Abstract
Performance improvement of chief nurse executives (CNEs) is an integral part of a healthcare organization's program of continuous improvement. However, the process of evaluating CNEs is an increasingly complex and costly one. This is, in part, because the formal evaluation process for a CNE of a stand-alone hospital building is considerably different from that of a CNE in an integrated health-care system of hundreds or several thousand nursing personnel. Reflecting on staff's perceptions of the CNE evaluation process in a large system, the author highlights major concerns related to issues of trust, their careers, the organization, their patients, and themselves.