A Chief Nursing Officer has to be more than a leader behind a desk
EDITOR'S NOTE: Below, the Arkansas Medical News features interviews with five Chief Nursing Officers (CNOs) about the challenges, rewards and leadership vision for the major medical institution where they head the nursing staff.
Michael Howard
Michael Howard, BSN, MM, MSN, MHA, NE-BC, is the CNO for Arkansas Children's Northwest (ACNW). He is responsible for planning, organizing and directing the overall operations of Nursing/Patient Care Services at ACNW. Howard comes to ACNW from the Children's Hospital of San Antonio, where he served as the director of pediatric emergency services.
Why does there seem to be a high turnover rate for CNOs?
The position of CNO requires a dedication and time commitment that can prove to be impactful to other aspects of life. As overseers of patient safety and excellence, we carry a great deal of responsibility. I believe that. The responsibility, time requirement and dedication may be hard to maintain for an extended period of time for some leaders.
How do you keep morale up and retain good nursing staff?
Employees want to feel that they are an important part of the team. As a leader I use communication and recognition to build up the team. I don't see the staff in a tiered approach. Rather I envision the staff in a team approach. I believe that when all parts of the team are functioning at a high level then you will have great moral and a culture of ownership.
What is your leadership vision for your hospital?
I want to be part of an organization where the staff that is taking care of the patients is empowered to be leaders in the organization. I model my personal leadership after the Servant Leadership Model where the leader focuses on the growth and well-being of the staff. As a CNO, I want to see the staff strive to provide excellent nursing care and great patient outcomes.
What personal experiences prepared you professionally?
I spent eight years as an officer in the U.S. Air Force. This experience plus the fact that I have been blessed to have several great mentors in my professional career prepared me for the leadership opportunities as a CNO.
How do you like to be recognized for your work?
The only recognition that I need is happy employees. When the employees are happy, engaged in the organization and we have great patient outcomes, then I know that I have been successful as a leader.
Michele Diedrich
The CNO of Baptist Health Medical Center-Little Rock, Michele Diedrich, DNP, MA, RN, NEA-BC, has been a registered nurse for 29 years. She began her healthcare career in 1989 upon receiving her Associates of Science in Nursing and most recently completed her Doctor of Nursing Practice last year. Diedrich joined Baptist Health as the CNO and Vice President of Patient Care Services in January.
Why does there seem to be a high turnover rate for CNOs?
There are many reasons for turnover in the CNO including the increase stress and demands. The CNO is responsible for professional nurse practice, clinical practice and knowledge, quality, healthcare policy, patient safety, patient experience, performance improvement and workforce planning. The role has changed over the years with a large focus on the changing environment of health care and the financial impact of those changes. The nursing shortage is an issue for many states including Arkansas.
How do you keep morale up and retain good nursing staff?
My goal as the CNO is to ensure that we are utilizing the correct model of care to provide a safe environment for the patients and coworkers. It is important for all co-workers to feel that their concerns are heard with response. I feel that it is important to implement shared governance to stay connected with the work challenges that are faced on a daily basis.
What is your leadership vision for your hospital?
My leadership vision is one of transparency, fairness, evidence-based practice and empathy. I value every member of the healthcare team, and therefore I want to ensure that we do not create silos amongst our team.
What personal experiences prepared you professionally?
My parents were my role models for the person I have become professionally today. They were both driven by relationship building, customer service and loyalty. They both exhibited a positive attitude but held me accountable for my actions and the consequences of my actions. My parents came from a poor background, but through their hard work and determination became a successful business owner and executive.
How do you like to be recognized for your work?
The greatest recognition for me is the success of our team.
Meredith Green
Meredith Green, MSN, APRN, was named Senior Vice President & CNO, Washington Regional Medical System, Fayetteville, in 2017. She was formerly Administrative Director in Women and Infants Services. Green earned both a bachelor's degree and master's degree in nursing at the University of Arkansas and received credentialing as a Clinical Nurse Specialist in Adult and Geriatric Health.
Why does there seem to be a high turnover rate for CNOs?
There are demands that come with any nursing role. But, being a new CNO, right now I am appreciating the opportunity to be a mentor and advocate for our talented nursing staff.
How do you keep morale up and retain good nursing staff?
Washington Regional continues to embrace a culture of open communication, promoting a positive and collaborative environment. It is important for our staff members to feel empowered to grow personally and professionally. At Washington Regional, we offer and encourage participation in organizational and community-driven programs and activities. Advanced education programs and proficiencies strengthen knowledge base, critical thinking skills and positively impact employee and patient satisfaction. Since Washington Regional has a long history in this community, providing care since 1950, we see our patients as our own family. In fact, our values statement includes, "To treat others as we would want to be treated." That fosters a very supportive for environment for our nurses.
What is your leadership vision for your hospital?
