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?"
"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."
"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."
Nurses should be involved in innovation so that it happens with them, not to them, says this CNE.
It’s an exciting time for innovation in the healthcare space, as new technologies pop up across the industry that can improve care delivery.
Health systems everywhere are experimenting with several new innovations, all with the goal of streamlining processes and removing unnecessary burdens from nurses and physicians alike.
At Houston Methodist, the innovation team built what the Houston Methodist Center for Innovation Technology Hub, nicknamed the Tech Hub, which according to Murat Uralkan, director of innovation at Houston Methodist, serves as a hands-on living laboratory.
“When we need to push a new configuration, or a new network setup, we can do this all in isolation, without disrupting any patients,” Uralkan said. “We can try things before [they hit] the floor, because no matter how small a pilot is, it is still going to be very disruptive.”
A peek inside the Tech Hub
Within the Tech Hub, there are several rooms that simulate the patient’s experience, both at home and at the hospital. There, the health system tests new technologies before implementing them, Uralkan explained.
“We bring it here first, the technology is not fully ready for operations, but we’ll host it here,” Uralkan said, “and then we’ll start building awareness first, then we’ll start building proof of concept, and when it’s ready we’ll start taking it to operations.”
Inside the Tech Hub, along with the health system’s virtual nursing platform, are digital whiteboards, which show the care team members, the patient’s isolation status or risks, and when the patient has made a request from another handheld screen. Another piece is the BioButton, which can monitor a patient’s vitals and streamline data into the electronic health record more frequently and regularly.
“Today, the standard of practice is someone comes into the room every four hours, or every six hours, to take your vitals,” Uralkan said. “We’re taking your vitals, or at least important critical vitals, every minute now, and we can trend that data and help nurses relieve the burden, and also increase safety.”
Getting nurses involved
Last week, Gail Vozzella, senior vice president and chief nurse executive at Houston Methodist, spoke live from the Houston Methodist Tech Hub at the Ion, to talk about why and how nurses should get involved with innovation, and how leaders can use their seat at the table to advocate for nursing technology.
According to Vozzella, nurses should lead innovation for four reasons: nurses are vocal and will give direct feedback; they understand the “why” and are directly impacted by new technologies; the most successful innovations happen with nurses, and not to nurses; and lastly, nurses are able to help spread the technology across health systems quickly.
“You have to have nursing involved at the unit level in trialing [new technology],” Vozzella said. “We have to be open to the feedback that they give us.”
Vozzella also sat down with HealthLeaders live at the Ion to further this discussion, so tune in below to hear her insights.
Gen Z is looking for purpose at work, says this CNE.
HealthLeaders spoke to Jean Putnam, chief nurse executive at Baptist Health South Florida and HealthLeaders Exchange member, about workforce challenges in nursing and innovative ways to recruit and retain Gen Z nurses. Tune in to hear her insights.
The HealthLeaders Exchange is an exclusive, executive community for sharing ideas, solutions, and insights.
Nurse leaders should take a deliberate and disciplined approach to workplace violence, says this CNO.
On this episode of HL Shorts, we hear from Michele Szkolnicki, senior vice president and chief nursing officer at Penn State Health Milton S. Hershey Medical Center, about how CNOs can help keep their nurses safe in the face of rising workplace violence incidents. Tune in to hear her insights.
CNOs should pay attention to these nurse leaders in the new year.
2024 was a prosperous year for new nurse leadership.
This year, HealthLeaders spoke to several new CNOs, CNEs, and other nurse leaders for the Exec. Each leader shared their insights on the hottest trends and challenges in nursing, and left pieces of advice for their peers. As all of them thrive in their positions, they will continue to grow in their leadership and have great impacts on the industry.
Here are eight nurse leaders that you should watch in 2025.
Click below to view each executive's full interview.
Addressing SDOH comes down to knowing the community's needs, says this CNO.
On this episode of HL Shorts, we hear from Jess Almeida, chief nursing officer at Cedars-Sinai Marina del Rey Hospital, about how health systems can address social determinants of health to improve patient care. Tune in to hear her insights.
Health systems should be careful to avoid misclassification of nurses as independent contractors, according to this law professional.
CNOs everywhere are strategizing how to fill workforce gaps left by the nursing shortage.
While navigating recruitment and staffing challenges, it’s important to look at how nurses will be brought on and integrated into the workforce. Part of this process involves making sure nurses fall under the proper worker classification, and ensuring that the hospital or health system remains in compliance with legal requirements for classification.
