A first-time Chief Nursing Officer, arriving after a bad exit

The situation

A well-regarded nursing director stepped up to Chief Nursing Officer for a system with four sites and roughly 2,600 nursing staff. Her predecessor had left abruptly nine weeks earlier following a serious staffing dispute.

She inherited a leadership team of six, two of whom had applied for her job, and a workforce that had learned to treat announcements from the executive floor as weather.

The work

Before day one

Two sessions before she formally started. The output was an entry plan with a deliberately short list of things she would change in the first ninety days — one item — and a long list of things she would visibly not touch until she understood them.

A designed listening tour

Forty-one conversations in six weeks, in a sequence that was itself a message: night-shift charge nurses before executives, the two internal candidates early rather than politely late.

The ninety-day pulse

Six structured conversations at day ninety. The dominant theme was that she was visible and trusted, and the second theme was that people still could not describe what she was going to do — a fair criticism of a deliberate strategy that she had not explained.

Where it ended

• The gap identified at day ninety was addressed with a single all-staff communication setting out what she had learned and the two things changing by the end of the quarter.
• Both internal candidates were still in post at twelve months; one had taken an expanded remit.
• She has since sponsored transition coaching for two of her own directors.

We have promoted good clinicians into executive roles for twenty years and mostly left them to it. The difference in her first six months against that pattern was not subtle.
Chief Executive, the health system