Chief Nursing Officer Research Articles

Leading With Hope: Seven Insights From Get Well's Nurse Executive Council on the Future of Digital Health.

In an era where digital transformation is reshaping healthcare, the role of the chief nursing officer (CNO) has never been more important. CNOs are strategic and visionary leaders, adept at blending clinical expertise and a deep understanding of care team workflows with technology innovations-to uphold patient-centered care at the forefront of all decisions.

Virtually integrated nursing care: A case study in diffusion of innovations

Bedside nurses are suffering from nurse fatigue owing to excessive workload and work hours. Nurse fatigue results in missed nursing care, which has a direct impact on patient care and safety. Loss of experienced nurses also affects novice nurses, leaving them without strong mentoring. They may suffer from imposter syndrome, which instils self-doubt and limits their professional development, potentially resulting in burnout and attrition. A case study regarding the leadership of the Chief Nursing Officer as aligned with Rogers’ diffusion of innovations theory is presented. There is an initial accumulation of knowledge regarding the innovation, followed by persuasion (through perception of positive attributes to enhance speed of adoption), decision making, actual implementation and confirmation. Use of virtually integrated nursing helped alleviate bedside nurse fatigue by removing overtime hours and reducing workload. The virtually integrated nurses supported the bedside nurses, allowing them additional time in direct patient care, enhancing patient satisfaction and safety. The objective data indicates a decrease in patient fall by over 50 per cent. The integration of virtual nursing reversed the nurse attrition rates. Initial results revealed a 47 per cent reduction in registered nurse turnover. This allowed for retention of experienced nurses, which aids in mentoring novice nurses. The impact of virtually integrated nursing is yet to be completely realised. Based on this case study, the implementation of virtually integrated nursing is possible and beneficial to nursing, patient safety and the bottom line. This innovation had additional positive consequences and led to future considerations regarding continual process improvement and dissemination of knowledge.

The San Francisco Health Systems Collaborative: Public Health and Health Care Delivery Systems’ Response to the Covid-19 Pandemic

The Covid-19 pandemic challenged health care delivery systems worldwide. Many acute care hospitals in communities that experienced surges in cases and hospitalizations had to make decisions such as rationing scarce resources. Hospitals serving low-income communities, communities of color, and those in other historically marginalized or vulnerable groups reported the greatest operational impacts of surges. However, cross-institutional collaborations within jurisdictions offer unique opportunities to prevent or mitigate health disparities in resource utilization and access to care. In January 2020, in response to the emerging coronavirus epidemic, the San Francisco Department of Public Health (SFDPH) and local hospital and health systems partners convened to align and coordinate medical surge planning and response. Adopting a governance structure of mutual accountability and transparency, the San Francisco Health Systems Collaborative guided local medical and public health response in the areas of medical surge, vaccination administration, testing, and therapeutics. Four principles guided the collaborative response: (1) shared priorities, (2) clear governance and accountability, (3) data transparency, and (4) operational coordination. High-level priorities established included protecting vulnerable people, protecting health care workers, and maintaining health system capacity. The governance structure consisted of three layers: local hospital and health systems’ CEOs coordinating with SFDPH executives; hospital chief medical and nursing officers coordinating high-level surge capacity assessments and mitigation plans; and local clinical operational managers working with public health response operational leaders to coordinate scarce resource utilization. Fluctuating with the tempo of the disease indicators and medical surge, governance and coordination were maintained through a tiered meeting and reporting system. Data visibility and transparency were key principles facilitating operational decision-making and executive-level coordination of resources, including identifying additional surge bed capacity for use systemwide, as well as ensuring efficient and equitable vaccine distribution through implementation of five mass-vaccination sites with prioritized access for vulnerable communities. Applying these four principles of shared priorities, accountability, transparency, and operational coordination and pragmatism helped the public health and individual hospital systems make contributions to the overall response that were aligned with their unique strengths and resources. Publication here represents the first official public use of the name San Francisco Health Systems Collaborative (which had served as the term used internally to refer to the group) and the first time codifying this structure. Through this coordination, San Francisco achieved one of the lowest Covid-19 death rates and had one of the highest vaccination and booster rates, compared with rates across California or the United States. Similar principles and implementation methods can be adopted by other health jurisdictions for future emergency outbreak response.

Leading through the COVID-19 pandemic: Experiences of UK Executive Nurse Directors.

