The Pathway Forward - Emerging Nurse Leader

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

A critical care director recently asked me how she should be thinking about a pathway out of the current situation she finds herself in. Her unit has, in her words, “quickly unraveled in a way I would never have thought possible.” Most of her core staff with her for years left feeling burned out and exhausted. Two years of relentless waves of COVID patients wreaked havoc on her team and Beacon unit. Her current staff is composed mainly of new graduates and many travel nurses. She spends most of her time recruiting, staffing and scheduling. She does not plan to give up – too much of an optimist for that, she told me.

Her question about the pathway forward is a good one and on the minds of most nursing leaders today. I have given a lot of thought to this and believe the following about the pathway forward for nursing:

It will take a minimum of two years to rebuild teams and regain nurses’ trust – this will not happen overnight.
Nurses need to be involved in the rebuilding process and voice their ideas about the new priorities moving forward.
Employee loyalty programs need to be established to reward and honor longevity.
Staff wellbeing needs to become a core value and cornerstone for rebuilding – some things have happened during the past two years that must never happen again.
Organizations should make a financial commitment to rebuilding the healthcare workforce and design programs/benefits that the current generation of nurses will value.
Nurse leaders need to learn to do scheduling that accommodates 4 hours, 6 hours, 8 hours, and 10-hour tours – seek partners outside of healthcare (look at the airlines) to figure out how to do this.
There will need to be a frank discussion about what all healthcare clinicians will stop doing in acute care settings and a commitment to be relentless in eliminating duplication.
Where possible, technology and robotics needs to be leveraged to support nurses.
Care delivery needs to be redesigned, but it will never be a one-size-fits-all solution.
Organizations should commit to career planning and internal mobility for staff from the time of onboarding – this is what our younger generation wants.
Attention needs to be paid to the social determinants of work health, including childcare support and student loan repayment plans.
Healthcare systems need to be open to remote work and decide what roles can be done remotely. Many nurses want this option.

For unit directors such as this critical care leader, my suggestion is to build a vision with your team of your unit culture two years from now. Then work backward and ask – for this to happen, what needs to be true that is not true today. Based on some of what she told me, this could include the following:

Nurses will feel psychologically safe and cared for.
Our unit HWE assessment scores will significantly improve.
We will reduce the number of travel nurses by 75%.
Our new graduates will have experienced preceptors as their coaches and mentors.
We will have very flexible scheduling.
Our nurse-to-patient ratios will not exceed one nurse to two patients.
As a leader, I will have time to coach our staff.
Patients and families will be respectful to staff.
We successfully brought back home some of our team who had left to travel.

Don’t wait to do sweeping innovations or implement recommendations from consensus panels – pilot small changes and keep iterating – that is how most innovation happens. The wonderful thing about focusing on the future and setting goals is that nurses will be more optimistic if hope for a better future is projected. Right now, many nurses don’t see a way forward from the turbulence and chaos. This has led to anger, negativity, and mistrust. We all need to be the change that we wish to see in nursing – so begin today with some small bets that could lead to a better future.

Our Most Popular Right Now – Become the Boss No One Wants to Leave Nurse Retention in Turbulent Times

Give your leadership team the gift of a highly rated webinar – Nursing Leadership in 2022: Rebooting after a Life-Quake A Nursing Leadership Reboot Workshop

Read the Nurse Leader Coach – Available at Amazon and Other Book Sellers.

Recommended Book by the Association of Critical Care Nurses – The Nuts and Bolts of Nursing Leadership: Your Toolkit for Success