Chief Nursing Officer and Nurse-Sensitive Indicators


A role of a Chief Nursing Officer (CNO) as an agent of change has been long recognized by influential healthcare organizations such as the American Nurses Credentialing Center (ANCC), the American Nurses Association (ANA), and the Institute of Medicine (IOM) (Clavelle, Drenkard, Tullai-McGuiness, & Fitzpatrick, 2012). By empowering staff and creating a shared vision, a CNO can advance the development of nurse-sensitive indicators. Such indicators are essential for improving the quality of care and reducing the incidence of adverse events. The aim of this paper is to discuss the role of a CNO in relation to the following nurse-sensitive indicators: central line-associated bloodstream infection (CLABSI), catheter-associated urinary tract infection (CAUTI), ventilator-associated pneumonia (VAP), and pressure ulcers.

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Four Indicators

It is a CNO’s responsibility to ensure that patients receive comprehensive and coordinated care based on quality models supported by the most current research. Therefore, a CNO has to identify and monitor CLABSI, which is one of the first outcome measures recognized by ANA (APIC, 2015). Adherence to best professional practice has been found to substantially reduce the incidence of CLABSI (O’Neil et al., 2016). Another CLABSI prevention method is “education of healthcare personnel responsible for catheter maintenance” (O’Neil et al., 2016, p. 694). Given that CNOs are accountable for promoting safety and achieving excellence in practice, it is their responsibility to minimize the number of CLABSI among their patients.

When it comes to CAUTI, CNOs have to develop reminder systems, which can be both physical and virtual. Furthermore, it is necessary to educate staff on proper catheter use and removal, thereby controlling the key risk factor for CAUTI—the duration of catheterization (Tambyah & Oon, 2012).

Many hospitals have been penalized for excessively high rates of VAP, which means that CNOs should be especially interested in monitoring ventilator-associated events. In order to achieve acceptable VAP rates, it is necessary to apply a complex approach developed by the Institute of Healthcare Improvement (IHI). The approach involves the following elements: “head of the bed elevation, oral care with chlorhexidine, stress ulcer prophylaxis, deep venous thrombosis prophylaxis, and daily sedation assessment” (Kalanuria, Zai, & Mirski, 2014, p. 211).

Not unlike the previous indicators, a CNO should use pressure ulcers indicator in their regular quality improvement efforts. Also, it is essential to understand the relationship between pressure ulcers and staffing levels. CNOs should educate their staff on the importance of moisture management and routine repositioning to decrease hospital-acquired pressure ulcer rates in their organizations (Bergquist-Beringer, 2013).


An outcome measure is considered nursing-sensitive only when there is a proven correlation between some elements of nursing practice and a result (Heslop & Lu, 2014). Therefore, as a CNO, I will carefully review and analyze the extant scientific literature on the topic of interest in order to gain evidence of the connection between the two variables. Furthermore, I will find information on the threats to the validity of an indicator (Heslop & Lu, 2014). It is also necessary to contact clinical experts in order to receive professional feedback. Based on the feedback, I will develop a guideline for a pilot testing process for the indicator. The guideline will include definitions, instruments, and data collection methods among others. After conducting the pilot testing process, the obtained data will be analyzed and evaluated. The time for the development and approval of the indicator will depend on the number of nursing units and the size of a facility. It will range from several months to a year.


The paper has assessed the role of a CNO in the development and monitoring of nurse-sensitive indicators. It has been argued that by adhering to the principles of best professional practice, a CNO can substantially reduce the incidence of key indicators in their organization.

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APIC. (2015). Guide to preventing central line-associated bloodstream infections. Web.

Bergquist-Beringer, S. (2013). Pressure ulcers and prevention among acute care hospitals in the United States. The Joint Commission Journal on Quality and Patient Safety, 39(3), 404-414.

Clavelle, J., Drenkard, K., Tullai-McGuiness, S., & Fitzpatrick, J. (2012). Transformational leadership practices of chief nursing officers in Magnet organizations. JONA, 42(4), 195-201.

Heslop, L., & Lu, S. (2014). Nursing-sensitive indicators: A concept analysis. Journal of American Nursing, 70(11), 2469-2482.

Kalanuria, A. A., Zai, W., & Mirski, M. (2014). Ventilator-associated pneumonia in the ICU. Critical Care, 18(1), 208-214.

O’Neil, C., Ball, K., Wood, H., McMullen, K., Kremer, P., Reza, S.,… Warren, D. (2016). A central line care maintenance bundle for the prevention of catheter-associated bloodstream infection in non-ICU settings. Infection Control Hospital Epidemiology, 37(6), 692-698.

Tambyah, P. A., & Oon, J. (2012). Catheter-associated urinary tract infection. Infectious Diseases, 25(4), 364-369.

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