Will It Always Be Like This? - Emerging Nurse Leader

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

Nurse leaders across the healthcare delivery system are struggling. One critical care director explained what she is experiencing on a recent webinar.

I have been an ICU director for ten years. I have always felt good about the work and our team. The past year has been so challenging. I looked at my staff the other day and realized that more than 50% of them are new to the unit, and I have five travelers who will be with me for the foreseeable future. It seems to have happened overnight. For many years I had a low turnover rate and a cohesive unit. COVID has changed everything. Today, I feel like I am whitewater rafting without a paddle. What do you think – she asked me – will it always be like this?

My honest answer to this question is that what we are seeing will probably continue, at least in the short term. The long-term changes with the workforce are harder to predict. We know two things have changed. The first is that our workforce is demographically different than they were even two years ago. We have more new and inexperienced nurses and fewer seasoned nurses. More than half the current workforce are now either Millennials or Generation Z, and this number will build to close to 70% in the next 5-7 years. What these generational cohorts want from employers and leaders is different. They want attention paid to their mental health and well-being. They are career-oriented and want leaders to coach them to advance in their careers. When they don’t get what they need – they are more likely to leave than previous generations.

The second phenomenon we are seeing is more nuanced and related directly to the COVID experience. For many nurses, COVID was a disruptive life-quake in both their professional and personal lives. When people go through life-quake experiences, they emerge from them with changed beliefs and ideas. Nurses are thinking about the following:

Asking – what just happened here to us? Are we really expected to go back to work and act as if nothing happened?
Evaluating – whether they are truly respected or expendable in the eyes of the public?
Reconsidering – where they want to live geographically?
Assessing – what kind of work they want to do and whether acute care is the right setting?
Discussing – life-work balance and how many hours they want to work?
Evaluating – their economic worth and how much they are paid or could be paid to do the same job?
Considering – career options outside of nursing and wondering whether the expectations of the nursing workforce are just too much

So what can leaders do? If we look at what is happening through the lens of trauma-informed leadership and the life-quake experience, the turnover, and disruption, begin to make sense. It does not make leadership easier but should inform our thinking. The coaching that many nurses need today from leaders is a better understanding of the uneasiness and anxiety they feel and a need to avoid making rash decisions about their lives and careers. Today, leaders need to play the long game and ask the question – what needs to be true that is not true today for us to stabilize our staffing? Then work backward to help staff by identifying your current barriers and challenges. Ever the optimist, I believe it won’t always be like this, but for now – it is.

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