Diversity should inform your strategy, according to this CNE.
On this episode of HL Shorts, we hear from Claire Zangerle, CEO of the American Organization of Nursing Leadership (AONL), and senior vice president and CNE at the American Hospital Association (AHA), about how CNOs can improve nurse manager retention. Tune in to hear her insights.
Nurse practitioners may soon be able to classify chest radiographs, according to the CDC.
Nurse practitioners' (NPs) scope of practice will potentially be expanded once again as the Centers for Disease Control and Prevention (CDC) considers allowing NPs to try their hand at reading a specific type of X-ray.
The CDC's National Institute for Occupational Safety and Health (NIOSH) submitted a request for information regarding the B Reader Program from interested parties to determine whether or not they should allow nurse practitioners and physician assistants (PAs) to become B Readers.
The goal is to grant nurse practitioners and physician assistants eligibility to take and pass the NIOSH B Reader exam and become certified B Readers. According to the information request, the interested parties include experts in occupational respiratory health surveillance and radiology, nurse practitioners, physician assistants, and workers unions who represent workers exposed to mineral dust, and/or the workers themselves.
What is a B Reader?
According to NIOSH, the B Reader program "trains and certifies physicians in the International Labour Organization (ILO) International Classification of Radiographs of Pneumoconiosis." In simpler terms, B Readers classify chest radiographs of employees participating in health surveillance programs, such as the NIOSH Coal Worker's Health Surveillance Program.
Currently in the United States, only licensed physicians can become B Readers, and as of October 2024, only 184 U.S.-based physicians in 35 states are licensed B Readers, according to the information request.
The CDC's goal is to increase access to B Readers across the country.
"NIOSH is interested in ensuring that B Readers are available to classify chest radiographs obtained in all states and territories," the information request says.
What does NIOSH want to know?
NIOSH specifically is inquiring about the following questions from the interested parties, according to the information request:
What is the current demand for B Readers, and would expanding the program to include nurse practitioners and physician assistants help meet this demand?
Are there specific geographic areas or populations that might benefit from having nurse practitioners and physician assistants certified as B Readers?
Are there any potential risks associated with expanding the B Reader certification to nurse practitioners and physician assistants and, if so, how can those risks be mitigated?
ILO classification of chest radiographs is not the same as clinical interpretation. Are there states where scope of practice and standards of care allow nurse practitioners and physician assistants to perform clinical interpretation of chest radiographs without physician oversight? In states where physician oversight is required for clinical interpretation, is it also required for ILO classification? What would be the best approach to ensuring that appropriate clinical interpretations are obtained for all contemporary chest radiographs undergoing ILO classification by nurse practitioners and physician assistants?
How do you anticipate different interested parties (e.g., physicians, nurse practitioners and physician assistants, industry representatives, workers, health profession boards) would view the potential expansion of the B Reader program to include non-physicians?
What challenges might arise during the implementation of this expansion, and how could they be effectively managed?
Do you have any other information or comments relevant to whether nurse practitioners and physician assistants should be able to become B Readers and, if so, the best way to implement that expansion?
The request's comment period ends March 17, 2025.
Moving forward
If nurse practitioners become eligible to take the B Reader exam and become licensed B Readers once they pass, that will once again expand the role that nurse practitioners play in care delivery.
According to a 2024 report from the Association of American Medical Colleges (AAMC), the United States will face a shortage of 86,000 physicians by 2036. An increase in nurse practitioners and physician assistants will help fill that gap.
There are over 385,000 nurse practitioners across the country, according to the American Association of Nurse Practitioners (AANP). If all of them have the potential to get B Reader certified, that will be a significant step toward NIOSH's goal of expanding access.
At age 28, Zangerle was working in clinical exercise physiology in cardiac rehab, and was inspired by what the nurses were doing.
"I can do that, I can educate, I can do all these great things the nurses are doing," Zangerle said, "I can take the clinical knowledge that I learned in exercise physiology and elevate that into nursing."
