Alternative Care Models in Midst of a Nursing Shortage

A combination of patient surges in 2020-2022 and nursing shortages have forced healthcare organizations to pursue new strategies for care delivery, or alternative care models. Pre-pandemic care models are stretching thin during a nurse shortage, so many U.S. health systems are rethinking their labor resources.

Health systems are deploying alternative care models to address a nursing shortage, and its all-hands-on-deck! Team-based care is becoming a new reality. Team nursing allows for clinicians with varying skill levels to collaborate in providing patient-centered nursing care.

A team-based care approach brings together RNs, unlicensed assistive personnel, and LPNs with other disciplines (including physical therapists and rehab therapists.) By distributing appropriate duties to LPNs, UAPs, and less-experienced RNs under the direction of an experienced RN, a team-based care model has shown it can enable care settings to do more with less. Each unit will have to determine how many patients the experienced nurse/team leader can handle based on the acuity and number of patients.

A Case Study – Advent Health Celebration

Advent Health recently completed a study that looked at integrating LPNs to help nurses with care delivery needs (Click Here – The Impact of an Innovative LPN-RN Care Delivery Model). LPNs were hired into the acute care setting to work on a team-based nursing care model alongside RNs. Previous research provided evidence that LPNs’ unique skills can address escalated workloads, as well as enhance clinical outcomes and the quality of care provided.  Advent Health’s research is evidence that implementing a new care delivery model can help address staff resource issues and provide adequate patient care.

Advent Health’s study also revealed that the model of care enhances the nurses’ work environment in the areas of autonomy, control over practice, and teamwork. Several campuses within Advent Health have now implemented LPN-RN programs. It will now start to develop standardized processes to train and orient more LPNs to enhance this model. There is some evidence that LPN models are not as effective in fast-paced/high turnover environments as those with longer patient stays, but the health system will continue to monitor this.

Besides altering care delivery to include unlicensed staff and moving to team-based care delivery, here  are two other tactics to help fill in care gaps and minimize effects of a nurse shortage:

Cross-Training + Float Pools of Nurses/Staff

Hospitals are cross-training nurses in non-critical areas to fill labor needs on the critical care areas. Float pools can help to manage this issue. Utilizing and cross-training float pools can help redeploy labor resources easier and fast. This more agile labor model involves cross-training a pool to work across adjacent specialty areas and as a backup, having the full-time staff cross-trained to work across adjacent specialties in an emergency situation. This interdisciplinary team-based approach allows for rapid deployment of staff to areas of high need. Besides just helping with labor needs, when a hospital has more nurses trained to work in adjacent areas, it’s more feasible for staff to take time off and recharge.

If hospitals are only relying on staffing agencies to fill all vacancies it can be unsustainable and costly. Agency staffing should be used to fill in gaps, not the pillar for staffing an organization. For extra hands-on-deck, future care settings will likely collaborate with nursing schools and training programs (or even state and local governments) for unlicensed providers to increase the talent pool where the needs become urgent.

Strategic Investments in Staffing Data and Tech

Health systems are adding tech tools to handle labor-some tasks more efficiently. This includes robotics, telehealth, mobile-first technology, plus using professionals with specialized skills to minimize the supply issue.

Scheduling technologies allow for shift and vacation bidding to help balance personal and work life. Some acute care hospitals rely on manual scheduling models when handling day-to-day staffing needs, so this technology could be used more frequently.

Nurse leaders are saying that data is essential to adequate staff planning. It can help predict how many nurses are needed per shift/unit, minimize nurse frustration regarding assignments, identify staff issues such as burnout and weekend duty, and help justify budget requests.

For hospitals and health systems interested in nursing retention and healthcare career pathways, Catalyst Learning offers a variety of workforce development tools for your frontline team.  Contact us at or 502-584-7337. 


