The expectations of nursing have changed drastically in recent years, and CNOs need to pivot their strategies to sustain their workforce.
HealthLeaders spoke to Melanie Heuston, chief nurse executive at WVU Medicine and HealthLeaders Exchange member, about how CNOs can keep up with changing workforce expectations and support their nurses. Tune in to hear her insights.
The HealthLeaders Exchange is an exclusive, executive community for sharing ideas, solutions, and insights.
Changing expectations have led to a trend of new nurses leaving their jobs.
Many things have changed in healthcare in the past few years, since the beginning of the COVID-19 pandemic and the implementation of new technologies and workflows.
Recruitment and retention have become increasingly more difficult for CNOs and other nurse leaders, as both new graduate nurses and tenured nurses are leaving the workforce at alarming rates.
Here are some of the reasons why new graduate nurses are leaving their jobs.
The key to recruiting and retaining new generations of nurses is strong mentorship, onboarding, and support programs, according to these nurse leaders.
While healthcare changes, so do the expectations of the workforce.
Newer generations of nurses are expecting more technology, flexibility, and reassurance from management, and without that setting, many new graduate nurses are choosing to leave their health systems or leave nursing entirely.
CNOs need to pivot their strategies to meet these new expectations, while balancing the needs of their organization.
According to Melanie Heuston, chief nurse executive at WVU Medicine and HealthLeaders Exchange member, and Gloria Carter, vice president and chief nursing officer at St. Mary Medical Center and HealthLeaders Exchange member, there are several strategies that CNOs can use to improve the recruitment and retention of new graduate nurses and tenured nurses.
Mentorship and support
CNOs must ensure that the work environment is supportive of both new and tenured nurses, with plenty of opportunities for career advancement and mentorship.
Carter explained that the first step is to support the nurse leaders who will be managing new graduate nurses and facilitating their introduction into the organization.
"Mentoring includes ongoing communication, engaging with their staff and having that presence as a leader to establish and maintain a rapport with the new graduates is critical to their success," Carter said, "so that you have awareness what is contributing to them staying in the organization or leaving] …and hopefully you can help support them through the latter to avoid them exiting the organization."
Heuston recommended implementing preceptors and training to support new nurses, while also focusing on making sure that the tenured nurses doing the training are recognized.
"You've got to focus on the retention of your senior staff," Heuston said. "The very first thing I did was talk to senior nurses to see what was difficult for them, and they felt really unrecognized for the work of training new nurses."
Heuston said the solution was building the training into the clinical ladder, in a program called CAPE, which stands for clinical advancement for professional excellence. Within the program, nurses can move up a level and get extra compensation added to their base salary for preceptoring and mentoring. The nurses also receive training on how to function in a training role.
"I felt like really acknowledging the senior staff who are putting that time and energy into training, and training, and training new people and new nurses," Heuston said, "and really being attuned to the newer nurse."
At St. Mary Medical Center, they have students who use the hospitals as part of their clinical rotation, which provides a first impression of the organization and work environment.
"This provides an opportunity for all nurses to mentor future nurses to gain the confidence and skills necessary to develop their clinical expertise," Carter said. "We have to take time to ask and answer questions to ensure we are creating a great learning experience for potential employees."
According to Carter, leaders also have a role in creating a first impression by being visible and approachable for students who are seeking guidance.
"Being visible is extended outside of the hospital with our academic partnerships and community events," Carter said. "Our facility also precepts graduate and doctoral students to ensure we provide opportunities for all future healthcare careers.
At WVU Medicine, Heuston said they piloted an Aspiring Nurse program, in partnership with academic institutions throughout West Virginia and the surrounding states. The goal of the program is to take into consideration the social determinants of health and to give nurses the support they need to continue their education.
"We selected really good partners and developed a contractual agreement with them, where we gave five thousand dollars a semester with absolutely no strings to how they spend it," Heuston said. "What we needed in exchange [was] we developed a role where we had mentoring for them on a monthly basis to the organization."
