the COVID-19 pandemic. Weighted proportions of hospitals for each potential action were calculated to create estimates across the entire population of US hospitals, accounting for both the sampling strategy and nonresponse. Also examined was whether the types of actions taken varied according to the cumulative regional incidence of COVID-19 cases.ResultsResponses were received from 169 of 540 surveyed US hospitals (response rate, 31.3%). Almost all hospitals canceled or postponed elective surgeries (96.7%) and nonsurgical procedures (94.8%). Few hospitals created new medical units in areas not typically dedicated to health care (12.9%), and almost none adopted triage protocols (5.6%) or protocols to connect multiple patients to a single ventilator (4.8%). Actions to increase or preserve ICU staff, including use of ICU telemedicine, were highly variable, without any single dominant strategy. Hospitals experiencing a higher incidence of COVID-19 did not consistently take different actions compared with hospitals facing lower incidence.InterpretationResponses of hospitals to the mass need for critical care services due to the COVID-19 pandemic were highly variable. Most hospitals canceled procedures to preserve ICU capacity and scaled up ICU capacity using existing clinical space and staffing. Future research linking hospital response to patient outcomes can inform planning for additional surges of this pandemic or other events in the future.

Exploring Various Leadership Styles to Use Among Nurses Towards Challenges Faced Within the 21st Century: A Systematic Review

The workforce for registered nurses (RNs) are currently facing unprecedented challenges. Current challenges such as the consequences associated with patient falls and healthcare-associated infections (HAIs) have placed a social and financial burden on the U.S. healthcare system. What’s more, future challenges such as the expected retirement for baby boomers and an expected shortage on the availability of medical physicians has raised many concerns for healthcare organizations on how they will deliver care in the years to come. The conclusion is that these challenges will significantly affect the well-being of the RN workforce. Hence, because of these challenges, the objective of this research was to explore various leadership styles to use among nurses towards challenges faced within the 21st century. By focusing on these challenges, the researcher provided findings around ethics and its impact on decision-making. Thereafter, the researcher highlighted common leadership styles that are used, and then proposed a new leadership theory, servant leadership, as an option for Chief Nursing Officers to use to help guide its nursing workforce going forward.

The Relationships Between Resilience, Job Satisfaction, and Anticipated Turnover in CNOs

Rising chief nursing officer (CNO) turnover remains a topic of professional discussion. Leader stability ensures nursing excellence in a frenetic, complex, highly networked, portable, and technological era. When nurse executives vacate their role, the turnover disrupts the practice environment, threatening clinical and cultural performance. A paucity of evidence exists on the components of CNO turnover. Findings from a national research study reported resilience and job satisfaction may work synergistically to reduce anticipated turnover, providing insight on CNO role tenure. Rising chief nursing officer (CNO) turnover remains a topic of professional discussion. Leader stability ensures nursing excellence in a frenetic, complex, highly networked, portable, and technological era. When nurse executives vacate their role, the turnover disrupts the practice environment, threatening clinical and cultural performance. A paucity of evidence exists on the components of CNO turnover. Findings from a national research study reported resilience and job satisfaction may work synergistically to reduce anticipated turnover, providing insight on CNO role tenure. Noreen Bernard, EdD, RN, NEA-BC, FAAN, is a Chief Nursing Officer at University of Colorado Health in Erie, Colorado. She can be reached at [email protected]

Medication access and midwifery integration: An example of community midwifery advocacy for access in Washington State, USA.

Medication access and midwifery integration: An example of community midwifery advocacy for access in Washington State, USA.

