How One Chief Nurse Executive Builds Strong Nurse Leaders

'Taking care of those who are taking care of the patients' is crucial, CNE says.

When Leanne Salazar, APRN, DNP, MBA, chief nurse executive (CNE) of HCA Healthcare's West Florida Division, is filling a nurse leader position, she looks for someone who will take good care of their nursing staff and guide them well.    

Because good leadership is key in retaining nurses, Salazar is taking the culture of nursing excellence she built as chief nursing officer (CNO) for nearly seven years at HCA's Oak Hill Hospital in Brooksville, Fla., before becoming CNE in early 2020, and expanding it throughout the division's 15 acute care hospitals.

"Our next generation of nurses is very important," she says. "My reasons are twofold; No. 1, because our nurse turnover rates are high, but No. 2, two of my daughters are nurses and I have a personal stake in it."

HealthLeaders spoke to Salazar about how she finds and builds strong nurse leaders for her division.

This transcript has been lightly edited for length and clarity.

HealthLeaders: Why is nurse leadership of such relevance to you?

Leanne Salazar: Leadership is really the key to nursing retention, and we experienced a shortage in nursing leaders, as well, so attracting and retaining nursing leaders has been a top focus over this past year. [Oak Hill has] seen a 140% reduction in new nurse leader turnover year-over-year. I was a chief nurse for six and a half years, and we really built a culture of nursing excellence, and that's what I'm trying to duplicate at a higher level up the division.

HL: What are some of those steps you're doing to create a culture of nursing excellence?

Salazar: The first is obviously attracting the best talent, so really leaning in and developing a pipeline of new nurse nursing leaders. I am involved in the interview process of all nurse managers, directors, and up. There are two reasons for that. No. 1, when they get to me, I really am looking for culture; I'm not looking at their degrees. If they already got all the way up to me, then obviously they meet the minimum requirements.

No. 2, I'm looking for somebody who really has the heart and the compassion to lead. They have to take care of people who are taking care of the patients, so it really is an art.

We started a Nurse Leader Fellowship, and that's a 12-month program for new nurse leaders where they meet with me every single month. We kick it off with a three-hour orientation where they get one-on-one time with me and other nursing executives.

Then, for every month for the next 12 months, we have sessions with them where we bring in executives at all different levels to really work with them and to develop them. We do individual development plans to help them grow to meet their professional aspirations.

HL: What do they learn in those monthly sessions?

Salazar: We've had several chief nurse executives who have talked about culture and how you develop a culture. We've done different workshops with them on teaching the "why" behind the "what" of teaching nurses at the bedside. Why we do, for example, bedside shift reporting and what that looks like in a safe culture.

Another [workshop] talks about, how do you hire for fit? What does that look like? They go into detail about what they look for in their nurses when they hire. How do you develop those new nurses? Because remember, we're teaching leaders now, so how do you choose and select the right nurse for your organization?

We had one of our CNOs recently speak about wellness and resiliency. Our next session coming up is about really reconnecting to our "why." This last couple of years has been tough and we've been navigating these uncharted waters together, so you know they've been extremely resilient.

We've had our president [of HCA’s West Florida Division], Dr. Ravi Chari, speak to the group. We've had our VP of human resources speak to the group, and our chief medical officers recently spoke to our obstetrics leaders to help them on some of our quality metrics. It's a multidisciplinary approach to supporting the new nurse leader, and I truly believe what's led to this reduction of first-year nurse leader turnover is focusing on them and supporting them.

HL: Are most of these new nurse leaders new to the company or are they brand new as a nurse leader?

Salazar: Actually, it's both. Most of them are new to leadership or they're stepping up in leadership. Maybe they were a charge nurse or supervisor somewhere and now they're a manager or director. But we also have leaders, managers, and directors that come in from another organization, and we want to assimilate them into the HCA West Florida Division culture and what our standards look like and teach them how we do what we do and why we do what we do. So, they're incorporated into the Nurse Leader Fellowship, as well.

HL: What other kinds of new CNO programs do you offer?

Salazar: We have several. We do the Leadership Development Institute and we go into each market and have all nursing leaders, including the CNOs. That session is really focused on gratitude and resiliency, and I'm really excited about that. We're giving our nurse leaders a journal and we're giving them the power of "moments"—how to make ordinary things extraordinary for our teams. Again, this is focused on taking care of those who are taking care of the patients and that's really what that's about.

For our assistant chief nurses, we have an advanced leadership course that probably 80% of them have gone through. They have to be here for at least six months and then we put them through advanced, corporatewide training and it incorporates different classes and executive projects. It's a good, structured program, and we've seen great success. Our most recent graduate was just promoted recently to chief nurse, so we're really excited about her.

And then for our chief nurses we have a corporate coach that comes in. She's a coach and a mentor and she meets with all my new chief nurses. And then I, of course, meet with them every week for the first three months and then I meet with them monthly.

HL: Chief nurses are more involved now in the business side of a hospital or health system. Is that factored into your new-CNO training?

Salazar: Yes. One great thing about being a nurse executive is that we have a seat at the table—an equal seat to the chief financial officer and the chief medical officer—so that really gives us that voice. And by being there, we are responsible for strategic plans, budgets, and those types of things.

HL: Sounds like you're very hands-on.

Salazar: It's important, because if we can't stabilize our nursing leadership team, then it's very difficult to stabilize nursing, so that's why I feel that our focus on our nursing leaders is critical.