“The Impact of an Innovative LPN-RN Care Delivery Model,” Advent Health Celebration, Marie L. Desir MSN, RN, CCRN-K, Deborah Laughon MSN-Ed, DBA, CCRN, CENP, AONL National Conference 2022

“Nursing’s Wakeup Call: Innovative Approaches to Talent, Technology, and Care Models,” Health Leaders Media, Anne Dabrow Woods DNP, RN, CRNP, ANP-BC, AGACNP-BC, FAAN, April 22, 2022

“The nursing shortage demands boldness and creativity. Now.,” Wolters Kluwer, April 1 2022

“Building Capacity in a Pandemic,: An Alternative Staffing Model,” AONL, Laura Jansen, MSN, RN, CNML, Kelly Poskus, MS, RN, CNRN, Jeannette Bronsord, DNP, RN, NEA-BC,  Sept. 2020

“Bringing Back the Team Approach: It’s Time for Alternative Staffing and Onboarding Models,” Lippincott NursingCenter, Anne Dabrow Woods, DNP, RN, CRNP, ANP-BC, AGACNP-BC, FAAN, March 26 2020

“Cross-Training for Workforce Resiliency,” Minority Nurse, Michele Wojciechowski, September 14 2021

“Nursing’s Wake-up Call: Change is Now Non-Negotiatble,” Nursing Workforce Survey, UKG/Wolters Kluwer, Nursing Workforce Survey – Nursing’s Wake-up Call: Change is Now Non-negotiable (

How Can I Be The Boss No Nurse Wants To Leave

This article is a summary of a digital workshop given by Rose O. Sherman and Catalyst Learning Company on 9/1/2021. Ms. Sherman’s presentation was titled “Become the Boss No One Wants to Leave: Nurse Recruitment in Turbulent Times.” Catalyst Learning sponsored the event in recognition of the heroic role that nurses played in the U.S. in 2020 and 2021.

Across the U.S., nurse leadership is struggling with unprecedented staffing shortages and high turnover. COVID-19 has been a ‘Quake Experience,’ a massive life change with aftershocks that will likely last for years. Nurses have experienced an impact both personally and professionally, leading to stress, burnout, exhaustion, hopelessness, and some disengagement. Nurses and other health staff may be reconsidering their professional lives, asking questions like “am I really supposed to go back to work like nothing happened?” “What is my economic worth, and am I respected?”  “Is acute care the right setting for me? Have I found the right work-life balance?”

In the midst of this nursing workforce landscape, nurses are leaving the hospitals and systems they work for. While burnout, stress, inadequate staffing and better pay may get more attention and headlines, a major reason that nurses leave organizations is lack of good leadership. A lack of leadership doesn’t just mean the nursing VP. All levels of leadership, including the Charge Nurse, play a key role in retention. Nurses look for stability, trust, compassion and hope from their leaders. Younger nurses especially have different work demands than their more experienced peers, with needs evolving from paycheck to purpose, from wanting a boss to wanting a coach, and they look more for frequent feedback than annual reviews.

So given this new reality, how can I be the boss that no one wants to leave?

Focus on a Healthy Work Environment, plus Focus on Unit and Team Culture

Unit culture is an invisible architecture that new staff sense quickly. To have a healthy work environment, Nurse Managers and Charge Nurses set the tone. Make sure these frontline leaders encourage nurses to ask questions, make nurses feel appreciated, and listen to staff concerns. Nurse leaders who inspire staff generally have a strong bias toward taking action to correct situations, are vulnerable and compassionate toward staff, and manage conflict and diversity of ideas well.

Teach frontline nurse leaders to have zero tolerance for disrespect and abuse. A Charge Nurse who sees and ignores incivility or bullying has just normalized the behavior. Staff then either become part of the hostile workplace or leave entirely.

What is something nurse leaders can do quickly to help with culture issues? Consider bringing back an old ritual, or even start a new one. During COVID madness, many teams lost the rituals that connected nurses to the team and created a psychological safety net for the unit.

One last thought to help with work environment is to create a culture of recognition. Give symbolic gestures to show that leaders appreciate nurses. Begin shifts with “thank you for being here,” nominate your staff for awards, write thank you notes, and attend events where staff are being recognized. If your managers and Charge RNs see you doing this, they will likely follow your lead.

Do what you can do to encourage group cohesion and stronger work teams, remember that a toxic culture will destroy the best plans. Focus on work culture will help make leaders that staff do not want to leave.

Develop Charge Nurses to be Unit Cohesion Leaders

Organizational loyalty is cemented through relationships with supervisors, managers, Charge Nurses and team members. Many nurses don’t leave a health system, they leave their first-level supervisor. Develop your Charge RNs to be unit leaders, by teaching critical thinking, delegation, effective communication, conflict management, leading through change, and other qualities for successful leadership. Charge Nurses are the first-level supervisors who play a role in retention, onboarding, coaching, plus of course patient experience and safety.

