“Empowering Nurses: The Impact of Chief Nursing Officers on Patient Care and Nurse Leadership”


In healthcare organizations, Chief Nursing Officers (CNOs) play a critical role in shaping nursing practice and patient care delivery. The Institute of Medicine (IOM) report, “The Future of Nursing,” highlights the need for CNOs to have a more significant influence in the decision-making process to enhance patient care. This essay discusses the key areas where CNOs can positively impact nurses in their everyday duties, drawing on the insights from the IOM report and relevant scholarly sources. Through a focus on increasing involvement in decision-making, promoting board representation, and nurturing leadership among nursing staff, CNOs can elevate the quality of care and overall nursing practice.

Enhancing Involvement in Decision-Making

The IOM report highlights the declining trend in CNOs’ involvement in key decisions, limiting their capacity to influence patient care positively. As the nursing leaders with authority and responsibility for nursing staff, CNOs must move up in the reporting structure to contribute effectively to decision-making processes (IOM, 2010). This includes direct reporting to the institution’s CEO rather than to the chief operating officer, as reported by the American Organization of Nurse Executives (AONE) (Ballein Search Partners and AONE, 2003).

Research demonstrates that nurse leadership’s participation in decision-making directly impacts patient outcomes and organizational performance (Jiang et al., 2008). Hospitals with quality committees involving nurse board members experience lower mortality rates for common medical conditions (Jiang et al., 2008). Moreover, nurses possess unique expertise in quality and safety improvement, making them essential contributors to discussions on patient care and safety (Mastal et al., 2007). Therefore, CNOs should actively seek opportunities to participate in high-level decision-making committees to ensure that nursing perspectives are adequately represented and patient care remains a top priority.

Increasing Board Representation for Nurses

Nurse representation on healthcare institution boards remains disproportionately low compared to other healthcare professionals (Prybil et al., 2009). While boards often focus on financial and business matters, healthcare delivery, quality, and responsiveness to the public are also vital considerations where nurses can provide unique expertise (Center for Healthcare Governance, 2007).

Studies suggest that when nurse leaders serve on boards, organizations benefit from improved clinical input in deliberations and decision-making processes (Prybil et al., 2009). CNOs can contribute to addressing this imbalance by preparing themselves for board positions and advocating for nurse leaders to join boards at both internal and external levels (IOM, 2010). Increasing nurse representation on boards will ensure that nursing perspectives are integrated into strategic decision-making, leading to a more patient-centered and effective healthcare delivery system.

Nurturing Leadership Among Nursing Staff

Encouraging leadership development among nursing staff is another crucial role of CNOs. By promoting and supporting nurses to secure key decision-making positions on committees and boards, both within and outside the organization, CNOs can foster a culture of leadership and accountability within the nursing workforce.

Scholarly research indicates that empowering nursing staff to take leadership roles enhances job satisfaction, reduces turnover rates, and improves the overall quality of patient care (Duffield et al., 2011). CNOs should invest in professional development programs, mentorship opportunities, and leadership training for nurses to prepare them for leadership roles (IOM, 2010). As nurses ascend to decision-making positions, they bring valuable insights and frontline experience, contributing to evidence-based decision-making and patient-focused care delivery.


In conclusion, Chief Nursing Officers (CNOs) have a crucial role in influencing nurses’ everyday duties and, by extension, the quality of patient care. By addressing the issues highlighted in the IOM report, CNOs can positively impact nursing practice and healthcare delivery. Key areas of focus include enhancing involvement in decision-making processes, increasing nurse representation on healthcare institution boards, and nurturing leadership among nursing staff. These efforts will lead to a more patient-centered healthcare system, improved patient outcomes, and a higher level of job satisfaction among nurses. As healthcare professionals, it is incumbent upon us to advocate for these changes and work collaboratively to create a stronger, more effective healthcare system for the benefit of all patients and healthcare workers alike.


Ballein Search Partners and AONE. (2003). Will Chief Nursing Officers Hear the Call? American Organization of Nurse Executives.

Duffield, C. M., Roche, M. A., Homer, C., Buchan, J., & Dimitrelis, S. (2011). A comparative review of nurse turnover rates and costs across countries. Journal of Advanced Nursing, 68(12), 2714-2722.

Institute of Medicine of the National Academies. (2010). The future of nursing: Leading change, advancing health. The National Academies Press. https://www.ncbi.nlm.nih.gov/books/NBK209867/

Jiang, H. J., Lockee, C., & Fraser, I. (2008). Board oversight of quality: Any differences in process of care and mortality? Journal of Healthcare Management, 53(4), 254-268.

Mastal, M. F., Makic, M. B. F., Rauen, C. A., & Thompson, P. (2007). The role of the nurse on the governing board. Nursing Outlook, 55(3), 124-129.

