CNO Roundtable 2022

How Things Have Changed and Where They’re Going Next

Innovation, staffing challenges, and a growing need to support nurse resiliency

How have the many changes in the healthcare landscape shaped nursing leadership — and what do you anticipate for nursing in the next decade?


Elizabeth Adams, Kaiser Permanente Downey Medical Center

Historically, healthcare organizations didn’t have clinical informaticists. Now, we can’t operate without them. Also, our aging population means today’s nurse leaders must have strong financial acumen to effectively manage the cost of care. The nurse leader’s relationship with the chief financial officer is more important than ever.

During the pandemic, we witnessed nurses applying incredible innovation, which has paved the way for nurses to shape the future of healthcare delivery. I believe we will see more nurse entrepreneurs, more practice autonomy and greater utilization of technology in the delivery of care.


Lori Burnell, Valley Presbyterian Hospital

A significant change in the practice landscape is the mutual respect between nurses and physicians. Back in the day, it was an unwritten rule that nurses should vacate their chairs or stand at attention at the foot of a patient’s bed when a physician walked into the room. Now, nurses and physicians are more collaborative and have ongoing communication about patients.

After the shock of the pandemic settles, many frontline nurses will seek positions away from the bedside: launching startup businesses, elevating their skills and shifting to advanced practice roles or exploring jobs like legal nurse consulting. Telehealth will also become a viable career option for nurses who desire to work remotely.


Anita Girard, Cedars-Sinai

Healthcare today requires constant innovation and teamwork. Nursing leadership must be incredibly flexible and fearless. Due to the pandemic, units keep changing, staffing models remain in flux and mandates at the state and national level add to the ever-shifting landscape.

We need to start planning for the innovations that will be required in the COVID-19 recovery phase, including genomic treatments, utilizing artificial intelligence to enhance staffing, and increased use of robotics in logistical areas like supply chain management and medication delivery.


Karen A. Grimley, UCLA Health/UCLA School of Nursing

Today’s nurse leader must be nimble and willing, and must build space for nurses to heal. The two-year adrenaline rush of the pandemic has taken an emotional and physical toll, and the once-resilient nursing workforce is now fragile. Special attention to workforce wellness will be crucial to healing the wounds caused by the pandemic.

I fear that COVID-19 will result in an exodus from the bedside. Many nurses appear to be holding on to get the country through the pandemic with the intention of resigning or retiring shortly thereafter.

To avert the projected staffing crisis, it is imperative that we maintain a safe and healthy work environment and acknowledge and take action on systemic issues that threaten health equity, diversity and inclusion.


Ceonne Houston-Raasikh, PIH Health Downey Hospital

Historically, nursing leaders were expected to have a laser focus on day-to-day operations, bedside nursing and patient care. Leadership today requires more agility: The CNO must be a strategic, forward-thinking change agent.

Nursing leaders need solid business acumen and must be able to contribute and lead not just within the nursing arena, but across the entire healthcare landscape. I think we’ll see a shift from hospital-based care to a home-based model, with more traditional nursing roles shifting from onsite to remote.

New hospitals will have reduced bed capacity, but more flexibility to expand as needed. We have already started to see hospitals designed with features like parking garages and lobbies that can be converted to care areas.


Katie Hughes, Casa Colina Hospital & Centers for Healthcare

The biggest change I’ve experienced as a leader is in the workforce we serve. Employee priorities have changed: Work-life balance, opportunities for advancement and a sense of belonging are values that resonate with today’s nurses more than in the past. As a leader, it is important to create a place where nurses want to work, have a sense of purpose and feel like they belong.

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The nursing shortage and growing technological advances in healthcare have already started to shape the future. For example, we will use technology to more closely monitor patients with chronic diseases, enabling early intervention and reducing hospital admissions. Nurses will play a role in this as navigators and case managers, helping patients access the resources and levels of care they need.


Evelyn Ku, Henry Mayo Newhall Hospital

Nursing leaders today must be willing to change with the times when appropriate. We must also adapt to the newer generation of nurses and how they learn.

While the new nurses of today are bright and eager, it is imperative that we teach them how to connect with the patient. I have witnessed nurses of the new generation who are super technology-savvy, but lack the personal touch when caring for the patient at the bedside. For the next five to 10 years, nurses will have to be more innovative, ensure that our skill set remains current and relevant, and be able to respond quickly to crisis.

The nursing shortage will also continue to be a trend. We lost 40,000 nurses in California during the surge, so we will need to redouble our efforts to recruit and retain the best nurses. We need to make sure our hospitals are places nurses are proud to work.


Joyce Leido, Kaiser Permanente Los Angeles Medical Center

Today’s nurse leaders have to embrace innovation, see technology as an ally rather than a barrier, and keep clinical nurses engaged as thought partners. We also have to keep the mental, emotional and spiritual health of our teams at the forefront of everything we do.

I foresee a blitz of innovation and transformation. The past two years have propelled many of us to embrace disruption and to use it as fuel for reinvention. What many thought would take years or even a decade to achieve, we were able to accomplish in weeks or months. Technology is going to be an essential ingredient.


Jinhee Nguyen, Adventist Health Glendale

We have to get comfortable with thinking outside the box. We need to match the pace of innovation and pivot quickly to adopt new technology. However, we cannot lose sight of the people involved in developing and using that technology. The pandemic has underscored the need to remain focused on the people — patient and care provider alike.

