Nurse Leadership During Organizational Mergers and Acquisitions

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Attractive business woman working on a tablet in the office.When hospital and health system mergers bring together the services of two healthcare organizations, chief nursing officers (CNOs) must be ready to support the transition by anticipating emerging issues, providing skilled communication and tackling the dynamic changes. Executive nurse leaders working as CNOs provide steadfast and dependable governance in a time of upheaval.

Using their nurse leadership skills, CNOs help with smooth transitions, particularly for staff nurses who worry about their future. Ruthie Robinson, Ph.D., RN, said nurse executives on both sides of an acquisition – the acquiring and acquired hospitals – face similar challenges. In a study published in Nursing Management, Robinson found that nurse executives help the merger process because of their skills and knowledge.

“CNEs [chief nurse executives] on both sides of the transaction are ideal for leading through the process because they have a nurse’s unique understanding of the human experience,” Robinson said in the study. “This can be a time of great professional growth for the nurse leader willing to remain open to the possibilities. Most of the CNEs, whether on the acquiring or acquired side, agreed that it was an incredible learning experience and an opportunity to develop relationships with a variety of stakeholders.”

Despite slowdowns from the COVID-19 pandemic, hospital and health system mergers are expected to continue through 2020 and beyond. CNOs will play a vital role in mergers and acquisitions by utilizing nurse leadership skills and being an effective nurse manager. Registered nurses (RNs) who earn doctor of nursing practice degrees, including through online DNP programs, learn essential skills to usher nursing staffs through mergers and acquisitions.

A CNO’s Role in Mergers and Acquisitions

In the study titled Hospital Acquisitions: The Chief Nurse Executive Perspective, Robinson found four major themes that were identified as difficult during a transition:

1. Poor Communication

Nurse executives who participated in the study described leadership communication during the transition to be poor or even nonexistent in some cases.

2. Lack of Respect

Nurses from the executive to staff levels felt that their expertise was not respected, particularly for smaller institutions being acquired by larger ones.

3. Sudden Changes

Nurse leaders said they felt unprepared for the loss of leadership during the period, including during layoffs.

4. Bumpy Transitions

Many nurse executives surveyed felt that the institutions had no solid transition plan or clear shared vision, leaving a culture gap among the two staff.

However, Robinson noted, plenty of nurse leaders who underwent a merger or acquisition found ways to make it work. Some of the experiences included:

  • Developing simple steps that allow the two organizations to work cooperatively
  • Creating a synergy document that outlines supporting healthcare and identifies how the cultures fit
  • Celebrating the new merger or acquisition as a first step in a new history
  • Reducing staff stress by hosting informational sessions about the change process
  • Reassuring staff by being as transparent and honest as possible

Robinson said one nurse executive stated that the transition might not always be smooth, but that continuing to acting professionally was important.

“Acquisitions are predicted to maintain growth throughout the next few years,” Robinson said. “As one CNE stated, ‘With mergers and acquisitions, things might be really wonderful at the top when they shake hands and seal the deal, but there’s a lot of work to be done at the point of care and not everybody is just thrilled about it. There’s a lot of role shuffling and a lot of competition for resources and attention. It’s a human experience.’ ”

Being an Effective Nurse Manager During a Merger or Acquisition

As leaders, nurse executives are paramount to successful mergers and acquisitions. The American Nurses Association (ANA) said nurse leaders could make improvements that impact patient care, foster a safe and healthy workplace, craft a vision for the future and drive quality improvements.

The ANA suggested nine principles to improve the effectiveness as a leader, which can apply to leadership through mergers and acquisitions:

  1. Commit to excellence
  2. Measure important things
  3. Build a culture around service
  4. Create and develop leaders
  5. Focus on employee satisfaction
  6. Build individual accountability
  7. Align behaviors with goals and values
  8. Communicate on all levels
  9. Recognize and reward success

Clearly, nurse leadership skills translate from bedside care to the boardroom, including in assisting through mergers and acquisitions. As DNP-educated nurses, CNOs can meet the needs of professional nurses, hospital executives, and patients.

At Duquesne University, RNs who enroll in the online DNP program learn essential skills for leadership, including social justice, organizational leadership, business strategy, nursing informatics, and budgeting and finance, to name a few.

About Duquesne University’s Online DNP Program

Duquesne University’s online DNP program trains RNs for leadership positions to implement positive changes and professional accountability in healthcare. Students learn how to build on existing experiences and knowledge and implement evidence-based practices in clinical settings. Graduates use their healthcare expertise and business acumen in leadership roles.

Duquesne University’s online DNP program offers three tracks:

  • Clinical Leadership DNP
  • Post-Bachelor’s Executive Nurse Leadership DNP
  • Post-Master’s Executive Nurse Leadership DNP

Duquesne University’s online DNP program also allows students to continue working and maintain family responsibilities while earning an advanced degree.


Nursing Management, “Hospital acquisitions”
ANA, “Nine Principles to Improve Your Effectiveness as a Leader”