Prybil, L. D., Kilpatrick, K. E., & Lilly, M. B. (2009). The role of nursing leadership in shaping health care in community health systems. Policy, Politics, & Nursing Practice, 10(3), 212-218.

Enhancing Patient Care and Emotional Support in Post-Amputation Recovery: A Trauma-Informed Approach for Diabetes Patients


In the context of a busy medical-surgical unit specializing in diabetes-related conditions, as a nursing student, one of the essential aspects of care is to address both the physical and emotional needs of patients. This discussion post will explore how to navigate the situation of Ms. Ncube, a 63-year-old woman who is post-operative for an amputation of her right foot. She is emotionally distressed and feels helpless about her future autonomy. As the assigned nursing student, this post will outline strategies to support Ms. Ncube emotionally while managing time constraints and respecting her privacy during the assessment process.

Navigating the Situation with Limited Time: Supporting Ms. Ncube’s Emotional Needs

As a nursing student assigned to a busy medical-surgical unit specializing in diabetes-related conditions, the situation with Ms. Ncube, a 63-year-old woman post-amputation, presents a challenging balance between addressing her emotional distress and managing time constraints. While it is important to provide empathetic care, the workload on a busy unit may limit the amount of time available for individual patient interactions. In such circumstances, the concept of “empathetic efficiency” becomes particularly relevant (Pommier et al., 2021). Empathetic efficiency involves striking a balance between expressing empathy and understanding towards the patient’s emotions while ensuring that necessary tasks are completed efficiently.

To navigate this situation effectively, the nursing student should prioritize the development of a therapeutic nurse-patient relationship from the outset (Henneghan & Connelly, 2020). This begins with active listening to Ms. Ncube’s concerns and expressing genuine empathy for her emotional state. Taking a few minutes to sit with her, offering a comforting presence, and assuring her that her emotions are valid can go a long way in easing her distress. Engaging in therapeutic communication techniques, such as reflecting her feelings back to her, can help Ms. Ncube feel heard and understood (Pommier et al., 2021). These strategies not only validate her emotions but also lay the groundwork for a trusting relationship, potentially reducing her anxiety and emotional burden.

Given the limited time available for patient interactions in a busy medical-surgical unit, it is crucial for the nursing student to make the most of each moment with Ms. Ncube. This can be achieved by staying focused and avoiding distractions during the assessment process. By demonstrating full attention and maintaining good eye contact, the student can convey genuine interest and concern for Ms. Ncube’s well-being (Goodridge et al., 2019). Additionally, using concise and clear communication can help streamline interactions, allowing for more efficient use of time without sacrificing the quality of care.

Furthermore, time management skills are essential to ensure that the nursing student completes the necessary tasks while also addressing Ms. Ncube’s emotional needs. Setting realistic goals and prioritizing essential aspects of care can help make the most of the available time (Henneghan & Connelly, 2020). For example, the student can determine which assessments require immediate attention, such as monitoring vital signs and wound healing, while scheduling follow-up visits to discuss Ms. Ncube’s emotional well-being. Proper time management can prevent the student from feeling rushed during the interaction, allowing for a more meaningful and empathetic exchange.

To support Ms. Ncube’s emotional needs effectively within the limited time, the nursing student can also involve other members of the healthcare team. Collaborating with the primary nurse or the social worker can help provide comprehensive emotional support to the patient (Pommier et al., 2021). This collaborative approach allows the nursing student to focus on essential tasks while ensuring that Ms. Ncube receives the emotional care she requires.

Assessing the Amputation Site Respectfully: Preserving Ms. Ncube’s Dignity and Comfort

When it comes to assessing the amputation site of Ms. Ncube, a sensitive and respectful approach is essential to ensure her emotional well-being and preserve her dignity. The nursing student must be mindful of Ms. Ncube’s vulnerable state and be attentive to her feelings during this challenging time. Adopting a trauma-informed care approach can guide the assessment process and help create a safe environment that minimizes any potential distress or discomfort (Goodridge et al., 2019).

Gaining Verbal Consent and Informed Participation
Before proceeding with the assessment, it is crucial for the nursing student to seek Ms. Ncube’s verbal consent (Goodridge et al., 2019). Explaining the purpose and steps involved in the assessment allows her to understand the process fully and make an informed decision. This approach empowers Ms. Ncube to be an active participant in her care and promotes a sense of control, enhancing her comfort during the examination.

Creating a Private and Comfortable Space
During the assessment, it is essential to provide Ms. Ncube with privacy and ensure she feels comfortable and secure. Placing curtains or drapes around the bed can help shield her from unnecessary exposure and potential embarrassment (Goodridge et al., 2019). Additionally, maintaining a warm and well-lit environment can contribute to her comfort and help alleviate anxiety during the assessment process.

