Killing Our Darlings - Emerging Nurse Leader

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

Experienced writers know how hard it can be to “kill your darlings.” In writing, you kill your darlings when you decide to get rid of an unnecessary storyline, character, or sentence in a piece of creative writing—elements you may have worked hard to create but that must be removed for the sake of your overall story. It serves as a good metaphor for letting go of some of our longtime practices in nursing that no longer work today.

Nurse leaders tell me that they are quickly redrawing boundaries they thought they would never cross. As I ask them what they have changed their minds about (i.e., what darlings are being killed), here is some of what they tell me.

I realize that primary care as a delivery model will no longer work (outside of a few specialty areas) in an era with intense nursing shortages. We must be honest with ourselves and our nurses that it will not be achievable in the current environment.

I realize that patient satisfaction and nurse staffing are closely linked. My unit has many inexperienced nurses and chronic staffing shortages. Patients and families are angry, so I can no longer expect the scores I had in the past.

I realize that nurses are in the driver’s seat – my whole idea about flexibility in scheduling has changed. I will do everything I can to keep staff, even if it is a .10 FTE.

I realize that nurse tenure will never be what it once was – I am grateful when my nurses stay a year.

I realize that working at an academic medical center with a level 1 trauma center is not the draw for new graduates as it was in the past – I no longer have a waiting list but rather vacancies, which will probably not change.

I realize that mental health is a massive concern for my younger staff – they take their mental health days and talk about sabbaticals even though they may have only worked one year. Gone are the days when you leave your emotional baggage at the door.

I realize that nurses leave to travel for many reasons, including debt – so I hold positions vacant and welcome them back with open arms.

I realize that childcare has become unavailable and costly – I am working closely with all my nurse moms to try to retain them. I have even worked to set up some babysitting arrangements among the staff.

I realize that our new nurses have problems talking with me – I am trying to reach out, and I find that bringing them together as a group works well.

I realize we don’t have enough preceptors for all new staff, so I have moved to a model where one preceptor may have four new staff with a significantly reduced assignment.

I realize that travelers will probably always be part of my core staffing and now work hard to treat them as valued team members, so they promote the unit to other travelers.

I realize that I might invest a year in training an OR nurse only to have him or her leave before I have any return on the investment. It is now a risk I take.

I realize that although I am doing the best I can – some days it may not be good enough, and I am now at peace with that.

I often ask nurse leaders today about their thoughts about the future of nursing. Most tell me they remain optimistic but uncertain how best to tame the turmoil. Watching our frontline managers evolve in their thinking and a willingness to kill their darlings has given me hope and pride over the past year. As Albert Einstein so eloquently observed – We cannot solve our problems with the same thinking we used when we created them.

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