By Rose O. Sherman, EdD, RN, FAAN
Every year for the past decade, I have assigned my graduate students to interview their Chief Nursing Officer or Nurse Executive asking a range of questions about their role, challenges and advice they would give to young leaders. It is interesting for me in these interviews to look at what changes over time and what remains the same. This blog is the one of two outlining the responses of 21 nurse executives related to the changes they see in the healthcare environment and what keeps them awake at night. Most but not all of these nurse executives work in acute care.
What major changes have you seen over the past 5 Years in your work environment?
* A bigger emphasis on quality, safety and service
* A focus on fiscal responsibility and cost control
* The first real attempt at health reform
* A rapidly aging healthcare workforce
* Concern about 30 day readmission rates and an expectation that we manage patients across the continuum.
* The decreased number of leadership roles – organizational flattening
* A focus on evidence-based care
* Rising number of executive nurse leadership roles in ambulatory care and the community.
* More focus on the patient experience
* The rapid growth in new technologies which will enable patients to be cared for at home
* More patients in an observation status
* A movement to pay for performance
* A growing gap between skill sets and competencies of what we need from new employees and what they bring
* Greater transparency and more public reporting of our quality data
* A focus on patient satisfaction and the patient experience
* A shift from volume to value-based care
* A rapidly aging patient population
* Staff difficulty managing workloads and assignments
What issues and/or challenges keep you awake at night?
* Trying to keep staff engaged – This is proving increasingly more difficult.
* How can I maintain our patient satisfaction and improve care delivery – The bar keeps being raised and resources decline.
* Ensuring my staff feel supported in their decision making
* Our financial future – We are a community hospital that is not part of a system and I don’t think we will survive without a merger.
* Taking care of and growing my team – I am asking more and more of my leaders.
* New initiatives and the constant change – It is hard enough for me to keep up let alone communicate the changes to staff.
* Patient lack of understanding about health reform – I think patients are in for a very big surprise about the impact on what care they will get and where.
* Staffing challenges and meeting patient care needs – I keep being told to do more with less but we are at the breaking point.
* Variability of our census – There is so much more unpredictability in our census than even one year ago.
* Risky staff behaviors – I am increasingly shocked at the lack of compliance with policies.
* Nothing keeps me awake
* Keeping staff secure in their jobs – I anticipate that sometime soon we will have layoffs and I dread it.
* It depends on the day – for me every day presents different challenges and stresses
* Wondering if my nurses have enough resources to do their work
* When my leaders are struggling – There is so little time to offer the coaching that new leaders need and I know they struggle.
* Staffing – It is now centrally controlled at the corporate level and I have little input into the variance issues between sites.
* The uncertainty of healthcare and the economy – Where is all of this headed? I don’t know and I do worry about it.
This year is the first year where we are beginning to see very substantive changes that are coming with health reform. The uncertainty about where all of this is headed is clear from these interviews. Managing finances, the patient experience and promoting quality care are key drivers for nurse executives today. At the same time, they worry about the impact on staff. In Part 2, I will discuss the advice that these seasoned leaders give to today’s emerging nurse leaders.
© emergingrnleader.com 2013
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