Authentic Work Experiences of Chief Nursing Officers: A Phenomenological Inquiry

Sunday, 8 November 2015: 4:20 PM

Charlene M. Ingwell-Spolan, PhD, MSN, BSN, RN,
School of Nursing, University of Maine, Orono, ME, USA


Background: Studies have shown that job dissatisfaction, increased workload demands, poor working conditions and high patient acuity (overload) are among the challenges facing the registered nurse (RN) today.  These challenges are also being faced by the Chief Nursing Officer (CNO), the leader of the professional nurse, in advancing the RN into a highly functioning professional practice guaranteeing, daily, the delivery of quality patient care.  Today’s CNO must think differently to remove the barriers in the acute care setting, providing effective practice at the point of care. 

Purpose: The purpose of this study was to explore the work experiences of the CNO as the leader, voice and advocate for the professional nurse in the acute care setting.  This information may help determine how future CNOs will be even more successful in the leadership role for the professional nurse to provide even more consistent, quality patient care.

Methods: Guided by the naturalistic inquiry paradigm, this qualitative, phenomenological inquiry (Moustakas, 1994) yielded an understanding of the human experience of the CNO as the leader for the RN.  This approach determined textural-structural, “what” and “how” composite descriptions through the lens of the participants, conveying an overall essence of the CNOs’ work experience as the leader of the RN.

Results: The CNOs in the study experienced bullying and unwritten hierarchy in the corporate suite.  They were not fully prepared to communicate in financial/business terms and, therefore, were not heard and understood by the other members of the executive team.  As a result, the CNOs engaged in many battles and decisions were often made regarding nursing and patient care issues without the full and adequate input of the CNO, all affecting quality patient care.   

Conclusions / Implications for Practice: This study was the first to investigate and explore the work experiences of the CNO as the leader  for the professional nurse.  One of the themes that emerged from this study was “battling”, primarily caused by the CNOs’ expertise in clinical matters and not high level business and financial expertise.  The CNO is the professional nurse’s leader and must communicate total, net worth impact for both the nursing and organizational areas in order to be heard.  Evaluation of nursing curriculum is needed to ensure that future leaders of nursing have all the knowledge and skills necessary to be dynamic, innovative leaders, establishing a lasting impact on the healthcare industry.