To explore the challenges experienced by Executive Nurse Directors during the COVID-19 pandemic, and to inform future nursing leadership strategies. A qualitative research project involving interviews with 21 Executive Nurse Directors from England and Wales. Participants were purposively sampled and recruited through Chief Nursing Officers and nursing leadership networks. Semi-structured interviews were conducted and recorded online via Teams. Braun and Clarke's approach to thematic reflexive analysis was applied to data analysis. Executive Nurse Directors played a critical role during the COVID-19 pandemic. Six themes are explored: tensions, and adaptive response to personal leadership styles; uncertainty and support at the board level; responding to national political decision-making; the personal and emotional impact of the role and the sources of effective support; the voice and public profile of nursing; lessons learnt and strategies for future leadership development. Enablers of decision-making included effective multidisciplinary working, freedom from normal organizational constraints, support for innovation, and the development of stronger bonds with colleagues. Barriers to decision-making included limited knowledge of the virus and its impact and lack of guidance, particularly at a national level. Priorities, strategies and actions for recovery include recognizing the emotional impact of being in a high-level decision-making role, protecting staff from burnout and understanding the long-term implications of pandemic work for nurse leaders. Future strategies for nursing leadership during public health, national and global emergencies are recommended. This study contributes to the literature exploring the Executive Nurse Director role and their experiences of leading through the COVID-19 pandemic, and identifies priorities, strategies and actions for recovery and learning for the future of senior leadership. The study adhered to the Consolidated Criteria for Reporting Qualitative Research. No patient or public contribution.

The CMO and the Chief Nursing Officer: Creating Synergy

The Chief Nursing Officer and the Chief Medical Officer are responsible for the oversight of clinical outcomes within a complex and rapidly changing environment. Much attention has been paid to the interplay between these strategic executive roles. As the two chief clinical officers, they need to create synergy to realize the imperative of exemplary care delivery. While a great deal of evidence supports a partnership model of leadership, attainment remains elusive for many CMOs and CNOs.

The Uncharted Path: Understanding the Gap Between Chief Nursing Officers and CEO Roles in Healthcare

The Uncharted Path: Understanding the Gap Between Chief Nursing Officers and CEO Roles in Healthcare

England's Chief Nursing Officer 7Ps: a new nursing framework

Penny Harrison explores a new nursing framework, launched in November 2023, colloquially termed the ‘7Ps’

Operationalizing the Vision: Collaboration With the Chief Nursing Officer.

Operationalizing the Vision: Collaboration With the Chief Nursing Officer.

A renewed focus on school nursing

Sallyann Sutton shares the Chief Nursing Officer's recent announcement on school nursing and discusses the importance of clearly articulating the role and changes to practice.

Building a COVID Field Hospital in Less Than 30 Days: The CNO Story

Following a phone call from our respective chief nurse executives, two experienced nursing leaders from two large health systems put their ‘day’ jobs on hold to pivot and help build a COVID field hospital in the Baltimore Convention Center, transforming it into the Baltimore Convention Center Field Hospital (BCCFH). Both leaders, although qualified, had not served as chief nursing officers (CNOs), and the assignment for the BCCFH was to colead nursing as a CNO. Priorities included hiring over 3,000 per diem staff, writing policies and procedures needed to care for up to 250 patients, and designing workflows from patient admission, medication administration, shower schedules, and overall patient care, all of which required infection prevention protocols. Along with other key executives, the CNOs designed, created, and opened the BCCFH in less than 30 days.

The Role of the Wider Organization and Community in Meaningful Nurse Manager Recognition

The span of control of the nurse manager role argues for an interdependent approach to generate meaningful nurse manager recognition. As part of a larger descriptive qualitative study, nurse managers, directors, and chief nursing officers (CNOs) were interviewed using open-ended semistructured questions to examine a culture and climate of meaningful recognition. The purpose of this article is to advance the call to improve nurse manager recognition by the wider health care organization and community. Triggers and best practices to enable nurse manager recognition are presented based on observations with key stakeholders: CNOs, the C-suite, internal departments, and the wider community.

Creating an Organizational Culture and Climate of Meaningful Recognition for Nurse Managers.

To examine the current nurse manager (NM) recognition culture and climate in organizations and to develop a theoretical foundation for meaningful recognition. Nurse managers call for wider recognition, but the theoretical conceptualization and underpinnings of meaningful recognition are sparse in the literature. A qualitative descriptive design was used utilizing individual interviews. The study participants included 30 individuals consisting of NMs, chief nursing officers, and chief nursing executives. Content analysis was conducted. A theoretical model with super-categories and supportive quotes was created to operationalize a culture and climate of meaningful recognition in the organizations represented by the sample. This qualitative descriptive study highlights the importance of recognizing the value of NMs for their contributions to nursing leadership and patient care. Implications of recognizing NMs are counteracting the feeling of being invisible and mitigating issues within the work environment.