The CNOs at WVU Medicine will interview each candidate to develop relationships with them early on. Once the students are in the program and go through a signing ceremony, they become integrated into the health system's culture, Heuston explained, and leadership follows up with them on a monthly basis and students can receive support tailored to their needs.
"We rolled it out to our health system, and we have nearly 250 nurses in that program that we know is a guaranteed pipeline," Heuston said, "and there are nurses now going to school that would not have normally gone."
Onboarding
Another key strategy for CNOs is placing nurses within the right departments and making sure that the onboarding process is smooth and efficient.
At St. Mary Medical Center, Carter said the nurses join the workforce in one of the following ways, experienced nurses, new graduate nurses or transition to new specialty. Carter explained the transition program option affords nurses the opportunity to train in a different specialty.
The most common pathways for transition nurses are telemetry to the intensive care unit or telemetry to the emergency department.
"Transitional nurses are highly motivated to make this change," Carter said. "It's the same onboarding process that is provided to the new grads, with less precepting time based upon their previous clinical experience."
"Similar to our nurse residency program, the transition program includes class time and clinical experience in the patient care area," Carter continued. "Training is supported by a preceptor, residency coordinator, department staff and leaders. There are learning modules and additional class time to support their learning."
Carter said the outcomes of this program have been positive, and that the transitional tracks support nurse retention by allowing the nurses to train in new specialties and transfer to another department within the facility.
"It's more important that they stay within the hospital as a whole," Carter said. "It's fine if they want to move from department to department, but as long as they stay at the organization that's the greatest benefit to the facility and the community."
At WVU Medicine, Heuston recommends switching focus to making nurses excited about joining the med-surg units.
"Med-surg nursing is really where we need the nurses, where we need to recruit to, and make the better work environment," Heuston said. "We’re really focusing this graduation class on in-depth clinical experiences in med-surge environments that are welcoming and excited to have them."
Heuston said it's the CNO's job to then give nurses a great clinical ladder to climb so that they want to stay in the field.
"The new generation [wants] to continue to develop and see themselves advance in their career and not have to wait 20 years," Heuston said. "[Not] every nurse [has] to go to CRNA school or nurse practitioner school to advance their career, because all of us need good med-surg bedside nurses that are going to take care of us when we're sick."
This is part two of a two-part series. Read part one here.
The HealthLeaders Exchange is an exclusive, executive community for sharing ideas, solutions, and insights.
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Nursing and the expectations of the job have changed drastically in recent years, and CNOs need to understand why to pivot their strategies.
Many things have changed in healthcare in the past few years, since the beginning of the COVID-19 pandemic and the implementation of new technologies and workflows.
Recruitment and retention have become increasingly more difficult for CNOs and other nurse leaders, as both new graduate nurses and tenured nurses are leaving the workforce at alarming rates.
According to the American Nurses Association, almost 18% of newly licensed registered nurses (RNs) quit their jobs within the first year. A 2024 study found that new graduate RNs are leaving for a multitude of reasons, including their age, health status, supervisor and peer support, job demands, job competence, organizational commitment, job satisfaction, and work environment.
Why are nurses leaving?
Melanie Heuston, chief nurse executive at the WVU Medicine and HealthLeaders Exchange member, explained several additional reasons for this departure from the workforce, including the attitude toward nursing on social media.
"Social media has not been our friend," Heuston said, "I think it's absolutely been a place where people can talk about the negative and not necessarily the positive."
Heuston recommended that health systems focus more on social media and use strategies to improve the nurses' experiences.
"I do think that we as leaders need to own the work environment and I think that there's been some bullying in nursing, which I'm not proud to say," Heuston said, "but it's there, and we've got to get strategies to get that under control."
Heuston also cited the nursing shortage, and how more nurses are necessary to create a better work environment.
"It's a little bit of a chicken and egg problem," Heuston said, "you need more nurses to make the work environment better, as it's one of the ingredients."
According to Gloria Carter, vice president and chief nursing officer at St. Mary's Medical Center, and HealthLeaders Exchange member, another contributing factor is the prioritization of work-life balance.
