Investment in technology depends on the financial status of your organization, says this CNO.
On this episode of HL Shorts, we hear from Keri Brookshire-Heavin, senior vice president, chief nursing officer, and chief operating officer at Phelps Health, about making the pitch for technology and innovation in a rural healthcare setting. Tune in to hear her insights.
Aspiring CNOs should take these steps to gain perspective as future leaders, says this CNO.
CNOs play an integral role in nursing.
They act as the voice for nurses in the executive space, advocating for investment in new programs that can better the patient care environment. CNOs carry the entire weight of the nursing workforce, and it's not without challenges.
According to Gay Landstrom, senior vice president and chief nursing officer at Trinity Health, CNOs are critical because they can provide insights for the entire nursing team, since they are responsible for all aspects of nursing care.
"It just makes so much sense that the leader that has responsibility for much of the product that we're producing,” Landstrom said. “That care, that experience for patients and all those caregivers; you want them [CNOs] to be at your executive table so that everyone on the executive team has a deep understanding of the patient and those that care for them each day."
CNOs bring what others can't
If CNOs weren't at the table, Landstrom explained, the C suite would lack valuable perspectives and information.
"There would be so much missing information, so much missing perspective when it comes to setting strategy or determining how to improve operations," Landstrom said. "You would just be missing some of the most vital information about your operation and about the care that you deliver."
CNOs must share their perspectives and insights about nursing, since it's vital to patient care. To Landstrom, however, it's not just about advocating. Listening and seeking understanding opens the door for advocacy.
"For the chief nursing officer to really be a vital and vibrant part of that executive team, they also need to listen," Landstrom said. "They need to hear the perspective of others on the executive team to understand what they're concerned about as well."
Building C suite relationships
Another key aspect of being a part of the C suite is relationship building. CNOs need to become translators, according to Landstrom.
"You absolutely need to build personal relationships with other members of your executive team," Landstrom said, "but it also means that you need to learn enough about strategy to speak strategy language and understand strategy language."
It's critical that CNOs understand all the financial elements of their organizations, including challenges with reimbursement, billing, and revenue cycle. In exchange, CNOs should translate information about clinical matters to non-clinical executives such as CEOs and CFOs.
To communicate better with those executives, Landstrom recommends that CNOs begin with identifying gaps.
"I think it's important to start with what [we're] trying to accomplish," Landstrom said. "Starting with what we agree on needs to be accomplished, and then being really gracious in sharing what you know, and teaching."
Advice for upcoming CNOs
In 2025, many CNOs will be focusing on succession planning and growing the next generation of nurse leaders. According to Landstrom, there are several key things that nurses must learn in preparation to become a CNO.
"An individual does not just arrive in that important role automatically being able to be successful," Landstrom said. "It's important to learn things before you step in that seat and continue learning all throughout your time as a chief nurse."
Landstrom recommends that nurses who want to become CNOs experience other areas of clinical care besides acute care.
"Other services outside of acute care are really growing and I think will continue to grow in the coming years," Landstrom said. "If a CNO's experience is completely in the acute care setting, then they really need to ask for and seek some other learning experiences in other parts of the continuum."
For example, aspiring CNOs should get to know the challenges of home healthcare, palliative care, and senior care, and why those services are important for different populations.
"An aspiring CNO should learn all they can about that, and about payment systems, and what some of the challenges are now and will likely be in the future," Landstrom said. "All of those things are important to learn to gain a really broad perspective and the ability to strategize, [make] improvements, [and innovate] in the care delivery system."
As Gen Z and new technologies arrive simultaneously in the nursing industry, CNOs need to take a hard look at their recruitment strategies.
In the latest edition of HealthLeaders' The Winning Edge webinar series, a panel of nurse leaders discussed best practices for recruiting the best nurses.
The discussion included three key takeaways: how to reboot the nurse recruitment process, the ways Gen Z nurses are changing the face of recruitment, and how CNOs should leverage social media to help new nurses decide where to work.
As Gen Z and new technologies arrive simultaneously in the nursing industry, CNOs need to take a hard look at their recruitment strategies.
Nurse recruitment remains a priority for CNOs and healthcare executives everywhere in 2025 as the workforce shortage continues.
In the United States, the Bureau of Labor Statistics expects the number of registered nurses to grow by 6% before 2033. According to the Health Resources and Service Administration workforce projections, between 2025 and 2037, show the demand for registered nurses is going to continue to outpace the supply.
First and foremost, recruitment and retention go hand in hand and are inseparable processes. According to the panelists, health systems must be ready to offer new nurses enticing hiring packages with benefits, and check in with them throughout their first year of employment. CNOs should focus on improving transition to practice programs as well to better acclimate new nurses to the fast-paced hospital environment.
Additionally, CNOs and talent acquisition staff should streamline the job application and hiring process. Shortening the length of time it takes to reach out and communicate with an applicant can greatly improve the chances of the candidate wanting to work with that particular health system. Applications should be as accessible as possible, even on mobile devices, and their statuses should be updated frequently.