Jacqueline Herd DNP, RN, NEA-BC

Jacqueline Herd, DNP, MSN, RN, NEA-BC is the Executive Vice President and Chief Nursing Officer (CNO) at Grady Health System in Atlanta, Georgia. She is a California native and moved to Georgia in 2009 as the chief nursing officer at Grady Health Care in Atlanta (Tenet Health Care). With over 20 years’ experience as a nurse executive, her passion is inspiring and empowering nurses to lead. Before moving to Georgia, she was a member of the Association of California Nurse Leaders (ACNL), and since moving to Georgia, she is a member of the Georgia Nurses Association, American Nurses Association, and an active member of Georgia Organization of Nurse Leaders (GONL). She has served as a member at large, president elect, president and immediate past president on the GONL State Board. She is an active member of American Organization of Nurse Leaders (AONL), has volunteered on the by-laws committee and the publication committee for the “Voice of Nursing Leadership,” and is current AONL board member elected to represent Region 4. She is a strong advocate for the March of Dimes (MOD) and has served on the MOD Atlanta Planning Committee and the Nurse of the Year nominating committee. She has also served on the Georgia State Community Advisory Board and is currently on the Emory University Nell Hodgson Woodruff School of Nursing DNP Community Advisory Board. She is married with 3 children and 7 grandchildren.

Quality and Safety in Healthcare, Part LXXIX: Chief Nursing Officer Development, Assessment, and Turnover: An Example for Many Other Healthcare Executives.

Most executives new to a health care organization should have introductory and development programs during their first year, which should include networking opportunities, special projects to improve skills, independent or assigned course work, multiple types of assessments, and periodic discussions regarding expectations about their work and their progress in achieving them. It is preferable for the organization and the new executive to have information from outside sources about how a person in that position can achieve success and the reasons for turnover in the position. This is discussed in this article, using the chief nursing officer as the example.

COVID-19: Nurses have responded, now it is time to support them as we move forward.

The inspiration for The American Nurse Project, Dr. Rhonda Collins, DNP, RN, FAAN, is Chief Nursing Officer for Vocera Communications. Every year around Nurses Week, Dr. Collins publishes a report examining important issues that impact the nursing profession worldwide. Her 2020 CNO report looks at many of the challenges impacting nurses before, during, and after COVID-19—highlighting the mental anguish and physical burdens that COVID-19 has placed on nurses and other frontline healthcare workers as they put themselves in harm’s way to protect others. Dr. Collins examines the foundation of cognitive science and outlines a three-point strategy to guide hospital and nurse leaders moving forward as they strive to support staff members: lightening clinicians’ cognitive load by addressing the difference between documentation and communication, relieving the burden of adapting to multiple systems by giving clinicians control over how they communicate, and providing clinicians with clear, contextual, just-in-time information—using software to enhance workflow, not distract from it. During these unprecedented times, health leaders can honour nurses by providing them with the tools to help strengthen resiliency and healing from this crisis.

Quality and Safety in Healthcare, Part LXXVII: Major Roles of the Chief Nursing Officer.

The chief nursing officer serves in multiple roles, but among the most important are being the chief administrator for the division of nursing, the chief voice in the organization to engage and empower nurses as professionals, and a major leader for increasing patient satisfaction, quality, and safety. Each of these roles has overlapping responsibilities, and failure in any one of could result in failure in all of them. If all of these roles are done well, the value of the care rendered by the healthcare organization will be substantially increased.

Quality and Safety in Healthcare, Part LXXVIII: Expected Competencies of the Chief Nursing Officer and Most Other Healthcare Executives.

Numerous expected competencies of a chief nursing officer are outlined in this article including communication, ability to build relationships, expertise about the environment of healthcare and its future directions, leadership, expertise in business matters, combating bullying, encouraging shared decision making, and optimizing interdisciplinary teams and the use of advanced practice providers. These skills are also expected of most other healthcare executives, whether or not they are nurses, because using these competencies increases quality, safety, and value for the patients and improves conditions for the healthcare organization and those who work there.

