Case Study
Addressing Leadership Challenges Impacting Culture, Retention, and Patient Experience
The Challenge
When the Chief Nursing Officer of a 3,200+ employee hospital system came to us, her message was clear: “Our charge nurses are struggling, and it’s impacting patient care.” Despite being in leadership roles, many charge and relief charge nurses weren’t modeling the organization’s core values: Accountability, Integrity, Respect, and Excellence.
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The breakdown showed up in:
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Misuse of PTO, lack of follow-through, and poor communication
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Avoidance of conflict and a no-feedback culture
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Rising incivility, disciplinary actions, and turnover
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Risk to patient safety and experience demonstrated in monthly HCAHPS scores
It had grown beyond a typical performance issue into a culture issue, and it required more than another generic training or in-service.
The Intervention & Work
We developed a first-of-its-kind Charge Nurse Leadership Academy for the entire health system, which was a high-impact learning experience designed to help frontline leaders internalize and practically live out the hospital’s values in real time.
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Our approach included:
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Assessing the climate: We listened to staff and surfaced the root leadership gaps.
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Strategic program design: We built a custom roadmap aligned to both CNO priorities and actual team dynamics.
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Experiential learning sessions: A 4-part, in-person academy covering:
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Accountability
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Integrity
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Excellence
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Respect
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Each session (2 hours) was built around interactive, practical learning—real talk, not theory. Topics included:
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Psychological safety
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The 5 Dysfunctions of a Team
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Facilitating difficult conversations and managing conflict
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Giving and receiving feedback
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Leading with professionalism and presence
The Outcomes & Impact
We taught values, AND we made them actionable.
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What participants said:
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“It made me think about how my follow-through and tone set the tone for the whole shift.”
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“Now I’m more intentional about holding myself and others accountable.”
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“I left feeling grounded and more confident in what strong leadership actually looks like.”
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What’s shifted for the health system:
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Stronger peer accountability
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Clearer communication across units
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Leaders creating real-time action plans
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More confidence and ownership in the charge nurse role
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An increase in HCAHPS scores by an average of 2.1 percentage points month-over-month in one quarter