AdventHealth's 'Aggressive Approach' to CNO Succession Planning

CNOs are essential members of the C-suite. Hospitals and healthcare systems should dedicate time and resources to their professional development.

This article appears in the May/June 2020 edition of HealthLeaders magazine. 

We've all heard the phrase, "Great leaders are born, not made." Yet it takes more than talent to be a great leader. It also takes time, cultivation of skills, and learning leadership competencies.  

This is why AdventHealth, based in Altamonte Springs, Florida, is expanding its commitment to growing future chief nursing officers through its CNO executive leadership development program.

While the program has been in place for about four years, it is now going through a retooling process to meet the needs of a greater number of potential nurse executives in a more structured format, says Trish Celano, MSN, RN, senior vice president, associate chief clinical officer, and chief nursing executive at AdventHealth. The goal is to increase the preparedness and number of nurses ready for CNO roles in the AdventHealth system.

"[The original CNO fellowship program] started because we had a need to have a pathway specifically for development of nurse leaders. The role of the CNO in acute care is really dynamic. They need a broad background in a number of things. We [wanted a strong] structure so that we could develop our own nurse leaders from within," says Celano of the need for CNOs. "We are in nine states, and we have 50 acute care facilities."

HealthLeaders recently spoke with Celano, who discussed the importance of succession planning, shared how the CNO executive leadership development program is getting revamped, and talked about what CNOs need to learn.  

More Nurse Executives Needed

"At the end of the day, we needed a lot more [nurses going through the program]. It used to be that the CNO fellowship was just a couple nurses at a time. That's not meeting the need of the organization, so one change [we're making] is we're expanding it so that we have an aggressive approach to succession planning," Celano says.

Celano is currently identifying additional nursing directors and nursing leaders who should be part of the program. She says she hopes to go from having four nurse leaders per year in the program to around 30.

"There should be a director at every facility … acute care facilities, community facilities, and postacute facilities, who is in succession planning, and who you have identified as having high potential and is interested in nursing leadership development," Celano says.

The Program's Focus

"The focus is to develop CNOs. That's what I expect 90% of [the program participants] to be doing," Celano says.  

In the first iteration of the program, she estimates about 70% of the nurses who went through the CNO fellowship program ended up becoming CNOs. These nurses have also helped to identify the program's strengths, weaknesses, and opportunities for change.

As AdventHealth continues to grow, acquire facilities, and expand its services, the need for well-prepared CNOs has also grown.

"We have leaders who are solid chief nursing officers," Celano says. "But now we're ready for the next challenge. We just launched a regional nursing advisory council. In that role, we have one regional nursing lead who is a CNO at one of our facilities in Texas and provides regional support for a number of CNOs. [B]eing experienced and being able to take under her wing a couple of novice CNOs creates an opportunity."

The program is also not just about boosting the number of CNOs at AdventHealth, it's also about increasing their readiness to step into the role, she says.

Traditionally in the nursing profession, nurse leaders were left to learn on their own without much structure.

"[To] have a well-prepared CNO who could walk in and not have to learn on the job [that was rare]," Celano explains. "Learning on the job is not good for the CNO. The literature on turnover for CNOs is significant. It's high just like turnover for directors and frontline nurses."

Additionally, CNOs often have responsibility for quality outcomes, infection prevention, and case management.

"There are a number of areas beyond bedside nursing that the CNO has responsibility, so adequately preparing for that just makes sense," Celano says. "You're not going to send your kid to college without sending him to high school first, yet, we've done [something like this] forever [in nursing].

Filling in the Blanks

The CNO executive leadership development program consists of one-year didactic leadership classes where the future CNOs will go to AdventHealth's corporate offices six times. During those six visits, they'll have specific content to learn, Celano says.

"To start the development program, we needed to identify the competencies that we knew CNOs needed to develop—here's everything they should know and here's everything they [already] know. Then we reached out to new CNOs who had joined our company in the last two years and without a well-developed program. [We wanted to know,] what did they struggle with? 'When you went into the job, what didn't you know that you wish you had known?' " she explains.

One subject that rose to the top as an area for learning was creating a healthy work environment.

"The bedside is where we have some of the greatest challenges—how to communicate effectively with direct care nurses, how to develop them, how to make sure that they understand what their challenges are, and that they feel free to speak up," Celano says.

We know that the experience of direct care nurses right now is probably at the most challenging it has ever been just because of well-being, work-life balance, nursing fatigue, and working with the general public. There are issues in workplace violence you see popping up. A nurse leader has a responsibility to make sure that they're aware of these issues and that their frontline nurses feel heard," she says.

Celano points out that newly licensed RNs may not feel comfortable "looking someone in the eye and saying, 'I'm not happy with this thing today.'"

"It requires, nursing managers and directors who learned from the CNO how to have those conversations and how to set them up in a way that people feel like they can speak up and they are comfortable and they're willing to talk," she says.

Another area for development was operations.

"It sounds so basic, but it can get away from you very easily when you're looking at the tactical elements of: do I have the schedule, do we have the supplies, am I on budget? Am I meeting all of the quality outcomes? Are all the rooms clean? Is the food hot? How are the people who are doing all of that for you?" Celano says

Dyad Development

Dyad leadership partnerships have become a trend in recent years, which is why a portion of learning in the program is done with physician colleagues who are in a CMO executive leadership development program.

"The beginning part of the day when they come in to corporate, we'll have CMOs and CNOs together going over general leadership content. That clinical dyad is so important in our hospital world. They will be in class together, going over content, [learning] how to deal with performance issues, safety and service, managing leadership conflicts," she says.

In the afternoon, they will split into their respective groups to cover separate curriculum specific to CNOs and CMOs.

Celano says she is enthusiastic about the potential the program has to set nurses up to be successful members of the C-suite.

"The CNO in the C-suite is such a pivotal role. They have responsibility for the largest portion of the workforce in any hospital. One of the most important things that health systems can do is to make sure that their nurse leaders are positioned to be able to have [an impact], that they have a seat at the table, and they are in a position to be able to give input and feedback to help guide the decision-making of healthcare system. Their feedback is crucial."

Editor's note: This story was updated on April 28, 2020.