Be Flexible to Meet the Needs of Your Staff – Be a Coach for Younger Nurses

Older nurses are retiring fast, and even Gen X makes up barely a quarter of the nursing workforce. Gen Y and Gen Z make up 60% of the nursing workforce now. As a leader, don’t wait for these Millennials to grow up and become Baby Boom or Gen X nurses. It is not going to happen. Be flexible in your leadership style to meet needs of younger staff. Be as accommodating as possible with work schedules for example. Also be flexible in your leadership style by trying to think more like a coach than a boss. Younger nurses think more about purpose than prior generations, so show young staff how their role contributes to the mission of the organization.

Lifetime employment is not the goal of most nurse staff today. Staff are more likely to see their jobs as “tours of duty” on a professional career ladder. To show support for Millennial and Gen Z nurses, support nurses’ career goals and do not give any perception that you may hold associates back from moving to the next level. Ask your nurse staff questions to aid their career development with questions like: “what goals do you have,” “what types of professional roles have you considered,” “what obstacles are you encountering,”  and “what new skills do you want to achieve.” Consider using a Career Development GROW® Model Coaching Template with nurses to show you value their career trajectory.

Communication is Key, Especially During Turbulent Times

In complicated times, transparent communication and visibility is key. When leaders don’t communicate, staff will fill in gaps with misinformation. Nurse leaders should practice effective communication during practice and policy changes, consider diverse communication styles among different staff, and choose the right words and tone for communication. If leaders do not communicate effectively it can lead to gossip, mistrust, perceptions of staff favoritism, and staff can become defensive.

The correct communication tone and style can be difficult even during ‘normal’ times, but it is even more critical when staffing is short. When there are staffing issues, make sure leaders are transparent about the challenges the team is facing. Make sure leaders are transparent about recruiting tactics that have been tried, ask for staffing ideas from the team, and acknowledge that nurse leaders do not have all the answers. It may be a difficult message, but staff will appreciate honesty, and may even be able to help.

STAY Interviews and Strategic Off-Boarding

STAY Interviews are a way to help with avoidable turnover. Aim to do at least 2 each year per nurse, the first one within 90 days of hiring. After this interview, note the actions that you will take and the actions the nurse/staff member will take. After this interview, use a stoplight method to assess risk of turnover, with green being likely to stay 1+ years, yellow to likely stay 6-12 months, and red a high risk for immediate loss. Ask questions like “what do you look forward to each day,” “what are you learning or do you want to learn,” or “how can I make your job better or want to stay?” Even if you are likely to lose an employee in their current role, you may find other internal roles that may be better professional fits. STAY interviews can help with internal mobility which reduces recruitment costs, and keeps high-potential staff in the organization.

If and when nurses do leave, stay upbeat and positive. Thank them for their contributions, and remember that other staff will watch how you manage resignations. When valued staff resign, think about how to create loyal alumni who will recommend your organization, and leave the door open for boomerang employees.

Catalyst Learning produces the curriculum NCharge™: “Nurses Learning to Lead” for Charge Nurses, which is available for on-site or virtual instruction.

1st Year Nurse Turnover is High – Is Your Organization Actually Contributing to It?

Hospitals are struggling to hold on to all nurses, but especially the new ones. Eighteen percent of new nurses will change jobs, or even professions, within the first year after graduation. An additional one-third leave their organizations within 2 years. Nursing turnover can be extremely costly for health systems. Besides just the hard cost of recruiting and onboarding, it is hard to build a nurse leader pipeline when there is fluctuating talent being brought up within the system.

1st year nurses may be talking to their nursing school peers, and hearing about better opportunities at other hospitals. Or 1st year nurses may have no ties to a city/region which makes them more likely to interview other places. But even worse, your organization itself may be contributing to young nurses are leaving the organization. It could be creating a reputation among young nurses to avoid your hospital and go elsewhere.

How can your health system leadership, or your more seasoned nurses, actually contribute to 1st year nurse turnover?

  • Not valuing 1st year nurses, or at least are not showing it. Older nurses may make comments about Millennial workers or work ethics/work styles.
  • 1st year nurses could feel they are stuck picking up the slack for other nurses, or doing work other nurses do not want to do.
  • 1st year nurses may be given little role clarity. They may feel like goals are ambiguous, and that more experienced nurses are not helping to prepare them.
  • 1st year nurses may see little opportunity for growth or leadership development.