Gen Z will revolutionize recruiting
Right now, only about 6% of the nursing workforce is Gen Z, but that number is expected to grow exponentially. As a generation, Gen Z values social justice, equity and inclusion, work-life balance, and having a strong sense of purpose and connection to the work they do. They also have higher expectations of technology and flexibility in the workplace.
Gen Z grew up online and will use technology to research organizations and decide whether they want to be a part of them. They also deeply care about being part of something bigger than themselves. Because of this, the panelists emphasized that CNOs have a responsibility to be transparent about their positions on social issues. Health systems should provide volunteering and community outreach opportunities as well.
Also, nurses in all generations, not just Gen Z, don't want to feel burnt out at their jobs. To combat this, CNOs should set up robust mental health and wellness programs to care for their workforce. Flexible staffing opportunities and work-life balance values are also a must, as Gen Z nurses tend to set hard boundaries about taking their work home with them.
CNOs must leverage social media
By the time many new graduate nurses are out of school, they already have a good idea of where they want to go based on the reputation of different organizations. Overall, CNOs and health systems need to invest in social media presence and branding to help nurses decide where they want to begin their careers.
Social media is a great platform to recognize nurses for all the hard work they do, and to applaud nurses for their achievements. It can be a tool to display the diversity and inclusivity of a health system, which can improve the organization's public reputation and build trust with potential nursing candidates.
According to the panelists, it's critical that real, authentic stories about nursing are being told online. Nursing can be extremely difficult at times, and nurses as well as the public know that. Some health systems are even partnering with nurse influencers to help showcase nursing as a career. It is essential to share both the positive and not-so-positive sides of the profession, with the goal of showing nurses why what they are doing is important, and how they can help change the trajectory of the industry.
As the nursing shortage looms, new expectations give way to new recruiting strategies.
In the face of a daunting workforce shortage, health systems are struggling to recruit and retain the best talent.
Nurse leaders everywhere are brainstorming innovative ways to attract new graduate nurses from a new generation with new expectations, and it isn't always easy.
Right now in the United States, the Bureau of Labor Statistics expects the number of registered nurses to grow by 6% before 2033. According to the Health Resources and Service Administrationworkforce projections, between 2025 and 2037, the demand for registered nurses is going to continue to outpace the supply.
CNOs and other healthcare leaders must brainstorm ways to bridge that gap and to provide avenues for nurses to have safe, lifelong careers in their health systems.
The obstacles
Nurse leaders are facing many recruiting challenges.
As the workforce ages, more seasoned nurses are retiring, leaving a gap in both knowledge and skill in their wake. According to a 2023 study, there are around a million nurses over the age of 50, which means a third of the nursing workforce could retire within the next 10 to 15 years. Nurse faculty are also included, and the study states this can lead to issues with enrollment and graduation rates.
On the other hand, there are new generational demands from new graduate nurses who are entering the workforce for the first time. Gen Z values diversity, social justice, and work-life balance and prefers their job to align with their morals. Additionally, the cost of living is higher than ever now compared to wages, which impacts new graduate nurses' ability to cover educational and living expenses.
Record workplace violence and burnout rates are also deterrents when it comes to people wanting to pursue nursing. According to a National Nurses United report that measured data from the entirety of 2023, eight in 10 nurses experienced at least one type of workplace violence, and 45.5% reported an increase in workplace violence on their unit. The American Nurses Association reports that 62% of nurses experience burnout, with 69% of nurses under 25 reporting burnout.
All of these issues are major cause for concern for CNOs and other nurse leaders everywhere. CNOs need to strategize and implement robust programs that prevent workplace violence and create both physically and psychologically safe environments for nurses.
What's the solution?
In 2025, attracting nurses of all types means having benefits such as flexible scheduling, opportunities for professional growth and development, and having up-to-date technologies that cut down administrative burdens.
The next webinar in our Winning Edge series will explore ways to utilize technology, gain departmental buy-in, and streamline other resources to recruit the best nurses so health systems can put their best foot forward.
Nurse practitioners may soon be able to classify chest radiographs, according to the CDC.
Nurse practitioners' (NPs) scope of practice will potentially be expanded once again as the Centers for Disease Control and Prevention (CDC) considers allowing NPs to try their hand at reading a specific type of X-ray.
The CDC's National Institute for Occupational Safety and Health (NIOSH) submitted a request for information regarding the B Reader Program from interested parties to determine whether or not they should allow nurse practitioners and physician assistants (PAs) to become B Readers.
Here's the rundown on what it would mean for nurse practitioners to become B Readers.
Diversity should inform your strategy, according to this CNE.
On this episode of HL Shorts, we hear from Claire Zangerle, CEO of the American Organization of Nursing Leadership (AONL), and senior vice president and CNE at the American Hospital Association (AHA), about how CNOs can incorporate DEI into strategy. Tune in to hear her insights.