System Culture Change Decreases CAUTI

<h3>Background</h3> Across the healthcare system, catheter associated urinary tract infection (CAUTI) rates were escalating and the organization was not meeting goals. Facility assessments revealed; indwelling catheter placement without medical necessity, lack of alternative device use, broken sterile technique during insertion, improper maintenance, and unnecessary catheter longevity. Improvements in standardization of products, insertion techniques, and the development of nurse driven standing orders for removal were needed to eradicate system wide CAUTI. <h3>Methods</h3> A steering committee was formed and lead by a Chief Nursing Officer and Clinical Practice Specialists. A multidisciplinary team was developed consisting of fourteen facility leads, Clinical Nurse Educators, bedside nurses, Infection Prevention, Quality Improvement, data analysists, and sourcing representatives. Following in-depth review of CAUTI cases and analysis of the data, several evidence based practice CAUTI reduction strategies were implemented including, product standardization, focused education/validation, indwelling urinary catheter care teams (UCCT), buddy system, standardization of process including utilization of necessity forms, placement checklists, audit tools, and data collection. <h3>Results</h3> The nurse driven system CAUTI eradication plan has been successful. The incidence of CAUTI has decreased 27.8% from 2015-2019 with the initiation of an evidence based plan. Routine placement of indwelling urinary catheters has declined. Alternative device use has increased. Sterile technique during insertion has improved with the use of validated catheter teams and the implementation of the buddy system. Product Life Cycle Assessments conducted in 2017 and 2019 have demonstrated improvements related to indwelling catheter use and care. While the goal of eradication has not yet been achieved, the system has decreased CAUTIs drastically and continues to assess for areas for improvement. <h3>Conclusions</h3> Eradication of CAUTI aligns with the mission, vision and values of the organization. A system wide culture change based on evidence based practice, led by nursing leadership and all levels of nursing, has decreased CAUTIs in a large healthcare system.

CAUTI Eradication Through System Culture Change

<h3>Background</h3> Across the healthcare system, catheter associated urinary tract infection (CAUTI) rates were escalating and the organization was not meeting goals. Facility assessments revealed; indwelling catheter placement without medical necessity, lack of alternative device use, broken sterile technique during insertion, improper maintenance, and unnecessary catheter longevity. Improvements in standardization of products, insertion techniques, and the development of nurse driven standing orders for removal were needed to eradicate system wide CAUTI. <h3>Methods</h3> A steering committee was formed and lead by a Chief Nursing Officer and Clinical Practice Specialists. A multidisciplinary team was developed consisting of fourteen facility leads, Clinical Nurse Educators, bedside nurses, Infection Prevention, Quality Improvement, data analysists, and sourcing representatives. Following in-depth review of CAUTI cases and analysis of the data, several evidence based practice CAUTI reduction strategies were implemented including, product standardization, focused education/validation, indwelling urinary catheter care teams (UCCT), buddy system, standardization of process including utilization of necessity forms, placement checklists, audit tools, and data collection. <h3>Results</h3> The nurse driven system CAUTI eradication plan has been successful. The incidence of CAUTI has decreased 27.8% from 2015-2019 with the initiation of an evidence based plan. Routine placement of indwelling urinary catheters has declined. Alternative device use has increased. Sterile technique during insertion has improved with the use of validated catheter teams and the implementation of the buddy system. Product Life Cycle Assessments conducted in 2017 and 2019 have demonstrated improvements related to indwelling catheter use and care. While the goal of eradication has not yet been achieved, the system has decreased CAUTIs drastically and continues to assess for areas for improvement. <h3>Conclusions</h3> Eradication of CAUTI aligns with the mission, vision and values of the organization. A system wide culture change based on evidence based practice, led by nursing leadership and all levels of nursing, has decreased CAUTIs in a large healthcare system.

Passing the Chief Nursing Officer Baton: The Importance of Succession Planning and Transformational Leadership.

In today's dynamic healthcare environment, it is more important than ever that the chief nursing officer (CNO) possesses transformational leadership skills. This includes the cultivation of leaders whom the CNO can partner with to advance strategic priorities that benefit patients, families, clinical nurses, and others within a strong, supportive practice environment. A collaborative partnership not only ensures the advancement of an agenda for change but also enhances communication and visibility and provides an opportunity for development of key individuals on the executive team. By supporting partnerships, the CNO has the opportunity to keep talented leaders in the pipeline and to identify those who should be a part of the succession planning process. This is a critically important concept that can lead to a smooth leadership transition.

