An Ethnographic Investigation on How Chief Nursing Officers Use Transformational Leadership to Lead and Support New Nurse Graduates

Purpose: The purpose of this ethnographic study was to examine how chief nursing officers (CNOs) use transformational leadership to lead and support new nurse graduates based on the Transformational Leadership Skills Inventory (TLSi) tool developed by Larick and White (2012). Methodology: The sample for this qualitative ethnographic study included 13 CNOs in 4 counties in California (Los Angeles, Orange, San Bernardino, and Riverside) working for hospitals and other healthcare settings. The data sources for this study included observations, interviews, and artifact reviews. Data were analyzed using a thematic analysis. Findings: 8 major findings emerged: (a) CNOs participate in rounds and take time to listen to new nurses, (b) CNOs create a culture of caring and compassion with new nurses, (c) CNOs use storytelling to create sustainable change, (d) CNOs meet with new nurses regularly, (e) CNOs recognize generational differences, (f) CNOs hire new nurses with critical thinking and soft skills, (g) CNOs support evidence-based decision making, and (h) CNOs encourage teamwork and collaboration through shared governance. Conclusions: Based on the findings, it can be concluded that new nurses thrive when CNOs communicate with them by rounding and listening to them; new nurses understand their responsibility to patient outcomes when CNOs create a culture of caring; new nurses are retained when CNOs adapt rapidly to change; new nurses thrive when they feel like they are able to share their opinions, thoughts, and experiences with their CNOs; CNOs are working to engage older generations with the new millennial generation of nurses; patient satisfaction increases when CNOs focus on ensuring new nurses have good customer service and critical thinking skills; new nurses make fewer medical errors when CNOs support evidence-based decision making; and new nurses thrive when CNOs encourage teamwork and collaboration through shared governance. Recommendations: Further research is recommended in other geographical areas, with other types of nursing facilities, on factors that influence new nurses to leave the profession within 2 years of graduating nursing school, using new nurses as the population to understand their perspective, on nurses who have at least 5 years of experience, and to further correlate patient satisfaction surveys to employee satisfaction surveys