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

A colleague of mine has to relocate for family reasons. She is currently a CNO in a non-unionized environment in a right-to-work state where few hospitals are unionized. She has no personal experience leading in a unionized environment at any level. She now plans to move to a region where most hospitals are unionized, and there has been some strike activity. She recently applied for a CNO position in an organization that she felt was a great fit. She went through the interview process but was not selected. Very disappointed; she asked the executive recruiter what had led to her elimination as a candidate. The recruiter told her that the selection team felt her lack of leadership experience in unionized environments was problematic for them.

When she contacted me, I think she expected me to commiserate with what she saw as an unfair decision. She told me that, as part of the interview, she assured them, “I am smart, and I am a quick learner.”  My response was more nuanced than she expected. I told her that part of one’s success in leadership is dependent on the context of the environment in which you lead. You can be very successful in some environments and less successful in others.

I believe this organization had legitimate concerns about her lack of experience working with unions. Rookie mistakes at the executive level can lead to costly union grievances. In today’s healthcare and corporate landscapes, the “rules of engagement with unions” have shifted significantly, moving beyond traditional contract negotiations into deeper issues of culture, technology, and social dynamics.

Despite the reality that one in five nurses now work under a union contract, bringing yourself up to speed can be more challenging than you think. At the national level, there is also a notable lack of resources or leadership courses tailored for nurse leaders in these environments, with most nurse leaders acquiring these skills on the job. Without these resources, health systems rely on their nurse executives to coach their frontline managers in how to effectively work with unions – something you can’t do if you have had no experience with it yourself.

The recent nursing strikes in New York City have highlighted just how complicated and fraught with controversy contract negotiations have become. None of the leaders involved (nor the nurses themselves) ever expected a strike lasting more than 40 days. As I work with leaders in unionized environments across the country, I realize how much the landscape has changed since I myself was an executive leader working in partnership with unions at five VA medical centers. There are five key areas that illustrate what has changed and why modern union leadership is more complex:

1. The Complex Intersection of Providing Staff with Psychological Safety in a Grievance Culture

In the past, union environments were often viewed by leaders through a transactional lens. Nurse leaders followed the union contracts to the letter. Today, leaders must balance strict labor agreements with the need to provide younger staff who have a lower baseline level of mental with psychological safety. How do you foster an environment where staff feel safe to speak up about errors or concerns without it being perceived as a “disciplinary” interaction that triggers formal union representation? Leaders now have to be experts in “soft skills” while operating within “hard” contractual boundaries. This is very challenging, leaders tell me.

2. The Shift in Nurse Priorities from Strictly Economic to Work-Life Balance

Traditional unionism focused heavily on wages and benefits. Unions today put much of their focus on staffing ratios. However, the post-pandemic workforce (particularly younger generations) is prioritizing flexibility, autonomy, and mental health. Many rigid union contracts were not designed for “flexible scheduling” or “work-from-home” arrangements. Leaders are now caught between a workforce demanding individualized flexibility and a collective bargaining agreement that mandates standardized treatment.

3. Rapid Technological Integration into Nursing Work

As AI and digital tools are integrated into workflows, the definition of a “job description” is changing faster than contracts can be renegotiated. Implementing new technology can be seen as an “alteration of working conditions.” Leaders must navigate the delicate balance of driving innovation and efficiency without triggering unfair labor practice (ULP) charges or resistance based on perceived shifts in the scope of practice. This is making innovation in care delivery very difficult in many settings. It is not unusual for me to hear System CNOs now say that their unionized environments are the last to be selected for innovation pilots.

 4. Communication in a Social Media Era 

Social media and internal messaging apps have democratized information. Employees often hear about union-management “news” via TikTok or group chats before official leadership can provide context. It has become routine for frontline staff who cross picket lines and nurse leaders to be cyberbullied during strikes. Nurse leaders in unionized environments must maintain “direct-line” relationships with their teams to build trust, but they must do so without “direct dealing”—the legal pitfall of bypassing union leadership to negotiate with employees. Managing this “information vacuum” requires high-level communication agility.

 5. Generational Clashes about Union Priorities

As contracts are negotiated, nurse leaders must consider the needs of all generations in the workforce today. While seasoned staff may see the union as their advocate on staffing and other issues, this is not true across generations. There is a growing gap between veteran staff who value seniority-based systems and newer staff who may want merit-based recognition and don’t plan to stay long enough to benefit from the seniority features in a contract. Leading in this environment means managing a fragmented workforce, with the union itself facing internal generational tension. Leaders are no longer just managing a contract; they are managing a diverse social ecosystem.

Nurse leaders sometimes ask me what I see as notable gaps in leadership science and education today. Working effectively with union partners is always in my top five. We don’t discuss lessons learned with each other. We also don’t write about it or research it. In ten years as editor of Nurse Leader, I never received a manuscript on this topic. So, as I thought about my friend’s dilemma, I could definitely understand both viewpoints about the value of experience before taking a CNO role in a unionized environment. Unfortunately for my colleague, there is no nursing boot camp to teach this – at this point, it is all lived experience and very challenging at that.

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

A CNO recently reached out to ask me what I was seeing in nursing recruitment and retention. She had just reviewed the nurse turnover for the previous quarter in her large hospital and was surprised to see that it was now trending upward. I assured her that she is not alone. The recently released 2026 National Health Care Retention and RN Staffing Report indicates that turnover is now once again on the increase.

After a drop to 16.4% last year, current RN turnover averages 17.6%. This 1.2% increase in RN turnover has already cost the average hospital an additional $360,000. This increase was in contrast to the average US hospital’s overall 2025 goal of reducing turnover by 2.6%. The report indicates that the healthcare landscape now faces a deteriorating national crisis in which demand for care significantly outstrips the supply of labor. While hospitals have successfully lowered vacancy rates to their lowest levels this decade at 8.6%, the RN labor shortage could increase to 250,000 by 2028.

