Chief Nursing Officers (CNOs) have a demanding, complex role that commands accountability in leading the nursing profession and achieving quality patient outcomes. The purpose of this study was to understand the CNO's view of meeting the needs of the Registered Nurse (RN) at point of care and how this could affect quality patient outcomes. In two qualitative studies twenty-five CNOs were individually interviewed in eight states including: Florida, Tennessee, Kentucky, Maine, New Hampshire, Vermont, Massachusetts, and New Jersey. The majority of these CNOs interviewed believed they were doing the best for their nurses and their healthcare facility. After analyzing their responses, it was apparent that some CNOs actually encouraged peer pressure among nurses to achieve compliance and felt patient acuity is being addressed adequately, since most patients were discharged within three to four days and those that were more critical were admitted to the critical care units. The average length of stay, which is the number of paid days a patient remained in the hospital, was an important metric. A large amount of nurses felt they were unable to deliver the care needed for their patients due to patient load, lack of collaboration among the health care team, higher patient acuity and absence of decision-making and autonomy. Many of the CNOs trusted that patient care outcomes, meaning relatively short hospital stays, demonstrated that the nursing practice was successful; rather than first having the nurse being set up for success to provide the best care possible to their patients.
Keywords: healthy work environment; leadership; nurse education; nursing leadership; patient outcomes.