Monitoring the Unforeseen Risks from COVID

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

How do you anticipate the unknown unknowns from the COVID experience? It is a question that many nurse leaders are asking themselves today. In an excellent article in this month’s Harvard Business Review, The Risks You Can’t Foresee, three business experts attempt to provide some guidance on evaluating novel risks. These risks usually arise out of one of the three following situations:

A triggering event that is outside the leader’s realm of imagination or begins somewhere far away.
Multiple routine breakdowns that, at some point, trigger a massive failure.
The risk materializes rapidly and on an enormous scale.

COVID is clearly a novel risk that falls into the first category described by the authors. The wake left from COVID could leave us with even greater risks moving forward that fall into the second and third categories described above. As I read this article, I began to think about what I am now hearing in my work with leaders across the country. Many nurse leaders are wondering out loud as to whether we will emerge from COVID with an intact nursing workforce. These leaders pick up what the article describes signals that something different is happening and are very worried.

Nurses are fearful and anxious about the implications of a massive second wave. Many have told their leaders that they cannot go through this again. Some are taking action by planning their departures. FMLA use is up. The slices of data that we have about the impact on the nursing workforce are not encouraging. Negativity, incivility, and anger are on the increase. Overall well-being is down. Mental health issues are on the increase. Trust in leaders has been compromised. Anecdotally, retirements among nurses who planned to work for another 2-5 years have skyrocketed. One perioperative leader reported in an AORN chat this weekend that 12 of her staff had retired in the past three months. We are also seeing a rapid increase in the number of new nurse leaders moving into roles vacated by retiring nurse leaders. Nurses with young children are making difficult choices about work because of a lack of availability of childcare. Among many new nurses, core beliefs about what it means to be a nurse have been shattered. A concerning trend that some organizations are reporting is new graduates either leaving the profession or deciding not to work in acute care nursing.

The signals are troubling. As the article authors remind us, risks come in many forms and flavors. It takes brutal honesty to admit them sometimes. Most nurse leaders are struggling just managing day to day in their organizations. Game-changing risks often come from a complex set of circumstances that create a perfect storm leading to more massive events. This is what we need to pay attention to at the local, state, and national levels. The nursing workforce is needed now more than ever but we may be seeing some signals of unforeseen risks down the road.

Reference

Kaplan, R.S., Leonard, H.R. & Mikes, A. (2020). The risks you can’t foresee: What to do when there is no playbook. Harvard Business Review. September-October. 40-46.

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