Managing Staff Negativity about Staffing

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

January and February are proving to be very challenging times for hospitals across the United States. In record numbers, patients with COVID, the flu, RSV, and pneumonia are now being admitted. Becker’s Hospital Review reported that flu cases have surged to numbers that have not been seen since 2009, and bed occupancy rivals the numbers seen during COVID. With an aging US population, it is not surprising that many more patients now require hospitalization when seen for respiratory issues.

Nurse managers report that this volume surge has led to a nurse staffing crisis in many settings. Nurses were already struggling with exhaustion and burnout. Many clinicians are themselves becoming ill. Not surprisingly, against this backdrop of events, many leaders report that staff negativity about staffing is growing. Even on well-staffed units, patient acuity is higher, and the number of admissions, discharges, and transfers is skyrocketing in attempts to manage patient volumes. It is not unusual in larger hospitals to hear that 50-100 patients a day are boarded in EDs cared for by hospitalists awaiting admission to units.

As I discuss in my forthcoming book, *Nursing Leadership in the New World of Work*, we are witnessing unprecedented challenges in healthcare. The work of nursing has become complex as patient acuity and volumes grow. We have new nurses entering the workplace with different views about their careers, resulting in higher turnover and much less experienced staff at the point of care. Workplaces have also changed as there seem to be strong headwinds ahead around financing. Delivering healthcare and ensuring access is more difficult while patient expectations about their experiences continue to increase.

Unsurprisingly, many nurse managers have contacted me during the last three weeks asking for help dialing down staff negativity. One manager’s story provides a good example of what others are experiencing:

Our unit is hectic right now. Fortunately, I have no vacancies, but that doesn’t matter because the workload is heavy, and most of my staff are very young. I have three nurses out on FMLA, and many others call in routinely. I am always at least one nurse short. No one wants to work overtime or flex their schedules. I explain that we are staffed to the numbers allocated by our health system, which seem low to my nurses, given the workload. Using travel or agency nurses is out of the question because of our hospital finances. I am not sure how to have this discussion with my staff.

These are challenging conversations. What you don’t want to do is deny what staff are experiencing or try to shut down concerns. You want to reframe the conversation and talk about what is in your circle of influence and what is not. Chronic negativity is toxic for a team, and I would be clear with staff that you need to keep the conversation solutions oriented. Below are some questions you can use to guide your discussion:

What factors are in our Circle of Influence regarding our current concerns about staffing?

Give some examples as outlined below, but ask for more ideas:

Provide strong team back up to one another.
Avoiding unplanned PTO.
Assessing how we treat new graduates and new team members as we onboard them to our unit.
Deciding to view the glass as half full rather than half empty.
Establishing three goals for the shift when short-staffed, such as ensuring that everyone leaves on time or takes breaks off the unit.
Holding mid-shift huddles to reassess our staffing situation and help staff who fall behind.
Identifying what care we can miss on a shift when we are short-staffed.

Which factors in our Circle of Concern influence our staffing levels, but they remain outside our control?

Give some examples as outlined below, but ask for more ideas:

Planned PTO and FMLA use.
A lack of experienced nurses applying for positions.
Our health system benchmarked staffing grids that no longer reflect our patient acuity.
The nursing shortage in our area.
Our system’s financial viability as reimbursement levels continue declining and costs increase.

The goal is to keep these conversations constructive and plan to implement strategies that we do have control over.

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