Posted September 08, 2017

If I Knew Then What I Know Now: Advice for Nurse Leaders from a Former CNO

By Davy Crockett, RN, MPA, FACHE

Healthcare has changed a lot over the last 39 years. When I started as a nurse in 1978, things were a little simpler. There were no HCAHPS scores to worry about, high reliability wasn’t yet a buzzword, and patient engagement as a concept hadn’t even been conceived. I became a Studer Group coach in 2005, but before that, I had more than 22 years of experience in acute and post-acute hospital operations and as a CNO.

Looking back, there are several pieces of advice I wish I could give my younger, greener self to help prepare for the current state of healthcare. Luckily, you can take advantage of my hard-won wisdom. Here are my top 10 tips for new nurse leaders and CNOs, based on my own experience.

  1. Align your goals tightly to those of your direct reports. It is vital to ensure that your employees share your goals so that you are all working toward the same outcomes. Hold everyone on the team accountable, and do not tolerate excuses.
  2. Coach for performance. Use the “support-coach-support” method in which you provide constructive feedback or coaching sandwiched between two positive comments. Don’t forget to start with the wins!
  3. Move low performers out of the organization more quickly. Low performers can drag a department down quickly. Don’t let them become a drain on your organization. Begin the process of coaching them either up or out of the organization sooner.
  4. Partner with physicians. Communicate proactively, ask for feedback, and interact as peers. Truly act like their colleague.
  5. Provide specific reward and recognition. Reward employees more specifically and be sure to tie reward and recognition to results, not personality. It’s not a popularity contest.
  6. Investigate before you indict. Don’t be one of those leaders who shoots first and asks questions later. Make sure to gather all of the facts before you have a critical conversation with an employee.
  7. Be the Chief Patient Engagement Officer whether you have the title or not.  Have a philosophy that the patient and family is always right, even when they are not. You may be the clinical expert, but they know what matters most to them. Engaging patients in their care leads to better outcomes.
  8. Leverage the power of your position. You need to define yourself. Don’t allow others to do it for you. Leverage the power of your position as the CNO.
  9. Seek and give timely feedback. This is truly a two-way street. It is important to not only give timely, specific feedback to your staff, but to also proactively seek feedback about your own performance. This is one of the best ways to continue to grow in your career.
  10. Acknowledge you cannot do this job alone. Surround yourself with trusted advisors and strong lieutenants. Have mentors (at least one outside your immediate contacts) who challenge you and help you to learn from your mistakes (of which you will make many).
Of course, everyone’s experience is different, and I’m sure other veteran nurse leaders could edit or add to this list. These are the lessons that I wish I had learned earlier in my career, and I hope any new nurse leaders reading this will benefit from my advice.


  • Davy Crockett

    Davy Crockett, RN, MPA, FACHE

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