So You Want to Be a Chief Nursing Officer?

Laura A. Stokowski, RN, MS


March 26, 2015

In This Article

The Nurse Leadership Pipeline

Nursing leadership within a hospital or healthcare system can't be left up to chance. Succession planning and leadership talent development are used strategically by organizations to identify and develop high-potential nurses for leadership positions.[9] Future nurse leaders must be cultivated from within the organization.[1]

A formal succession plan is crucial to the financial and operational viability and sustainability of the hospital or health system. Leadership development is an essential business strategy that promotes effective leadership transition and continuity while maintaining productivity.[10] The responsibility for filling and maintaining the nursing leadership pipeline typically falls to the senior nurse executives of the organization or system.

Businessman Harvey Firestone once said, "The growth and development of people is the highest calling of leadership." If this is so, then the growth and development of leaders must be equally, if not more, important. Gordin believes strongly that emerging leaders need support in the form of guidance, coaching, mentoring, and training.

"Succession planning is something that I actively work on every day," says Gordin. "We partner with human resources for our succession planning and leadership development program. Every year we assess all of our leaders from supervisor up through director. This talent assessment allows us to identify people who have untapped potential, are ready to be promoted, or are able to take on more responsibility even if they are not interested in promotion. Who do we have in the pipeline who could move into a specific leadership role? In what period of time could that person be ready? How would we fill various leadership positions if the current leaders left tomorrow? We identify one or two people who could take over a certain leadership role if necessary. We then steer them into specific leadership development programs or our own program. We put people in teams and give them a project to work on together. It gives them a chance to develop their leadership skills in a different way from what they do in their regular jobs."

Polhemus agrees that good succession planning is key. "Health networks need to identify rising stars and create hands-on training programs to ensure that talent pool for the future. Healthcare systems have been more intentional about developing their talent from within. In some cases, this might involve supporting a nurse to get more education or an advanced degree."

When a high-level nurse executive position, such as a systems-level CNO, can't be filled internally, organizations often turn to executive search services. Polhemus works with a firm that specializes in not-for-profit healthcare associations, engaging with clients to help fill critical position openings on their leadership teams. To find the best match for an organization, Polhemus explains, "We go on site to the client and meet with the stakeholders and even the staff nurses to understand the strategic goals, the opportunities, and the challenges of the organization. That way, when we examine the market, we know what the organization is looking for in a new leader. It's a small talent pool, so it can take 4-6 months to find the right person for a systems-level CNO position."

Day-to-Day Challenges of Being a Nurse Executive

Gordin cites as the greatest challenge for nurse executives the fact that healthcare itself is changing. "It is being repriced, and there is intense pressure to provide ever better patient care at lower and lower cost. Whenever anyone starts to look at costs, they target full-time equivalents (FTEs), and the bulk of the FTEs are at the bedside. People wouldn't be in the hospital if they didn't need nursing care. Trying to articulate the value of nursing and the risk associated with cutting nursing to the bone is the toughest part of the job. Nurse executives must be heard, and to do so, they need to be facile with the financial side of operations so they can make a case with both a clinical and a financial argument behind it."

The current healthcare climate offers both challenges and opportunities for highly motivated nurses to become successful in nurse executive roles. The mandate to prepare nursing leaders was clear in the Institute of Medicine's 2010 report, The Future of Nursing: Leading Change, Advancing Health.[11] Effective nursing leaders are imperative to meet the tremendous financial pressures and also maintain healthy work environments and promote nurse retention at a time when the country faces the impending retirement of a significant proportion of the workforce.[12] Research consistently demonstrates the influence of nursing leadership on such outcomes as patient satisfaction, patient mortality, medication errors, restraint use, and hospital-associated infections.[13] It is both bewildering and unfortunate that some nurse leaders still have to defend their right to have a seat at the executive table.[14]


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