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We proudly partner with the New England ONL to present the Nuts and Bolts of Nursing Leadership. The program on January 8th is a great introduction for Nurse Managers to key competencies they need in their roles. The program on January 15th  is an excellent introduction to leadership for current, new, or prospective Assistant Nurse Managers, Team Leaders, Clinical Managers, or Charge Nurses. A recent Laudio report noted that when nurse manager turnover occurs, the most likely replacement is a frontline nurse working on the unit (37% of the time) or an assistant manager (20% of the time). This speaks to the need to develop strong leadership bench strength by investing in emerging leader programs. You can register your team for these programs using this link  

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

I was reminded again last week in talking with managers about how important leadership boundaries are today. I asked how many of you have a hard stop to your days. The answer was very few – most don’t have hard boundaries about when they leave at the end of the day. So many leaders feel under intense pressure to be everything for staff, but leadership roles are unsustainable without boundaries. Nurse manager recruitment and retention is a critical challenge. We have new generations of nurses who are interested in their well-being. Unsurprisingly, many have said that leadership roles do not provide the balance they need and want. Many nurse leaders are not role-modeling well-being. They are exhausted and burned out. Expectations are high, and the workload can be crushing.

Frontline nurse leaders struggle to set work-life boundaries, especially those new to their role. The problem has become even more challenging over the past four years. Many leaders have seen their spans of control grow as their staff is less experienced and requires more coaching. New managers often want staff to visibly see they are supporting them and tend to work long hours, including getting involved in direct care activities. Emails and texts from staff 24/7 are no longer that unusual.

Unlike in a staff nurse role where you work a set shift, nurse managers must set boundaries around their work and decide when to leave at the end of the day. Failure to do this can quickly lead to burnout. Sometimes, leaders reach a point where they feel the only way to regain control is to leave the position.

Setting boundaries in our work can help us control our lives. Making decisions about where we invest our time and work hours and what we should delegate helps us preserve our physical and emotional energy and identify our limits. The following are four critical steps in setting your boundaries:

1. Identify your limits– we are often our worst enemies when working. You may have challenges saying no. Understanding your emotional, mental, physical, and spiritual limitations is an essential first step. Acknowledging our limits helps us know when we are stepping over lines and moving into destructive patterns. Limitations are very individual and may vary considerably among leaders.
2. Pay attention to your feelings – feelings gauge whether we have moved into overdrive with our work. Pay close attention when you feel discomfort, resentment, or guilt about work. These feelings can signal that a boundary issue may be present. If you think of these feelings repeatedly, it is time to restructure your boundaries.
3. Permit yourself to set boundaries – nurse leaders often feel they should be able to cope with challenging work situations and time constraints. Sometimes, their immediate supervisor may see the leader working long hours and say nothing. Leader boundaries are something that you have the right to set. If you do not set limits, you will feel drained, overextended, and resentful at best. When these doubts occur, reaffirm that you have this right, permit yourself to do so, and work to preserve them. Plan a time to leave work every day and stick to it except in extreme emergencies. Be clear with the staff about boundaries involving texts and emails in the evenings and on weekends.
4. Consider your environment – work environment context plays a crucial role in how comfortable leaders may be in setting boundaries. Your environment can either support your setting boundaries–making it easier for you–or present obstacles to boundary setting–making it more challenging. Nurse executives are crucial in making it OK for their leaders to set boundaries. This is best done through role modeling by not sending emails on the weekends or asking for updates.

A conversation about work boundaries is essential if you have nurse managers who report to you or are part of a nurse manager practice council. Many managers tell me that they struggle with this issue and need coaching. One CNO colleague makes quick rounds each night in her hospital at 5:30 PM to send managers home. She tells me she does not take no for an answer and reminds her leaders that the work will be there in the morning.

Self-care is critical, especially in our current environment. So, as we start a new year, look at your work and life and ensure you have balance and boundaries. No one can do this for you.

© emergingrnleader.com 2024

Coming in 2025

Bring Leading in the New World of Work to Your Organization.  Click on Flyer The New World of Work Workshop

Bring the Nurse Leader Coach Workshop to Your Facility Virtually or Onsite. Click Here for the Nurse Leader Coach WS Flyer

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

Some of the most troubling conversations I have with leaders today concern a growing number of nurses who seem to lack empathy. Caring for patients in a way that projects concern and empathy has always been a core value in nursing. Leaders see an increasing number of new graduates who view nursing as a potentially well-paying job rather than a passion or a calling. Many of today’s new graduates are also very young and lack the life experiences to help them better relate to their patients.