Using a Nursing Professional Governance Approach to Improve Nurse Satisfaction and Participation With Health Information Technology

Do you have the tools to perform your work/practice? This question is typically one of the lowest ranking questions on employee satisfaction surveys. Chief nursing officers (CNOs) struggle with how to address this question in particular when addressing the electronic health record. Nurse dissatisfaction with the electronic health record requires a new approach. This CNO utilized a nursing professional governance model to improve nurse satisfaction and involvement with the electronic health record. The results reflect a positive impact on nurse satisfaction. Additionally, it revealed that nurses have a desire to be included in the quality of design, implementation, and sustainability of electronic documentation. Do you have the tools to perform your work/practice? This question is typically one of the lowest ranking questions on employee satisfaction surveys. Chief nursing officers (CNOs) struggle with how to address this question in particular when addressing the electronic health record. Nurse dissatisfaction with the electronic health record requires a new approach. This CNO utilized a nursing professional governance model to improve nurse satisfaction and involvement with the electronic health record. The results reflect a positive impact on nurse satisfaction. Additionally, it revealed that nurses have a desire to be included in the quality of design, implementation, and sustainability of electronic documentation. Diane Drexler, DNP, MBA, RN, FACHE, is chief nursing officer at Yavapai Regional Medical Center in Prescott, Arizona. She can be reached at [email protected]

USE OF LEAN SIX SIGMA METHOD TO IMPROVE PROCESS OF ELECTROLYTE REPLACEMENT PROTOCOL IN ICU

TYPE: Abstract Publication TOPIC: Education, Research, and Quality Improvement PURPOSE: Electrolyte imbalance is a common and potentially life threatening phenomenon in critically ill patients. Our data analysis found failure to implement the ICU protocol leads to inadequacy, inconsistency and delay in correcting electrolytes in critically ill patients that can cause life threaterning complications. METHODS: The team utilized a Lean Six Sigma approach to identify the root causes of delays in treatment. This project specifically utilized: affinity diagram, regression analysis and Failure Mode Effects Analysis. Team composition included the Chief Nursing Officer, ICU physicians, nursing director, nurse manager, ICU nurses and a pharmacist. Initial cycle of improvement focused on nurse education and awareness of the impact of a lack of adherence to the protocol. Lab initiated a secondary cycle focused around rapid provision of the lab results to assist in this process. Quality improvement impacts virtually every level of healthcare, from supply chain management to patient safety. RESULTS: Process changes demonstrated a 44% improvement in potassium replacement and 71% improvement in magnesium replacement in the ICU. Significant improvement was demonstrated in the time from lab available to start of electrolyte replacement. CONCLUSIONS: Lean Six Sigma methodology can be used successfully to reduce variation in ICU protocol like electrolytes replacement. CLINICAL IMPLICATIONS: Process variation improvement 71% for Magnesium and 44% for potassium replacement protocol leads to reduction in morbidilty and mortality from arrythmia in ICU. DISCLOSURE: No significant relationships. KEYWORDS: Lean six sigma, process improvement, ICU protocol

The Positive Impact of Establishing an Internal Transfer Center

Health systems are facing greater pressures than ever before, with factors ranging from mergers and acquisitions and changing reimbursement models to capacity challenges and staffing shortages. A transfer center, where with 1 simple call from a referring physician, a decision to accept a critically ill patient can be made, placing them at the most appropriate level of care, the first time. Baptist Health in Jacksonville, Florida, went from an outsourced to an in-house center in 3 months—in the first 28 days alone, patient transfers increased from 900 to 1,500, growing to an average of 1,583 transfers per month.

On the Frontline of the COVID-19 Outbreak: Keeping Patients on Long-Term Dialysis Safe.

We received a call at 9:00 pm on Friday evening, February 28th that our patient had died of coronavirus disease 2019 (COVID-19) disease. This would be the first reported death from COVID-19 in the nation. After suspending disbelief, we began our approach following three guiding principles: provide

Ready or Not, Patients Will Present: Improving Urban Pandemic Preparedness.

