Tips for the Modern Chief Nursing Officer

March 18, 2010

Sarah Sinclair, a speaker at the marcus evans National Healthcare CNO Summit Spring 2010, offers her insight into some of the challenges facing Chief Nursing Officers in North America.

Interview with: Sarah Sinclair, Executive Chief Nursing Officer, The Cleveland Clinic

A day in the life of a Chief Nursing Officer (CNO) is balancing the world of budgets, statistics, the logistics of running patient care services and the almost parental aspect of patient care, ensuring patients receive the highest and safest level of care possible. With a shortage of nurses, new technologies, policy changes and tighter budgets, Chief Nursing Executives (CNEs) are facing particularly demanding times. Here, Sarah Sinclair who will be speaking at the marcus evans National Healthcare CNO Summit Spring 2010, taking place in Florida, April 25-27, shares her thoughts on the critical issues facing modern CNOs in North America today.

What are the most prominent issues challenging CNOs at the moment?

Sarah Sinclair: Ensuring adequate numbers of experienced nurses at the bedside despite the current nursing shortage, is one of the critical challenges for patient care services at the moment. The second difficulty is in complying with all new regulations, while providing the resources and technologies that are needed without impacting nursing care. Finally, communicating across the entire enterprise to ensure that employees feel connected to the mission and vision of the entire organization. They need to feel that they belong to a part of the larger purpose. The challenge in my case is that I manage more than 11,000 nurses and staff. What keeps employees engaged is understanding how they fit into the big picture, so communication is vital.

How are you addressing some of the challenges that you are encountering? 

Sarah Sinclair: From a staffing perspective, we have a major recruitment strategy in place in partnership with our human resources department. We also have a very strong nurse manager academy, making sure our nurse managers are making staff feel welcome and supported, and that they have the resources they need to do their job. We make sure employees have the information they need to know how they are performing. We have built an integrated nursing scorecard that actually tells each unit their scores on quality and safety, and their scores related to patient experience. We have graphs of these scores posted on the units. People are naturally competitive – if they see how they are performing, it will drive them to continuously improve.

What initiatives to improve operational efficiency and reduce costs have you implemented? 

Sarah Sinclair: The first thing I did at Cleveland Clinic was a full 30-day assessment of every single unit throughout the entire organization. From there we did a strategic planning process, consisting of getting about 285 stakeholders’ views on nursing at Cleveland Clinic. I talked to executives, physicians, nurses, other health professionals and patients, either through focus groups or individual interviews. We organized our first all day retreat with about 50 people and had a visioning exercise: “Where do we want to be in one, two or five years from now?” We went through, “Where are we now?”, “Where are our strengths and weaknesses?” and the strategic initiatives that could get us from where we were to that future state. 

That gap analysis is what drove our four major themes of work: standardization in clinical practice, leadership development, continuous improvement, and communication. Standardization of clinical practice is for me critical to ensure safety and quality in patient experience, but is also a way to optimize efficiencies and processes and reduce costs. Leadership development is imperative, because if you do not have someone on the units who acts like a little CEO of that unit, then you will never be able to have them look at it both from the patient-centered perspective but also as a business. They need to be careful with valuable resources. To ensure we continuously improve, we have a team focused on looking at our scorecards and the things we need to work on to improve processes. 

What long-term strategies and best practice tips would you recommend to CNOs?

Sarah Sinclair: I would say hire the right people; make sure that they are prepared to do their job, get great leadership in place and create the infrastructure for collaboration and development. CNOs have a responsibility to create the leaders that will take our position in the future. The biggest thing that any CNO has to do is to be the advocate for the patient. No matter what is going on or where they are working, they should never lose sight of that. We carry a license that says we are the advocates for the patient.

From both a patient and quality experience point of view, it is very important for nurses to do hourly rounds on patients. If they involve the patient and their family in their care delivery and help them understand what we are doing for them, they have better outcomes.

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