| Description |
Background: The chief nursing officer (CNO) plays a well-documented role in fostering a thriving culture for both nurses and patients. Inadequate orientation of new hospital CNOs can result in unstable clinical care environments, escalate nurse turnover, incur significant financial and operational costs, and degrade quality outcomes. Research supports dedicated leadership orientation programs. Local Problem: A local Mountain West health system provided minimal formal training of eleven new CNOs, potentially precipitating underperformance in their responsibilities relative to receiving an optimal onboarding process. The purpose of this Doctor of Nursing (DNP) initiative was to enhance the knowledge and competency of new chief nursing officers within the health system through the development and implementation of an evidence-based leadership program, including training, a toolkit, and customized resources. Methods: This initiative adhered to the Johns Hopkins Evidence-Based practice model to develop orientation materials that enhance the knowledge and competence of new chief nursing officers. These materials covered content from the AONL Nurse Executive Competencies and included a resource toolkit and assignments to create relevant documents for hospital and nursing operations. The content was organized into seven training sessions. Interventions: This eight-week initiative took place in eleven hospitals in the Mountain West, including academic, trauma, community and critical access facilities. Each facility designated one novice CNO to engage in the orientation program, culminating in a total of eleven leaders. In addition to weekly group training, each participant received a one-on-one session, allowing for Plan Do Study Act (PDSA) cycles to enhance their learning. Pre- and post-intervention surveys and a competency assessment were administered to determine efficacy of the intervention, using descriptive and inferential statistics to analyze the findings, including the Wilcoxon Signed-Rank (alpha=.05). Results: The pre- and post- intervention survey analysis suggested statistically significant increases with medium to high effect sizes in four areas: post-intervention perceptions in confidence and knowledge of the hospital CNO role (p=.020, r=.703), barriers limit me to excel in my role as a CNO (p=.023, r=.685), resources needed to fully succeed as a CNO (p=.034, r=.640), and awareness of resources available that can help manage job stress (p=.046, r=.603). Participants liked the broad overview of a spectrum of topics, peer CNO support during the sessions, and the resources provided. Participant suggestions for improving the training included more focused time on financial concepts, providing sessions in-person for more interaction with peers, and a longer orientation program. Conclusion: The program was deemed successful and will be adopted for continued use in the health system to train new CNOs. Future cohorts would benefit from extending time for a longer orientation period, in-person discussions, and individual assessments of the leader in areas of emotional intelligence, personality, and behaviors to create a personalized development plan. |
