By Rose O. Sherman, EdD, RN, NEA-BC, FAAN
In my leadership development work with health systems across the country, I feel like I have a front row seat to the evolving picture of what is happening in healthcare and nursing. We are almost at the end of the first quarter of 2025, and here is what leaders are telling me now:
- There is growing concern among nurse leaders about potential cuts to Medicaid and Medicare. The House of Representatives recently backed administration plans for at least $880 billion in spending reductions through 2034, with Medicaid widely expected to bear the brunt of these cuts. Currently, Medicaid covers 72 million Americans, many of whom live in rural areas. Removing their access to care will be not only devastating to these individuals but also to the health systems that care for them. According to the Commonwealth Fund, cuts could result in losing up to 880,000 jobs, 477,000 of which will be in healthcare.
- Nurse turnover in most health systems has declined, except for turnover in the first two years of employment, which remains high. Leaders attribute this to efforts to provide more flexibility in scheduling and the instability of jobs in other industries, which is impacting spouses and family members.
- Nurse leaders continue to report their growing concern about the decline in baseline mental health, especially with younger staff.
- Nurses and nurse leaders now worry more about physical assault and violence after the two recent brutal attacks on nurses in Florida and Pennsylvania.
- In many areas, long-term care facilities are at full capacity, making patient transfers from acute care environments more challenging.
- The rising number of hospitalized patients over 85 leads to higher patient acuity, more futile care, and fall risk concerns.
- Nurses continued to report higher levels of burnout and exhaustion to their leaders as patient volumes grew in the first quarter and providing staffing coverage became more difficult.
- Issues at the Department of Education make it challenging for nurses to receive loan forgiveness. Employers are trying to provide support.
- Intergenerational conflict is a rising concern for many nurse leaders, who are now asking for help bridging staff differences.
- Changes in NIH funding have seriously impacted university academic medical centers, especially in Massachusetts.
- Union activity continues to grow nationwide, with almost one in five nurses now represented by a union. Increasingly, agreements include clauses that nurse leaders cannot contact their staff during non-work hours or expect them to read any communication.
- Nurse leaders worry that changes in vaccination recommendations and policies could ultimately lower vaccination rates and increase hospitalization rates.
- Nurse leaders are fielding staff concerns about immigration raids on health facilities.
- Nurses are growing more optimistic about the potential of artificial intelligence to reduce the documentation burden in practice today.
- Nurse leaders are increasingly finding that Servant Leadership principles are the best strategy to provide leadership support in today’s environment.
Most nurse leaders feel they are in environments of constant change, now accompanied by political and social uncertainty. They are doing their best to stay hopeful about the future because that is what their staff needs from them.
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