How can your organization turn this phenomenon around?

Offer better role clarity, which can also help alleviate stress

First year nurses have just had 14-16 years of schooling or more, where curriculums are clear from the first day. Then they begin working and realize work and life are messy and there is role ambiguity. This can lead to a low sense of control over job performance, and ultimately stress. What can nurse leaders do to stop this? For starters, make sure role expectations and performance is communicated well and across multiple channels. Have periodic check-ins with your new nurses. Let them know how their performance is contributing, and offer support.

Offer better communication; a 1st year nurse needs management to communicate about critical issues

Most surveys and studies show that Millennial workers want more communication and feedback, or at least more than other generations have. While older generations value a big paycheck or advancement opportunities, Millennial workers are more likely to aim for career or organization purpose. Show your 1st year nurses how their contributions help the larger health system at a macro level, and how they contribute to your team at a micro level. Management and supervisors should be available, or at least visible to nurses who are finding their way early in careers. Solicit input from young nurses on critical work issues. Incent your team to share 360-feedback to improve how critical issues are handled. This could show 1st year nurses that you value communication, and show they are a part of critical issues and decisions.

Offer rewards or recognitions for accomplishments

Nurses who feel valued, appreciated, and respected—and who enjoy professional communication and working relationships—will stay at an organization and remain engaged in their profession. This is especially true for nurses newly out of school.  Offer recognition for accomplishments to show young nurses they are valued. Recognizing and rewarding nurses does not have to be complicated or time-consuming. It could be on-the-spot recognition, maximizing staff meetings, fun activities, feedback surveys, or general retention activities.

It’s not uncommon to forget to show associates that they are highly valued. Sometimes a shout out will do; other times an offer of lunch with the boss or an invite to attend an off-site training will help demonstrate that you are indeed happy to have this young nurse on your team.

Offer support from more experienced nurses

Young nurses are not looking for authoritarian leadership, they want coaching to help them learn and grow as professionals. Retaining nurses requires adjusting to adapt to this generation, so make sure the right older nurse is coaching. The right coach/mentor can help a young nurse to see how their contributions are valued. It can also help encourage continuous learning, can help young nurses to build networks/join professional organizations, and can even help teach young nurses about emotional intelligence. For example, Franciscan St. Francis Hospital in Indianapolis implemented a preceptor and mentor program to help new graduate nurses during their first year of employment. This decreased the organization’s 1st year turnover rate from 31% to 10% in 2 years. There is nothing in a textbook that can replace real-life experience of a seasoned nurse who has navigated a full career. If your health system doesn’t already have a young nurse mentor program, maybe it is time to start.  

Offer opportunities for growth for high-performing young nurses

1st year nurses want to see that their health system is willing to invest in them and prepare them for future leadership roles. Actively supporting career development through online and in-person training courses can help maximize skills, growth potential and professional opportunities. For a young nurse, the first opportunity for team leadership is generally the Charge Nurse role. Leading and delegating to peers, especially to older peers, is stressful. As a manager or director, you may see that offering these roles to young nurses without leadership development and preparation may lead to stress for young nurses. So offer Charge Nurse leadership development.

East Alabama Medical Center (EAMC) is a 340-bed hospital in a rural area. Because it is an area where there is a smaller talent pool than larger metro areas, EAMC really prioritizes growing its talent from within. Rosemary Cummings is the Director of Medical Surgical Services at EAMC, and recently implemented NCharge to prepare young nurses for leadership roles. She commented “We take a lot of pride in how we do things from a quality and cost perspective. It <NCharge> helps our frontline nurse supervisors to see we’re investing in them. Development at this organization is an important piece of who we are. I think that’s why people stay.”

NCharge: “Nurses Learning to Lead” is an evidence-based curriculum that gives first level supervisory nurses the insights, interpersonal skills, and business knowledge they need to more effectively manage, inspire, and lead. Courses are delivered either classroom-based or virtually. NCharge is for nurses who desire to build management and leadership skills and/or want to learn about the business-related aspects of nursing. Health systems use NCharge to build a nurse leader pipeline, ensure a smooth transition from peer to leader, and to increase nurse engagement and retention.

Feel free to read our related articles!