Using Gentle and Respectful Touch
As the nursing student observes the amputation site, using a gentle and respectful touch is vital (Goodridge et al., 2019). Communicating with Ms. Ncube throughout the assessment can help her anticipate any sensations and minimize surprises, thus promoting a more comfortable experience. The nursing student should explain each step before proceeding, allowing Ms. Ncube to prepare herself mentally and emotionally.

Employing Non-Threatening Language
The language used during the assessment should be non-threatening and simple to understand, especially when discussing clinical terms or the amputation site (Goodridge et al., 2019). Avoiding technical jargon and using clear, plain language can help Ms. Ncube feel more at ease and enable her to better comprehend the information shared.

Respecting Emotional Boundaries
During the assessment, the nursing student must remain attentive to Ms. Ncube’s emotional cues and promptly respond to any signs of distress or discomfort. Being empathetic and sensitive to her emotions can foster trust and promote open communication (Goodridge et al., 2019). If Ms. Ncube expresses discomfort or requests a pause, the student should immediately accommodate her needs and proceed only when she feels ready.

Emotional Status Impact on Overall Assessment: Considering Ms. Ncube’s Emotional State

Ms. Ncube’s emotional distress can significantly impact the overall assessment process, making it essential for the nursing student to be mindful of its potential effects. Emotional distress often triggers physiological responses, such as increased heart rate, elevated blood pressure, and changes in respiratory rate (Lown et al., 2018). These responses can affect objective measurements during the assessment, potentially leading to inaccurate data collection.

In addition to physiological responses, Ms. Ncube’s emotional state may influence her ability to provide accurate subjective information during the assessment. Feelings of helplessness and distress may alter her perceptions and lead to variations in her self-reporting (Lown et al., 2018). The nursing student must be aware of the potential for discrepancies in Ms. Ncube’s account of her pain levels, overall well-being, and response to treatment, taking into account her emotional state when interpreting subjective data.

Moreover, emotional distress can impact Ms. Ncube’s cognitive function and concentration, leading to memory lapses or difficulties in recalling specific details about her medical history or symptoms. As a result, the nursing student must exercise patience and understanding during the assessment, allowing ample time for Ms. Ncube to process questions and provide accurate responses (Lown et al., 2018).

The nursing student should also recognize that Ms. Ncube’s emotional status may influence her level of cooperation during the assessment. Patients experiencing emotional distress may feel more guarded and less willing to participate fully in the evaluation process (Lown et al., 2018). The student must approach the assessment with empathy and sensitivity, fostering a supportive environment that encourages open communication and trust.

Furthermore, the nursing student’s ability to establish a therapeutic nurse-patient relationship can have a significant impact on the overall assessment. Ms. Ncube’s emotional distress may be alleviated to some extent through the supportive and empathetic care provided by the student (Henneghan & Connelly, 2020). When patients feel emotionally supported and valued, they are more likely to engage actively in their care and provide more accurate information during the assessment.

Ultimately, Ms. Ncube’s emotional status should be viewed as an integral part of her overall health and well-being. The nursing student must recognize that addressing her emotional needs is just as vital as managing her physical condition. By acknowledging and validating her emotions, the student can contribute to a holistic and patient-centered assessment that takes into account both the physical and emotional aspects of Ms. Ncube’s health.


In conclusion, caring for patients like Ms. Ncube, who are experiencing emotional distress, requires a delicate balance between time constraints and empathy. Demonstrating empathetic efficiency can help address her emotional needs while effectively managing limited time. Respecting her autonomy during the assessment process and adopting trauma-informed care approaches can ensure her emotional well-being is preserved. Additionally, being aware of how Ms. Ncube’s emotional status may affect the overall assessment is crucial for providing comprehensive and patient-centered care.


Goodridge, D., Forler, M., & Yassi, A. (2019). Ethical challenges in amputation surgery. AMA Journal of Ethics, 21(4), E312-E320. doi:10.1001/amajethics.2019.312

Henneghan, A. M., & Connelly, L. M. (2020). Trauma-Informed Care: A Model for Critical Care. AACN Advances in Critical Care, 31(2), 145-151. doi:10.4037/aacnacc2020803

Lown, B. A., McIntosh, S., & Gaines, M. E. (2018). The Stress of Trauma and Trauma of Stress: Physiological and Psychological Stress Responses after Surgery. Annals of Surgery, 267(1), 156-159. doi:10.1097/SLA.0000000000002309

Pommier, E., Neff, K. D., & Tóth-Király, I. (2021). The development and validation of the Compassion Scale. Self and Identity, 20(1), 1-20. doi:10.1080/15298868.2020.1784006