Over the past century, society has achieved great gains in medicine, public health, and health-care infrastructure, particularly in the areas of vaccines, antibiotics, sanitation, intensive care and medical technology. Still, despite these developments, infectious diseases are emerging at unprecedented rates around the globe. Large urban centers are particularly vulnerable to communicable disease events, and must have well-prepared response systems, including on the front-line level. In November 2018, the United States' largest municipal health-care delivery system, New York City Health + Hospitals, hosted a half-day executive-level pandemic response workshop, which sought to illustrate the complexity of preparing for, responding to, and recovering from modern-day infectious diseases impacting urban environments. Attendees were subjected to a condensed, plausible, pandemic influenza scenario and asked to simulate the high-level strategic decisions made by leaders by internal (eg, Chief Medical Officer, Chief Nursing Officer, and Legal Affairs) and external (eg, city, state, and federal public health and emergency management entities) partners across an integrated system of acute, postacute, and ambulatory sites, challenging players to question their assumptions about managing the consequences of a highly pathogenic pandemic.

Advocacy: 2019 PCNA Advocacy Activities With Focus on Cardiac Rehabilitation Accessibility.

Advocacy: 2019 PCNA Advocacy Activities With Focus on Cardiac Rehabilitation Accessibility.

Chief Nursing Officer Council Partners With Sustainability Department to Develop a Model of Success for Reducing the Organization’s Carbon Footprint

The health care industry, a major contributor to greenhouse gas emissions and landfill waste, must focus on sustainable efforts. The American Nurses Association (ANA) Scope and Standards of Practice deems nurses accountable to achieve sustainable goals in the workplace. This article shows how the chief nursing officer (CNO) council of one health care system partnered with the organization’s sustainability department to integrate sustainability efforts into daily operations across the system. Each CNO was tasked to determine key performance indicators for their location, identify facility champions, and support sustainability efforts. Some joint initiatives included education, waste reduction and diversion, 501(c)3 donation, and device reprocessing. The health care industry, a major contributor to greenhouse gas emissions and landfill waste, must focus on sustainable efforts. The American Nurses Association (ANA) Scope and Standards of Practice deems nurses accountable to achieve sustainable goals in the workplace. This article shows how the chief nursing officer (CNO) council of one health care system partnered with the organization’s sustainability department to integrate sustainability efforts into daily operations across the system. Each CNO was tasked to determine key performance indicators for their location, identify facility champions, and support sustainability efforts. Some joint initiatives included education, waste reduction and diversion, 501(c)3 donation, and device reprocessing. Deborah C. Stamps, EdD, MBA, MS, RN, GNP, NE-BC, is system vice president at Rochester Regional Health/Quality, Safety & Innovation Institute, in Rochester, New York. She can be reached at [email protected] . Michael G. Waller, PhD, is Director of Sustainability, Special Assistant to the CEO at Rochester Regional Health. Susan M. Foley, PhD, RN, is a consultant at Rochester Regional Health, Wegman Center for Workforce Development. Jennifer Gales, MSN, RN, is Vice President, Chief Nursing Officer at Unity Hospital in Rochester. Rebecca Alley, BSN, MS, RN-B, is Chief Nursing Officer at Alexander Park Medical Group in Rochester. Cindy Lovetro, MS, BS, RN, LNHA, is Chief Nursing Officer, Long Term Care at Rochester Regional Health. Kristin Opett, BSN, RN, MSHA, is Vice President, Chief Nursing Officer at Rochester General Hospital, Rochester Regional Health. Theresa Glessner, DNP, RN, ACNP, BC, NEA-BC, CCRN, is Vice President, Chief Nursing Officer at Newark Wayne Community Hospital in Newark, New York. Sheri Faggiano, MSN, RN, is Vice President, Chief Nursing Officer at United Memorial Medical Center in Batavia, New York.