The COVID-19 pandemic may be over but chief nursing officers (CNOs) continue to grapple with the aftermath. The turnover rate among registered nurses (RNs) continues to be high, estimated at more than 22% annually, and can cost hospitals millions of dollars every year. Healthcare organizations are understaffed, and recruitment is difficult.

Not surprisingly, job satisfaction among registered nurses is low. A March 2023 survey by revealed:

  • 39% of nurses said they are dissatisfied with their current job, while only 28% said they were satisfied.
  • 61% of nurses feel unsupported in their jobs.
  • 91% believe the nursing shortage will get worse because of burnout, poor working conditions and inadequate pay.

Clearly, CNOs have a lot of work to do if they want to re-energize and re-engage their nursing teams. Fortunately, there is a structured, efficient, evidence-based path forward to a better nursing work environment and improved nurse satisfaction: the journey to nursing excellence.

The question facing nurse leaders is how to plan for and then start the journey, while recognizing the realities of the last few years.

To develop a solution for this challenge, Tipton Health has been working with CNOs from around the nation. The result is an innovative new program: the Tipton Health “90-Day Nursing Excellence Care Plan”©.

The “90-Day Nursing Excellence Care Plan” is a comprehensive strategy to help nurse leaders formulate, develop and implement a strategic program in just 90 days to rebuild their hospitals’ cultures of nursing excellence and increase satisfaction among the nursing staffs. The care plan works equally well for those who are just beginning their journey and need a rocket-charged start.

The plan, which is customized to the unique needs of Tipton Health’s clients, was designed with the following goals in mind:

  • Efficient use of resources;
  • Engage the entire organization;
  • Propel nursing excellence and the achievement of improved nurse and patient outcomes;
  • Elevate the nurse leader practice at all levels and encourage evidence-based leadership practices;
  • Foster system integration;
  • Align nursing with hospital goals;
  • Prioritize structures and practices that yield measurable impacts and deliver return on investment

Here’s how the plan works:

Step 1: Assessment

The work starts with a two-day kickoff meeting to assess the hospital’s current state of nursing excellence and any programs it already has in place.

Tipton Health’s nurse experts meet with key stakeholders, including nurses at every level, and the executive team. Discussions with nurses focus on their personal commitments to their patients and profession. We talk about their calling as nurses and why they do what they do.

Step 2: Diagnosis and Goals

Tipton Health will evaluate findings from the assessment meetings to develop initial recommendations. Working with the hospital nursing leadership team, priorities are established for work supporting a transformational nursing work environment. Key nursing influencers at all levels are identified and teams are formed to drive action plans.

Step 3: Interventions

Tipton Health’s consultants return for another two-day, on-site summit on nursing excellence. At this time, working with nurse leaders, an overall work plan is developed, and action plans are scheduled and assigned. Implementation of interventions has begun!

When complete, the 90-day plan helps healthcare organizations understand where they are and where they need to be. It prioritizes everything the CNO would like to do and identifies the actions that should be completed first. The plan identifies any gaps that may exist in the organization’s efforts and suggests ways to close those gaps. Finally, the recommendations serve as a strategic plan the organization can use for years to come.


2023 NSI National Health Care Retention & RN Staffing Report, January 2023. Retrieved July 10, 2023 from NSI_National_Health_Care_Retention_Report.pdf (

2023 This is the State of Nursing, March 2023. Retrieved July 10, 2023 from State of Nursing – 2023 (

Why Become Magnet. ANCC. Retrieved July 10, 2023 from Why Become an ANCC Magnet Recognized Organization? | ANA (

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