Reflections on My First Year as CNO

By Shannon Kunberger, MSN, RN, NEA-BC, CNO of Cleveland Clinic Euclid Hospital

When I joined Cleveland Clinic as chief nursing officer (CNO) of Euclid Hospital in June 2021, I knew that the only way to effectively lead the 320-plus caregivers under my direction was to walk in their shoes. So, I put on scrubs and spent time on all the nursing units.

I recall the day I shadowed nurses in the operating room where Peter Brooks, MD, now retired, was performing orthopedic surgeries. They looked surprised to see a CNO in the OR and asked why I was there. I responded, “How can I be your advocate if I don’t know what you do every day and understand your barriers to success?”

As a leader, you need to be humble enough to admit that you don’t know everything. My clinical experience is in critical care, emergency medicine and flight nursing, but the role of CNO requires a much broader knowledge base. A previous CNO I worked with once told me that it’s important to know a little bit about a lot of things.

During my first year at Euclid Hospital, I sought to build trusting relationships with my team and engage in appreciative inquiry – ask lots of questions and include stakeholders in decision-making. My goal is to respect the historical legacy built here at Euclid while making improvements where needed.

We’ve achieved many accomplishments during the past year, including Joint Commission accreditation and ANCC Magnet® recognition. There have been challenges along the way, too, including a power outage in the middle of the night. (Thankfully, incident command processes were swiftly put in place to resolve the problem.)

As I continue to lead the nursing team at Euclid Hospital, I’d like to share a few thoughts on my first year as CNO.

Looking through a different lens

Unlike some nursing leaders who were “home grown” at Cleveland Clinic, I came as an outsider, having spent the previous five years as executive director of Network Nursing for Community Health Network (CHNw) in Indianapolis. I was new to CHNw when I joined that organization, so I learned a lot of lessons from the experience that benefit me now about how to understand culture and navigate the landscape of stakeholders.

It sounds elementary, but one of the first things I did when I arrived at Euclid was print out the organizational chart with photos of the hospital’s leaders. When I had questions and someone suggested I speak to a particular colleague, I could look at the chart and understand what role they played within the health system.

Getting to know people takes time, of course, but this small practice helped me immensely.

One of the gifts of being new to an organization is the opportunity to view it through a different lens. My decades of experience in other health systems allow me to ask, “Why are we doing things this way?” Asking questions forces others to look closely at the processes, policies and procedures they have accepted as status quo.

I’m not the only new kid on the block. Darlene Morocco, MHA, BSN, RN, NE-BC, FACHE was appointed CNO of Cleveland Clinic Lutheran Hospital in March 2022 after serving as a clinical director at the University of Pittsburgh Medical Center. We’ve quickly developed a strong connection with each other and other CNOs and are using our experiences to help create positive change.

The one constant in healthcare is perpetual change. Executive Chief Nursing Officer Meredith Foxx, MSN, MBA, APRN, NEA-BC, is creating a collaborative environment in which all nursing leaders are empowered to adapt to change and work toward common organizational goals that foster Cleveland Clinic’s commitment to its four priorities – care for patients, caregivers, community and the organization.

Investing in leaders and caregivers

I would not have had a successful first year as CNO without the support of my nursing leadership team at Euclid Hospital, including nursing directors and nurse managers. Their invaluable guidance has allowed me to establish my role here.

I am committed to further developing a strong leadership team. I am particularly excited about holding my second leadership retreat in September. The team will participate in engagement-based activities to build stronger connections and explore new ways of doing things. Last year, one of the activities was a “start-stop-continue” exercise, which required leaders to reflect on three questions that drove action plans throughout the year:

• What do you want to start doing in your role?
• What do you want to stop doing in your role?
• What do you want to continue doing in your role?

I want to empower my nurse leaders to be change agents, which ultimately will help achieve one of my primary goals – improving recruitment and retention.

The rate of nurse turnover in the U.S. averages between 8.8% and 37%, depending on the region and specialty. The COVID-19 pandemic has exacerbated these challenges, forcing healthcare leaders to take a closer look at clinical workloads and models of care. We need to invest in our nurses, provide opportunities for advancement and ensure their voices are heard.

I want caregivers to know they are valued from day one on the job. I receive a list of new Nursing Institute employees each week. I write personal, handwritten notes to each one of them, whether they are a full-time employee, a student beginning a rotation or an agency caregiver on contract. I thank these caregivers for being part of the team and encourage them to reach out to me if they have any questions.

Gratitude is one of the foundations of recruitment and retention. So is visibility. I work closely with Cleveland Clinic’s Talent Acquisition team to attend as many recruiting events as possible, share my personal journey and explain why nursing at Euclid Hospital is so special.

Thoughts for other new nurse leaders

My first year as CNO was a whirlwind, filled with triumphs and a few setbacks. My message to other nursing professionals embarking on a new leadership position is to be patient and give yourself grace.

Like most leaders, I am extremely driven. I want to accomplish as much as possible, but implementing meaningful change takes time. I often remind myself – and encourage others – to be patient.

In my second year, I will continue to ask questions, foster trusting relationships with my leadership team and listen to caregivers with an open heart and mind. My vision for Euclid Hospital relies on attracting and retaining nursing professionals who have the tools and support to deliver high-quality care to the community.