Nursing and healthcare will need to create and enhance policies to address workforce mental health and wellbeing. Other critical topics will include ensuring that nursing schools are able to continue supplying the nurse workforce as it evolves. Innovations like tele-nursing and virtual care platforms will help us further streamline workflow.


Tanya Osborne-McKenzie, MLK Community Healthcare

Being transparent and including the team in decision-making have always been topics of discussion for nurse leaders. The difference is that with the complexities of today’s healthcare environment, leaders can no longer just talk the talk.

Success in any healthcare role today requires true teamwork. People feel much more connected to their work and have a greater sense of purpose if they understand the whys and are involved in solution-finding. Although the number of travelers may decrease, I don’t think it will return to pre-pandemic levels. Hospital leaders will need to learn how to partner not only with their permanent staff, but also with temporary staff to implement and sustain performance improvement processes.


Chiarina Piazza, West Coast University

Compared to past eras, disruption of every type is more of a norm now, whether it be a natural disaster, political unrest or even innovation — and we need to be able to lead through it all. Nurses were catapulted into the spotlight as powerhouse heroes during the pandemic. We need to continue to elevate nurses, whether they’re in scrubs or suits, to have visible authority in influential leadership positions. I see us playing a leading role in the transformation of global health equity.

Nursing Education


Ramona Pratt, PIH Health Whittier Hospital

In my first leadership role years ago, I was allocated one administrative day per pay period for timecards, schedules, quality assurance audits, managing budget, hiring, etc. Nursing budgets were developed on a piece of paper with a pencil and calculator.

Today, the frontline leadership role requires advanced knowledge of strategic planning, finance, staff recruitment, supply management, data analysis, and more. As the pandemic has demonstrated, it also demands expertise in disaster management and the ability to pivot quickly.

I have serious concerns about nurses leaving California in search of more affordable housing. Also, the cost of nursing will continue to rise, which will likely result in new staffing models emerging. I am hopeful that advancing technology will support nursing at the bedside rather than adding to the workload — but I have been waiting for this for quite some time.


Gloria Sanchez-Rico, Huntington Hospital

Historically, the focus was on managing teams. The expectation now is that we lead by mentoring and engaging nurses as colleagues and helping them grow as leaders. The results are overwhelmingly positive: an engaged, collaborative environment that allows nurses to thrive, be professionally satisfied and provide the best care for our patients. I think we’re going to see the emotional and psychological impact of COVID-19 for many years to come. We must continue to make wellness an organizational priority for virtually everyone working in healthcare.


Darlene Scafiddi, Pomona Valley Hospital Medical Center

Today’s nursing leadership must invest in innovative recruitment and retention strategies. Numerous surveys have projected a shortfall of nurses in California and nationwide over the next few years, exacerbated by the pandemic.

The pandemic has been a catalyst of a shift towards prevention and wellness-focused programs as well as the growth of telemedicine programs. We can expect major technological advances in patient monitoring and care systems, which should improve access to care and reduce healthcare costs for many in our communities. Hospitals will continue to see patients, but more will be seen on an outpatient basis, with inpatient care reserved for our sickest patients.


Linda Soubirous, Loma Linda University Medical Center – Murrieta

The past two years have emphasized the need for resiliency. Staff and leaders are mentally and physically exhausted. Yet, they come together day after day and continue to find creative ways to address the needs of our patients, families and staff.

I am amazed by the commitment of our leadership team to thinking outside the box while keeping patient safety the top priority. Nursing leaders will need to focus on lobbying efforts as healthcare legislation is written and policies are reviewed. The rising costs of healthcare infrastructure, equipment, supplies and staff will be difficult to meet. Nursing schools and new graduate programs will also have to grow exponentially to meet the fast-growing healthcare needs of our elderly population.


Lauren Spilsbury, Redlands Community Hospital

In years past, the nurse leader was a great nurse who oversaw the practice of nursing. Today, nursing leadership provides oversight on all aspects of the healthcare endeavor, including the financial side, quality initiatives and regulatory compliance as well as supervising nursing practice. Strategic planning is essential in the rapidly changing healthcare environment.

A strategic plan used to be five to 10 years; now, looking three years out can be a long time. New technology is changing how we do our work, and will continue to do so. We have to be ready for the adoption and integration of new technologies while maintaining the human touch.


Sarah Stevens, California Rehabilitation Institute

Nursing leadership has become progressively more challenging over the last few years. Technology has made us more accessible, but there is an expectation of immediate response or resolution. Setting personal boundaries has become more and more important to ensuring the continued resiliency of nursing leadership. We need to protect our energy and time.

The last two years have highlighted what it means to be a nurse and the importance of self-care. I’d like to see more focus on caring for nurses as individuals, with a greater emphasis on coaching and mentoring as well as normalizing talking about difficulties as work. I think we’ll see a swing back towards seeing nursing as the calling that it is.


Annette Sy, Keck Medicine of USC

Nurse leaders today need to understand the science and bring that science to the bedside while still demonstrating leadership qualities such as effective communication, accountability, delegation and the ability to receive constructive feedback.

Strong nurse leaders are in the boardroom, sharing their knowledge and expertise in all decision-making. Sadly, I feel we will continue to see more nurses retiring early. We need to ensure that we have adequate resources to train and support new cohorts of nurses.

To satisfy the growing need for education, we’ll need to be able to modify course delivery, move to online delivery when reasonable and strategize student engagement. We will also have a growing role for nurses in our informatics teams and an increasing emphasis on population health.

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