Nursing practice leaders’ perspectives on continuing challenges related to the Doctor of Nursing Practice Degree

In 2020, deans from top-ranked nursing schools authored a Nursing Outlook article titled, “Doctor of Nursing Practice (DNP) Degree in the United States: Reflecting, Readjusting, and Getting Back on Track.” In 2022, the American Association of Colleges of Nursing published the report, “State of the Doctor of Nursing Practice Education.”- Both have been critical to advancing national discussions on the implementation of a universal DNP practiceentry standard in nursing. This paper, written by Chief Nursing Officers from top-ranked academic medical centers, reports on perspectives from practice settings/employers regarding issues raised by educators and deans in those documents. Barriers to acceptance of the DNP degree in practice include a lack of degree standardization, a need for DNP outcomes data, and a desire for a clearer return on investment for the DNP degree among graduates and employers.

Women's autonomy for managing labour pain in a relational context: An interpretive description study.

To describe how women perceived relational autonomy for decision-making during childbirth pain and illuminate influencing factors. Most women report challenging pain during birth. Circumstances can affect their ability to engage in pain management decisions. We used an interpretative description approach to conduct this study. A purposive sample of ten women who reported pain during childbirth participated in semi-structured interviews. The study was conducted between July 2019 and November 2020 and reported according to the COREQ checklist. Circumstances during childbirth, such as women's expectations and relationships, influenced their efforts to engage in relational autonomy. Care providers dealt with the unpredictability of childbirth and challenges with pain management using decision-making practices that could disrupt women's expectations, undermine women's trust, demonstrate disrespect for women and rely on inadequate communication. Women who felt dependent on others were less likely to participate in decision-making. When care providers' perceptions about pain differed from women's reports of pain, participants became distressed because care providers did not acknowledge their subjective pain experiences. Women regarded their relationships and communication with care providers as foundational to relational autonomy in decision-making about pain management during childbirth. Study findings can support care providers' considerations of the complexity of childbirth pain and factors affecting women's relational autonomy in decision-making about pain. In particular, the findings highlight the importance of women's expectations and care providers' recognition of women's experiences of pain. Women who shared their stories of childbirth pain contributed to the data collected. The chief nursing officers in the data collection setting facilitated the recruitment and data collection.

An overview of nursing and midwifery leadership, governance structures, and instruments in Africa

BackgroundInvestment in nursing and midwifery leadership and governance are key suggested approaches by the World Health Organization (WHO) Africa Regional Office to address the shortages in the nursing health workforce. However, there are few if any studies that have investigated the existence and operationalization of the nursing and midwifery leadership and governance structures in Africa. This paper fills this gap by, providing an overview of nursing and midwifery leadership, governance structures, and instruments in Africa.MethodsWe conducted a descriptive cross-sectional study of the nursing and midwifery leadership, structures, and instruments in 16 African countries using quantitative methodology. Data was analyzed using SPSS IBM 21 statistical software. Data was summarized in frequencies and percentages and presented as tables and charts.ResultsOnly (9,56.25%) of the 16 countries included had retrievable evidence of all expected governance structures while (7, 43.75%) lacked one or more of the structures. A quarter (4, 25%) of the countries did not have a department of nursing and midwifery or chief nursing and midwifery officer at their Ministry of Health (MOH). The dominant gender representation across all the governance structures was female. Only Lesotho (1, 6.25%) had all expected nursing and midwifery governance instruments while the remaining (15, 93.75%) had either one or four of these instruments missing.ConclusionsThe lack of complete nursing and midwifery governance structures and instruments in various African countries is a matter of concern. Without these structures and instruments, the strategic direction and input of the nursing and midwifery profession cannot be maximized for the public good in relation to health outcomes. Addressing the existing gaps requires a multipronged approach with the need to strengthen regional collaboration, and advocacy, creating awareness, and advancing nursing and midwifery leadership training to enable nursing and midwifery governance capacity development in Africa.

The Alberta Health Services Emergency Strategic Clinical Network™ Quality Improvement and Innovation Forum 2023

Evidence-based research and quality improvement work are pivotal to health systems meeting their goals. Translating findings and disseminating innovative practices to new settings occurs in part through knowledge translation events, such as conferences and workshops. The annual Emergency Strategic Clinical Network™ (ESCN) Quality Improvement and Innovation Forum fills a gap between local and national events. It is devoted to sharing methods and results of emergency department projects in Alberta among those working in emergency care. The event provides an opportunity for those pursuing quality improvement initiatives in emergency medicine to network with one another, share innovative projects, share experience, and translate promising works to new settings. In addition, the event provides an opportunity to identify projects for potential development through local, provincial, or national funding opportunities. After providing only an online forum throughout the pandemic, this year’s event was held in-person in Red Deer, Alberta and live-streamed for those who wished to attend virtually. Nineteen oral presentations were delivered including a keynote address by Dr. Leigh Chapman, Chief Nursing Officer of Canada. Strong attendance shows the value practitioners see in the forum. In 2023, approximately 160 educators, managers, nurses, physicians, researchers, and patient advisors attended the forum. Post-event evaluation survey feedback suggests that most of the participants found the presentations helpful and that the virtual presentations were as effective as in-person presentations. Attendees indicated that many of the initiatives presented would be explored further. We are grateful to the Canadian Journal of Emergency Nursing for publishing abstracts from the event.