“Preparing Millennial Charge Nurses to be Successful Leaders”

“Encouraging Your Nurses’ Career Path?”

“What Your Nurses Didn’t Learn in Nursing School”


“Millennial Workers Want More than a Paycheck. So What Exactly do They Want?” Monster Inc, Roberta Matuson

“Nurse Retention Toolkit: Everyday Ways to Recognize and Reward Nurses,” HC Marketplace, Lydia Ostermeier MSN, RN, CHCR and Bonnie Clair, BSN, RN

“Strategies to reduce nursing turnover,” Nursing Made Incredibly Easy, Lisa Lockhart MHA, MSN, RN, NE-BC, April 2020

“7 Things That Cause Nurse Turnover (and 8 Things That Stop It)” ita group

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Nursing Trends to Watch in 2021

First off, take the 2020 nursing trends article we wrote back in January of 2020, and throw it in the shredder. Whew, no one saw 2020 coming, and hopefully we’re soon to see it leaving. But there are some trends for 2021 and onwards that we see bubbling up from American Nurse Today, American Nurse Journal, AMN Healthcare, the Bureau of Labor Statistics, plus some respected nurse leadership bloggers who we follow. Here are several high-level trends to prepare for as we head into a new and hopefully more optimistic year:

Shake-Ups in the Traditional Demographics and Backgrounds of Nurses

According to the U.S. Bureau of Labor Statistics, there will be an additional 735,000 nursing jobs by 2024. With this increased demand, future wage growth, and revived interest in nursing after 2020 was the Year of the Nurse, nurse recruiting will expand to non-traditional labor pools. For one, male nurses will become more common. Already 12% of RNs are now men, up from 2% in 1970.

Nurse recruitment will also focus on nurses from different countries, or bilingual RNs. There are 60-65 million people in the U.S. whose native language is something other than English, so patient safety can be a risk factor with language barriers.

The field of nursing is becoming more accessible, with great pay and flexible hours, making it a workforce that is ever changing and growing.

Increased Focus and Awareness on the Obstacles that Nurses Face

Nurses faced unprecedented challenges in 2020. Extreme stress led to burnout. Nurses are subject to substantially higher rates of workplace violence injuries than other professions. They’re more likely to experience incidents of hitting, kicking and beating in inpatient facilities, and these injuries often go unreported. Bullying and harassment are also issues that nurses have faced. In 2020 especially, nurses unexpectedly dealt with limited PPE supplies and elevated risk of personal illness, so all around it’s a tough job in a really tough year.

There is some good news. In the 2020 Nursing Trends and Salary Survey organized by the American Nurse Journal (ANJ), 85% of nurses surveyed said the pandemic hasn’t changed their career plans, and they intend to stay with the nursing profession. With more organizations emphasizing the importance of self-care, and with increased national and legislative attention, nurses should expect working conditions to improve and access to more resources to address these workplace challenges . Health leaders will need to provide nurses with the resources and tools they need to care for patients without sacrificing their own health along the way. COVID-19 has brought this issue into the spotlight, so expect increased awareness this year.

Technology Enhances How Nurses and Patients Interact and Communicate

We have already seen that telehealth and chatbot services are making it easier for patients to access care. 2020 has accelerated usage of virtual health, perhaps faster than many of us are comfortable with. Relaxation of rules around reimbursement for telehealth visits in the wake of COVID-19 has shown health care providers and patients alike how effectively virtual communication tools can work. These telecommunication services will continue to be the norm, and blend into nurse job descriptions and care administering tactics.

Telehealth is moving past just being a window for patients with minor complaints. It is becoming a boon for nurses, plus therapists and providers using technology to manage patients with mobility challenges or who are considered high-risk for the virus. Nurses and healthcare providers will need to continually improve their communication skills via virtual platforms, just as their patient population has needed to.

Besides just using technology for direct communications, the field of health informatics will grow. Using IT systems to create more collaboration between and patient and providers will change nursing roles in 2021 and beyond. Expect some nurses to fully buy-in to the use of informatics and move to the discipline as a full-time specialty in 2021.

Technology in nursing-to-patient communication is here to stay, and nurses will need to become confident and comfortable with it. Privacy concerns and compliance with HIPAA will have to adjust of course, making sure platforms being used are secure for communication of sensitive data. But it’s a new world we’re adjusting to. Technology can bring better communication and collaboration, and nurses have to be smart in how they use it.