"It's not just the new nurses, I think overall individuals have learned about having resiliency and focusing on work and life balance," Carter said. "I think when you look at it from that lens, there are individuals that are saying 'I need to be mindful and take that time out for me.'"
Changing expectations
Additionally, there has been a generational shift in what to expect from nursing as a profession, according to Heuston. New generations of nurses want to take advantage of new technologies to advance their nursing practice.
"They want the ease of technology," Heuston said, "and we need to be better at responding to that."
Along with many other organizations, Heuston said that WVU Medicine has piloted virtual nursing to support their nursing staff.
"I like to actually call it virtual patient care, so nurses don't believe we're replacing nursing, we're trying to support it," Heuston said. "It's warmly received by newer nurses. In fact, they're starting to expect it."
Heuston also explained that new nurses want to have a supportive environment where nurse leaders check in frequently and deliberately, and provide feedback.
"Generationally, I think that is more the expectation," Heuston said, "to get a lot of feedback, both positive, and what we need to do to improve."
Building resiliency
CNOs are in the position to bridge the gaps between new expectations and the realities of nursing, which involves building resiliency among new graduate nurses while also improving the work environment.
Now more than ever, according to Heuston, nurse managers have been acting as coaches and counselors due to more generational anxiety and depression caused by the COVID-19 pandemic.
"I think equipping [nurse managers] with better tools to be in that role, because they weren't trained to be in that role," Heuston said, "I think we could do better at getting more resources for them to be better."
For nurses, Carter said it's all about having awareness and accessing your support systems.
"It's also [about] connecting within the community and networking with your friends and family, and just bringing awareness and being open to having the dialogue about what you need individually," Carter said. "Then also being a part of that solution in terms of communicating for others that may be having similar challenges."
St. Mary's Medical Center has implemented a wellness app that nurses can use to track physical activities, such as walking, strength training, and other exercises, and obtain nutrition recommendations and other wellness practices that focus on mental and physical well being.
"Participants receive points that accumulate for submission for a reward card of their choice," Carter said.
Heuston suggested using podcasts, since many nurses engage with that medium rather than old fashioned communication methods.
"I'm very interested in doing [a podcast] with a younger generational nurse who can help to educate me on the needs of the workforce," Heuston said. "I think it's [about] being open to all the wellness support that we can offer our staff other than just a relaxation room where they don’t even have time to go, or putting structures in place where they can go there and feel like they can recharge."
This is part one of a two-part series. Part two will be published Monday, September 30, 2024.
The HealthLeaders Exchange is an exclusive, executive community for sharing ideas, solutions, and insights.
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The nursing industry is always changing. With the introduction of new technologies, new generational needs and values, and innovative ideas about recruitment and retention, it seems like there are always new disruptors and challenges that CNOs have to face.
Dr. Kathy Boyle, chief nursing officer at Denver Health, and associate CNO, Dr. Natalie Nicholson, have been implementing new programs over the last several years that tackle these disruptors and improve the overall wellbeing and environment for their nurses.
To address staffing concerns, Denver Health has started offering a hybrid work model for nurse leaders, and nurse apprentice programs to focus on recruitment and retention.
"Our nurse leaders can work from home a day a month, or every two weeks," Boyle said. "We are now researching this intervention through first qualitative research to see the impact on our nurse leaders, and then now we're studying the impact on staff."
"[The nurse apprentice program] has been a really big support not only to the staff," Nicholson said, "but it has created a pipeline to getting student nurses within the Denver Health walls."
To boost nursing education, the health system has placed over 2000 clinical placements since the start of their longitudinal clinical placement program, Boyle explained, with the intent to continue key partnerships with nursing schools and to support students in their careers and entry to practice.
Nicholson added that Denver Health also has programs that encourage high school students to come into the medical field and help them continue their nursing education and careers.
"In the end, I think what we are encouraging here with our nursing profession is that continuous learning," Nicholson said, "we should never stop learning and we want to support and encourage and grow our nurses in the way that they would like."
Listen to this week's episode of the HealthLeaders Podcast to hear more on how Boyle and Nicholson plan to keep tackling disruptors and improving the experience of their nursing workforce.
