1. Interviews with Executive Nurse Leaders
NGR

2. Nurse Executive Comments
27 Interviews with Nurse Executives
Comments in red were not included in last year’s responses.

3. Major Changes in their Role
Movement to LEAN to implement change.
More involvement at the health system network level
Much more focus on community and population health
Interdisciplinary care focus
Nursing roles have become more specialized
Pace of change
Empowered consumers
More business oriented – Pay for Performance
Staff want more work-life balance
Focus on patient engagement and satisfaction
Turnover of executive colleagues is higher
Different generation now – different expectations
Nursing has much broader role responsibilities
Technology changing at a fast pace – movement to telehealth – data from EHR

4. Current Role Challenges
Staff and leadership alignment with organizational change initiatives.
Increasing issues with behavioral health – limited resources.
Declining reimbursement under the ACA – cost versus quality
High turnover of millennial nurses.
Public health is very low paying.
Professional engagement
Having to make tough decisions that the CNO does not always agree with
Bundled payments specifically the cardiac bundles that are coming
Nursing shortage is back
Preceptor burnout
Staffing is a growing challenge – sign on bonuses a new norm
Avoiding leader burnout – my own included
Maintaining performance above the national benchmarks – the goalpost keeps moving.
Assuming risk for what patients do at home after discharge
An increasing number of Baby Boomer Nurse Retirements – loss of their knowledge
A complex patient population – more demanding.
Maintaining excellent customer service scores.
Nursing staff resistance to changes in the healthcare environment.

5. Key Leader Competencies Needed
Project Management
The ability to execute decisions and programs
Strong analytical abilities
Ability to work with diverse stakeholders.
Social media savvy
Adaptability with change
Self awareness and systems thinking
Transparency
Masters prepared – a must today – MBA would be helpful as would a PhD or DNP
Strong business skills and fiscal acumen
Strategic thinking
Generationally sensitive
Life-long learner
Emotional Intelligence
Resiliency and ability to deal with ambiguity
Political savvy and ability to deal with conflict
Vision - Innovation – Ability to think out of the box

6. What is Needed to Be an Employer of Choice?
RNs working at full scope of practice
Student Loan Repayment
Family Friendly
Interesting work
Forward thinking
Socially responsible organization
Clear career advancement
Compelling leaders
Commitment to patient safety
Competitive salary-benefits
Generational sensitivity
Tuition reimbursement
Employee advocacy
Healthy work environment
Shared governance
Flexibility
Solid physician-nurse collaboration where nursing is valued
A walk the talk culture
Work-life balance
High Quality Care
Magnet or Pathways to Excellent Environment
Pay for certification
Health incentives

7. Pros and Cons of Magnet Cons Pros Expensive Higher staff engagement
Time consuming
Resource intensive
Rigid & tedious process
Not enough return on investment – may not boost excellence.
Magnet has become a business onto itself
Not always genuine
Keeping up your scores
All about nursing
Higher staff engagement
Visible that “we care about our nurses”
Reduces turnover
Elevates nursing professionalism
Promotes shared governance
Magnet for recruitment
Attracts patients
The pride/excitement that nurses feel when they achieve it.

8. Changes Needed to Adapt to a Nursing Shortage
Nurses need to do a better job of owning their profession
Changes in our care delivery models
Recognition that care is moving to the community
Much more flexibility with scheduling and work-life balance
Preceptor recognition – we are asking so much of them
Scholars programs and better onboarding.
Nurses need to practice at the full scope of their licenses.
Better academic-practice partnerships.
Less reliance on traditional means of staffing
More nursing faculty and student acceptance into programs
A more nurturing environment in nursing
Nursing residency programs
Develop strong leaders to mentor staff

9. What is Needed to Mentor Younger Nurses into Leadership?
Recognize that not everyone will have the skills or desire.
Succession planning at every level – example groom Assistant Nurse Managers
Be committed to eliminating horizontal violence
Formal and informal mentoring into the role
Current leaders must engage nurses in leadership activities.
Plant the seeds – give them small projects and assignments
Encourage them to take risks
Send high potential staff for development
Embrace succession planning
Don’t set them up for failure
Map out development plans for high potential staff
Stop talking about the challenges of being a leader and mention the positives – project enthusiasm.
Provide development programs

10. Strengths You Bring to the Executive Team
My experience
Passion
Trust
Honesty
Transparency
Advocacy for clinical care giving and patients
Great communicator
Compassion
Strategic and visionary
A willingness to learn
Innovative thinker
Enthusiasm
Tenacity
Long-term focus
Fully present
Stability
Clinical knowledge
Risk-taking
Voice of the patient
Team player
Change agent
Tactfulness
Great listener
Accountability for my areas of responsibility
Timely decision making
Quiet strength
Analytical thinking

11. What Keeps You Awake at Night?
Too much change and lack of alignment.
Access to care especially for children in Florida
Lack of capacity to meet care needs
Reductions in Medicaid funding
The Nursing Shortage – it will grow worse
Patient safety – too many inexperienced staff without good mentors
Volumes are too high especially during the season
Safe Staffing
Organizational politics
Insuring I have a competent workforce
Staff retention
Staff engagement
Staff adaptation to change
Staff morale

12. Advice for Emerging Nurse Leaders
Take the time to learn about leadership before you jump into it.
Seek out knowledge from other departments.
Develop a high level of self-awareness.
Show passion
Be humble
Get ready for the ride of your life
Think about your legacy
Begin small – chair a committee
Advance your education – get certified…stay educated about healthcare changes ----be a lifelong learner
Be flexible – say yes if possible.
Don’t take things too personally.
Be willing to leave a position if it is not working.
Make yourself visible.
Develop career goals and stay focused.
Realize that failure is OK.
Don’t compromise your values.

13. More Advice for Emerging Nurse Leaders
Don’t let go of your sense of humor.
Take care of yourself.
Put yourself in uncomfortable situations – this is how you learn.
Surround yourself with the best people you can find.
Leadership is all about relationships – you must engage the hearts and minds of others.
Just do it – fake it if you need to.
Give yourself time to find your niche.
It may be scary but don’t stop.
You have to love what you do or you won’t do it well.
Listen more than you speak.
Make your bed in the morning – then you will have accomplished the first task of the day.
Find a good mentor and read leadership books.
Seize the day.
Be open to change.

14. To our 27 Nurse Executives