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Top 5 Nurse Leadership Issues for 2019

Analysis  |  By Jennifer Thew RN  
   December 28, 2018

Here is one chief nursing officer's take on the issues nurse leaders should focus on this year.

The Magic 8 Ball was recently inducted into the National Toy Hall of Fame. As I sat down to write about the top issues nurse leaders need to pay attention to in 2019, I was tempted to think about how easy it would be if nurses could consult this iconic fortune-telling game for answers.

But, of course, the field of nursing is not easy, and the challenges within the healthcare industry that affect nursing require more insight than vague answers from a plastic toy. To get a real understanding for what the future holds for nursing, I spoke with Paula McKinney, DNP, RN, NE-BC, vice president, patient services at Woodlawn Hospital in Rochester, Indiana, who is knowledgeable about the challenges chief nursing officers are facing this year.

According to McKinney, here are five issues that will likely garner the attention of CNOs in 2019, ranging from recruitment and retention to employee engagement. The transcript has been lightly edited for clarity.

1. Recruitment and Retention

"I think the No. 1 issue is going to continue to be recruitment and retention and, over the next several years, [an area] where CNOs will be focusing. It's a multifaceted issue and there are so many reasons why we're not able to recruit and retain nurses."

"On the recruitment side, I think it's because there's a lot of competition. There are more areas for nurses to work like occupational health or informatics. More people are wanting to become nurse practitioners and they are moving out of that bedside role into a provider-type role."

"I think [healthcare executives] need to look at being more creative in recruitment activities to attract people to their facilities. But then, if they can attract them, they need to make sure they can retain them. Again, that's multifaceted. I think what hospital executives need to understand is that the generation of nurses that have been coming out [of nursing school] over the last five to seven years—and the ones that will be coming out over the next five to seven—they want something different than what the baby boomers wanted. They want flexible schedules. They want to feel appreciated. They want engagement. I think hospitals, as far as nursing in general, gear running nursing departments for the boomers. This new group of nurses wants something different."

"The boomers they 'lived-to-work,' whereas this next generation has a work-to-live mindset. The philosophy of nursing over the next several years needs to be focusing on what this [new] generation wants so that we can retain them. I think a lot of them are struggling with the 12-hour shifts. Over the past several years, I've spoken to many of these newer nurses, and as far as the 12-hour shifts go, these nurses want to get home and be with their friends and their families. But a lot of places only do 12-hour shifts."

2. Innovative Technology

"We need to be paying attention to innovation in technology. There are a lot of creative, innovative ways [to take] care of patients now. For example, there are glucometers that transmit [patient] information to the electronic health record. Those are time-savers for nurses. But if a hospital doesn't invest in a good system, it just creates more work for nurses as far as double documentation and things of that nature. Some hospitals are getting on that technology bandwagon, but some are not because of the price. They're looking at the financial impact and the bottom line more than they're looking at innovation."

"As CNOs, we need to stay abreast of new technology and how it will help us to better care for patients. And we need to be advocates for the technology that will help our nursing staff take care of patients better and quicker and make [nurses] more available to the bedside."

"This younger group of nurses, they're more technologically driven. When we [pair] them with new technology, it's going to be a benefit for the hospitals."


3. Culturally Aware Patient Care

"We need to pay close attention to people that speak other languages or are from other cultures. I don't think in nursing we've done a good job of that over the years. Yes, people do their computer-based learning to be culturally competent, but I think we've gotten lax regarding how we interpret [the term] competent and how we train nurses to provide that bedside care. But, with what's going on in society—migration and the #MeToo movement—our patient population is going to be made up of more people from different cultures."

"Along with that is we need to get out in our communities and make sure that we're hiring diverse nurses. Nurses that speak Spanish or Russian or Chinese. Many hospitals have a language line, but you miss the human connection. And the human connection is a huge part of caring. If we are able to pay attention to society, and the different cultures that are out there and encourage people of other cultures to get into nursing, then it's going to be a benefit to our whole profession and to patient care."

4. Employee Engagement

"You don't need to be a Magnet hospital to get bedside nurses involved in quality care, safe care, hospital projects, committees, and those things. For hospitals that can't afford Magnet certification, how do you engage your bedside nurses? We can still take some of those [Magnet] principles to help our bedside nurses be more engaged in safety and quality projects. I think the more engaged this next group of nurses is, the more likely we're going to retain them."

"We need to pay attention to recognizing people for their good work. CNOs need to be more visible and connect with that bedside nurse. I think this generation of nurses is going to require that of CNOs. We're going to have to make sure that we're [personally] engaging [nurses] by asking them to serve on committees and [having them get] involved in a project that we're working on instead of their manager or director asking them. I think it will be more meaningful from the CNO, and I think we'd have better participation and engagement; that helps our nurses become more autonomous and feel like they're part of the bigger team. It may even inspire some of them into nursing leadership."

5. Promoting Self-Care

"For me, the thing I think we need to emphasize is getting nurses to take care of themselves. It starts with CNOs. What are we doing for stress relief? When we're struggling in the personal world, it's reflected in your professional world."  

"As nurses, we do not typically take good care of ourselves. What are things we can encourage nurses to do right where they are? I would to encourage relaxation techniques. For example, a meditation room or somewhere staff could go for time to just reflect, do some deep breathing, and get away from the craziness to give them spiritual time or comfort time, whatever they might need."  

"Maybe we can ask the chaplain to engage with the nurses and [notice or recognize] when someone seems like they need to take a deep breath—just anything that we can do towards self-care. Many places are starting wellness programs, but wellness isn't just physical. It's not just making sure you're getting the physical activity or that you're keeping your blood pressure and blood sugar down. We often forget about the psychological piece."

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


Retaining nurses will require CNOs to consider the wants and needs of a new generation of nurses.

Nurse leaders must be aware of and advocate for innovative technology.

CNOs must be role models of self-care.

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