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

I am hearing from an increasing number of nurse managers, clinical managers, and charge nurses that many nurses are vigorously pushing back on patient care assignments they have been given. One permanent night charge nurse gave the following case example during a program:

Jason is an RN on your unit who recently completed his first year of practice. As a charge nurse, you are pleased with the progress he is making with his skills and competency development. The challenge you have with Jason is that he routinely complains about the patient care assignments he receives, contending that you give him the most difficult patients, and is resistant to taking new admissions when it is his turn. He has accused you of being unfair to him and has threatened to contact the union representative on several occasions. You have discussed this and reviewed his assignments with your nurse manager, and she sees no issues of unfairness.

This charge nurse is far from alone in her experience. One of the trickiest operational challenges facing nurse leaders at all levels today is managing assignment pushback. The contemporary nursing workforce is highly vocal, much more willing to speak up, and increasingly comfortable pushing back on assignments they perceive as unfair or unmanageable. When a nurse reacts with displeasure or resistance to a shift assignment, it can easily feel like a personal challenge to leadership authority. However, in today’s complex clinical environments, the goal of a nurse leader shouldn’t be to “shut down” pushback, but rather to navigate it constructively while maintaining unit safety, equity, and accountability.

The reality is that there are many things that could be driving Jason’s behavior. Several workforce studies indicate that male nurses do report feeling that they are more frequently given the “heavier patients” and those who present behavioral management issues. This charge nurse met with her nurse manager who reviewed the assignments and felt they were fair so this perception may not be the problem in this situation. Jason may feel very underappreciated in his role and could be lashing out and pushing back in response to this. If this is part of the issue, the night nurse needs to provide more frequent affirming feedback and recognition.

But the reality is that for some nurses, pushing back on assignments has become habitual. Here are strategies nurse leaders can use in these situations to have the difficult conversation and handle assignment pushback effectively:

1. Always begin with the WHY. 

When staff nurses do not understand the rationale or logic behind an assignment, they frequently default to assuming favoritism, unfairness, or managerial oversight. The challenge today is that unlike hospital patient populations in the past – there are NO easy patients. Leaders must share their “why” upfront. Briefly explaining the complex puzzle required to build the schedule—balancing patient acuity, clinical continuity of care, and overall team skill mix—instantly defuses the feeling of being singled out. One leader in the session said that her manager sometimes gives nurses paid time and a shadowing exercise with charge nurses to better understand how assignments are made.

2. Separate the emotions from the facts.

Assignment resistance is rarely personal although it can certainly feel that way. It is often fueled by underlying anxiety, physical exhaustion, or a genuine fear of a heavy workload. De-escalate high-emotion situations by stripping away the emotional language and pivoting entirely to objective, data-driven facts. Instead of arguing about the abstract concept of fairness, look at the concrete details together. Use phrases like: “Let’s look at the acuity scores together. You have two total-care patients and one discharge. Tell me specifically what part of this clinical mix feels unsafe.”

3. Carefully listen to the nurse whether or not you agree with what is being said.

The natural human reaction to pushback is defense or immediate refusal. When confronted by a frustrated staff member, leaders must actively resist the urge to interrupt or double down on their authority. Implement a mandatory “pause” and actively listen for at least 60 seconds without interrupting. Sometimes, a nurse simply needs to feel heard and validated after a grueling week. Acknowledging their current baseline stress (“I know you had a brutal shift yesterday, and I see why you’re worried about this assignment”) lowers psychological defenses and opens the door to an objective, professional conversation.

4. Manage pushback as a coaching opportunity with novice staff.

Often, vocal pushback from newer or novice staff stems from a fundamental lack of clinical confidence rather than defiance or bad behavior. They may feel genuinely overwhelmed by a specific, highly complex patient type because they haven’t encountered it frequently. Dig deeper by asking a targeted coaching question: “What specific support or resources would make you feel comfortable and supported taking this patient today?” OR “Let’s talk through how you will prioritize the care over the next hour.”

5. Agree on next steps and how you will support this nurse during the shift.

Despite excellent communication, there will inevitably be shifts where an assignment simply cannot change due to strict staffing constraints, call-outs, or immediate patient safety needs. In these moments, leaders need a firm, highly professional script to hold the line without burning bridges. An example would be to tell the nurse, “I hear your concern, but based on the layout of the unit and our staffing numbers today, this is the safest configuration we have. I cannot alter the assignment right now, but I will prioritize checking in on you first during my rounds to help you catch up and ensure you have the support you need.”

