4 Ways to Elevate the CNO-CFO Relationship

4 Ways to Elevate the CNO-CFO Relationship


As senior management team members, CNOs and CFOs work together to provide and manage care clinically and financially. A collegial relationship and knowledge and insights that each party needs for operational, strategic, and organizational success are essential. 

Today’s most successful nurse executives clearly understand how the CNO areas of responsibility impact the organization’s overall business goals and strategic agenda. They can concisely and accurately report on the financial status and advocate for adjustments as needed with the healthcare organization’s CFO. While the task may seem straightforward, CNOs and CFOs don’t always “speak the same language.”

Read, ‘Overcoming Leadership Challenges in Healthcare.

Balancing Business & Healthcare Delivery


The complexity of the CNO-CFO relationship stems from the very different lens through which each leader sees the organization. CFOs spend their days focusing on the financial status, while many nurse executives manage the day-to-day operational activities of nursing staff and patients. The CFO views the hospital as a business and focuses on ways to improve the bottom line. The CNO views the hospital as a care delivery system and prioritizes the patient care experience. Each executive’s goals may not always align, so a productive relationship between them is critical to the organization’s success, especially in times of change.

So how can the CNO advance a mutually productive relationship with the CFO? 

4 Ways to Elevate the CNO-CFO Relationship


1. Lead PEOPLE. Speak their language.


When the CFO asks a CNO how things are going in his or her department, the CFO is not looking for stories about patients or staff. The CNO should answer this question with specific data-driven details, including patient census, workforce plan, supply usage, length-of-stay, reimbursement trends, and budget variances. When making requests, CNOs must prepare to present the business case using sound data.

2. Lead for PURPOSE.


Experienced nurse executives with a high degree of financial acumen who have experienced a productive relationship with their CFOs share two crucial conclusions.

  • Differing attitudes and terminology related to data pose the most significant disconnect between the CNO and the CFO.
  • CFOs are looking for facts, not emotions. Being well-prepared and using a standardized reporting tool allows for a highly productive CNO-CFO conversation.

3. Lead for RESULTS. Understand their goals (and help them understand yours).


With increasing pressure to improve operational results, CNOs and CFOs must work together to balance the imperatives of the organization—both as a business and as a provider of quality patient care. For nurse executives, this starts with developing an understanding of how strategic plans and budgets are created, operationalized, and managed. For finance leaders, this means accepting that patient care demands may impact the budget in unavoidable ways. Clear communication and agreed-upon terminology between the CNO and CFO is imperative for alignment and performance accountability. 

4. Lead SELF.


The CNO must work with the CFO to develop a budget that supports the organization’s imperatives of quality, safety, patient experience, staff engagement, and fiscal accountability. Knowledge transfer is essential in this area of expertise, so educate your team on the financial space. Be transparent about why and how the budget was created. Assist your team in adhering to the budget, understanding the variance reporting process, and making adjustments as needed.

These steps will help CNOs build rapport with CFOs to establish an effective executive partnership. If the nurse executive can effectively speak the financial language, understand the business goals, and do his or her part to achieve them – the CFO will respect the opinion and contributions of the CNO. Both will be more likely to collaborate to discover innovative strategies in addressing and solving complex opportunities.

CNOs should ask themselves:

  • What kind of healthcare financial training did I receive in preparation for my role as a nurse executive? 
  • Am I frustrated by the budget process, monthly executive financial discussions, and departmental financial concerns? 

Kirby Bates Associates can help. Led by successful and highly experienced CNOs with first-hand executive clinical and business operations experience, Kirby Bates can help you learn the skills to strengthen your CNO-CFO relationship resulting in a more effective and collegial approach. 

Kirby Bates Associates drives healthcare organizations to achieve high quality, cost-effective patient care through our comprehensive portfolio of proven leadership services, including Executive Search, Interim Leadership, and Executive Advisory Services. As successful healthcare executives, our effective and inclusive approaches deliver sustainable solutions for our clients’ greatest leadership challenges. Contact us to learn more about how we can achieve sustainable outcomes for your executive, operational, and clinical leadership teams.

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