The complexity of care, increased cost pressures, nursing shortage, competition for experienced nurses, and focus on "never events" are some of the challenges faced by chief nursing officers (CNOs). The CNO is the executive leader for the largest and most influential group of professionals in most health care organizations. He or she can provide transformational changes that are needed to address issues such as those cited in the opening sentence. For this reason an in-depth literature review was performed to summarize key findings and factors that contribute to the high CNO turnover. The results of this review can be used as the basis for planning strategies to assist new and current CNOs in their development to reverse this turnover trend.