Want to Advance Your Career? Here's What CNOs Should Know

An experienced healthcare executive recruiter shares insights on how nurse leaders can find positions that are the right match and that can move them forward in their careers.

Healthcare professionals are living in turbulent times. Even before the recent COVID-19 pandemic hit the United States, mergers and acquisitions, restructuring, and retirements were catalysts of uncertainty for many nurse executives.

Off the record, I have heard myriad concerns from the nursing field regarding job stability. They are asking, what if their hospital goes through an M&A? Will their positions change? Some are wondering, at their age, will they be able to find a new position? Will they be passed over because it is assumed they'll retire in a few years? And others may want to move into a larger C-suite role, but are not sure how to get there.

To help answer career questions for nurse leaders, I recently spoke with Donna Padilla, managing partner and practice leader, healthcare, at WittKieffer, a global executive search firm in Chicago.

The transcript has been edited for clarity and brevity.  

HealthLeaders: How has the role of the "top nurse" changed over the years?

Donna Padilla: What a top nurse is depends on the environment. There are top nurses, meaning the senior leader within a hospital—the chief nursing officer in the flagship of a large system, for example.

But, when you look at systems and how they've crafted the nursing organizational charts given that there are 10 or 11 hospitals in a system, you may have 10 or 11 CNOs sitting around a table. Is there a broader system CNO who focuses only on that job or is it a combined job? Or do all those CNOs come together in a council and create strategy across the system?

HL:  What are some of the qualities and attributes organizations look for in their next high-level nurse?

Padilla: I think there are some common elements [organizations] look at when they start to think about who's leading. One is the ability to advance the professional practice of nursing. I see that just about in every profile we write. [Organizations] are looking for the ability to understand what it means to elevate [nursing] and to have nurses working at the highest level of their practice.

[They are also looking for the ability to come to the table with a hat beyond nursing. So positionally do [nurse leaders] come in with, "I'm great with change as long as it doesn't affect my nurses," or is it, "I'm part of the broader team, just like finance, just like operations, just like legal, and I have a specialty but I'm not protectionist. I'm an ambassador of nursing but I think broader about what's happening."

The other piece, which probably isn't surprising, is [needing a] depth of business acumen. Early on in a career, it's very much about the clinical ladder and working your way through it and starting to gain muscles around leadership. Then it moves into [if you] can sit side by side with the finance team and talk about projections? For example, if [they're] thinking about opening five new towers, what does that mean? From your particular role, what will you need resource-wise? What does that look like strategy-wise for nursing? One of the questions we get [for job candidates] is, "Where's your nursing strategic plan? What does that look like?"

HL: Let's go back to the ability to advance professional practice for a moment. What specifically is meant by that? Because sometimes I think what that looks like in real life gets lost or it turns into a cliché like, "We want to take things to the next level."

Padilla: Some of it is around being able to answer the question around care models. So, it's getting very detailed on care model pieces, shared governance, and ability to interact with physicians. When you sit with a frontline leader, they understand how they connect to the whole. To me, the professional practice of nursing in its best expression is the fact that everyone within the nursing team—frontline manager to top-line—have an answer to, "What does nursing look like within this institution? What's our goal long term? Do we have a healthy relationship with the other clinicians and is there a care team model around that?"

[And] I think that from an attribute perspective, [it's important to have the] ability to read the room, read the environment, and to read the culture.

HL: Have you noticed any hiring trends among organizations? Do they tend to hire from within versus doing succession planning or hiring from the outside?

Padilla: This is my opinion, but I think it's easier to move into the operations role internally and from there, there's a path to CEO. Sometimes the broader CNO to CEO is sometimes harder than CNO to COO to CEO. If the question is how do you get to the CEO role, the answer is get experience and accountability for things outside of nursing. Broaden [your experience] to pharmacy and lab and other things that may still be clinical in nature but aren't necessarily just nursing. Or get accountability for some of the service line pieces as well. Start to flex some of the business development growth pieces because on the CEO report card it's always important to make sure the trains run on time, but it's also important to look at how [your organization is] growing.

The more involvement CNO candidates can have with boards, with quality committees, and externally in the community, the [more experience they gain].

Smaller organizations tend to combine the CNO and COO roles, which I think is a great opportunity for individuals that aspire to be a CEO because then they've got two-thirds of the house basically.

Also, among what I call "flagship CNOs," you would expect them to say, 'Hey, I want to be a system CNO.' I would say we see more and more folks saying they'd actually like to be a COO or CEO or something different. Their job opportunities have become much broader. I think it's fantastic especially with organizations that want clinical credibility in a CEO.  Typically, we've seen nurses have a strong showing in that. In fact, a couple of systems we've worked with had a preference for someone who had been a nursing leader before.

HL: What are factors that stand out to CNOs when they're considering a job opportunity?

Padilla: They ask me when I call them, 'Is it snowing in the location you've told me about?' Joking aside, I think location is often the first question, especially if it's an individual who is already in a seated role, then reporting structure and where they would fit in. Are they at the table? Are they the equivalent to the CMO? That's a question we get all the time. They want to know what the physician-nursing relationship is.

[Also,] what's the [organization's] reputation and its quality metrics? It doesn't mean that if [the organization is] in desperate need of someone to help advance that, that it's a bad thing. Some candidates are really excited by massive turnaround and others say, "I've already done that three times and I don't have another one in me."

[They also ask,] is there a union? Some candidates are much more facile at working in those environments and others don't have that lens.

And [they also ask about the] organization's goals.