After receiving a Bachelor of of Science in Exercise Physiology from Texas A&M University, Zangerle went on to get a master's in nursing administration from Kent State University, a master's in business administration with a focus in healthcare from Lake Erie College, and a Doctor of Nursing Practice from Texas Christian University.
Zangerle previously served as principle of CMZ Strategies, LLC, offering nurse leader coaching and nursing organization strategy. She is the former chief nurse executive at Allegheny Health Network and CEO of the Visiting Nurse Association of Ohio. Zangerle spent several years at the Cleveland Clinic where she served in a variety of roles, including as chief nursing officer, director of quality and accreditation and director of preventive cardiology.
Now, Zangerle serves as chief executive officer of the American Organization for Nursing Leadership (AONL), and senior vice president, chief nurse executive of the American Hospital Association (AHA). In her role at AONL, she leads a membership organization of more than 12,000 nurse leaders whose strategic focus is excellence in nursing leadership. In addition, she works collaboratively with the AHA to ensure the perspective and needs of nurse leaders are heard and addressed in public policy issues related to nursing and patient care.
On our latest installment of The Exec, HealthLeaders sat down with Zangerle to discuss her journey into nursing, and her thoughts on trends in the nursing industry. Tune in to hear her insights.
CNOs will continue to focus on workplace violence, wellbeing, and digital transformation, according to this nurse leader.
It's 2025, and while there will be many new beginnings in healthcare, CNOs will also face some perpetual challenges that continue to rear their heads.
According to Robyn Begley, CEO of American Organization of Nursing Leadership (AONL), and senior vice president and CNO at the American Hospital Association (AHA), several of the biggest issues going into 2025 will be the same that the industry has seen for the past couple years.
Here is the 2025 forecast of challenges that CNOs should keep tabs on.
Nurse manager turnover is highest within the first four years of leadership, so CNOs must focus on how to retain them, according to this CNO.
On this episode of HL Shorts, we hear from Robyn Begley, CEO of the American Organization of Nursing Leadership (AONL), and senior vice president and CNO at the American Hospital Association (AHA), about how CNOs can improve nurse manager retention. Tune in to hear her insights.
CNOs must keep an open mind and try new things in the new year, according to this nurse leader.
As the saying goes, "new year, new beginnings."
It's 2025, and while there will be many new beginnings in healthcare, CNOs will also face some perpetual challenges that continue to rear their heads.
According to Robyn Begley, CEO of American Organization of Nursing Leadership (AONL), and senior vice president and CNO at the American Hospital Association (AHA), several of the biggest issues going into 2025 will be the same that the industry has seen for the past couple years.
Looking ahead
Begley emphasized that workplace violence will continue to be a challenge as CNOs continue to work diligently at strategies to protect patients and staff.
"Healthcare is not isolated from society," Begley said, "mitigating workplace violence and promoting workplace safety is really important."
Work-life balance and wellbeing will stay a priority in 2025 for nurse leaders, according to Begley. These challenges go hand in hand with staffing hurdles as well.
"Retirements and newly licensed nurses leaving the profession are things that we are actively working on," Begley said.
Begley predicts that health systems will continue having financial challenges.
"We know that many hospitals and health systems in our country are facing grave financial constraints," Begley said, "so that is also a challenge."
Additionally, Begley pointed out that the speedy implementation of new technologies and innovations presents both a challenge and an opportunity.
"The introduction of technology and innovation into care delivery settings is a challenge," Begley said, "but also [it's] really an opportunity for us to dig in and participate and get things right."
Working together
CNOs and nurse managers will have to work together to address these issues going into 2025, and according to Begley, communication is key.
"Communication, communication, communication," Begley said. "[Have] regular check-ins that are scheduled, that aren't just catch-as-catch-can, but really rise to the top from the perspective of importance."
Begley emphasized communication is critical at all levels of nursing, not just for nurse managers.
"We need opportunities for nurses to provide feedback," Begley said. "Policies have to be and are best set when they're developed jointly."
