The Transition of Chief Nurse Executives into Chief Executive Officer and Chief Operating Officer Roles.

Abstract

It is difficult navigating the whitewaters of today’s healthcare. Finding and keeping a competent and capable chief executive officer (CEO) and chief operating officer (COO) is pivotal to successful navigation. Chief nurse executives (CNEs) are advancing into CEO and COO roles. Successful transition from a clinically focused role to a strategically and operationally focused role is critical. The purpose of this study was to understand the experience of transition and identify the barriers and facilitators to transition in order to prepare the next generation of CNEs for the CEO/COO role. Grounded theory was used to study a purposeful sample of fifteen CNEs who transitioned into the CEO or COO role. Loosely structured, open ended questions were used to elicit the experience of transition and to determine the barriers and facilitators. Interviews were audio-taped and transcribed verbatim. Constant comparative analysis of the data and literature were used to establish conceptual trends and initial theory. Theoretical coding, memoing, and data-sorting were used to modify concepts and integrate the data.

Participants traversed four stages of role exit before successful transition into their new role: First doubts, seeking and weighing alternatives, the turning point, and creating the ex-role. Participants moved through the first three stages of role exit with relative ease. The fourth stage, creating an ex-role was the basic social-psychological problem that the CNEs faced during their transition to the CEO/COO role. Their biggest challenge was letting go of their persona as a nurse, and embracing their new persona as a CEO/COO. Reframing identity was the basic social-psychological process the participants used to create an ex-role, learn their new role, and embrace it. Reframing allowed participants to use and preserve the best aspects of nursing to support the organization in their new role as CEO/COO. As participants moved through the process of reframing they began to see themselves differently – they were no longer nurse CEOs/COOs (nurse first, CEO/COO second), rather they were CEOs/COOs who were nurses (CEO/COO first and nurse second). Because they saw themselves differently, they asserted themselves differently. Their role sets began to see them in their reframed identity.