I can’t remember ever seeing an article thanking chief nurses. Seems they’re always the ones thanking their nurses. Recognition is long overdue.
Even before the pandemic, chief nursing officers (CNOs) had a tremendous challenge. Now, it’s even worse. I can’t help but feel a profound sense of gratitude and respect for these nurses because I understand clearly that they have their fingers in the dike of healthcare, preventing the entire system from collapsing—every day. If you understood their culture, I know you would feel the same.
When I was teaching a few charge nurses last week who were angry about inadequate staffing, one blurted out, “You should tell our CNO what you’re telling us.” I responded, “Who do you think brought me in here to speak with you?” Staff nurses don’t understand that the real problem is the system and not their leader. So, they blame their CNO.
Politics are thick in the C-suite—a term used to describe the CEO, CFO, CXO team. In every hospital, the CFO has the last word because our healthcare system primarily is designed for profit. The CNO typically is the last voice for safe, quality care. Nowhere are the different goals of healthcare more blatantly obvious than if you lay the job descriptions of the CFO and CNO next to each other. Working in this bi-polar world can make you crazy. The best hospitals I’ve visited have a combined CNO/CEO role as one person—that’s where I would want to work.
Since nursing is a cost and not a ‘payment,’ CNOs find themselves responding to C-Suite discernment, critiques, assumptions, and requests (demands) to constantly evaluate potential cost reductions that force them to constantly justify patient care staffing needs. Because nurses are perceived as a cost and not a revenue driver, many CNOs have little clout. But the real issue is that as a society, our system values profit over people…business over service…capitalism over caring.
Many CNOs lack the support and power they deserve. In large healthcare organizations, hospitals compete against each other rather than cooperating between hospital systems that are so large they span states. Unless they have a corporate CNO to mentor and stand up for them, these CNOs are especially vulnerable. To what? To being deprived of what they need to do their job, getting lost in the thicket of numerical calculations and not being heard. Or as one CNO shared with me, “If I speak my truth as you say, I won’t have a job—they’ll just find someone else who will stay silent.”
A heartfelt thank you to every CNO for your compassion, creativity, tenacity, endurance, and dedication. Your challenges are greater than any other role in healthcare. Or maybe I should ask other people to thank you, knowing that you’re the least likely to have time to read this post.
Stop and ask your CNO what you can do for them today. Appreciate the breadth and depth of their challenges.
Bartholomew K. By design: Aligning structure with values to impact outcomes in a public utility model. J Public Health Int. 2021;4(3):15-21. openaccesspub.org/jphi/article/1725
Bombardieri M, Zhavoronkova M. Opinion: There’s a dire shortage of nurses across the US. There’s also an overlooked solution. CNN. July 20, 2022. cnn.com/2022/07/20/opinions/nursing-shortage-covid-hospitals-bombardieri-zhavoronkova/index.html
Love R. Want to fix the nursing shortage? Change this 100-year-old policy. Becker’s Hospital Review. July 18, 2022. beckershospitalreview.com/want-to-fix-the-nursing-shortage-change-this-100-year-old-policy.html
Kathleen Bartholomew, RN, MN, is an internationally recognized patient safety and health culture expert. Kathleen has spoken on leadership, communication, patient safety, and peer relationships to hospital executives and nurse leaders for twenty years.
All of her books come from her passion to understand the stories of nurses. Her books, “Ending Nurse to Nurse Hostility” and “Speak Your Truth” illuminate our relationships with our peers and physician partners. She is also co-author of “The Dauntless Nurse” which was written as a communication confidence builder.
Kathleen is also a guest Op Ed writer to the Seattle Times and has been interviewed twice on NPR’s “People’s Pharmacy”. Her Tedx Talk calls for changing our belief system from a hierarchy to equality in order to keep our patients safe – and also explains how disaster thrust her into ‘the best profession ever’.