Given the escalating volume and acuity level of patients across the United States today, nurse leaders should expect but also learn to effectively manage pushback on patient care assignments. Keep in mind – these reactions from nurses are not a personal reflection on the leader, but rather often reflect the burnout and exhaustion that nurses are reporting.

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

Nursing turnover is a complex issue for health systems that are spending considerable sums to improve their work environments. Two recently released studies (one published in Health Affairs using the 2022 Nursing Sample data and one published by Press Ganey using data from their NDNQI database) provide some additional insight into what we are seeing

As we navigate 2026, data from these studies indicate a meaningful shift from acute crisis to the early stages of recovery. However, this positive momentum is not evenly felt, and nurse retention remains a top-tier operational challenge. When looking at national benchmarks, enterprise-level averages can hide the real areas of vulnerability. Turnover clusters within specific cohorts, roles, and shifts:

Turnover is Highest in Early Career Nurses
Turnover is heavily concentrated among early-career nurses. Gen Z registered nurses experience a 22% turnover rate, closely followed by Millennials at 21%. Conversely, Gen X stands as the most stable cohort at 14%. While Baby Boomers also show a 22% departure rate, this is primarily driven by an exodus of retirements, which presents a separate risk: the rapid loss of institutional knowledge and clinical mentorship. A significant challenge for organizations is that nurse engagement experiences a sharp drop-off immediately following the initial professional socialization nurses receive in residency programs. A change in RN engagement in their organization starts to dip after the first six months, plummeting to their lowest levels between years 1 and 2 before recovering later in a nurse’s tenure (after year 5).

Night Shift is Most at Risk

Ironically, many new graduates begin their careers on the night shift because that is where the jobs are. Pockets of vulnerability are highly apparent when comparing day and night shifts. Night-shift nurses report significantly lower scores across multiple dimensions, with the starkest gaps appearing in safety culture prevention, reporting, and organizational pride.

The Actual Drivers of RN Turnover

Historically, much of the research on retention has relied on “turnover intentions” (what a nurse thinks) rather than actual behavior (what a nurse does). A massive multivariable regression analysis of frontline RN data from the National Nursing Sample highlights the heaviest modifiable weights behind actual, self-reported turnover. Not surprising job dissatisfaction is the single strongest predictor of turnover. Frontline nurses who are dissatisfied with their position are over 2.5 times more likely to actually leave. Frontline nurses experiencing chronic burnout also face significantly elevated odds of leaving their primary roles.

Interestingly, nurses enrolled in a degree program or those holding an advanced graduate degree (MSN/DNP/PhD) demonstrate substantially higher actual turnover. Rigid, unyielding work schedules often conflict with academic demands, and higher degrees make these nurses highly mobile and marketable for advanced practice or management positions outside the bedside. Many nurses today have second jobs to meet their economic needs. An analysis of the national nursing sample shows that frontline nurses balancing a secondary paid position in nursing are also far more likely to leave their primary role.

Turnover is rarely a sudden, random event; it is a predictable outcome of the structural environments we place our clinicians in. National unit-level analyses show that perceived staffing adequacy and frontline nurse manager support are the absolute bedrock of retention. When staffing is unreliable, nurses face constant cognitive reprioritization and workflow friction, making it impossible to feel successful. When an immediate supervisor’s span of control is excessive, their capacity to build relationships, provide coaching, and foster social integration collapses. Higher manager-to-FTE ratios are significantly associated with increased RN turnover and a rise in adverse patient outcomes, like fall rates.

Not Responding to A Satisfaction or Engagement Survey is a Risk Factor
We must pay attention to what nurses aren’t telling us. The data indicates that survey nonrespondents are twice as likely to leave an organization as those who respond (29% vs. 14%). Silence does not indicate neutrality; it signals deep disengagement and a total loss of trust.

Flexible and Nontraditional Scheduling is an Important Retention Lever

Because work-life balance and school obligations heavily drive actual turnover, deploying immediate policy changes—such as self-scheduling or non-traditional shift lengths—directly targets job dissatisfaction and curbs costly attrition.

