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David DeLong Writer of Workforce Issues

Here are four major challenges nurse leaders at leading healthcare organizations in the Northeast are worried about, and some ideas of how to address them. Are these issues on your agenda? How do you know they’re a problem? What are the business costs of not addressing these performance drivers? They’re relevant to leaders in many industries.

1. How do we protect our high performers from burning out?

As the nursing workforce ages, veteran high performers are much more likely to be asked to mentor younger staff. They’re also more likely to be called on to participate in performance improvement initiatives. This increases the chances of burn out, resulting in unwanted turnover or premature retirement of your most valued managers and clinical staff.

One medical center CNO said she works assiduously to shield her best performers from too many responsibilities. “When someone wants to start a new initiative, I think who is not overloaded, so the burden is not always on my high performing directors. I also want to stretch those who may not do it on their own.”

2. How do we recruit young staffers into the nursing leadership pipeline?

This is a universal problem among nurse executives I interviewed in advance of my keynote talk to healthcare leaders on “Accelerating Leadership Development: Lessons From the Leading Edge.” Everyone in nursing seems to know there’s a shortage of candidates willing to step into management roles.

One executive echoed a common theme saying, “A lot of young nurses aren’t interested in leadership because they don’t want the hours or the hassle. And staff nurses in big hospitals can make more money.” The question, of course, is what are healthcare organizations and nursing schools doing about this looming crisis?

As a small step, the CNO in a large rehab hospital created a nurse practice council to expose staffers to leadership opportunities. This group meets monthly to help facilitate change, addressing specific problems in clinical practice, such as alarm management. The CNO’s goal is to engage young nurses in management-related discussions, so they see leadership opportunities as more exciting.

3. How do I reframe the negativity my staff deals with continuously?

Demanding patients, new technologies, declining resources, continuous change and uncertainty about the evolving healthcare environment. These factors can create a pretty toxic work environment, quickly deflating staff morale. The goal, of course, is to promote retention of your experienced staff and to limit the costs of unwanted turnover in a demanding, high-stress environment.

Immediate supervisors make or break the experiences of their nursing staff. So progressive nurse executives continually strive to keep the workplace positive. One leader makes her office a haven for stressed out nurse managers. “One of my biggest challenges is keeping them buoyed up to overcome negativity. I try to create a safe space for them. I literally nurture them with tea and cookies. I also go on rounds with them so I can feel their pain.”

4. How do we create a more innovative culture when reimbursements are changing and resources are threatened?

Cutting costs in an era of healthcare reform will require very innovative solutions that lead to better and more cost-effective patient outcomes. But to create solutions that have a beneficial impact on costs, leaders must understand specifically how nursing costs effect hospital performance.

For example, the CNO of one large hospital realized her nurse managers didn’t understand how their staffing decisions impacted the hospital’s financial performance. So she created a weekly meeting for her managers with an assistant in the finance department.

This ongoing tutorial addressed specific questions such as: What is my unit’s FTE utilization against budget? What if nurse preceptors have more incidental overtime because they’re mentoring young staff? Learning the real financial impacts of staffing decisions is an essential step in developing more innovative clinical practices.

Nurse leaders must play a central role in improving healthcare outcomes in the future. To succeed they need to do everything they can to:

  • Protect high performers from burn out
  • Recruit young high potentials into management roles
  • Create a more positive work environment
  • Build a culture that values both innovation and controlling costs

These are critical tasks for nurse leaders and, indeed, for virtually all executives today.