Nursing Shortages - A Wicked Problem

By Rose O. Sherman, EdD, RN, NEA-BC, FAAN

For many years, I worked closely with a program manager at a large local foundation where the nursing workforce was one of their targeted areas. We were often focused on issues around the shortage of nurses in our area. This program manager became very frustrated when the initiatives that we launched worked for a period of time, and then the shortage problem re-surfaced. She often complained that “nursing just cannot get its act together and solve this.” She wondered why I was not as mad as she was about this. I told her that her thinking was way too simplistic about what was, in fact, a wicked problem.

I am reminded of my conversation with her as I think about where we are today with a new nursing shortage that will be challenging to solve. COVID has changed the thinking of many nurses about both their personal lives and their profession.

Many younger nurses enter work settings today with a BSN. They have the career goals of working for a year and then pursuing an advanced practice track. At the request of her parents, I had a conversation with one such student the other day, graduating in May. She is career-oriented and expects to advance quickly. Even a year of working at the bedside seemed like too much time to her. She was not thinking about the investment that a health system would make in her through a residency program. While she may change her career plans, the current data indicates that she is not alone thinking about the lack of value in several years of acute care experience.

A higher turnover rate and a growing patient acuity versus nurse experience gap are likely to be with us for the foreseeable future. It will continue to be a wicked problem. Wicked problems are different from other problems. Some of the key features of these problems include the following:

Involve many unknown unknowns.
Lack a definitive explanation.
Are entangled with other organizational issues.
Are symptoms of other problems.
Are moving targets across time.
Lack straightforward articulation and are impossible to solve in a way that is simple or final.
Involve complex interdependencies and many viewpoints.
Are nuanced and may not be the same across geographical areas.
They are expensive to solve, and one-shot solutions have consequences.

The challenge is that we often assume a problem like nursing shortages is Complex instead of Wicked. Complex problems can be solves by rational analysis followed by a logical reductive process designed to get the situation firmly under control.

Wicked problems are different. They are subjective, relative, chaotic, and ambiguous, full of stakeholders and different agendas. They are messy, ad hoc, and sometimes unsolvable. You may achieve great results for a while with your interventions, and then you are back in the messy middle. You will try many things, and some will work, but you are never in complete control of the problem. You have to get comfortable with this if you are in leadership and have wicked problems.

When we face ambiguous situations and are under stress, we tend to default to what we know. We look at what we’ve done before, what we’re comfortable with, or what we think will take the least effort and give us the most control. And what we tend to default to most is the assumption that the problem we are dealing with is complex and, therefore, logical and solvable. This is fine if that is, in fact, what it is, but it is likely to be disastrous if the problem is, in fact, Wicked like this current shortage.

So what should nurse leaders do with this information? The first step is to recognize that the problem you are dealing with is a wicked problem. We may not solve it, BUT our interventions can make it better or worse in our setting. Achieving positive outcomes will take time, and we need to remain flexible. Before we take any critical steps – ask whether the step you are about to take will make the situation better or worse. In other words, is this intervention useful in the long run? And remember – you are working in a space that is highly complex and ambiguous. You will make mistakes, but even these can lead to progress.

Launch 2021 by giving your leadership team the gift of a highly rated webinar – Nursing Leadership in 2021: Rebooting after a Life-Quake A Nursing Leadership Reboot Workshop

Read the Nurse Leader Coach – Available at Amazon and Other Book Sellers.

Now Available to Strengthen Your Leadership in 2021 – The Nuts and Bolts of Nursing Leadership: Your Toolkit for Success