The old ways of growing the nursing workforce are no longer working, so it’s time to usher in some new strategies before it’s too late.
MAY 2024
The greatest challenge facing nursing leaders today is workforce development. Health systems are in dire need of solutions that improve both recruitment and retention.
These challenges come at a time when workplace violence is as prevalent as ever, and burnout is cited as a huge reason for nurse leader turnover. Virtual nursing and other new technologies like AI have also had an impact on the workforce and need to be considered when strategizing.
HealthLeaders spoke with four nurse leaders who are taking on these challenges to find out what workforce growth strategies need to be put to rest and explore four ways CNOs can move forward and build a strong, healthy, and happy workforce.
What happened to the workforce?
TAKEAWAYS
-
CNOs need to reexamine their recruitment and retention policies to be more inclusive, and redesign care delivery models to be more innovative.
-
Nurses want opportunities and flexibility, so CNOs should be open to new ways of scheduling shifts, and provide mentorship and avenues for career development.
-
Tackling workforce development issues should be a group effort between the CNO and the rest of the C-Suite, with support from the CEO and CFO.
As everyone in healthcare knows, the industry is suffering from a national nursing shortage. Allison Guste, corporate vice president of nursing and clinical services and LCMC health and CNO at University Medical Center New Orleans, said this issue isn’t new.
“I think as long as nurses have been around, there's also been a nursing shortage,” Guste said. “So how do we think about it differently than we have in the past?”
In addition to the lack of nurses, there is a shortage of nurse educators, according to Jennifer Croland, vice president and CNO at OSF HealthCare Saint Francis Medical Center.
Allison Guste
Corporate Vice President of Nursing and Clinical Services and LCMC health and CNO at University Medical Center New Orleans
“There are nursing schools who have space within their programs,” Croland said, “but they are limited in the growth of those programs because we don’t have enough people to either teach [in the] classroom or teach in the clinical setting.”
Additionally, many nurses are leaving the industry and taking their degrees elsewhere.
“We’re seeing people who are being innovative and looking at how they can use their degree in a different way,” Croland said. “Maybe they’re getting into informatics [or] maybe they’re just leaving the profession altogether.”
D’Andre Carpenter, DVP, RN, senior vice president and chief nurse executive at Allina Health, added that there is an imbalance in the workforce between experienced RNs leaving the workforce and new-to-practice RNs coming into the industry for the first time.
“Before, it was because of the competitive nature [of nursing] and being able to recruit and retain experienced registered nurses,” Carpenter said. “Now, there’s this added complexity with burnout and RNs actually leaving the workforce.”
Additionally, according to Jennifer Mensik Kennedy, PhD, MBA, RN, NEA-BC, FAAN, president of the American Nurses Association (ANA), nurses are concerned about inadequate staffing, inadequate compensation, and well-being in the work environment.
“We really do need to focus on those three [issues] particularly if we want to change the future for nurses, and with the younger generations coming in,” Mensik Kennedy said.
“Traditional models we've used in the past are no longer working,” Carpenter said. “If you're not in the business right now of truly understanding your workforce and the multi-generational team members that are making up your teams, you're not doing the service you need to be doing.”
—D’Andre Carpenter, DVP, RN, senior vice president and chief nurse executive at Allina Health
Out with the old
The first thing CNOs need to do to combat these workforce issues is take a long look at their current practices to see what is effective and what isn’t, especially with recruitment and retention. Carpenter described the idea of being a little disruptive and looking at strategies differently.
CNOs need to look at academic pipelines and how they can improve diversity, equity, and inclusion. Guste emphasized that patients deserve to have someone treating to which they can relate and who looks like their community
“What doesn’t work is not doing anything about it,” Guste said. “You have to address it head on and you have to see where [your gap is].”
Care delivery models are also due for an update. Mensik Kennedy talked about how team nursing and primary nursing are models of the past, and how oftentimes “new” care models being proposed are just old ones being brought back that are not actually innovative.
“We do need to modernize our care delivery models,” Mensik Kennedy said. “We need to look at how we fold in nursing practice with virtual care, with remote care, and really understand how we can provide nursing practice.”
Rigidity and being strict with shifts or what roles nurses can fill will no longer work. Croland discussed how CNOs need to be open-minded about staff schedules and specialty positions, and having flexibility to better accommodate each nurse’s needs.
“I think we have to think very differently as to what our workforce [and] our potential applicant pool is looking for,” Croland said, “and then respond better to that.”
In with the new
Let’s take a look at what is working. It all comes down to redesigning care models and effective recruitment and retention strategies.
