What’s Trending with Nurse Leaders

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

As we enter the last quarter of 2024, it is good to step back and look at the challenges at the top of nurse leaders’ minds. The following is what is trending as I work with and do focus groups with nurse leaders across the country:

1. There is a massive increase in interest among college students in nursing as other fields experience layoffs. That is the good news. The bad news is that programs are still turning away students and the commitment of those entering the profession is more transactional.
2. Nursing faculty and Deans report skyrocketing mental health issues in the college-age population, which will ultimately impact the nursing workforce.
3. 40% of health systems are losing money as payer mixes become much less favorable in some geographic areas
4. Recruiting new staff has become easier in some geographic areas. Still, most new staff have no experience in the specialty areas they apply for, and health systems now devote a massive level of resources to subspecialty training.
5. Turnover at the unit or department level remains high in clinical areas such as med-surg, ED, behavioral health, and telemetry.
6.  Redesigning care delivery to include virtual nurses or team-based care delivery has become trickier as nursing unions resist innovation.
7. Nurse leaders self-report skyrocketing levels of burnout, exhaustion, and stress as the scope of their roles increases and staff expects 24/7 access to them.
8. Newer nurses resist their organizations’ efforts to become involved with shared governance as trust in leaders and organizations declines.
9. CNO turnover is at an all-time high with the retirement of seasoned CEOs and their replacement by younger leaders who see no reason not to turn over their entire C-Suite.
10. In many settings, executive leadership rounding is no longer done, leading to trust and communication gaps.
11. Nurse leaders report feeling that nursing is losing influence in health system strategic decision-making as they are blamed for financial issues.
12. The use of travel and agency nurses has substantially declined in many settings but nurse leaders report the downside is chronic understaffing.
13. Nurses ask to work fewer hours which is contributing to enlarged spans of control for nurse leaders and lower productivity in the nursing workforce.
14. More patients now select Medicare Advantage Plans when they are Medicare eligible (often a one-way door decision) which deeply concerns nurse leaders as these plans limit health access and push back on timely reimbursement.
15. Professional accountability for practice is an ongoing issue for frontline leaders as nurses push back on feedback about their practice.
16. Patients and families have become more challenging to deal with as health systems promote world class care but then don’t deliver it.
17. Lack of anesthesia services is a growing issue throughout the country and perioperative leaders predict there will be massive shortages in a few short years.
18. Nurse leaders in unionized settings report that partnerships with the union have become much more contentious as unions work to establish themselves as the primary advocates for nurses.
19. The drumbeat grows for mandated staffing ratios in nursing as hospitals are unable to fully staff the ratios they currently have in place.
20. Nurse leaders now talk about how healthcare leaders have seriously underestimated the impact of the experience with COVID-19 in how nurses view their work and life. Most feel that the level of commitment shown by nurses during that time will not happen again if there is a future event like this.

There is clearly much work to be done in nursing leadership. I always advise leaders to start from where we are as we look for tools and solutions. That means we need radical candor in identifying our challenges. Frontline leaders today tell me that it is so helpful to know two things – one that they are not alone and others are having the same issues that they experience. The second thing is to know that they are not crazy and that many strategies we have used in the past don’t work today.

© emergingrnleader.com 2024

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