Teacher, Learner, Cheerleader

Important Leadership Skills

By Topic: Leadership Operations Process Improvement


As the system CNO, I am part of the executive team that leads at the national level through the Command Center. In addition, my leadership dyad partner—the national CMO—and I met (and still meet) weekly with the division CMOs and CNOs via Zoom. We shared Command Center information, heard lessons learned from the divisions whose COVID-19 census spiked earliest, shared best practices and agreed on crisis-inspired emergency clinical procedures. Several division CMO/CNO leadership dyads presented their challenges to the Command Center and how they mitigated those with creative staffing solutions, use of technology and teamwork. 

The nurse executive team (consisting of the division CNOs, nursing leaders of our senior living division, our health-at-home company and my national direct reports) also met weekly to concentrate on nursing challenges caused by the pandemic at all of our sites. These ranged from development of new nursing virtual models and workflows, staffing issues, patient and family experience issues, appropriate use of technology, and staff morale. 

I believe it (cheerleading) is one of the most important skills we have as leaders during good times as well as during crises like what we are facing now—balanced with the ability to communicate honestly, transparently and with straight talk.

The emotional and physical strain on nursing teams was a major topic on every call. We knew that not all clinical staff cared directly for patients with COVID-19 diagnoses, but they were affected, either through loss of income/work while their clinics or units experienced low census or closure all together, or by being asked to work in areas that were not their specialties. 

The front-line nurses who did care for victims of the pandemic faced the fear of an unknown disease while enduring the trauma of losing many people, regardless of every effort made to help them survive. On the units, those patients who died usually passed away with only the nurse at their bedside. So, while the nurses supported patients and (virtually) the families who could not be there, the nursing leaders tried to support the nurses. 

At the national level, nurse leaders developed a toolkit for nursing unit managers with guidance on how to promote resilience and how to help nurses remember to care for their own physical and mental health. As the national CNO, I represented the team by providing video messages of support and gratitude, with reminders to the nurses to care for themselves, their families and each other. During National Nurses Week, we sent parchment certificates of gratitude to our 45,000 nurses, acknowledging their service during 2020, the World Health Organization’s Year of the Nurse that also became the year of COVID-19. Our thought was the certificate would serve as a visible reminder to show a child, grandchild or someone else who might ask what he or she did during the pandemic. 

Along with other executives, I gave verbal reports to our national board of stewardship trustees, (who were equally concerned for our patients, communities and staff). I shared our successful practices with nurse executives from other systems and gratefully accepted what they shared with me. I also received emails from front-line caregivers with good suggestions of what we could do to support them. I was happy that I had two decades of experience setting up and researching the efficacy of virtual inpatient models, so was ready to support the rapid deployment of virtual care.

Overall, my part in this pandemic has been to balance my roles as a convener of experts and other leaders; a nursing voice on multidisciplinary teams; a team leader and also a team member; a decider/approver of crisis staffing plans, procedures and products; a sender and a receiver of new information; a teacher and a learner; and a cheerleader. I listed cheerleader last, but I believe it is one of the most important skills we have as leaders during good times as well as during crises like what we are facing now—balanced with the ability to communicate honestly, transparently and with straight talk.

In addition, I have relied on my education and experience during this year. Both have taught me that there is no one person, no one profession, no one organization and no one leader who has the answers to all of the problems we now face in healthcare, or even in more stable times. As leaders, we need to listen to a variety of voices, and be just as good at being a team member (when appropriate) as we are as team leaders. While we need to make timely decisions, the further we are from the bedside, the more we need to depend on the expertise and innovative thoughts of a variety of expert team members.

Kathleen D. Sanford, DBA, FACHE, is executive vice president/CNO, CommonSpirit Health, Chicago. (