NCCN Highlights Best Practices for Challenges in Oncology

NCCN Highlights Best Practices for Challenges in Oncology

Not Just a Vaccination. Provision of Public Health, Environmental, and Social Needs in an Austere Environment in Miami, Florida

Introduction:The recently approved COVID-19 vaccine in 2021 provided a glimmer of hope to all people who had isolated, or lost loved ones to the SARS-COVID-19 virus. Clinics were rapidly established in non-traditional settings in order to meet the need in the early phases of the vaccination program. Contractor support provided rapid personnel support to meet the needs of many locations in several states. Consideration of basic infrastructure requirements such as Incident Command, security, HVAC, electricity, water and sanitation were part of a state supported vaccine clinic in an economically challenged neighborhood in downtown Miami, Florida.Method:Topics to be discussed include staffing mixes, language/cultural concerns, handheld EMR applications, patient flow, immunization practices, testing practices, vaccine security, adverse event management, infection control procedures and the ever present supply chain challenges. The discussion will be framed from the perspective of the Chief Nursing Officer in an ever challenging vaccine environment.Results:Over 20,000 vaccines were successfully provided in a little over three months, and a community-based Student Internship program was also implemented.Conclusion:Vaccine administration is possible in a variety of settings. Foundational principles of vaccine security, management of the environment and provision of safety and security for patients and staff will help to ensure a successful public health campaign.

Designing A System for Safe Staffing

Developing effective systems to ensure safe and appropriate nurse staffing is a critical priority for both chief nursing officers as well as the governance and leadership of health care organizations. Bedside nurses will gain confidence in their employer’s commitment to ensuring safe nurse staffing if they are actively engaged in designing staffing systems in a meaningful way. Investment in comprehensive, well-integrated staffing systems can offer an effective and viable alternative to regulatory solutions.

Budgetary investment in evidence-based practice by chief nurses and stronger EBP cultures are associated with less turnover and better patient outcomes.

Hospitals and healthcare systems strive to meet benchmarks for the National Database of Nursing Quality Indicator (NDNQI) measures, Centers for Medicare & Medicaid Services (CMS) Core Measures, and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) outcome indicators. Prior research indicates that Chief Nursing Officers and Executives (CNOs, CNEs) believe that evidence-based practice (EBP) is important for ensuring the quality of care, but they allocate little funding to its implementation and report it as a low priority in their healthcare system. It is not known how EBP budget investment by chief nurses affects NDNQI, CMS Core Measures, and HCAHPS indicators or key EBP attributes and nurse outcomes. This study aimed to generate evidence on the relationships among the budget devoted to EBP by chief nurses and its impact on key patient and nurse outcomes along with EBP attributes. A descriptive correlational design was used. An online survey was sent to CNO and CNE members (N = 5026) of various national and regional nurse leader professional organizations across the United States in two recruitment rounds. Data collected included CNO/CNE EBP Beliefs, EBP Implementation, and perceived organizational culture of EBP; organizational culture, structure, personnel, and resources for EBP; percent of budget dedicated to EBP; key performance measures (NDNQI, CMS Core Measures, HCAHPS); nurse satisfaction; nurse turnover; and demographic questions. Descriptive statistics were used to summarize sample characteristics. Kendall's Tau correlation coefficients were calculated among EBP budget, nursing outcome measures, and EBP measures. One hundred and fifteen CNEs/CNOs completed the survey (a 2.3% response rate). The majority (60.9%) allocated <5% of their budget to EBP, with a third investing none. An increase in EBP budget was associated with fewer patient falls and trauma, less nursing turnover, and stronger EBP culture and other positive EBP attributes. A greater number of EBP projects were also associated with better patient outcomes. Chief nurse executives and CNOs allocate very little of their budgets to EBP. When CNEs and CNOs invest more in EBP, patient, nursing, and EBP outcomes improve. System-wide implementation of EBP, which includes appropriate EBP budget allocation, is necessary for improvements in hospital quality indicators and nursing turnover.