What keeps nurse leaders up at night?

By | 2021-05-07T15:12:01-04:00 August 23rd, 2017|Tags: |7 Comments

Nurse leaders have complicated roles and big responsibilities that may be the cause of some wakeful nights.

When I was a chief nurse, I thought I was the only one up at night worrying about what was going on at the hospital. But as the years went by, I learned I wasn’t alone in my wakefulness; many of my nurse executive colleagues had the same problem. I recall one of them, in fact, telling me she always had so much on her mind that she often had to set aside time just to worry.

Staffing was right up near the top of our worry lists, along with patient and staff safety; cost control; strategic planning and goal setting; recruitment, retention and turnover; education; quality; satisfaction; ethics; policies; and so much more. We knew they all were important and all in need of our attention.

That was a couple of decades ago. The world has changed since then, and so has healthcare and nursing. As a nurse leader in today’s world, you have a variety of new challenges to include on your worry list, from HCAHPS patient surveys and other hospital “report cards” to healthcare reform issues, new payment models, rapid changes in technology, and of course continuing mergers and acquisitions.

Hiring the right people is always on your mind, engaging and enculturating them into your staff and giving them the training they need. Their career growth and advancement are important to you.

You work hard on staffing and no doubt worry whether your nurse-to-patient ratios are correct, if your facility is providing a healthy work environment for staff and the best quality care for patients. You question if you too often need staff to work overtime or back-to-back shifts, and if that’s causing decreased workforce satisfaction rates or lowered morale. You’re concerned about staff fatigue and burnout and preventing falls, infections and medication errors.

You work hard on staffing and no doubt worry whether your nurse-to-patient ratios are correct, if your facility is providing a healthy work environment for staff and the best quality care for patients.”

And I know you worry about finances. As a chief nurse, I knew collaboration with our finance teams was very important, and today that collaboration remains crucial. Nurse leaders oversee the largest portion of the hospital budget and need to be fully conversant with organizational and healthcare financing, expenses and the bottom line. They need to have strong strategic plans based on organizational goals and resources. How many nights do you lay awake thinking about that budget presentation you’re working on, or how you’ll get the dollars you need approved?

You even worry about the future — about the impact of the aging nursing workforce on our profession, the “brain drain” it will cause in education as well as in service, and the need it will create for better succession planning and leadership training. You know that without enough nurse leaders in the hospital and educators in the classrooms, both patient care and student clinical experiences will suffer.

But at the very least, nurse leaders should be able to get a good night’s sleep, even when you haven’t solved every problem, right?

In my case, I would make up my mind to tackle whatever problem I had head on in the morning, but I knew I wouldn’t be able to sleep well until I figured out a plan. When I got to work, I’d focus right in on what needed to be done. I’d think about the different resources available to me, and who I could turn to for some answers to my questions or advice. And usually in the light of day, the problem seemed less overwhelming.

When my worrying was at its peak, I would find a quiet place to sit, think and plan. I would remind myself of the importance of work/life balance and would work on being more present when I was home. I would attend programs to update myself on current news in nursing to make myself feel more prepared for the issues I might have to face.

When my worrying was at its peak, I would find a quiet place to sit, think and plan. I would remind myself of the importance of work/life balance and would work on being more present when I was home.”

If your worries weigh heavily on your mind, consider stress reduction classes or seminars, exercising or meditation to get help through the tough times. After all, this is advice nurses give to patients every day, so why not practice what we preach?

What are some of the things that show up frequently on your worry list and keep you up at night, and what do you do about them? Tell us what you think. We’d love to hear from you!

Courses Related to ‘Stress Management’

CE424: From ‘Distress’ to ‘De-stress’ With Stress Management (1 contact hr)
A stress response causes specific biological changes, such as increased heart rate, bronchodilation, horripilation (goose bumps), increased blood pressure, increased sweat production, decreased immune response, decreased insulin and increased blood glucose. The volume of research in this area is growing rapidly, and it is safe to conclude that immune modulations caused by psychosocial stressors or interventions directly affect health outcomes. In the 2011 American Nurses Association survey of health and safety concerns, 74% of nurses reported effects of stress and overwork as their number one concern. This result is up slightly from the 2001 survey. A recent publication reports that nurses experience high levels of workplace stress with negative effects on both individual nurses and the organizations that employ them. This module provides information to help healthcare professionals manage their own stress and patients’ stress.

