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...from the first phase of a three-phase study examining CNO turnover and retention in U.S. hospitals. GNOs were invited to complete an online survey to gather data about their experiences with turnover and to identify CNO retention issues. Our sample includes responses from 622 CNOs employed in hospitals and healthcare systems across the United States.
Approximately 38 percent of the respondents reported having left a CNO position--13 percent within two years before the survey and 25 percent within five years before the survey. Of these, approximately one-quarter had been asked to resign, had been terminated, or had lost their jobs involuntarily. When asked about the context of their departure, a high percentage reported leaving their position to pursue another CNO position (50 percent) or for career advancement (30 percent); approximately 26 percent reported leaving because of conflicts with the chief executive officer. Of great concern is the finding that approximately 62 percent of respondents anticipate making a job change in less than five years, slightly more than one-quarter for retirement.
Respondents clearly indicated that CNO turnover is a problem that requires attention. The knowledge gained from this study can be used by healthcare leaders to develop strategies and policies aimed at recruiting and retaining CNOs and easing the transition for CNOs and others in the organization when CNO turnover does occur.
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The chief nursing officer (CNO) represents and advocates for nursing at the most senior level in hospitals and health systems and is responsible for understanding the capability and capacity of the nursing department (American Organization for Nurse Executives [AONE] 2005; Clifford 1998; Freund 1985; Kippenbrock 1995; Kippenbrock and May 1994; VHA, Inc. 2005). Unfortunately, anecdotal evidence suggests that many persons who fill this critical role are dissatisfied and intend to leave their positions. When an organization experiences CNO turnover, the workload of the executive and nursing leadership teams is undoubtedly affected, and even if the CNO is quickly replaced, relationship development must begin anew--between the CNO and the executive leadership team and between the CNO and nurse managers and staff nurses.
Very little recent research has been conducted to understand the nuances of CNO turnover. We have limited knowledge of why CNO turnover occurs, or what could be done to prevent CNO turnover. Kippenbrock (1995) reported the top two reasons for CNO turnover as lack of power (more than 50 percent) and conflicts with the chief executive officer (CEO) (45 percent). In a more recent study by the VHA (2005), the top factors contributing to CNO turnover were work-life balance (70 percent), CEO conflicts/financial issues (62 percent), physician conflicts (54 percent), staff nurse turnover (53 percent), and dissatisfaction with their current position (49 percent).
However, these studies do not provide current statistics on CNO turnover or information that is needed to quell CNO turnover and promote retention. These issues served as the impetus for this study, which was conducted to explore the current CNO role, as perceived by current, interim, or past CNOs in U.S. hospitals, and to describe the experiences of current, interim, or past CNOs regarding recruitment, retention, and turnover issues. To achieve these goals, we used a confidential, online survey that was completed by current, interim/acting, and past CNOs to glean information about the CNO role, experiences with voluntary and involuntary turnover, and related CNO retention issues. Healthcare leaders can use the knowledge gained from this study to address the serious concerns associated with CNO turnover and develop strategies and policies aimed at recruiting and retaining CNOs as well as to ease the transition for CNOs and others in the organization when CNO turnover does occur.
METHODS
A three-phase study was conducted to examine CNO turnover and retention in U.S. hospitals. The first phase, reported in this article, included a confidential online survey of current, interim/acting, and past CNOs. This survey, developed by the research team and pilot-tested by a group of experts, asked participants about the CNO role, current or prior experiences with turnover, the organizations where CNOs work, career intentions, support available and needed for CNOs who experience voluntary turnover (i.e., turnover based on personal desires) and involuntary turnover (i.e., terminated or asked to resign), and related CNO turnover and retention issues. The survey was developed from the literature (Bleich 1998; Freund 1985; Freund 1987; Kippenbrock and May 1994; Kippenbrock 1995) and from the researchers' knowledge of turnover and retention in general and CNO turnover in particular. Before initiating the survey, current and past AONE board members reviewed the survey and provided useful feedback to the study team about the content and formatting.
Approximately 6,000 hospital and health system CNOs were invited by email to participate in the survey; the list of CNO e-mail addresses was obtained through the American Hospital Association. This initial survey announcement was e-mailed to the survey population approximately three days before the online survey was initiated. A follow-up e-mail was sent to the CNO population approximately one week after the survey was initiated to thank those who had participated and remind others that the survey was still available. Similar e-mails were sent two and three weeks after the online survey began to increase the response rate.
The questionnaire was formatted as a web-based survey using Zoomerang, a tool for developing online surveys. In the initial survey announcement, CNOs who were interested in participating were asked to read an informed consent statement that was attached as a rich text file to the e-mail announcement. If, after reading the document, they agreed with the terms of participation, they were directed to point their web browser to the Zoomerang survey. The entire online survey took approximately 20 minutes to complete. All surveys were confidential, and there was...
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