Nurses in Unions are Less Likely to Leave

One of the most interesting data points in the national nursing sample study is the protective effect of representation. Participation in a labor union or collective bargaining unit is strongly associated with a lower statistically significant likelihood of turnover. The researchers speculated that these environments often reflect stronger protections, structured mechanisms to voice concerns to leadership, and clearer guardrails around working conditions.

High Impact Professional Governance Environments Help Retain Nurses
Engagement rapidly converts into authentic ownership when nurses and APPs possess clear, credible pathways to influence practice and work design. High-impact governance structures with clear decision authority and visible feedback loops foster the psychological safety needed to normalize professional voice and retain staff long-term.

These two studies help to provide insight into what has become an intractable problem in so many organizations. Retention programs need to employ multiple strategies which can change over time.

Read to Lead

Witkoski Stimpfel A, Padhye NS, Tran AK, Djukic M. Drivers of frontline registered nurse turnover: evidence from the 2022 National Sample Survey of Registered Nurses. Health Affairs Scholar. 2026;4(6):qxag140. doi:10.1093/haschl/qxag140  Health Affairs 2026 Nurse Turnover Based on National Nursing Sample 2022

Press Ganey Associates LLC. State of Nursing 2026. Press Ganey Associates LLC; 2026. Accessed June 28, 2026. State of Nursing 2026 _ Press Ganey

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

I heard Brené Brown on her The Curiosity Shop podcast talk about the importance of team members being willing to bring up gritty facts while also having the gritty faith that problems can be solved. Nurse leaders often bring this up in leadership development sessions.

Every nurse manager has had the experience of walking into the breakroom or a staff meeting and being met with a wall of heavy, exhausting complaints. The staffing is short, the tech is glitching, the budget is tight, and everyone is tired. As a leader, you want to encourage transparency, but you also can’t let your unit drown in negativity. How do you honor the very real challenges your nurses face without letting the culture spiral into chronic complaining?

Some staff repeatedly raise concerns without proposing constructive solutions. When a unit only has Gritty Facts, it spirals into a culture of toxic complaining and hopelessness. When it relies solely on Gritty Faith, it slips into toxic positivity, where real workflow flaws and safety risks are ignored. The magic happens right in the middle. Healthy, resilient teams must hold space for both simultaneously. To better understand this paradox, here is what both mean:

• Gritty Facts: This is the unvarnished, brutal truth about reality. It’s admitting that a unit is novice-dense, that a workflow is broken, or that resources are constrained. Masking these facts destroys trust.

• Gritty Faith: This is the unwavering belief that, despite the brutal facts, the team has the collective capability, resourcefulness, and grit to figure it out, improve the situation, and take care of each other.

When a team focuses strictly on the problems without believing in a solution, they become victims of their environment. This leads to burnout, disengagement, and a culture of “Why even try?” When a manager responds to massive systemic issues with “Just stay positive!” or “This is only temporary,” without addressing the operational breakdown. This alienates staff and makes leadership look dangerously out of touch.

From Complaints to Solutions

To shift from gritty facts to gritty faith in your conversations with staff, do the following:

• Validate the Gritty Facts First: Never skip this step. If a nurse brings a hard truth forward, acknowledge it. “You’re right. Being short-staffed on a high-acuity shift like last night is incredibly difficult and exhausting.” Validation stops the defensive need to complain louder.

• Pivot to Gritty Faith with a Coaching Question: Once the fact is on the table, immediately invite the faith (the belief that action can be taken). Move the ownership back to the team by asking: “We know this is our reality for the next few weeks. What is one small workaround we can control on this unit to protect our workflow?” or “I hear the frustration about the new charting process. What is one specific solution we can pitch to informatics to make this better?”

• A Team Culture of Bringing Gritty Faith to the Table: Create a team ground rule for huddles, unit councils and meetings: Anyone is welcome to bring a Gritty Fact to the table, but it must be accompanied by at least one idea, workaround, or suggestion for how we can handle it.

Nurse leaders are role models, so staff will closely watch your behavior. When you bring a dropping performance metric to the attention of staff, say staffing is incredibly tough right now, and our metrics are showing it. That is the gritty fact. “But my gritty faith is in this room. I know the talent, the heart, and the resourcefulness of this team, and I know we are going to navigate this together.” Complaining is passive; problem-solving is active. By demanding both the facts and the faith, you aren’t silencing your nurses—you are empowering them. You are shifting them from victims of a broken healthcare system to active authors of their unit’s culture.

Please consider participating in this important research study. Link for Eligibility Criteria

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