Job dissatisfaction and turnover are growing concerns in the U.S. nursing workforce. Nearly 30% of nurses considered leaving the profession in 2021, compared to 11% in 2020, according to Nurse.com's 2022 Nurse Salary Research Report. And in the March 2022 COVID-19 Impact Assessment Survey, the American Nurses Foundation and the American Nurses Association reported that more than half of nurses were thinking about leaving their jobs because of insufficient staffing, negative effects on their health from work, and an inability to deliver quality care. Among the potential solutions for these workforce challenges is effective leadership by strong nursing leaders who make their nurses feel valued and respected at work. "Creating safe, empowering, and healthy work environments" is a complex issue leaders need to address, according to a statement on the ANA's website. And although the need for healthier work environments has been an issue since well before the unrest caused by the pandemic, COVID-19 brought nurses to their breaking points. Nurse leaders and nurses who aspire to become leaders should keep abreast of all the issues that affect the profession and what nurses want and need, so they can find ways to address issues, support nurses, and keep their teams intact. Let's discuss what nurses want.
Nurses want shared decision making
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Felicia Sadler, RN[/caption] Transparency in the hospital setting, as well as shared decision making or shared governance, can improve nurse satisfaction, write the authors of the book Nursing Shared Governance. The authors define nursing shared governance as shared decision making between bedside nurses and nurse leaders about everything from resources and evidence-based practice projects to staffing. But there's more to it than having a voice, according to Felicia Sadler, BSN, MJ, RN, CPHQ, LSSBB, Vice President of Quality for Relias. "Nurses want to be heard and know they have been heard," she said. Shared decision making was challenging during the height of the pandemic when hospitals were dealing with unknown variables and were forced to pivot and make decisions in real time, according to Sadler. The good news at many hospitals and healthcare systems is that the pandemic brought to light the need to be flexible and agile in their decision making, but with added input from front-line teams. COVID-19, in essence, created an opportunity to gain insight and promote meaningful change, said Sadler. Among the specific issues that nurses say is a decision in which they have little say is staffing with travel or contract nurses. "Having been on the front lines, support from travel and other nurses during a time of crisis can be helpful," Sadler said. But it can also be a challenge to staff nurses and hospitals, alike. In a March 23, 2023, correspondence to the House Ways and Means Committee, Lisa Kidder Hrobsky, Senior Vice President, Advocacy and Political Affairs at the American Hospital Association noted: "It is unstainable for hospitals to continue to make up workforce gaps through staffing agencies in light of the exorbitant costs associated with these short-term workers. The financial burden of relying on travelers reinforces the financial stress that challenges hospitals' ability to recruit a more stable, long-term workforce." Healthcare organizations are responding by developing strategies to offer staff nurses better pay and more flexibility.
"Some health systems have created their own travel divisions," said Sadler. "They've enhanced their float pools to allow more autonomy and flexible work schedules for nurses. Post-pandemic, we are now seeing many travelers come back as staff nurses because they want that stability in their schedules and want to be part of the culture."
Christus Health is one example of a health system that created an internal travel program post-pandemic, according to an article in Beckers Hospital Review. The Texas-based nonprofit organization has about 45,000 employees internationally, and the travel program allows nurses in the system to take assignments at different Christus locations. According to the article, Texas used federal money to pay temporary healthcare workers during the pandemic. When the state began demobilizing temporary workers, Christus stepped in and offered its program to temporary nurses who were slated to leave the health system. "Workers in the Christus program typically take 12-week assignments, though the assignments can be modified based on the needs of travel nurses and facilities. The health system pays the workers' travel fees, and those in the program have access to Christus benefits," according to the article.
Nurses want a safe space to speak freely
Nurses need the psychological safety of being able to express concerns to leaders without fear of retribution, according to Sadler. Sadler gave the example of a nurse who has a high acuity load of five patients, with two or three patients just back from the operating room and one who is receiving a blood transfusion. A nurse who lacks the bandwidth to care for those patients safely must be able to talk it through with their leaders. Nursing leaders must make themselves available to listen and offer support and resources. Team huddles should also be a safe space for nurses, said Sadler. "The point is to freely express our concerns and be involved in the decision making to address those concerns," she said. "I think that's just as important. It all goes back to shared decision making and shared governance."
Nurses want leaders who take action
Sadler says when she was a front-line nurse, the nurse leaders who made the most positive impressions were visible, present, and involved with staff nurses. "They were mindfully present, meaning they were not just there to check a box," Sadler said. And the reason Sadler was able to determine that these leaders listened was because they acted on what she and her nurse colleagues shared. A nurse leader might not be able to fix every problem, but by doing their best to act on a staff nurse's concerns and being transparent about their efforts and the results, the leader shows their commitment to addressing the staff's concerns, Sadler explained.
Nurses want leaders who'll walk in their shoes
Nurses want nurse leaders who know, by experience, what work life is like on each unit at any time of day, which goes back to being present, visible, and accessible, according to Sadler. Nurse leaders should be visible on each shift, at some point. They should also meet with nurses individually or in groups on every shift to get their input and feedback. "I would call those intentional check-ins with front-line staff," Sadler said.
Nurses want (and deserve) genuine recognition
Nurses want to be appreciated. "It's not that they have to have a pat on the back all the time, but they certainly want to be recognized for the work they do and the visible impact they make with their work as individuals and as a team," Sadler said. Recognition for individual nurses should be meaningful, and leaders should recognize exactly what nurses did to make a difference, according to Sadler.
"When we think about transformational leadership, it's really providing that meaningful feedback -- specifically calling out how they made a difference in a patient's life, with a patient's family, or with their colleagues," Sadler said.
What nurses can do to get what they want
Just as they advocate for patients, nurses should also advocate for what's important to them in the workplace, according to Sadler. Nurses can work on enhancing their communication skills, which will help when they present challenges and successes to leadership. It's also helpful if they offer solutions, she said. Nurses can gather data or research to show why a suggested change would improve conditions such as workflow, patient care, or the bottom line. "If you're presenting a case for change, make sure you've done your research and present the data because that is what your leader is going to look at," Sadler said. Prepare for your nursing certification examination with our self-paced certification review online modules and comprehensive Focused CE courses.
