Skip to main content

4 Trends Nurse Leaders Are Facing

Analysis  |  By Jennifer Thew RN  
   May 10, 2019

The Journal of Nursing Administration editor-in-chief addressed emerging nursing issues during AONE 2019.

At some point during HealthLeaders' annual CNO Exchange, usually after a fantastic discussion session about top nursing issues, I can count on an attendee saying, "It's so good to know others are going through the same things. It's not just me."

I thought about this sentiment during the AONE 2019 Plenary Session, "Innovative Research Impacting Leadership: Emerging Topics from the Perspective of the Editor-in-Chief" by Karen Hill, RN, DNP, NEA-BC, FACHE, FAAN. In addition to being chief operating officer and chief nursing officer at Baptist Health Lexington in Lexington, Kentucky, she is also the editor-in-chief for the peer reviewed Journal of Nursing Administration.

A few years ago, I spoke with Hill about the success of her patient flow nurse program at Baptist. At the time I remember her saying the reason she was able to implement so many innovative ideas at the organization was because she learned about them through her work with JONA. She reiterated that during her plenary presentation.

"I've been the chief nurse [at Baptist Health Lexington] for 28 years, and one of the things that my staff ask me is, 'How do you keep thinking of all these ideas?' " she says. "I'm honest with them. I have very few original thoughts. I learn a lot from people who take time to publish because when you do something great and you let other people know about it in writing, it lives forever. I really appreciate that."

In other words, when it comes to nursing, "Sharing is caring." By sharing their challenges and successes, nurse leaders can find solutions that improve patient care and outcomes, elevate the nursing profession, and achieve organizational goals.

Below are Hill's insights on emerging issues and trends nurse leaders grapple with today plus HealthLeaders articles on the topics.

1. Ensuring Nurse Managers Have the Right Skills and Competencies

"Nurse managers have very complex roles. Things that have been published [about nurse managers include] competencies, the engagement not only of the nurse manager, but the role of the nurse manager in engaging others," Hill said. "There's been a shift [toward] complex accountabilities and responsibilities."

Ronda J. McKay, DNP, RN, CNS, NEA-BC, vice president of patient care services and chief nursing officer at Community Hospital in Munster, Indiana, and Paula McKinney, DNP, RN, NE-BC, vice president, patient services at Woodlawn Hospital in Rochester, Indiana, recognized there was often a variation in the skills and competencies of nurse managers since nurses with strong clinical skills often find themselves in role of nurse manager without the training and skill development to thrive in the role.

In McKinney and McKay's study, "Improve Nurse Manager Competency With Experiential Learning," published in the October 2016 Nurse Management, 86% of respondents said they had no formal leadership development when they first became a nurse manager.

However, when nurse managers have the right skills and competencies, they can play key roles in improving financial, clinical, and quality outcomes, say McKay, McKinney, and Hill.

In the HealthLeaders article "Investing in Nurse Manager Development Pays Off," the pair spoke about how a targeted experiential education module gave nurse managers a better understanding of financial issues, such as the topics of expense forecasting and cost-benefit analysis.


2. Defining Nurse Manager Job Scope

"We have really burdened our nurse managers with so much today," Hill said. "They're the chief retention officers, the chief strategy officers, and they have to make sure all the patients are happy. They have to meet their budgets and they have to manage a million metrics in addition to having a life."

Cincinnati Children's Hospital Medical Center former Senior Vice President of Patient Services Cheryl Hoying, RN, PhD, NEA-BC, FACHE, FAAN, spoke about this issue in the 2017 HealthLeaders article, "The Case for Supporting Nursing Directors."

She encouraged CNOs to ask: "What are the supports that nurse managers need to be resilient in that role?"

For Hoying, that meant evaluating expectations placed on nurse managers. She had noticed a trend among the nursing directors at her organization. "What I was seeing was all the directors getting out of here at seven or eight o'clock at night and not being able to get home in a timely manner," she says.

To combat overworking its nursing directors, the organization implemented a one-manager-to-25-FTE ratio.

"By that [ratio] you're able to work with the staff and do all of the education with the staff that's needed and vice versa. It allows the manager to be successful and be the nurse leader that individual could be."


3. Developing Millennial Nurses

"Almost 50% of the nursing workforce right now are millennials," Hill said. "We have to learn how to work with them, how to engage them, and how to maximize that talent capability."

Also with the hopes of meeting the needs of this generation of nurses, Karen Clements, RN, BSN, MSB, FACHE, CNO at New Hampshire–based Dartmouth-Hitchcock, decided to partner with a millennial nurse mentor.

"In my hospital, I have five generations of nurses working for me, and I want to make sure I’m meeting the communication needs, the recruitment and retention needs, [and] the development needs of our nurses," Clements said when interviewed for the HealthLeaders article, "Why This Nurse Takes Advice from a Millennial Nurse."

When Clements meets with her millennial mentor they discuss topics like professional development, recruitment and retention, scheduling, work-life balance, and work environment.

4. Improving Nurse Retention

"I think the costs of [nurse] turnover in the United States is severely underestimated. I'm in southeast United States, and I cannot cover turnover of a nurse for $61,000. They give you a month's notice when they leave, then you have to submit the request [to fill the position] to the budget control committee, and they have to decide if they want to let you replace it or not," Hill said.

"It takes me, honestly, eight to nine months to replace a nurse. So, I think we've underestimated that [cost] in our business case for more resources. One statistic I did want to show you, because I do think this would be helpful on a business case, is a 1% decrease in turnover of nurses is worth about $337,000 a year. That's a big deal," she said.

In the recent HealthLeaders article "Want to Keep Nurses at the Bedside? Here's How," three nurse executives share how they are working to recruit and retain nurses. Their solutions include improving nursing's reputation at the organization and in the community, modernizing their clinical ladder program, recruiting nurses back to the bedside who had stepped away from practice, and implementing a holistic nursing practice model.

Jennifer Thew, RN, is the senior nursing editor at HealthLeaders.


Nurse leaders across the country are facing similar challenges.

By sharing solutions, nurse leaders can improve their organization and support other nurse leaders.

Nurse manager development, recruitment and retention, and the millennial workforce are common issues for nurse leaders.

Get the latest on healthcare leadership in your inbox.