CNO Burnout

[NRSKarenRN, BSN, RN]

from aha's hospital & health networks:

[color=#336699]cover story cno burnout

the onus is on nurse executives to improve quality of care, cut budgets, fill a staffing void and keep up with technology. many are quitting, and hospitals are hard-pressed to replace them.

chief nursing officers are feeling pressured from all sides these days, and--much to the alarm of hospitals--a growing number are throwing in the towel.

the announcement that medicare this fall will stop paying to treat eight "never events" like infections and falls added yet another layer of stress for cnos. improving the quality of patient care has become a national priority, and making it happen in the hospital is largely the responsibility of the nursing staff--and ultimately nurse executives. that means collecting reams of quality data for a multitude of government, payer, consumer and watchdog organizations--data that will impact everything from the hospital's reputation to its reimbursements.

and that's just part of the issue. cnos also have to deal with a chronic nurse staffing shortage, an ever-sharpening focus on cost containment, fast-paced technology implementation and a complicated regulatory atmosphere. many highly qualified and effective cnos say it's all become too much and they can't take it anymore.

"absolutely we're in a crisis. we paid tremendous notice to the staffing shortage and took our eyes off the ball that there would be a commensurate leadership slump," says christine mackey-ross, senior vice president in executive search firm witt/kiefer's st. louis office. three years ago, mackey-ross could turn up eight to 10 well-qualified cno candidates for an average tertiary care hospital. now, she says she's "lucky to find four to six, and if there is a diversity agenda [in hiring] at the hospital, it's more complicated."

a 2006 survey by the american organization of nurse executives found that 62 percent of cno respondents expected to make a job change in less than five years. of those, more than one-quarter planned to retire. adding to the drain: some baby-boomer cnos are being promoted to higher c-suite jobs, particularly as chief executive officers or chief operating officers, and high demand for their skills is luring others to health care careers outside of hospitals.

[herring_RN, ASN, BSN]

Hospitals are asking the impossible of the CNO. (What happened to the Director of Nursing title?)

No wonder I don't have enough fingers to count the DONs, VPs of Nursing, Chief Nursing Officers, and Chief Nurse Executives who have left while many of us whose job is to provide nursing care are still here.

[RN4MERCY]

Dana Beth Weinburg wrote a compelling book that speaks to this issue.

Code Green: A Case Study in How Hospital Restructuring Undermines Caregiving

Suzanne Gordon wrote the forward for the book, and an eloquent, comprehensive review that was published in Revolution Magazine. I spoke with her recently about her new book, Safety in Numbers. I believe it validates the power of RNs when they act collectively and in unity for the exclusive benefit of their patients. Those of us who remain at the bedside, understand that nurses must retake control of their practice, in order to control the delivery of health care in the interest of patients. We must not allow engineering and manufacturing consultants to commodify health care for the profit of industry.

I'm reminded of the song, Big Yellow Taxi-"...don't it always seem to go, that you don't know what you've got 'till it's gone." That's why I'm a member of the National Nurses Organizing Committee; we're committed to Medicare for All, based on the Single-Payer Model. We need to work toward passage of HR676, The National Health Insurance Act. That way, direct care providers, nurses and MDs will be able to give the medically necessary care patients need, without interference, delays, and denials by insurance companies.

:nurse:"...perhaps most important, lesson of this book lies in its implicit critique definition of professionalism and professional behavior that have been adopted by many nursing elites. These self-appointed nurse leaders have taken the term "professional" and "professionalism" far beyond its original roots - to act on behalf of, to provide knowledgeable public service. They define the professional as an elite "autonomous" agent who acts according to a highly individualistic code of conduct. Their heroic professional is the lonely individual nurse valiantly trying - and ultimately failing - to advocate for her patient. Nurses of all ranks must ask themselves: Is this kind of professional model sufficient to protect patients against the brutal economics of today's health care marketplace?

In Code Green we learn that it is not.

In spite of their best intentions, the highly "professional" nurses at the BI Deaconess seemed powerless to protect their profession and their patients. They were not only hostile to unions, they were leery of any kind of public protest or action. Many of them considered attempts to warn the public about the dangers of managed care and hospital restructuring to be "unprofessional" and "inappropriate." The result? They were morally and politically sidelined and watched gains they'd worked for for decades disappear almost overnight.

Since Weinberg finished her observation at the hospital, the Beth Israel Deaconess fired its hyper bottom-line CEO and is now led by a more benevolent administrative team. Nurses and doctors at the institution are still extremely nervous about the future of both nursing and medicine. "Things are getting better," one nurse told me the other day, "but they have a long way to go."

Which is why we need to heed the lessons of this book. What Weinberg documents is that one of the most nurse-friendly hospitals in the world could not stand alone against an avalanche of cost-cutting. Since this kind of cost-cutting is still alive and well in global health care, it is time for nurses to consider augmenting their important model of individual patient advocacy with the kind of assertive collective action that will better help them meet the challenges nurses and patients face today." ~Suzanne Gordon

http://www.calnurses.org/nnoc/about-nnoc.html