What’s Trending As We Close 2023

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

What has been interesting in my leadership development work is examining the trends that emerge over time. We are at the end of 2023, and here is what leaders are telling me now:

1. We are in a new world of work, and many leaders are struggling with the changes in the healthcare workforce and their viewpoints about work and life.
2. Nursing turnover appears to be down from this same point in 2022 as health systems work hard to stabilize their workforce, yet filling vacancies is still very challenging.
3. Executive leadership positions, including nursing roles, are being eliminated to cope with declining hospital margins.
4. Health Systems are trying to do a quality reset in a post-COVID environment where some basic nursing care is not routinely done.
5. Many health systems struggle financially with the skyrocketing labor, pharmaceuticals, and supplies costs while lengths of stay increase and reimbursement declines.
6. Patient volumes remain very high, and waits in emergency departments for admissions often extend into days.
7. Unionized hospitals face more contentious relationships with their union partners, and strikes and picketing have increased.
8. The 2023 class of new graduates are more work-ready than those who graduated during the pandemic but still need extensive orientation, and many have had little experience with documentation of care.
9. New graduates are more tech-savvy, but many lack basic communication skills, impacting nurse communication scores.
10. Redesigning care delivery is a strategic Health System priority in 2024. Many are looking at new care delivery models that involve adding team members such as LPNs, Nurse Scribes, Virtual Nurses, and Mobility Techs.
11. Most RN applicants continue to be new graduates – experienced nurses are in high demand.
12. Nurses are less trusting of their leaders, and leaders struggle with staff negativity.
13. Many nurses now want to be entrepreneurs and have side gig businesses that are not in nursing.
14. Nurse leaders report that holding staff professionally accountable has become more challenging.
15. Accrual of PTO time is at an all-time low as nurses use their PTO immediately when earned.
16. Frontline nurse leaders continue to spend 60-80% of their time on staffing and scheduling.
17. Young nurses report relying on social media and social media influencers for professional support.
18. Nurses are more likely to argue and push back on policy changes where they don’t see a strong why.
19. Travel pay and benefits have declined, but the use of travelers as part of core staffing continues, especially in Med-Surg, ED, and the OR.
20. Creative Academic-Practice partnerships are forming to sustain RN enrollment as schools report declining enrollment in 2023.
21. Nurse leaders see an emergence of PTSD among nurses who still have not fully processed the COVID experience.
22. Money is top of mind for Generation Z nurses as they struggle financially with debt and skyrocketing housing costs.
23. Leaders report that nurses are more anxious now about student loans as they can no longer defer their payments.
24. Navigating the fine line between leader coaching and therapy has become more complicated as the younger workforce willingly shares their mental health struggles.
25. The cost of living, especially housing and parking fees, impacts recruitment, with high-cost urban areas and states in New England being the most affected.