Major Challenges for Nurse Executives in 2015

By Rose O. Sherman

“Balancing optimism and realism, intuition and planning, faith and fact can be difficult. But that is what it takes to be effective in navigating leadership.” John Maxwell

Each year in our Introduction to Nursing Leadership graduate course, students select a chief nursing officer in a health care agency to interview. The students have a list of questions that they ask and then add some of their own. I enjoy these reading these interviews because they highlight the changing issues in today’s health care environment. During the past decade, I have had to opportunity to learn through the eyes of the CNOs the major challenges that they face in their roles. Some problems remain the same but new issues surface across the years. Here is a list of current nursing challenges from 23 Chief Nursing Officers in Florida interviewed in 2015:

The nursing shortage is back
Turnover has increased especially among younger staff
Fewer experienced nurses – more new graduates
Preceptor burnout
Patient volumes higher than anticipated
Staffing is a growing challenge – sign on bonuses now a new norm
Finding nurse leaders who can manage frontline care
Accountable for multiple initiatives all at once
Avoiding leader burnout
Justifying magnet designation
Maintaining performance above the national benchmarks – the goalpost keeps moving and executive leaders expect perfection.
Assuming risk for what patients do at home after discharge
An increasing number of Baby Boomer Nurse Retirements – loss of their knowledge
A complex patient population – more demanding.
Stimulating staff engagement.
Helping staff to understand that we are in a value-based care environment.
Lowering costs but maintaining quality.
Promoting better teamwork among all staff.
Maintaining excellent customer service scores.
Nursing staff resistance to changes in the healthcare environment.der

As we can see from these answers, many of today’s challenges identified by nurse executives are symbolic of a health care environment where there has been a clear mandate for change. With the implementation of health reform – there are more performance metrics that they are accountable and care is now value-based. This is the first year in the last five where the nursing shortage was mentioned by the majority of CNOs and recruitment and retention are resurfacing as challenges Many CNOs mentioned the retirement of their baby boomer nurses has meant that staffing mixes include more inexperienced nurses creating patient safety challenges. Younger staff come in with less experience and different expectations from organizations and ideas about their own careers. Economic pressures in hospitals from decreased reimbursement have put pressure on staffing. CNOs are assuming responsibility for care across the continuum with the decreased reimbursement when a patient is readmitted within 30 days.

Bob Johansen in his book Leaders Make the Future has described today’s world as a VUCA environment characterized by volatility, uncertainty, complexity and ambiguity. Few nurse executives interviewed for this assignment would disagree with this assessment. Meeting these challenges involves a need for innovative thinking and the engagement of all staff. The business of caring and the work done by chief nursing officers is important perhaps today more than ever before.

Read to Lead

Johansen, B. (2012). Leaders make the Future: Ten New Leadership Skills for an Uncertain World. San Francisco: Berrett-Koehler.