Top 10 concerns of chief nursing officers

High turnover in the C-suite, disengaged staff, and nurse recruitment and retention are among the top concerns facing chief nursing officers in 2018.

Those are the findings of a CNO roundtable discussion recently conducted by Brian Hudson, senior vice president of Avant Healthcare Professionals, who met with nurse leaders from Southside Regional Medical Center in Virginia, Citrus Memorial Hospital in Florida, Cornerstone Healthcare Group in Texas, Carilion Clinic in Virginia, Coliseum Hospital in Georgia, Conroe Regional Medical Center in Texas and Great Plains Regional Medical Center in Oklahoma, to find out what keeps them up at night.

Here are their biggest headaches:

Declining reimbursements: This ongoing problem puts additional stress on hospital budgets.

Professional disengagement among staff: CNOs said this is often caused by a high-stress work environment and nurse burnout. Improper staffing levels only add to the stress. They recommend opportunities for professional growth and appropriate staffing levels to better engage staff, Hudson said.  

Turnover within the C-suite: For the third consecutive year, hospital CEO turnover remains at 18%, according to a report by the American College of Healthcare Executives. Continuous consolidation of healthcare organizations and retiring leaders from the baby boomer era are influencing these turnover rates. But CNOs said this constant change in hospital leadership negatively affects an organization’s care planning, often causing frustration and confusion about where the organization is headed.

Recruitment and retention: Location, competitive salaries and high competition for nurses are a few hurdles that hospitals face in nurse recruitment. To help combat these problems, Meg Scheaffel, R.N., CNO of Carilion Clinic, said her organization offers shorter shifts with higher wages to seasoned nurses to recruit them. Flexible hours for experienced nurses on staff may also stall them from early retirement, she said.

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But retaining new nurses may be the bigger struggle. “We’ve noticed a trend in new nurses not seeing the value in longevity at an organization,” Tamara Martin-Linnard, CNO of Great Plains Regional Medical Center, said. “They stay for two years and then they are on to the next opportunity.”

Brenda Woodcock, CNO of Southside Regional Medical Center, suggests that nurse leaders conduct peer panel interviews regularly to find out the career intentions of these millennial nurses.

Inconsistent nurse leadership on evening shifts: But by giving experienced nurses more flexible schedules and preference for shifts, it does make it difficult for hospitals to find seasoned nurses who can work the evening shift. This leads hospitals to frequently assign less experienced nurses to manage operations in the evenings, which creates a chaotic environment, Hudson said.

Rising labor costs for contract workers: The recruitment problem means many hospitals often rely on contract labor, such as travel nurses, to help fill the gaps in staffing. This alternative staffing approach can be costly and doesn’t provide for the long-term retention that hospitals need, the nurse leaders said during the roundtable discussion. International nurse staffing has been a viable option in combating the nurse shortage due to the long-term retention that it provides and has a positive impact on patient care.

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“We have had a lot of success with international nurses as part of our staffing solution,” said Caroline Stewart, R.N., CNO of Citrus Memorial Hospital. “Understanding what environment these nurses come from and then acclimating them to our environment has been key for our retention program.”

Nurse pipeline is primarily graduate nurses: Nearly 4 million millennials will enter the nursing profession from now until 2030, according to a recent Health Affairs study. The effect that this will have on patient safety is uncertain. Too many inexperienced nurses are a concern for CNOs as the pipeline of experienced nurses depletes. “Most new grad nurses have never worked a full shift in a hospital before,” Woodcock said. “They’re not prepared for a 12-hour shift and the stress can be shocking to them.”

Nurse leader turnover: Constant turnover of nurse leadership at all levels disrupts an organization’s flow of implementing new initiatives or models of care from the top down. This means it’s essential that CNOs take a proactive approach to succession planning, Hudson suggests. Having a pipeline of competent nurses prepared to step into leadership is vital. But it won’t be easy. “Succession planning is challenging,” Scheaffel said. “You have to focus on team building and not a lot of nurses want to move up or become CNOs.”

The lure of the outpatient setting: Specialized nurse clinicians with experience are often drawn to work in outpatient clinics that offer a Monday through Friday 9 a.m. to 5 p.m. shift, the nurse leaders said. This normalized schedule and low-stress environment is more attractive to RNs than working in a hospital. “More and more nurse roles are developing to outpatient roles, and it’s depleting the inpatient roles,” Scheaffel said. “We’re starting an LPN to BSN program to accelerate that path to becoming an R.N. If the demand is going to depend on the outpatient world, then that’s concerning.”

Behavioral health demands: In addition, nurse leaders said that the demand for psychiatric nurses is on the rise due to the increased awareness of mental health issues in the U.S. This high demand is pulling registered nurses away from hospitals and into private practices.