The challenge is that we depend on our staff to project empathy. Organizations may advertise that they are caring places, but this may differ from the patient’s experience. Not surprisingly, I am often asked the following question: Can we hold nurses accountable for being empathetic, and how do we teach this?

This question is an important one. Perceptions about empathy today indicate that most feel that it has significantly declined. Unsurprisingly, our young workforce may exhibit less empathetic behaviors because this is what they are exposed to in society. In his book, The War for Kindness: Building Empathy in a Fractured World, Stanford professor Jamil Zaki notes that the modern world has made kindness harder. He also notes that people become less empathetic when exposed to the following challenges (all of which we see in healthcare today):

• Feeling isolated and less a part of a team or community
• Exposure to trauma such as COVID
• Tribalism and polarization in society
• Clinical depression
• Feelings of compassion fatigue
• Disengagement from work

The good news, reports Zaki, is that empathy is a learnable skill and can be thought of as a mindset. Only about 30% of empathy is genetically determined. You can choose to be empathetic and learn how with effort and practice. There are three components to empathy:

• Cognitive: This is the ability to deliberately consider and perhaps understand the thoughts and feelings of other people. For instance, when we read about people starving in different parts of the world, we can feel pity for them.
• Emotional: This is the ability to vicariously share other people’s thoughts and feelings. Our brains have mirror neurons that allow us to feel what someone else is feeling. For instance, if a patient receives a terminal diagnosis, you are likely to react almost as if it had happened to you.
• Compassionate: This is the ability to sense what others need from you. For instance, you recognize that you can help a patient with their food tray when you see them struggling to cut their food.

So, how do we teach nurses to be more empathetic? We must begin by being intentional and promoting empathy skills as just as essential as clinical skills. Refrain from assuming (or judging) that new staff know how to be empathetic or decide to become a nurse when they are five years old because they are passionate about caring for others. That is not the reality of our society today. Nurses need classes on empathy, including developing it for themselves and others and how to project it.

Some teaching strategies include the following:

1. Teach patient interviewing skills that are not simply focused on physical assessment but are also designed to ask questions such as: What kind of work do you do or have you done? What are you struggling with during this hospitalization? As you look around this hospital room, are there things you are worried about, such as falling, getting to the restroom, or reaching for a tray? What should we know about you but may not know? 
2. Use simulation exercises such as having nurses spend 2-3 hours navigating their facility in a wheelchair or using a walker.
3. Practice listening: Have the nurse converse with another person to which they listen 80% of the time and talk only 20% of the time.
4. Use simulation exercises where nurses lay in a patient bed and watch nurses walk into a room, look at their phones, wear Airpods, and shut patients out of an interaction.
5. Role-play exercises about what to say to patients when your unit is short-staffed and you can’t meet a request – then debrief.
6. Read a story as a group about a patient who has received a very challenging diagnosis – talk about how to converse with the patient and family.
7. Design an empathy bingo game where the team goes out and performs acts of empathy.
8. Have nurses share their experiences when they were not treated empathetically and how they responded.
9. Have nurses design service recovery responses when patients complain about the care that projects empathy.
10. Help nurses design their self-care plans – empathy starts with self-empathy.

In a world where empathy is in short supply, you need to see it to be it. We can all learn to become more empathetic.

Read to Lead

Zaki, J. (2019). The War for Kindness: Building Empathy in a Fractured World. New York: Broadway Press.

© emergingrnleader.com 2024

Coming in 2025

Bring Leading in the New World of Work to Your Organization.  Click on Flyer The New World of Work Workshop

Bring the Nurse Leader Coach Workshop to Your Facility Virtually or Onsite. Click Here for the Nurse Leader Coach WS Flyer

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

As we approach the end of 2024, the trending topics that nurse leaders are talking about right now include the following:

1. The work of nurses, especially in acute care environments, is increasingly complex due to higher patient acuity, sustained patient volumes, and documentation requirements to achieve full reimbursement.
2. Nurse leaders hope that technology solutions such as virtual nursing and generative AI will help reduce the scope of nurses’ work but worry about the costs and staff acceptance.
3. There continues to be a misalignment between patient expectations and healthcare system capabilities, leading to significant amounts of leader time spent in service recovery.
4. The use of unplanned PTO and FMLA has skyrocketed as nurse leaders balance meeting patient care needs with maintaining staff health and well-being.
5. Many hospitals’ fiscal situations remain precarious as care costs increase and payer mixes include more Medicare Advantage patients with lower reimbursement levels and patients with higher deductibles who are having problems paying their bills.
6. Although organizational turnover is decreasing, nurses continue to request internal transfers, and unit/department turnover remains higher than historical levels.
7. Nurse managers report high levels of exhaustion and burnout as their role scope expands and their control span remains high.
8. The use of travel and agency nurses has declined, but many managers report that their units are rarely fully staffed and that they increasingly take assignments.
9. Younger staff continue to demand flexible schedules and resist working nights and weekends and taking call.
10. Nurse leaders struggle with communication with staff as generational preferences around communication methods shift, and staff are in cognitive overload.
11. Holding staff professionally accountable continues to be problematic as staff push back on feedback about their practice.
12. The relationships between leaders and staff have grown more tense in unionized environments as union representatives often work to erode leadership trust and convince nurses that they are their only advocates.
13. Shorter staff tenures continue to make team building very challenging.
14. Significantly more time is now spent orienting new graduates who are not work-ready for the complexity of the current work environment.
15. Redesign of care delivery systems is a top strategic priority for organizations, but implementing new models has proved challenging.

Nurse leaders are cautiously optimistic about 2025. Some turbulence in healthcare environments has subsided, but many wicked problems remain.

© emergingrnleader.com 2024

Coming in 2025

Bring Leading in the New World of Work to Your Organization.  Click on Flyer The New World of Work Workshop

Bring the Nurse Leader Coach Workshop to Your Facility Virtually or Onsite. Click Here for the Nurse Leader Coach WS Flyer

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

How many of you have seriously considered leaving your role?  I recently asked this question during a session with nurse managers, and I was not surprised to see 80% of the hands in the audience go up. While we are not seeing massive turnover in the nurse manager ranks year over year, the turnover rates among newer managers within their first four years of leadership have increased. CNOs tell me that they can see their managers struggling in this turbulent healthcare environment and want to implement the strategies that will be most helpful in retention.

That brings me to the recently released “Trends and Innovations in Nurse Manager Retention“ a collaborative effort between Laudio and AONL. The report is on insights from Laudio’s platform, which includes data on more than 200,000 frontline employers and AONL-led interviews with nine nurse managers.

Their key findings include the following:

1. Nurse managers are most likely to exit management and return to a frontline team member role within their organization within their first four years as managers. On average, the annual management exit rate for those in their first few years on the job is between 10% and 12%.
2. The average annual nurse manager organizational exit rate is 7.5%, though it can be as high as 12% for managers with around three years of experience.
3. Nurse manager turnover is disruptive to staff. It is associated with a 2—to 4 percentage point increase in average RN turnover in the year following the transition.
4. Most managers (89% of the leaders interviewed) rated a healthy work environment as their top priority, focusing on physical and psychological safety. This was followed by promoting leadership development, early identification and development of future leaders, and addressing the complexity of the manager role.
5. Managers wanted more flexibility regarding their schedules and the structure of their roles. This includes a four-day workweek, job sharing, and more administrative support when the manager is absent.

One interesting finding in the Laudio data set is that 50% of nurse managers have 3.5 years or less of experience, with the most common tenure being one year (21%). They are early in their leadership careers, and there is a significant risk that many won’t stay past the four-year mark. When nurse manager turnover occurs, the most likely replacement is a frontline nurse working on the unit (37% of the time) or an assistant manager (20% of the time). This speaks to the need to develop strong leadership bench strength by investing in emerging leader programs.

The report recommends that nurse executives focus on four key areas to promote nurse manager retention:

1. Ensure a healthy work environment
2. Promote leadership development
3. Identify and develop future leaders early
4. Address manager role complexity

While none of these recommendations are new, the report highlights a pressing need to address them to avoid future nurse manager turnover. Many nurse leaders are currently working on strategic priorities for 2025. Nurse managers are the linchpins for staff recruitment, retention, engagement, and achievement of performance metrics, so addressing their needs is a wise investment to improve many other aspects of nursing practice.

© emergingrnleader.com 2024

Brand New Workshop for 2024 – Leading in the New World of Work.  Click on Flyer The New World of Work Workshop

Bring the Nurse Leader Coach Workshop to Your Facility Virtually or Onsite. Click Here for the Nurse Leader Coach WS Flyer