What Nurse Leaders Are Doing to Fix the Things That Keep Them Awake at Night

Being a nurse leader in the post-pandemic healthcare environment means scrambling for staff, managing with even tighter resources and supporting clinical nurses still dealing with the trauma of COVID.

Will it be more of the same for nurse leaders in 2024? Three top nurse leaders discussed the issues they expect to face this upcoming year during Tipton Health’s recent Nursing Leadership Webinar, 2024 Nursing Trends: What Keeps Nurse Leaders Up at Night?

Staffing will continue to be an issue, making recruitment and retention critically important to nurse leaders. Webinar participants, Cindy Borum, DNP, APRN, FNP-C, NE-BC, assistant vice president, advanced practice & nursing excellence in the clinical operations group, HCA Healthcare; Mary-Michael Brown, DNP, RN, CENP, vice president, nursing practice innovation at MedStar Health; and Cheryl Reinking, DNP, RN, NEA-BC, DipACLM, chief nursing officer at El Camino Health, reviewed how they are addressing retention.

Nursing Across the Generations

One challenge is meeting the needs of nurses from Generation Z. As they enter the workforce, they bring different experiences and expectations that can challenge nurse leaders.

“They've known nothing but a digital approach to learning and communicating,” said Reinking. “Things move more quickly in digital.”

That quickness includes expectations about their careers, Reinking added. “We've been trying to meet them where they are and know they want to move quickly.”

That’s why El Camino Health hired a nurse retention specialist who meets with new graduate nurses in its residency program to develop a five-year career plan for them, Reinking said.

“From the day they start, we're going to help them get where they want to go, whether they want to be a critical care nurse, a manager or a labor and delivery nurse,” she explained. “It helps build loyalty. This is one way we address turnover, especially with young nurses, who tend to turn over more than our more senior nurses.”

El Camino Health also uses a “married preceptor approach” that pairs an experienced nurse with a resident nurse for the entire residency, Reinking said.

“Nurses from an older generation begin to know and understand a little bit more about Gen Z and are incorporating that into their practice,” Reinking said. “Wisdom is imparted from the older generation to the new, and reciprocation occurs from the younger generation to the older.”

Brown said MedStar works to develop future nurse leaders through its mentoring program.

“We developed a nurse leader mentoring program that spans Medstar facilities,” she said. “It's not just nurse leaders mentoring others in their entity. They've identified others across our system who would be a good fit.”

Modernizing the Charge Nurse Role

At HCA, the organization is changing traditional nursing roles to increase the appeal of nursing to new nurses.

“At HCA, we've taken the traditional charge nurse role and modernized it,” Borum said, adding that they call the new role a clinical nurse coordinator, or CNC.

Clinical nurse coordinators have the duties of a charge nurse, but HCA helps them develop more skills and exposes them to leadership opportunities, Borum explained. For example, she said, they may learn about conflict management or how to have difficult conversations with patients, their families or other staff members.

“We’re giving younger charge nurses, particularly Gen Z, skills and knowledge from a leadership standpoint around communication and managing others,” she said. “We’re trying to introduce the idea of leadership as something desirable or appealing.”

Nurse Well Being

Brown said nurses' well-being is the center of several initiatives at MedStar.

“I’ve had nurse leaders tell me patients are sicker and they're meaner,” Brown explained. “We now have a director who deals with workplace violence who is working with our director of security for the health system.”

Brown said that MedStar also has a center for well-being that nurses can contact anytime and as needed for an expedited behavioral health visit when they want it.

The well-being center also offers career planning services for any nurse who wants them. “It doesn't matter if they're a new nurse or a senior experienced nurse,” Brown said. “They will sit with a nurse and our HR colleagues to help nurses get to where they want to be in their careers.”

Virtual Nursing

Beyond retention, healthcare organizations are exploring innovative care models, such as virtual nursing. Medstar has recently partnered with a vendor that offers in-room patient care technology to run a virtual nursing trial.

“Remote nurses can do the admission history and describe what the nurse doing the admission physical should look for,” Brown continued, adding that the remote nurses are offloading whatever they can so the bedside nurse can spend more time with the patient.

Another benefit to virtual nursing at MedStar is that senior, experienced nurses who were relocating to different parts of our country because of family obligations could continue working for MedStar as remote nurses.

“We also try to address the well-being of our older generations of nurses who may want to work less,” Brown said. “We try to offer opportunities for part-time work, so they want to stay working with us and share their wisdom, but work the amount of time they want to work based on where they are in their life.”

HCA is also using virtual nursing to help older nurses extend their careers.

“We’ve taken some of our experienced nurses who are thinking about retirement and are trying to extend their careers by working remotely from home,” Borum said. “They have that knowledge of hospital operations and day-to-day care.”

Reinking said one of the most important things she does is talk with the nurses on her staff.

“I round with nurses. I ask, ‘How was the shift? How was the night?’ Providing a little bit of inspiration, saying thank you and expressing gratitude is the one thing I think is so important for our nurses to hear from us—from nurse leaders.” Reinking explained. “We're incredibly grateful for all they do for our patients every single minute, every single hour, every single shift, every single day.”