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’.
You can also find more information about Kathleen on her website, Twitter, and Facebook.
I just want to thank you for this informational article, I hope it brings light to the struggles of what CNO’s fight everyday day. Every nurse needs to I understand no matter what position a nurse holds, especially a CNO, she fights for nursing first. I unfortunately resigned my position as a CNO for many of the reasons you listed, in my heart I could not justify the staffing ratio’s, the quality of our care, the disappointment of not being heard, the exhaustion of fighting a system to do what was right and not not just cost effective, there were so many battles and very few wins. A CNO takes that position to create change, to grow nurses, to be a positive driver, to be the anchor in the storm, to be “their voice” at the table, but many don’t want to hear that voice now, it’s called the voice of reason. So again, than you, no one thinks about the life of the CNO, the person nurses assume has power to change their lives, so many times I wish I’d had a magic wand, but it just a title in some cases, especially now. God Bless and to all the nurses that dedicate and sacrifice your lives everyday, I thank you too.
You are most welcome and thank you for validating the reality that I wrote about and for fighting so many battles to protect nurses and the quality of care. To my knowledge, no one has ever written about this struggle and many a CNO have said nothing thinking it was only them. Perhaps now we can focus on the cause – which is the system.