5 Strategies New CNOs Should Know

Erin LaCross is five months into her role as chief nursing officer. She shares five insights and advice for her fellow nurse leaders.

For Erin LaCross, DNP, RN, CMSRN, CENP, nursing was not her first career path.

"I have a bachelor's degree in psychology and criminal justice and worked briefly for a mental health organization before deciding to become a nurse," she says.

Inspired both by her sister, who is a nurse, and the experience of being a patient after a "health scare" in her early 20s, LaCross took a position as a unit clerk at Parkview Health in Fort Wayne, Indiana, with the intention of going to nursing school.

"Between watching my sister and being a patient, I knew I wanted to be a Parkview nurse," LaCross says.

"Not just a nurse, but a Parkview nurse."

That was in 2003. Today, she is the chief nursing officer at Parkview Regional Medical Center and Affiliates at Parkview Health.

By traditional nursing standards, LaCross moved up the leadership ladder swiftly. In 2006, she became a registered nurse on the same inpatient surgical unit where she had been a clerk.

Then two years later she became the unit's nurse manager. After five years as a manager, she took on a newly created role of vice president of nursing services at Parkview Hospital Randallia, where she was tasked with overseeing the nursing and clinical teams' contributions to the facility's $55 million renovation.

In February 2018, she became CNO at Parkview Regional Medical Center and Affiliates.

HealthLeaders Media recently spoke with LaCross, who shared insights she has gained as a new CNO.

1. Ask for your nurses' feedback
 

As a CNO, LaCross emphasizes always seeking nurse feedback. "The key concept is about empowerment."

LaCross says, as a CNO it's important ask yourself if you have the right people informing the decisions you make. 

"I think for a new CNO just out of the gate, [it's good to have] that frame of mind that you're not expected to know all the answers yourself," she says. "It's always best to ask the people who provide direct care to your patients and to your community."

Even before she took on the CNO role, LaCross would bring in clinical nurses to help with strategic planning. Some questions she would ask them include:

• What do we need to have on our radar?
   
• What's going well, and what should we keep doing?
   
• What's not going well that we need to be innovative around?
   

Additionally, clinical nurses are involved in an annual SWOT analysis.  

"That really informs our plan for the year and everything we need to undertake," she says. "It's our 'true north' of things we need to focus on because it's come from our clinical nurses."

2. Don't forget to ask for physicians' feedback
 

LaCross also advises that CNOs should always ask physicians for feedback. "The overarching concept here is alignment," she says. "It's important for nurses and physicians to be aligned and making decisions."

Just as with nurses, CNOs should ask whether the appropriate stakeholders have been sought out.

"It's powerful when you have that partnership between nursing and providers," LaCross says. "We can get things right, or close to right, the first time around if we have physician leadership and we've asked our nurses what the right thing to do is."

Physician leaders are present throughout the organization's various service lines and institutes.

"We have many different projects, priorities, and initiatives," she says. "And, in general, the best traction we get and the best engagement we have is when we pull physicians in and have them champion different things."

For example, Parkview Health is currently working on care transitions, which are no longer about simply discharging patients from the hospital.

"Now, it's about how we hand them off to the next level of care within our own organization—whether it's home with home health or inpatient rehab, to our skilled nursing facility, or to our primary care clinic," she says. "As we look at how to undertake this work, having the physicians there to speak to the different vantage points has been very helpful, and it's helped us make sure that the workflows are correct."

3. Round, round, round
 

LaCross says the way to take care of people is to be among them, listen to them, and support them.

"This is really about servant leadership," LaCross says. "Our role as leaders is to take care of our people. And as a leader of leaders that means I'm here to take care of other leaders and to take care of coworkers. If we do that well, they will take care of our community in the way that we need."

LaCross dedicates time on her calendar for rounding. She acknowledges that this time can easily get swallowed up by meetings if she is not diligent.

"I have rounding appointments with every department and the coworkers know I'm coming," she says.

Each week she has an hour of rounding with a different department.

"Sometimes the coworkers are there in a meeting room waiting to talk to me and sometimes we just talk as I'm going through the unit," she says.

Additionally, she follows up each rounding visit with an email thanking coworkers for their hospitality and ideas, and sharing accomplishments they talked about. LaCross says through rounding and follow up she wants the staff members to know they are important and that she will listen and be their advocate.

She says she has collected many notes and items on which to follow up on through the rounding process.

"I've taken these last couple months' worth of rounding and distilled it into some common themes that I'm hearing," she says, "[and] I take that to our nursing operations team."

4. Adopt the philosophy of 'better is better than perfect'
 

LaCross uses a saying, "Better is better than perfect" with nurses, leaders, and nursing students.

"It's about having a mindset of continuous improvement," she says.

She recommends that CNOs take time to reflect each day on what went well and what can be done differently tomorrow.

"It just puts you in the frame of mind of always looking at being better than you are today, … and always learning and always forgiving yourself," she says. "If you did something today that you don't want to do again, then don't do it again. But you've reconciled that with yourself, and you don't have to be stressed about it."

This philosophy can help everyone from bedside nurses to CNOs learn and move forward.

"I think where we can get hung up is we want things to be perfect before we implement any changes," she observes. "And then, in the meantime, while we're waiting for perfection, how many patients could have had better care?"

5. Know that you are needed
 

Remembering that you are needed can help CNOs foster resilience in a challenging role.

"Nurses in this role are in this role because they have [the] skill set to put patients at the center of what we do, challenge the status quo, and bring all of the right people together to do the right thing every day," she says. "And that's not easy. That's not something everybody can do."

When things get overwhelming, especially as a new CNO, LaCross encourages others to remind themselves of their value and contributions.

"You are that voice that is speaking on behalf of the nurses, on behalf of the patients, and bringing the physicians to the table. You're bringing everybody to the table who needs to be there and seeing the big picture. You're asking the tough questions and ensuring accountability," she says.