CNOs should develop policies and procedures with staff and managerial input while using data and analytics.
"We have the data…to make informed decisions," Begley said, "not just 'this is what we sort of intuitively know,' but what are those things that we have data and analytics to support?"
Advice for CNOs
CNOs should remember they won't get things right the first time, Begley emphasized.
"Perfect is the enemy of good," Begley said. "Many times, we want to roll out an initiative that we think we have accounted for all the possibilities, [and] we just want it to be perfect, and we know in life that that's not what happens."
In this digital age where technology is advancing so rapidly, Begley recommends keeping an open mind.
"I think we have to be open to the idea that this is going to be iterative and we're not going to…just hit the home run and everything's going to be perfect," Begley said, "and that's hard for nurses."
Begley suggested starting with small changes and seeing how they work, and collecting the input of frontline staff and nurse managers. CNOs should also partner with colleagues in digital transformation and IT.
Nurses will have to learn new competencies to keep up with changing technologies and change the way they think about delivering and experiencing healthcare.
"We have to remember what the impact is on our patients and their families," Begley said. "We have to embrace new technology, [and] embrace making care more patient-centric."
In 2025, CNOs and other nurse leaders will have to keep track of many different trends and challenges, including the ones facing a critical part of the workforce: nurse managers.
HealthLeaders spoke to Robyn Begley, chief executive officer of the American Organization of Nursing Leadership (AONL), and senior vice president and chief nursing officer at the American Hospital Association (AHA), about AONL's nurse manager fall report and what CNOs can expect in 2025. Tune in to hear her insights.
CNOs need to make sure that nurse managers feel supported and have the proper resources do to their jobs.
In 2025, CNOs and other nurse leaders will have to keep track of many different trends and challenges, including the ones facing a critical part of the workforce: nurse managers.
Nurse managers are vital to the success of a health system. According to the Trends and Innovations Nurse Manager Retention report that was released by the American Organization of Nursing Leadership (AONL) and Laudio in the fall of 2024, nurse manager retention is key to building a sustainable and high-performing healthcare setting.
In the report, nurse managers had four priorities that they want CNOs and other nurse leaders to focus on. Here are those priorities.
Nurse managers are the 'CEOs' of their patient care area, and it's the CNO's job to support them, according to this nurse leader.
It's a new year, and people all around the world are setting new goals and resolutions for themselves, including CNOs.
In 2025, CNOs and other nurse leaders will have to keep track of many different trends and challenges, including the ones facing a critical part of the workforce: nurse managers.
Nurse managers are vital to the success of a health system. According to the Trends and Innovations Nurse Manager Retention report that was released by the American Organization of Nursing Leadership (AONL) and Laudio in the fall of 2024, nurse manager retention is key to building a sustainable and high-performing healthcare setting.
However, the report says that nurse manager turnover is highest within the first four years of leadership, and according to Robyn Begley, chief executive officer of AONL, and senior vice president and chief nursing officer at the American Hospital Association (AHA), this is due to very high levels of stress and burnout.
"As a former nurse manager earlier in my career," Begley said, "I can tell you it was the most challenging role that I've had in nursing leadership in my entire career."
Nurse manager challenges
Nurse managers are responsible for patient care, their nurses, 24/7 staffing for their units, budgeting, and compliance with regulations. Begley explained that it's not easy for nurses to move to a nurse manager role, and it should require formal training in leadership, management, and administrative skills.
"They are really the CEOs of their patient care area," Begley said. "Transitioning from a clinical role to a managerial role requires different competencies."
Nurse managers work long hours and have to constantly be available in case something goes wrong, and this can have a large impact on their personal lives and wellbeing.
“Hospitals and healthcare settings are very frequently 24/7 operations," Begley said. "Work-life balance gets a lot of attention, and this really is one of those areas [where] it's challenging for a nurse manager, and this can strain their wellbeing."
Organizational culture also has a large impact on nurse managers, and, according to Begley, it can influence a nurse manager's job satisfaction. CNOs need to make sure that support systems are available.
