Top Priorities Differ for Nurse Execs, Managers

So far in 2011, nursing executives have been focused on CMS’ value-based purchasing and what patient satisfaction scores will mean for reimbursement; healthcare reform and how our existing system will cope with potential influxes of new patients; ongoing cost reduction; and the never-ending quest to improve patient safety and quality.

I started wondering whether these are the top concern of nurse managers and whether their priorities mesh with those of their senior leadership. In a highly-unscientific survey, I found concern for nurse supply starting to beat out fears of ongoing budget cutbacks and any long-term concern for what healthcare reform might bring us.

As the economy improves, more nurse managers fear the brief respite they enjoyed from the nursing shortage may soon be coming to an end. Stories abound of nurse vacancy rates dropping across the country. Nurses are gaining confidence to move about in the job market and baby boomers are starting to talk about retirement once again.

In addition, union action around the country is heating up and calls for mandating safe nurse-patient ratios are generating a lot of media coverage. Consequently, nurse managers worry because staffing and scheduling cause unarguably the biggest headaches.

Nurse execs are concerned about nurse supply, according to the annual HealthLeaders Media Industry Survey, but they are not as worried as nurse managers. Only 34% of nurse execs believe nurse supply will have a negative or strongly negative impact on their organizations. They are much more worried about the threat posed by nursing unions, with 46% believing organized labor will have a negative or strongly negative impact on their organization.

Nurse managers deal face-to-face with overworked and union-susceptible employees, and those front line managers fear confrontation. At a high level, nurse execs know that ample staffing is crucial for high-quality care. In fact, nurse leaders ranked nurse-to-patient ratios as the most important factor for providing high-quality patient care. But ongoing needs to trim expenses leave little room for investment in staffing.

Nurse managers, most of whom are baby boomers themselves, see their staff getting older by the year and wonder how their units will continue when these staff begin to retire. Fifty-seven percent of nurse execs reported being unprepared for the expected mass exodus of baby boomer nurses. Not only do organizations have to plan for who will fill the day-to-day care needs of patients, they also need to plan for the brain drain of losing so much clinical and professional knowledge. Baby boomers are often the first to volunteer to join a new committee to solve a patient safety issue or implement a new practice change and their leadership will be sorely missed.

As healthcare reform and reimbursement deliberations continue in 2011, nurse execs would do well to keep an eye on the short-term fears of frontline managers as well.