We interviewed CNOs from across the nation to find out the secrets to their success. Rosanne Raso, CNO at NewYork-Presbyterian/Weill Cornell and Editor-in-Chief of Nursing Management Journal, reflects on managing a frenetic pace, hitting multiple goals with a single initiative, reaching out to frontline staff.
What are your top day-to-day challenges you’re facing today?
It’s challenging to manage the frenetic pace at the hospital and a steady stream of important initiatives, the imperative to hit huge goals. As a CNO, you get it from everywhere. So, prioritizing, managing time, and remaining focused on many things simultaneously are all crucial.
It’s also important that you nix any activity that doesn’t tie to specific initiatives. You manage multiple initiatives at once: patient outcomes from the clinical perspective, patient experience, length of stay, financial outcomes — you can’t pick a single one and focus on it exclusively. You have to keep all outcome goals in your mind simultaneously and work towards excellence all on fronts.
What unique strategies do you use to tackle these challenges?
It’s crucial to stay focused on what’s important and connect the dots all the time. All your work must have value for the big picture.
I try to make sure the work I do helps work towards multiple initiatives whenever possible. So, if I’m improving clinical outcomes while engaging the staff, I’ve hit two big goals. If I’m able to add a patient education piece, then I’m meeting our goal of increasing patient engagement, too. So, with the same effort, with the same work, you can push the envelope on three different outcomes.
Let’s say you are trying to decrease your central line bloodstream infection rate. You need to look at all your clinical protocols and determine whether they are meeting evidence-based protocols or not. Instead of siloing that effort, you work to involve the staff in the process, fold them into the evidence review and discuss what new protocols might work. This improves staff engagement. And that’s a win, too, because without the staff, nothing happens. Employee engagement is critical.
Then, say you have self-care patients with central lines. Involve them in the process. Create a patient education program that teaches a protocol for daily Chlorhexidine baths, engage them in setting it up, teach them using words about their health and safety. Then, you’ve improved patient engagement, too. With a single initiative, you’ve hit three major areas you’re looking to improve.
What the secret to your success as a CNO?
I think one key to being successful at the executive level is to not lose touch with your frontline staff. If you never get out of the executive suite and interface with nurses, providers, and other disciplines, if you aren’t integrated with the people actually providing the care, then you can’t advocate. I see the advocacy part of my role as so crucial, both for patients and staff. If you don’t really understand what’s happening on the ground, you can’t advocate appropriately.
Transparency is also so important. Being very communicative, approachable, and straightforward in all that’s happening helps you build strong foundations with frontline staff. You have to be sure to close the loop. If you speak to staff and work to solve their challenges, close the loop and get back to them. Be sure they know the work that’s going on on your end, too. Whether it’s one-on-one or through an email or newsletter, closing the loop and strong follow-up are very important.
Along those lines, regular rounding is really foundational. I have forums, staff advisory council, committee meetings, recognitions activities, unit councils — so many events, and I always try to show up. I do regular rounds and encourage departments to invite me in, too. It’s really a two-way street.
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