While nurses are often classified as full-time employees, some are designated as independent contractors, which depends on several factors, according to Richard Reibstein, head of Locke Lord's New York labor and employment practice and co-head of the firm’s independent contractor compliance and misclassification practice.
"There is no one particular situation where nurses can be legitimately classified as independent contractors," Reibstein said. "Rather, there are many different situations, and the facts are critical in determining if you are in sync with the law or out of compliance and facing IC misclassification liability."
Why independent contractors?
According to Reibstein, a nurse could be classified as an IC if their work is unsupervised or unassigned, they are not told how to perform services, they can determine their own schedule, negotiate their pay, and incur their own expenses.
Other factors include whether the nurse is free to accept or decline engagements and whether they have the right to work with multiple agencies or health systems. However, Reibstein explained, some states have more restrictive law tests for ICs than others.
"What is most important is a state-of-the-art analysis of these and other factors in view of applicable law," Reibstein said. "We look at more than 48 different factors to assess whether a worker is likely to be properly classified."
Reibstein emphasized that there are both upsides and downsides to classifying nurses as ICs, depending on the needs of a health system. The upside for IC classification, according to Reibstein, is that health systems need to worry less about compliance with the applicable federal, state, and municipal labor and employment laws that apply to employees.
However, the downside of IC classification has the potential to impact standards of care delivery.
"The downside is that the health care system engaging a nurse as an independent contractor cannot direct or control the manner in which the nursing services are being performed," Reibstein said, "if direction and control [are] important."
What about misclassification?
It’s critical that CNOs and other healthcare executives ensure that any nurses or clinicians treated as ICs must be classified properly, or there can be steep consequences.
According to Reibstein, health systems can face investigations and litigation in situations where misclassification occurs.
"They can be subjected to class action lawsuits as well as audits and investigations by state or federal workforce and tax agencies,” Reibstein said, "all leading to considerable legal exposure and liability."
To avoid these issues, Reibstein said health systems should structure their relationships with ICs in a manner that maximizes compliance with the applicable IC laws, and they should strive to meet as many as two or three dozen criteria for IC compliance.
Health systems must also document and implement the IC relationship in a compliant manner, Reibstein explained, and customize the IC relationships to meet their business model and objectives, so that the outcomes are sustainable.
"One-size-fits-all approaches are usually ill-fitting," Reibstein said, "and what may work for one health care system may not work effectively for another."
The key to success is getting to know your team, according to this CNO.
Jessica “Jess” Almeida’s background in nursing leadership spans a variety of patient care and nonclinical areas. Almeida earned her doctorate in nursing practice and her master’s in nursing from Capella University in Minneapolis, and professionally, she has led hospital-wide initiatives focused on improving communication, interdisciplinary care and operational efficiency.
Almeida joined Cedars-Sinai Marina del Rey Hospital in 2023 as associate director of Nursing Operations, and she now serves as chief nursing officer. She honed her nursing expertise over more than two decades and has extensive clinical experience working with patients in neonatal intensive care units, emergency departments and medical-surgical divisions.
Prior to joining Marina del Rey Hospital, Almeida served as the executive director of operations at Cedars-Sinai Providence Tarzana Medical Center, where she focused on quality improvement projects related to patient flow, work processes, clinical informatics and construction of the hospital’s new patient tower.
On our latest installment of The Exec, HealthLeaders sat down with Almeida to discuss her journey into nursing, and her thoughts on trends in the nursing industry. Tune in to hear her insights.
Workforce concerns go far beyond just recruitment and retention, according to HealthLeaders Exchange members.
Today's CNOs, CMOs, and other industry leaders are confronting AI, breaking down barriers to entry in education, and cultivating a sense safety in the workplace, all in an effort to create the most sustainable workforce possible. However, this work doesn't come without major challenges.
The 2024 HealthLeaders Workforce Decision Makers Exchange wrapped up last week in Washington D.C. after two days of insightful idea-sharing and compelling discussion about the most difficult obstacles in building a workforce.
Here are three key takeaways that leaders should know about workforce challenges.
The standard workforce challenges persist while others continue to pop up, according to this nurse leader.
On this episode of HL Shorts, we hear from Katie Boston-Leary, senior vice president of equity and engagement at the American Nurses Association (ANA), and HealthLeaders Exchange member, about the hottest workforce challenges that CNOs are facing right now. Tune in to hear her insights.
The HealthLeaders Exchange is an exclusive, executive community for sharing ideas, solutions, and insights.