To come up with solutions for their nurses, CNOs first must listen to them and hear about the challenges on a daily basis. The CNO can then strategize depending on their nurses' needs and develop programs or processes that address those challenges in an effective way.
“The first thing that I would say needs to be done is you have to listen to the front line and really understand what it is that they're telling us,” Croland said. “I think just admitting to ourselves that what we’re doing is not working is the first step.”
When it comes to recruitment and retention, Croland said that listening is the key to finding out what is important to nurses and what would make them want to stay or leave a position.
D’Andre Carpenter,
DVP, RN
Senior Vice President and Chief Nurse Executive
Allina Health
80%
of early-tenure nurses
reported mid-tenure and most tenured nurses were great resources to learn from.
Flexibility
CNOs need to be open to a new way of doing things when it comes to scheduling. Nurses are prioritizing work-life balance and considering what their personal needs are when deciding on where to work. Croland said OSF HealthCare is open 24/7, and that's tough for nurses who don’t want to work weekends.
“We found a path forward by adding in weekend programs at a premium rate of pay,” Croland said. “Yes, it did cost the organization, but I’ll tell you, we get a lot of experienced candidates wanting to come to our hospital.”
That way, the nurses who don’t want to work weekends don’t have to, and those who do want to are provided a great opportunity to do so, Croland explained.
“Being able to earn higher dollars and work less hours,” Croland said, “it’s really great for some people who are going to school or have young families and want to avoid daycare costs.”
During the COVID-19 pandemic, Mensik Kennedy said, many hospitals offered nurses the flexibility to rotate and change units when they needed a break. Some hospitals, she said, are still adhering to that model.
“When I hear from nurses who said they left to be travelers, they asked to do those same flexible practices,” Mensik Kennedy said. “If we really want to look at how we retain nurses, we need to be able to provide those flexible practices because nurses have a lot of options to go do a lot of things.”
Jennifer Croland
Vice President and CNO
OSF HealthCare Saint Francis Medical Center
Registered Nurses – Percent change in employment, projected 2022-32
Healthcare diagnosing or
treating practitioners
Registered nurses
Total, all occupations
3%
NOTE: All Occupations includes all occupations in the U.S. Economy. SOURCE: U.S. Bureau of Labor Statistics, Employment Projections program.
Mentorship
Mentorship between tenured and new nurses is critical for retention. Mensik Kennedy said a generational survey done by the American Nurses Foundation found that mentorship is mutually beneficial, and that 80% of early-tenure nurses reported mid-tenure and most tenured nurses were great resources to learn from.
“In a situation where we have so many newer grads and younger nurses on the floor as the older nurses leave,” Mensik Kennedy said, “we need to [look] at how we retain those long-tenure nurses to be those resources.”
The survey also found that 75% of mid-tenure and most tenured nurses really enjoy working with their less experienced peers, according to Mensik Kennedy. CNOs should try to provide time in nurses’ schedules to allow for communication and teaching moments to happen between staff members when possible. This is where flexibility and building healthier work environments are key.
“We need to stop thinking of it as non-productive time,” Mensik Kennedy said, “and really think about how productive this mentorship is to really keep nurses in the workplace.”
Mensik Kennedy, PhD, MBA, RN, NEA-BC, FAAN
President of the American Nurses Association (ANA)
70%
of mid-tenure and most tenured nurses
really enjoy working with their less experienced peers.
Education and career advancement
Education and career advancement are crucial pieces of the puzzle as well. According to Guste, hospitals may not have invested enough in professional development programs, so they need to reevaluate what those programs or departments look like. Professional development programs should meet the needs of the growing workforce and do more than just check the education box.
Defining that clear path is important as well. Programs should outline the steps needed to gain eligibility or acquire a new certification.
“I think one thing we’re doing here, too, [that is] is really investing in our student nurse program,” Guste said, “[is] making sure that we [have] not only a robust competency and education program for them, but really investing in the amount [of student nurse techs] that we're taking in.”
Health systems should also be building strong academic partnerships with nursing schools and other academic programs to create pipelines into the industry.
According to Carpenter, CNOs need to take that to the next level. When students come into the programs, leaders must work to understand more about them and create programs between the academic partners to focus more directly on their needs and desires.
”Believe it or not, our new nurses that are coming into nursing programs for the first time are starting to see their career path,” Carpenter said. “You know, five years out from where they are when they graduate [and] when they become a new to practice RN.”
CNOs should be a part of those development conversations and bring academic partner leadership to the table to have them.
