Reduce Friction in Nursing in 2025

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

Few nurse leaders would disagree with the need for disruptive innovation in our healthcare systems. Yet, not all innovation works and it can have unintended consequences and high costs. A more immediate return on investment and improvement in productivity for most organizations can be achieved by reducing the friction in the work environment.

Stanford researchers Robert Sutton and Huggy Rao provide some much-needed leadership insight into how to do this in their book The Friction Project: How Smart Leaders Make the Right Things Easier and the Wrong Things Harder. They argue that organizations today are plagued by destructive friction that makes work much more challenging. The authors contend that leaders are the trustees of their staff’s time and should see their roles as “friction fixers.”

The idea of leaders as friction fixers is not new. In 2017, in The IHI Framework for Improving Joy at Work, leaders were urged to identify impediments to joy at work. The recommendation was that leaders should work with staff to identify obstacles in daily work or the “pebbles in their shoes” and then set priorities and address them together. Nurse leaders who used this framework often found that the pebbles in their staff’s shoes were easily solvable problems that would not have been raised had the question not been asked. Fast forward to today, when the pebbles in the shoes of nursing staff continue to grow, leading to high turnover rates, burnout, and increasing frustration.

So why not commit in 2025 to studying ways to reduce the work friction nurses experience daily? For most senior leaders, it has been years since they have worked at the frontlines of care, so you must involve direct care staff in this discussion. The following are examples for leaders to consider to reduce friction in their environments:

• Figure out the value and cost of staff time spent in meetings. Try to reduce the time spent on organizational meetings by 50%.
• Review the number, time of day sent, number of staff included, and length of emails in your organization. Seek opportunities to reduce the email burden.
• Identify places within systems with significant natural friction (such as throughput in emergency departments) and put roles in place to screen, stall, and serve customers as gatekeepers.
• Start a nursing “get rid of stupid stuff” initiative and have a contest where you seek your staff’s best ideas.
• Recognize that as a leader, the more power you have, the less aware you are about the level of friction in your organization because you do not experience it.
• Be aware of the problem of “addiction sickness” to roles or processes, which accelerates friction over time. Adopt a subtraction mindset. When anyone wants to add anything to the role of nurses – it should be a zero-sum game.
• Focus on handoffs between departments and people within the organization, as these are often a source of friction.
• Look at friction points in medication scheduling that make it impossible for things to be done on time.
• Ask staff to track the time spent hunting and gathering equipment and supplies.
• Do polling in your nursing service on equipment breakdowns, workarounds, and malfunctions, and then demand that vendors improve the quality of their products.
• Choose one area in the EHR to reduce the documentation burden for nursing staff that would have the biggest payoff.

Often, interventions designed to reduce friction have low costs but can have an enormous impact. Starting your friction project in 2025 could be the most important thing you do as a leader.

© emergingrnleader.com 2025

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