Regional RN turnover was mixed in 2025. The South-East saw the high end of the average (18.7%) while the North-Central region saw the low end (16.2%). All regions except South-Central recorded increases, with the North-East posting the biggest jump (+3.3 points). Behavioral health nurses continue to lead all specialties in turnover at 22.5%, followed by emergency (20.7%), telemetry (19.5%), and step down (19%), all above the national RN average. Departments like Telemetry and ER are projected to replace their entire staff within less than 4.5 years. Interestingly, Magnet facilities did not, on average, beat the national benchmark of 17.6% annual turnover despite considerable efforts to improve work environments.

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

I am proud to partner with the New England ONL on the workshop that’s generating a lot of discussion, as leaders now see that the nursing workforce has undergone a structural change in acute care.

The traditional staffing pyramid — anchored by a deep layer of expert clinicians — has inverted. Today’s acute care units often rely on novice-dense teams supported by a limited experienced core. The leadership approaches that worked in the past assumed informal mentorship, accessible intuition, and layered experiential judgment. Those assumptions no longer consistently hold. The Inverted Pyramid™ framework helps leaders respond strategically to this shift in the workforce. Participants will learn how to reduce cognitive load, engineer safety supports, protect experienced staff from burnout, and rebuild sustainable pathways for clinical growth. This program moves the conversation from “How do we fix novice nurses?” to “How do we redesign systems to match today’s workforce reality? Register your team today using this LINK

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

Delivering workshops on Building Bridges, Not Walls: Leading Multigenerational Nursing Teams has given me the opportunity to speak with up-and-coming Generation Z nurse leaders across the country. I am always interested in what we are getting right in terms of meeting the needs of their generation, but more importantly, what we are getting wrong. Here is some of what they have shared with me that is also supported in recent literature about this generation:

• They want us to move past the “lazy” or “entitled” stereotypes and recognize a fundamental shift (from previous generations of nurses) in how this generation views work, authority, and well-being.
• They acknowledge they don’t see nursing as a calling, and that should be okay. While earlier generations of nurses entered nursing as a “calling” where sacrifice was expected. Gen Z views nursing as a specialized profession with a need to establish clear boundaries between work and life. Gen Z prioritizes a sustainable career. They see over-extension as a failure of management, not a badge of honor for the nurse.
• Gen Z grew up with the world’s information at their fingertips; they don’t respect “because I said so” or “that’s how we’ve always done it.“If Gen Z doesn’t understand the logic behind a clinical workflow, they are more likely to bypass it or leave. Generation Z nurse leaders tell me that their generation is very savvy and can see right through performative leadership behaviors.
• For Gen Z, mental health support isn’t a “perk” or a “pizza party”—it is a core safety requirement, similar to PPE.  They want proactive institutional support. This includes debriefing after traumatic shifts, manageable patient ratios, and leaders who actually model taking mental health days.
• This generation is used to real-time feedback (likes, comments, instant metrics). They want continuous feedback, not a yearly performance evaluation.
• Generation Z nurses are not disengaged, as some data suggests – rather, they are engaged and interested in different things than previous generations of nurses. If you want to engage a Generation Z nurse, ask them what their superpower is and how they can use it in various unit activities. Also, remember, they are still learning their skills, so a high level of engagement in the first year of practice is unrealistic, yet many organizations demand this.
• Gen Z are “Digital Natives” – yet this skill is underutilized. These nurses are always evaluating the technology that organizations invest in and rebel when it becomes a major source of frustration. They believe they are not being tapped into for their technology expertise and are not asked to sit on selection committees, yet they may be the best staff to give you an honest evaluation.
• Generation Z nurse leaders acknowledge that their generational cohort is much more suspicious of organizational leadership and less likely to be loyal. As one leader told me, we have learned that if you want to get ahead financially, you almost have to leave your organization to do it, so don’t be surprised when we do.
• Generation Z nurses are very focused on their own career development and want career coaching, even if it means they will leave you, the leader. As one Gen Z leader pointed out, isn’t two years of good work better than staying in place and being unhappy for long periods?
• Stop using the “We are a family” narrative or “We practice leadership love” to build cohesion. For Gen Z, this is often a red flag and a trigger. To a Gen Z nurse, the word “love” in a workplace context can feel cloying or manipulative—much like the “family” narrative. In a family, boundaries are blurry. You’re expected to do “favors” (like picking up a shift on your day off) because of emotional ties. Gen Z views this as a manipulation tactic used to compensate for poor staffing. Gen Z values a leader who respects their “off” time as sacred. They want a professional community, not emotional enmeshment.
• Gen Z has a very high “BS detector” when it comes to recognition. They can spot low-effort, “check-the-box” rewards from a mile away. In a high-inflation economy, Gen Z is practical. Recognition that impacts their bottom line (bonuses, help with student loan assistance, or even grocery stipends) carries more weight than a “Nurse of the Month” certificate or a Daisy Award. Gen Z would like organizational leaders to ask them what recognition would be most meaningful, rather than assuming what was meaningful to other generational cohorts is valued by them.

As each new generation enters the workplace, nurse leaders need to reconsider their leadership tools, tactics, and strategies to determine whether they meet the needs of the new generation. Too often, these Generation Z nurse leaders tell me that their leaders stick to what is comfortable for them, making them less effective leaders. As they remind me, they are the future, and as organizations plan their futures, it should be nothing about us without us.

emergingrnleader.com 2026

To effectively lead through these challenges and others, nurse leaders need new tools and strategies. Let me help you as I have helped hundreds of organizations over the past five years.  Book a workshop or keynote for your team by contacting me at roseosherman@outlook.com

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