“Meet the basics, [then] learn about your workforce and what their plans for the future are,” Guste said. “What are their dreams, and how can you give them a clear path to making those dreams or those outcomes come true for them?”
—Allison Guste, Corporate Vice President of Nursing and Clinical Services and LCMC health and CNO at University Medical Center New Orleans.
“So really [break] the mold there and [go] beyond just having [students] in our environment for clinical immersion and clinical experience,” Carpenter said, “and [start] to really get at career development progression with students early on.”
Croland recommended offering enhanced educational benefits for nurses to help both recruitment and retention. Before, Croland said, they would see nurses being hired and then leaving by year two to take positions outside the organization, until they started offering academic program reimbursement for any degree within nursing.
“You could come in as an entry-level EVS technician and if you want to be a nurse, we will 100% cover your tuition with zero commitment to the organization,” Croland said. “Were retaining these individuals during the whole time that they're in school.”
This way, Croland says they are recruiting people into the organization and getting more out of them since they are staying at the health system longer. Since offering program reimbursement, Croland said they have seen OSF HealthCare's college enrollment triple.
Incorporating technology
“At some point, if you're not doing it, you're going to be behind the 8-ball, and can be considered to still be on paper charts,” Guste said.
Guste said UMC has implemented virtual nursing to help with admissions, and they plan to expand on the program.
Croland said OSF Healthcare has virtual nurses doing admissions, as well as discharges and medication reconciliation, and they have plans to expand the program to include dual skin assessments, patient education, and sign-offs on high-risk medications.
“[With] models like that, you [are] able to use and spread one or two resources across multiple departments and really give a lot of time back to the bedside nurse,” Croland said, “to be able to do things that only a nurse in person is able to do.”
Rank top 3 initiatives that would support a positive work environment/collaboration across co-workers
SOURCE: Bureau of Labor Statistics RN Data. Additional data: https://www.bls.gov/ooh/healthcare/registered-nurses.htm#tab-6
AI will also heavily impact the workforce from many different angles.
According to Mensik Kennedy, the ANA released a position statement on AI to ensure that nurses are adhering to the highest ethical guidelines and following a set of standards to ensure safety, consistency, quality of care, and enhanced patient care experience.
“We need to make sure that when we develop this technology, the policies, and procedures, that it’s clear that it’s not a replacement for a nurse's knowledge and skill,” Mensik Kennedy said. “Oftentimes I think that gets lost and we need to make sure that nurses know that the technology doesn't hold the license.”
Making the pitch
So, we have the strategies, now what?
One of the toughest parts of any healthcare executive's job is proving ROI and making the case for investing money in new programs.
“CNOs and nurse leaders and managers have some of the hardest jobs,” Mensik Kennedy said. “They’re in between really wanting to take care of their staff and doing what’s right, and then working within their C-Suite and with their CEOs related to this.”
Mensik Kennedy said tackling these issues should be a group effort between the CNO and the rest of the C-Suite, where the CEO is supportive of the CNO reporting out in board meetings and having that voice for nursing, and that the CEO and board do what they need to do to support nursing.
What flexible work/scheduling options would you like your employer to offer?
SOURCE: Bureau of Labor Statistics RN Data. Additional data: https://www.bls.gov/ooh/healthcare/registered-nurses.htm#tab-6
“While I know CNOs advocate, it really needs to start with the CEO and the boards really saying, you know what, I want to listen to the CNO and I want the CNO to report out,” Mensik Kennedy said, “because CNOs are trying to advocate and sometimes the CEOs and the boards just don't want to listen.”
According to Carpenter, the best thing a CNO can do is make sure to be well positioned in their organization. CNOs must be comfortable being in forums in which they traditionally aren’t involved.
“If you are not comfortable with data and in the space of stewardship as it relates to data, you’ve got to be comfortable there,” Carpenter said. “So whatever forum is leading or advancing your enterprise business intelligence and data analytic strategy, it’s important to have the voice of [the] clinician there, [and] the chief nurse as well.”
Carpenter also recommends having a concrete definition of wellbeing and creating a more balanced workforce.
“Applying a very focused definition to that, with some key strategic targets and goals and objectives that we want to achieve as an organization,” Carpenter said, “and then starting to look at your people process and technology to figure out if you’re investing those resources in the right place in order to advance that work.”
Guste also suggested focusing on goals to help work out ROI, and determining how something like virtual nursing, for example, could help with retention and improving length of stay.
“I would say start small with your intentions about what your goals are,” Guste said, “and then build upon those as you move forward.”
G Hatfield, Editor, HealthLeaders