Chief nursing officers are frustrated. They also have high hopes for 2023

Chief nursing officers say they would love the opportunity to look beyond staffing to other initiatives in the second half of 2023. Unfortunately, despite innovative strategies to retain, attract — and, perhaps most important financially speaking, reduce reliance on contract staff — efforts to stabilize nurse staffing levels remain priorities 1, 2 and 3.

Seeking to get a peek into the minds of CNOs who are frustrated and overwhelmed but also focused on remaining patient centric and optimistic, Becker's asked nursing leaders what they want top hospital executives to know right now and what they hope will be the biggest wins in the remainder of the year.

Editor's note: Responses have been lightly edited for clarity and brevity.

Question: From your position as a nursing leader, what do you want your C-suite colleagues to know about how it really is in the nursing trenches?

Kay Carolin, BSN, RN. Chief Nursing Officer at Karmanos Cancer Institute (Detroit): I am lucky because my colleagues understand. Most of us have been touched by cancer. We know what good care looks like and what we want for ourselves, our families and our patients. I conduct clinical rounds weekly with our CEO and we talk with staff during our visits. 

Our CEO and I discuss daily the struggles that we are experiencing with staffing, but what keeps us motivated are stories like this one: We had one of our senior system executives as a patient. He related how he had always seen and thought about physicians as the most important component to providing quality healthcare. After being treated at our hospital for an extended period, he still thought the impact of world-class physicians was a key factor in quality care but realized that when you are sick and struggling or it is nighttime and you are afraid, that nurse at your bedside is the most important factor. 

It's through this story and dozens more like it that our executives understand what happens at the bedside and chairside when it comes to meeting the needs of our patients.

Bob Dent, DNP, RN. Vice President of Patient Care Services and Chief Nursing Officer at Emory Healthcare (Atlanta): I have a great C-suite team of leaders; they truly listen to understand what we’re going through. For nonclinical hospital C-suite leaders, they should try to be just as visible in the trenches as the nurse leaders are so they can see and feel what nurses and other clinicians are going through.

C.J. Marbley, BSN, RN. Chief Nursing Officer and COO at New Orleans East Hospital: C-suite leaders want feedback about potential improvements or possible blind spots. Also, they want to hear your creative ideas around improvements for the hospital and possible ways to increase the quality of or access to care for patients and communities. The day is spent making tough decisions that affect people and departments and wrong decisions to cost jobs or lives, so they are never made without thoughtful consideration.

Sylvia Martin, DNP, RN. Chief Nursing Officer and Assistant Medical Group Administrator at Kaiser Permanente Panorama City Medical Center (Panorama City, Calif.): We have many very dedicated, bright nurses and clinical leaders. They need to be included in the conversations when problems are being solved. Often, the voices in these conversations are not the ones doing the work and this is a barrier to effectiveness and sustainment.

Dawn Miller, DNP, RN. Vice President of Patient Care Services and Associate Chief Nursing Officer at City of Hope (Duarte, Calif.): Stability of staffing is critical. Clinical leaders must be proactive in addressing shortages and anticipate shortages to stay ahead of the competition for the same resources. We have to be creative in how we approach providing the safest care to our patients. The C-suite needs to partner with clinical leadership to determine the best way to be stewards of these efforts. A push-pull relationship will only thwart efforts.

Q: How can hospital leaders help each other deal with stress and overwhelming situations?

BD: Create psychologically safe spaces to have conversations about feelings, emotions and mental health. Be present for your teams.

CJM: Provide forums where they talk through the difficulties of the roles and learn coping mechanisms from each other.

SM: As leaders in healthcare, we can connect in our broader community. Learn from each other, extend emotional support and mentorship. Include each other in our support system model to build each other up and help each other to thrive.

DM: Clinical leaders can help each other by maintaining collaborative relationships, sustaining a sense of urgency, supporting each other and challenging ourselves to be innovative in our approach. We can celebrate our successes and learn from our opportunities.

Q: What's poised to disrupt or redefine nursing the most in the near future?

BD: Virtual nursing, powered by AI. 

CJM: Virtual/remote nursing and telenursing — where experienced nurses can guide and inform care to caregivers via remote video links while in the hospital and at home with the use of remote blood pressure, heart rate, pulse ox and glucose monitoring.

SM: The ability for data mining and computer learning has tremendous potential, as do wearable health devices and remote assessment tools. Additionally, preventative medicine and the promotion of health are building as an area that will answer the struggle to meet the demand of the sick care we currently must meet. 

The primary way to reduce the economic burden of healthcare is to help our communities be well. These are some of the things that are being further developed that will change the way health is managed and the healthcare industry must prepare for this now.

DM: Virtual nursing is a popular topic at present. Challenges to how to roll this out, particularly in states with mandated ratios, is an issue. Similarly, staffing models that support team-based care that utilize support staff are of similar concern.

Q: What can CNOs do to ensure a smooth rollout for virtual nursing? 

BD: The most important thing a CNO can do is establish clear communication and collaboration channels among the nursing staff, IT teams and other stakeholders involved in the implementation of virtual nursing. By doing this, the CNO can ensure that nurses are well informed, adequately trained and supported throughout the rollout of virtual nursing. This promotes a smoother transition, reduces resistance and increases the likelihood of successful implementation and adoption.

CJM: Validate proper information sharing, training and protocols and ensure proper implementation of a team nursing approach that ensures clarity of roles and responsibilities.

SM: Prepare teams to utilize technology and software comfortably. Helping the team to have a change mindset, to be engaged with change and prepared to lead change.

DM: For a smooth rollout for virtual nursing, it is important to do it in such a way as to gain the most benefit to the patient and the care team. Leaders must balance current cost constraints while honoring mandated ratios.

Q: What are your biggest priorities for the remainder of 2023?

BD: Addressing the nursing shortage through ongoing recruitment and retention activities; Supporting our teams well-being and mental health; advancing technology, including virtual care; the ongoing work related to enhancing a diverse and inclusive workforce along with promoting health equity and reducing disparities in care; and, supporting and strengthening nurse leadership development. These priorities reflect the evolving healthcare landscape and the need for nurse leaders to address current challenges while also fostering a vision for the future of nursing.

CJM: In the hospital, the priorities are decreasing labor costs, training new graduates and developing pipeline relationships and programs for future staff. In the communities, it is to increase access to healthcare by providing care right where patients live.

DM: My biggest priorities are to support an inclusive, supportive and accountable culture where patients can receive care that is effortless and exceeds their expectations. It's also important for the team to enjoy their work and colleagues feeling valued and respected.

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