CNO Sustainment: A Phenomenological Inquiry

The highly complex role of the Chief Nursing Officer (CNO) requires the refinement of a multitude of competencies and leadership skills in this unprecedented time of healthcare reform. As the senior most patient advocate in our medical centers the CNO is responsible for translating research into practice, policy development and implementation creating value based patient-centric strategies to transform health care.  The ability to sustain and thrive in this role is essential in repositioning nursing as a knowledgeable discipline actively contributing to the redesign of healthcare. 

            This qualitative phenomenological study was designed to explore and describe the elements that contribute to the sustainment of CNOs in their practice of nurse executive leadership. Ray’s Theory of Bureaucratic Caring (1989), Authentic Leadership Theory (Wong & Cummings, 2009), and Resiliency Theory (Earvolino-Ramirez (2007), provided the theoretical lens through which this study was grounded.  A literature review was completed and included articles related to; CNO turnover, CNO role and responsibilities including skills and competencies, leadership and complexity, CNO progression to CEO and resiliency.

            Semi-structured telephonic interviews were conducted with twenty CNOs all with two consecutive years experience in their current role. Demographic information collected resulted in a participant sample of 18 females and 2 males.  The mean age of the participants was 55.7 years.  Collectively they represented over 32.8 years experience in nursing, averaging 18.6 years total CNO experience but with 5.1 years experience in their current CNO role. The overwhelming majority held Master’s Degrees in Nursing.

 Six themes emerged after thorough content analysis which describes the lived experience of sustainment.  Each theme was supported by several subthemes. Themes and subthemes emerged as: Loving the Profession, with supporting themes of Innate Passion, Identity as Nurse, Terminal Career Choice and Pride. The second theme is, Having a Broader Impact with supporting subthemes of Scope of Influence, Keeping Patients Central, Mentoring, and Growth of Staff.  The third theme emerged as Reflecting on One’s Own Work with supporting subthemes of Time to Think, Learning from Mistakes, and Keeping an Optimistic Attitude.  The fourth theme is Learning to Manage Conflict, with supporting subthemes of, Understanding the Issues, Maintaining Objectivity, Direct Communication, Stepping Back, Utilization of Resources and Information, Positioning through Collaboration and Alignment, and Depersonalizing the Situation. The fifth theme emerged as Maintaining Work/Life Balance with the subthemes of Boundaries, Daily Time Management, and Diversionary Activities.  The final theme is Working with Supportive Leaders, with supporting subthemes of Supportive CEO, Supportive Administrative Team, CNO networking and Supportive Subordinates.

            The results of the research supported the three theories presented, as well as validated many of the concepts presented in the literature related to CNO success.  Interestingly different however was the emphasis the research participants placed on purposeful optimistic reflection guiding their ability to maintain collegial relationships and strategic initiatives.    

Recommendations included the need to incorporate education and competencies to include a broader scope of responsibility, conscious mindful reflection, strategic processing, and resiliency training in tandem with a working environment conducive to support and awareness of the importance of work/life balance.