My vision includes Washington Regional continuing to grow to meet the needs of the rapidly expanding Northwest Arkansas community and ensuring that our hospital's growth is thoughtfully designed to fulfill our mission-which is to improve the health of the communities we serve.
What personal experiences prepared you professionally?
I have been fortunate to have worked with some exceptional nurse leaders and mentors who inspired and shaped my training. Their passion for excellence in patient care and nursing practice remain a strong motivator for me.
How do you like to be recognized for your work?
It is exciting for me to see that some young nurses I have worked with-and in some cases, mentored-are achieving great things and growing into skilled clinicians and strong leaders. Their success is the best recognition I could hope for.
Angie Smith
Angie Smith, Vice President of Nursing at St. Bernards Medical Center, Jonesboro, received her BS in nursing degree in 1994 from the University of Central Arkansas in Conway. She received her MS in nursing in 2005 and her Doctor of Nursing Practice degree in 2017, both from Arkansas State. In her role as Vice President of Nursing, Smith directs all nursing activities at St. Bernards Medical Center, including education, recruitment, leadership and quality.
Why does there seem to be a high turnover rate for CNOs?
I am fortunate to work for an organization that has experienced longevity in this position. I was fortunate to be able to pursue this position when the previous CNO relocated to a different state. With that being said, the key to success in a high-pressure job is creating a vision for effective leadership at all levels and empowering staff to fulfill our mission. I feel blessed to work with an excellent team and that allows me to sleep at night.
How do you keep morale up and retain good nursing staff?
I believe the key to retaining good staff is ensuring a healthy work environment and a team approach to patient-centered care. We recently invested in a speaker who spoke on inspired care - his message was invaluable in terms of morale and attitude. These investments, as well as education and training, are something we must continue to do along with providing a safe, work environment where people can do their job efficiently and effectively. It is also not a campaign or initiative but rather the foundation of success that must be threaded throughout all of our work.
What is your leadership vision for your hospital?
To continue to build and support a strong nursing culture of professionalism and patient-centered care. The patient is the center of what we do, and we must continue to invest in those who provide direct, hands-on care to those patients as well as invest in their professional and leadership growth.
What personal experiences prepared you professionally?
I have been fortunate to hold a variety of nursing positions including bedside, education, recruitment and quality. I also believe that I have had the best mentors who have taught me through role modeling.
How do you like to be recognized for your work?
The best reward is a sincere, personal thank you. However, I believe the key to success is usually team-oriented and that is what gives me the most pride and accomplishment.
Louise Hickman
Louise Hickman, RN, BSN, MA, CLNC, Vice President, Patient Care Service and CNO of Jefferson Regional Medical Center (JRMC) in Pine Bluff, has been with JRMC since 1988 when she was recruited to help launch a new cardiac program. She received a bachelor's degree in nursing from Arkansas State University, and a master's in health services administration from Webster University. Hickman is president of the Arkansas Organization of Nurse Executives. She was a past board member of the Arkansas Association of Health Quality.
Why does there seem to be a high turnover rate for CNOs?
The complexity of care, increased cost pressures, nursing shortage, competition for experienced nurses and focus on "never events" are some of the challenges faced by CNOs. The stress of not maintaining a black bottom line leads to turnover of top executives including CNOs. The quest to provide high-quality care, high staff satisfaction, and low turnover can cause expenses to exceed both budge and planned variances. Competent succession planning can avoid major disruptions in morale and programs that are producing the desired outcomes.
How do you keep morale up and retain good nursing staff?
Gaining respect, support, and assistance in implementation to achieve the nursing agenda. Our organization has recently begun a culture transformation journey with some top executive changes, engagement with partner to assist and provide the roadmap for this journey, more staff engagement and input, implementation of shared governance professional practice model for nursing, leadership training on rounding, vital conversations, and other types of frontline management training along with staff training. We are beginning to see the shift in some of our outcomes of these efforts in a positive light.
What is your leadership vision for your hospital?
We are committed to excellence in patient-centered care because it is the right thing to do. We will know we have been successful when we are recognized as the hospital and employer of choice in Southeast Arkansas. We must be accountable to one another and lead by example every day. Our nursing vision is: "Nurses embracing healthcare excellence - one patient at a time."
What personal experiences prepared you professionally?
I started my nursing career in a small hospital and got to do a variety of positions to enhance my skills. I have had several mentors along the way to assist me in my career and to enhance my skill sets. I have maintained current knowledge of nursing practice and have been involved my state organizations for quality and nurse executives. There are a great group of peers in Arkansas that have helped me along the way also that I am very grateful for.
How do you like to be recognized for your work?
I want to be recognized as an expert in my field of nursing and nursing leadership. I want to leave a legacy that my facility is a better place upon my retirement and that I have left the nursing division in great hands with lots of successful nursing leaders. I also want to leave a scholarship to continue the contribution to the education of nurses.