Nurse practitioners may soon be able to classify chest radiographs, according to the CDC.
Nurse practitioners' (NPs) scope of practice will potentially be expanded once again as the Centers for Disease Control and Prevention (CDC) considers allowing NPs to try their hand at reading a specific type of X-ray.
The CDC's National Institute for Occupational Safety and Health (NIOSH) submitted a request for information regarding the B Reader Program from interested parties to determine whether or not they should allow nurse practitioners and physician assistants (PAs) to become B Readers.
The goal is to grant nurse practitioners and physician assistants eligibility to take and pass the NIOSH B Reader exam and become certified B Readers. According to the information request, the interested parties include experts in occupational respiratory health surveillance and radiology, nurse practitioners, physician assistants, and workers unions who represent workers exposed to mineral dust, and/or the workers themselves.
What is a B Reader?
According to NIOSH, the B Reader program "trains and certifies physicians in the International Labour Organization (ILO) International Classification of Radiographs of Pneumoconiosis." In simpler terms, B Readers classify chest radiographs of employees participating in health surveillance programs, such as the NIOSH Coal Worker's Health Surveillance Program.
Currently in the United States, only licensed physicians can become B Readers, and as of October 2024, only 184 U.S.-based physicians in 35 states are licensed B Readers, according to the information request.
The CDC's goal is to increase access to B Readers across the country.
"NIOSH is interested in ensuring that B Readers are available to classify chest radiographs obtained in all states and territories," the information request says.
What does NIOSH want to know?
NIOSH specifically is inquiring about the following questions from the interested parties, according to the information request:
What is the current demand for B Readers, and would expanding the program to include nurse practitioners and physician assistants help meet this demand?
Are there specific geographic areas or populations that might benefit from having nurse practitioners and physician assistants certified as B Readers?
Are there any potential risks associated with expanding the B Reader certification to nurse practitioners and physician assistants and, if so, how can those risks be mitigated?
ILO classification of chest radiographs is not the same as clinical interpretation. Are there states where scope of practice and standards of care allow nurse practitioners and physician assistants to perform clinical interpretation of chest radiographs without physician oversight? In states where physician oversight is required for clinical interpretation, is it also required for ILO classification? What would be the best approach to ensuring that appropriate clinical interpretations are obtained for all contemporary chest radiographs undergoing ILO classification by nurse practitioners and physician assistants?
How do you anticipate different interested parties (e.g., physicians, nurse practitioners and physician assistants, industry representatives, workers, health profession boards) would view the potential expansion of the B Reader program to include non-physicians?
What challenges might arise during the implementation of this expansion, and how could they be effectively managed?
Do you have any other information or comments relevant to whether nurse practitioners and physician assistants should be able to become B Readers and, if so, the best way to implement that expansion?
The request's comment period ends March 17, 2025.
Moving forward
If nurse practitioners become eligible to take the B Reader exam and become licensed B Readers once they pass, that will once again expand the role that nurse practitioners play in care delivery.
According to a 2024 report from the Association of American Medical Colleges (AAMC), the United States will face a shortage of 86,000 physicians by 2036. An increase in nurse practitioners and physician assistants will help fill that gap.
There are over 385,000 nurse practitioners across the country, according to the American Association of Nurse Practitioners (AANP). If all of them have the potential to get B Reader certified, that will be a significant step toward NIOSH's goal of expanding access.
At age 28, Zangerle was working in clinical exercise physiology in cardiac rehab, and was inspired by what the nurses were doing.
"I can do that, I can educate, I can do all these great things the nurses are doing," Zangerle said, "I can take the clinical knowledge that I learned in exercise physiology and elevate that into nursing."
After receiving a Bachelor of of Science in Exercise Physiology from Texas A&M University, Zangerle went on to get a master's in nursing administration from Kent State University, a master's in business administration with a focus in healthcare from Lake Erie College, and a Doctor of Nursing Practice from Texas Christian University.
Zangerle previously served as principle of CMZ Strategies, LLC, offering nurse leader coaching and nursing organization strategy. She is the former chief nurse executive at Allegheny Health Network and CEO of the Visiting Nurse Association of Ohio. Zangerle spent several years at the Cleveland Clinic where she served in a variety of roles, including as chief nursing officer, director of quality and accreditation and director of preventive cardiology.
Now, Zangerle serves as chief executive officer of the American Organization for Nursing Leadership (AONL), and senior vice president, chief nurse executive of the American Hospital Association (AHA). In her role at AONL, she leads a membership organization of more than 12,000 nurse leaders whose strategic focus is excellence in nursing leadership. In addition, she works collaboratively with the AHA to ensure the perspective and needs of nurse leaders are heard and addressed in public policy issues related to nursing and patient care.
On our latest installment of The Exec, HealthLeaders sat down with Zangerle to discuss her journey into nursing, and her thoughts on trends in the nursing industry. Tune in to hear her insights.
