What Happened to the Nursing Workforce?

The nursing workforce is plagued with many of the same challenges, so it's time for nurse leaders to switch strategies.

Editor's Note: This is an excerpt from a larger cover story, which can be found here.

Today, workforce growth and development are still the greatest challenges facing nurse leaders everywhere, and the old strategies are no longer working.

Even though many are working on creative fixes, health systems are still in dire need of solutions that improve both recruitment and retention. Workplace violence is as prevalent as ever, and burnout is cited as a huge reason for nurse leader turnover. 

Back in May, 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.

So, what went wrong?

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. 

"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. 

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 them that they can relate to 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."