Chief Nursing Officer Retention and Turnover: A Crisis Brewing?
Results of a National Survey, Cheryl B. Jones, Donna S. Havens, and Pamela A. Thompson
Anecdotal evidence suggests growing concerns about chief nursing officer (CNO) dissatisfaction, intent to leave, and turnover. However, little evidence documents the magnitude of the problem or whether CNO turnover requires direct action. This article reports the results from the first phase of a three-phase study examining CNO turnover and retention in U.S. hospitals. CNOs 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 their job—13 percent within two years of the survey and 25 percent within five years of the survey. Of these, approximately one-quarter had been asked to resign, had been terminated, or 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 was 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.
Rural Hospitals and Spanish-Speaking Patients with Limited English-Proficiency, Myriam Torres, Deborah Parra-Medina, Jessica Bellinger, Andrew O. Johnson, and Janice C. Probst
Between 1990 and 2000, the Latino population in the United States increased by 61 percent, becoming the largest minority group. Language differences contribute to patient safety and access to healthcare concerns for limited English proficiency (LEP) Latinos. The objectives of this research were to determine the techniques rural hospitals use to accommodate Spanish-speaking LEP patients, to identify strengths and barriers to providing language services, and to describe local approaches to language assistance services.
Surveys were mailed to 841 hospitals in 544 rural counties with moderate to high Latino growth rates between 1990 and 2000. A total of 319 rural hospitals (37 percent) responded. Nearly all rural hospitals (92 percent) reported having tools to help patients communicate language needs. The most commonly used tools include brochures (47 percent), language identification posters (36 percent), and language identification cards (33 percent). Strengths were institutional support for language assistance services (82 percent), staff willingness to use interpreters (79 percent), and access to telephone language lines (77 percent). Principal barriers included lack of funding for interpreters (46 percent), lack of local language training programs (37 percent), and lack of state agency support (34 percent). Hospitals that serve counties with higher Latino population growth rates reported higher demand for services compared with those hospitals with smaller Latino population growth rates. Several innovative approaches were also identified.
Various language accommodation resources, tools, and strategies are available for hospitals to help them serve LEP clientele. It is recommended that hospitals routinely review their policies and procedures for language assistance services to ensure compliance with federal and Joint Commission standards.
Board Engagement in Quality: Findings of a Survey of Hospital and System Leaders, Joanna Jiang, Carlin Lockee, Karma Bas s, and Irene Fraser
Hospital governing boards assume an important role in improving delivery of quality care in the hospital. More knowledge about the prevalence and impact of particular board activities can help them perform this role more effectively. This study draws from a survey of hospital and system leaders (presidents/chief executive officers [CEOs]) that was conducted in the first six months of 2006 with a total of 562 respondents. The survey contained 27 questions on various aspects of board engagement in quality. More than 80 percent of the responding CEOs indicated that their governing boards establish strategic goals for quality improvement, use quality dashboards to track performance, and follow up on corrective actions related to adverse events. The adoption of other practices was reported less frequently. Only 61 percent of the respondents indicated that their governing boards have a quality committee. The existence of a board quality committee was associated with higher likelihoods of adopting various oversight practices and lower mortality rates for six common medical conditions measured by the Agency for Healthcare Research and Quality’s Inpatient Quality Indicators and the State Inpatient Databases.
Hospital governing boards appear to be actively engaged in quality oversight, particularly through use of internal data and national benchmarks to monitor the quality performance of their organizations. Having a board quality committee can significantly enhance the board’s oversight function. Other potentially useful activities—such as board involvement in setting the agenda for the discussion on quality, inclusion of the quality measures in the CEO’s performance evaluation, and improvement of quality literacy of board members—are currently performed infrequently.