"Some new managers may feel isolated or perhaps unsupported," Begley said, "finding it difficult to navigate their new responsibilities and feel confident in their roles, especially in those first few years."
The nurse manager's role may also be ambiguous, so Begley recommends clarifying their responsibilities as best as possible to avoid confusion and lack of direction.
"Many times, if a new initiative comes into play, who is left to actually make sure that it gets implemented and outcomes are monitored and measured?" Begley said, "it's the nurse manager."
Nurse manager turnover also greatly affects the rest of the staff. Begley explained that strong, effective communication and trust takes time to build, and frequent turnover disrupts that process and makes it difficult for staff to develop meaningful relationships with their managers.
"Frequent changes in management can create a sense of uncertainty and instability among those units that have frequent turnover," Begley said. "This can lead to decreased morale and job satisfactions, as employees, the nurses, the nursing assistants, and the clerical support on those units may feel that their work environment is unpredictable."
Improving nurse manager retention
Begley had several tips for CNOs who want to improve their nurse manager retention. As CNOs continue to build an engaging and psychologically safe environment for nurses, they must also think about nurse managers and how they can feel safe speaking up, surfacing concerns, and potentially disagreeing without negative repercussions.
"They understand what it's like on the front line and they have to feel free to be able to communicate that back to executive nursing leadership," Begley said. "They have to feel like they can tell it like it is and not sugarcoat some of the messaging that they really do need to communicate to their leadership team."
Additionally, Begley suggested that CNOs allocate resources and advocate for the funding to provide formal training to their nurses who are aspiring to become managers or leaders.
"It takes continuing leadership development and education because we know there's always something new to learn and things are changing in healthcare very rapidly," Begley said.
CNOs also need to be showing up for their nurse managers in tangible ways.
"Nurse managers told us how important it is to actually see their leadership and to have communication and conversations with them," Begley said. "Not just fly by rounds where leaders will stroll through a unit, say hi, try to check in with the staff quickly, but really scheduled time for managers to be able to engage in dialogue is what is required."
Meeting nurse manager expectations
In the report, nurse managers had four priorities that they want CNOs and other nurse leaders to focus on: ensuring a healthy work environment, promoting leadership development, identifying new leaders early, and addressing role complexity.
Begley emphasized the necessity of succession planning for upper management and for executive management, and that there needs to be planning for every level of leadership.
"That involves a formal plan, a succession planning framework, that includes purpose, level, assessment, and nurturing," Begley said. "We know with the baby boomer retirements that we are creating space in leadership in nursing, as well as in many other professions."
The career trajectory of many nurses nowadays is also vastly different than what it used to be, Begley explained.
"There are some young up-and-comers who are very willing and able to take on more, to learn and aspire to be leaders," Begley said, "so these organizations need to do a deep dive and do that assessment and really figure out what their staff nurses desire to do in the future."
Health systems need to provide exposure to what nurses at different levels do, and provide formal education and leadership development, according to Begley.
"It's wonderful if nurses decide to stay on the clinical track and become more proficient in a specialty area, or go into a clinical track for advanced education," Begley said, "but there are also nurses that want to pursue nursing leadership as their specialty, and they also require a career plan."
In terms of role complexity, Begley said AONL is focusing not only on span of control, but also on what leaders can do to take some of the burden away from the nurse manager.
"Clerical work could be done by an assistant, by someone who is perhaps not a nursing leader or a nurse manager, but can do things like scheduling, managing logistics of their unit, [or] supplies," Begley said. "It's so complicated when we look at what [nurse managers] are actually accountable for."
Begley also emphasized the issue of having four generations in the workforce. One solution is technology and innovation, and having nurse leaders at all levels embracing technology and learning how to use it.
"These are skills that perhaps a decade ago or more, nurses weren't innately exposed to in their education," Begley said, "but we know now that technology and innovation is truly the key to the future of transforming healthcare and helping our communities become healthier."
To read more about AONL's previous spring report on nurse manager span of control, click here.
