A Longitudinal View of Nursing Leadership – Daily Nurse

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At this time in history, the American nursing profession and its leadership are in a state of flux. The November 2023 American Organization for Nursing Leadership (AONL) Nursing Leadership Insight Longitudinal Study leverages nursing leaders’ perspectives to shed light on where we are and where we’re headed as a nursing collective.

In coordination with the AONL Foundation and Joslin Insight, five longitudinal studies have been conducted since 2020. The collective data are a fascinating avenue into the hearts and minds of nursing leaders and how they perceive the healthcare industry and nurses’ places in it.

Leadership Identifies Top Challenges

According to the 2,477 nurse leaders surveyed for the current AONL study, the top ten challenges facing the profession are:

1. Staff recruitment and retention
2. Emotional health and well-being of staff
3. Financial resource availability
4. Workplace violence, bullying, and incivility
5. Communicating and implementing changing policies
6. Maintaining standards of care
7. Health inequity, social determinants of health
8. Travelers, contingent workforce
9. Adopting new technologies and innovation
10. Surge staffing, training, and reallocation

The graphic representations of the more detailed findings from these ten challenges reveal nurse leaders who fall along a continuum of self-perceived success in addressing such real-world issues.

Emotional Health and Workplace Behavior

Focusing on workplace behaviors such as violence, bullying, and incivility, 68% responded that they had witnessed one or more incidents of bullying at work. In terms of having seen one or more incidents of violence, 53% said they had. When it comes to incivility and intimidation, a stunning 77% and 72% had witnessed such aberrant behavior, respectively.

AONL concludes:

Nurses frequently encounter verbal abuse, physical assaults, and other forms of violence and intimidation from patients, patient families, the public, and coworkers, including physicians, other nurses, administration, managers, supervisors, faculty, and other staff (Figure 6). This hostile environment not only jeopardizes the safety and well-being of healthcare workers but also impacts patient care. The rising instances of workplace violence can lead to increased stress, burnout, and a sense of insecurity among healthcare professionals.

Addressing workplace violence, intimidation, incivility, and bullying requires comprehensive strategies, including enhanced security measures, de-escalation training, fostering a culture of safety, and providing trauma-informed care to healthcare workers. It also requires advocacy to raise broader public awareness.

Assessing nurse leaders’ emotional health, whereas 44% rated themselves as emotionally healthy in 2021, 52% now see themselves as such, and the number who viewed themselves as emotionally unhealthy dropped from 14% to 11% as we get further from the height of the COVID-19 pandemic.

The researchers state:

Regarding emotional health, there has been a slight improvement from last year. However, the data still shows a mix of emotional health states, ranging from very emotionally healthy to not at all emotionally healthy….. It’s crucial to recognize the need for continued efforts to support nurse leaders, especially nurse managers who fare worse in cultivating and maintaining healthier emotional well-being. Creating a nurturing environment for nurse leaders is vital to ensure their resilience, support, and effectiveness in their roles. 

Intent to Leave

Attrition from the nursing profession and the attempt to retain top talent continues to be a struggle. Reports of nurses’ intent to leave either a current position or the profession as a whole are constantly troubling, especially in light of the ongoing nursing shortage that can be found in many healthcare labor markets around the country.

The AONL longitudinal study reveals the following:

This survey shows a marginal improvement in nurse leaders’ intent to leave with a 5% decrease in those planning to leave from 2022 to 2023. The survey examined intent to leave based on roles. The largest cohort of nurse leaders reporting intent to leave exists in the C-Suite with 15% of CNOs/CNEs planning to leave their positions within the next six months, contrasting with 12% of managers and 10% of directors. Among nurse leaders contemplating leaving, a notable 25% report considering leaving nursing altogether. Previously, 27% of respondents reported considering leaving nursing altogether.

The most often reported reasons for nurse managers and CNOs/CNEs leaving their roles include:

1. The negative impact of work on health and well-being
2. Pursuit of new opportunities
3. Challenges with other leaders or colleagues

Identified strategies for nurse leader retention include facilitating time off for work-life balance, opportunities for professional growth, and the perception that the employing organization understands leaders’ concerns, cares for their well-being, acknowledges and responds to their concerns, notices their contributions, and takes pride in their accomplishments. In fact, employers would do well to enact these strategies universally for all staff consistently in the interest of retention and employee satisfaction.

Conclusions Abound

Many conclusions can be made from the data available from the ongoing series of AONL longitudinal studies. As AONL concludes, there is a “nuanced landscape for nurse leaders, tracking shifts in their challenges and perceptions since July 2020”, with a focus on well-being, retention, financial resources, and workplace violence.

This study demonstrates the need for interdisciplinary collaboration, innovative solutions, and consistently addressing challenges of staffing and retention. And while cookie-cutter solutions can sometimes be helpful, progressive and forward-thinking healthcare organizations would be prudent to create tailor-made solutions based on their challenges on the ground.

The researchers’ conclusions say a great deal regarding what lies ahead:

In conclusion, while certain issues have shown improvement over the course of this survey series beginning during the pandemic in July 2020, nurse leaders continue to face complex challenges. Addressing work-life balance, navigating staffing shortages and innovating models of care remain pivotal. This requires a blend of strategic interventions, policy support and inclusive organizational cultures to strengthen nursing’s future and, ultimately, improve the equitable delivery of quality patient care.

Keith Carlson, BSN, RN, NC-BC has been a nurse since 1996. As a holistic career coach, nurse podcaster, writer, blogger, and well-known motivational speaker, Keith empowers nurses regarding personal branding; professional networking; entrepreneurship; resume, job search, and interview strategies; emotional and relational intelligence; personal wellness; and the building of a dynamic nursing career. Keith happily resides in Santa Fe, New Mexico with his fiancée, Shada McKenzie, a gifted and highly skilled traditional astrologer. He can be found at NurseKeith.com and The Nurse Keith Show podcast.

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