WEB263: The Importance of Sleep for Combatting Stress and Improving Your Health (1 contact hr)
How many times have your patients said to you, “I’m tired, but I can’t fall asleep.” As practitioners we know how important good quality sleep is for us and our patients. Environmental, physiological, and habitual factors can influence our sleep lives. Gain an understanding of the health and healing power of restorative sleep and common interferences. Discover how you can assess sleep quality and help others achieve more satisfying sleep.


Nurse.com Job Seeker

Discover how Nurse.com can help you find your next dream job.
Just sign up and wait to be paired with your perfect match.

About the Author:

Eileen Williamson, MSN, RN
Eileen Williamson, MSN, RN, continues to write and act as a consultant for Nurse.com. Before joining the company in 1998, Eileen was employed by North Shore-Long Island Jewish Health System in New York (now Northwell Health System) where she held a number of leadership positions in nursing and hospital administration, including chief nurse at two of their System hospitals. She holds a BSN and an MSN in nursing administration and is a graduate fellow of the Johnson & Johnson University of Pennsylvania Wharton School Nurse Executives program. A former board member and past president of the New Jersey League for Nursing, a constituent league of the National League for Nursing, Eileen currently is a member of the Adelphi University, College of Nursing and Public Health Advisory Board.


  1. Avatar
    Biji Balan August 28, 2017 at 5:39 pm - Reply

    Very nice Article Eileen, just not for the nurse leaders, but for anyone who is climbing the leadership ladder..

  2. Avatar
    Terrie Watson August 28, 2017 at 7:40 pm - Reply


  3. Avatar
    Muzamil September 3, 2017 at 2:33 am - Reply

    very nice………

  4. Avatar
    Ayorinde mojisola September 7, 2017 at 7:22 am - Reply

    Intact you got me up,you are hooked to the corner when your administration seems not to understand your needing staff (nurses)

  5. Avatar
    Liz Mangold September 13, 2017 at 12:53 am - Reply

    After 25 years in hospital nursing administration, I retired. No more sleepless nights, no more 24 /7 call, no more upset yelling physicians and no more corporate undermining and other games, no more unrealistic regulations and nightmare surveys. I love my patients and I love my work but I don’t miss the baggage and stress that came with it.

  6. Avatar
    Linda McCallister September 14, 2017 at 11:49 pm - Reply

    “When I was a chief nurse, I thought I was the only one up at night worrying” resonated so deeply within me. I too was a CNO who constantly tried to juggle home and family with my own ever changing worry list priorities: yes, patient safety, staff safety/satisfaction/retention, budget, business goals and planning, quality measures, making patients AND clinicians AND medical staff happy AND safe all at the same time, laws and ethics, public policy, local politics, national quality metrics, and on and on and on. And then my hospital was closed, and I found myself wondering what I wanted to do next, because most certainly, as sad as I felt about the hospital closing and all of those wonderful employees have to start anew somewhere else, I ultimately felt relieved that I was forced into taking a hard look at what I really wanted from life. That was more than 15 years ago, and today’s climate is even more intense. I miss the camaraderie of my colleagues. I miss knowing that I made a difference in the lives of patients and their families, and for nurses. I miss the intellectual challenge of collaboration with multiple disciplines to resolve issues. I miss watching the children of my colleagues grow and mature into the fine people they are today. I do not miss the stress of trying to achieve the impossible goal of being all thing to all people. I now am challenged in a completely different area of regulated healthcare, and as I approach the end of my career I will have the satisfaction of knowing that in this newer adventure I have the opportunity to make a huge difference for future clinicians and patients for many years to come. I hope and pray that today’s nurse executives will also make a difference for today’s clinicians, that they will then be able to carry these differences into their own leadership positions and continue to make the provision of patient care the remarkably rewarding experience it can be.

  7. Avatar


    Thank you for this excellent article! I am a nurse practitioner and healthcare architect. I am currently focusing on ways to improve sleep for patients and staff. I would love to connect with you and interested readers on this topic.

Leave A Comment