Addressing Gaps in Health Equity – and Nurses Could Lead the Way

Health equity and disparities in healthcare became a large focus area during the pandemic. While health system leaders, politicians, and community leaders increased their focus on the social determinants of health and diversity during the pandemic, there will be an even greater focus in 2021. Payers, providers, and the entire health ecosystem will boost efforts to address these issues going forward. As corporate and community leaders are well intentioned, leadership should be from nurses. Finding where the gaps in care are will ultimately be tasked to nursing staff. Nurses can find actual combative steps for these inequities and recommend tactics to fill in care gaps.

Nurses may be able to help bridge social gaps, finding deficiencies in care for certain populations. From the ground level, nurses can make sure patients have a voice and that families (and even communities) are incorporated into the design and operations of their community health systems.

Recognizing, Respecting, and Investing in Nurses to Grow into Transformative Leadership Roles

Investing in growing nurse leadership and management skills translates into increased productivity and even improved patient outcomes. Growing nurse leadership is even more important during high stress times and times of change. Organizations investing in nurse leadership development will see benefits of efficiency in team management, organization, and delivery of care. With the global shortage of nurses, it is critical to focus on building up the competencies of our existing nursing workforce to ensure nurses are performing to their full potential.

Leadership development may be done in person, or it can be virtual. A curriculum like NCharge: “Nurses Learning to Lead” may be a program for your staff to consider, with a variety of flexible delivery methods. Courses like Charge Nurse Fundamentals enhance individual and unit performance by helping nurses understand the business aspects of Value Based Purchasing, as well as the various roles of an effective charge nurse. It also helps nurses create an individual action plan to identify challenges and maximize opportunities faced in today’s complex hospital environment. Other NCharge courses include “Critical Thinking for Charge Nurses,” “Leading Change in a Dynamic Climate,” and “Supervisory Skills for Positive Outcomes.” Organizations like Nemours Children’s Hospital offer NCharge to help communicate financial performance indicators for example. Learn more by reading our related article on Nemours Children’s Hospital.


  • “2021 Nursing Trends We Expect to See in 2021,” Carson-Newman University Online, January 19, 2021
  • “Trends Transforming The Nursing Industry Outlook in 2021,” Team Linchpin,, February 13, 2021
  • “Our future through my rearview mirror: Turn the troubling events of 2020 into opportunities in 2021,” Lillee Gelinas, MSN, RN, CPPS, FAAN, Editor-in-Chief, My American Nurse, January 8 2021
  • “Top 10 Nursing Trends for 2021,” Purdue University Global
  • “Top 7 Healthcare Technology Trends in 2021,” Nikita Shumov, MindStudios
  • “Top Nursing Trends for 2021: Paving the Way for Better Care in the Future,” Tiger Connect

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Moments of Joy, and Hope, from a Challenging Year

In what has been a year unlike any other, we are reminded of the importance of taking time to celebrate hopeful moments of joy. We’ve seen just how much frontline healthcare workers are putting on the line to provide safe, compassionate care during this pandemic. We have gathered photos from dear customers across the country as the COVID-19 vaccine is administered to Frontline Heroes.

Utilizing the Pathway Framework to Thrive During the COVID Crisis

This is an executive summary of a session from the ANCC Virtual Summit 2020, “Thriving in Crisis: Utilizing the Pathway Framework.” This summary focuses on the excerpt delivered by Patience Harris, BSN, RN, Sr. Pathway Specialist at the American Nurses Association.

2020 has been a strenuous year on the healthcare system. Nurses especially have felt much of the professional strain in the year of COVID-19. This year has led to nurse anxiety, for a crisis we are not able to see, understand, or prepare for. Nurses are dealing with issues like PPE and work efficiency problems and are adjusting to modified work schedules and responsibilities.

Given this challenging situation, now may be the best time for nursing leaders to recreate and maintain a positive practice environment that will ensure nurse teams feel supported, engaged, and listened to. The ANCC Pathway to Excellence® Framework can help you create a system that will enable your teams to be better partners and even thrive. Here are the Pathway Standards and examples of how they can be used.

Shared Decision Making

As a leader, engage staff at all levels through strategic planning. Because of the pandemic, shared governance councils may not be able to meet as regularly or formally as before, so be creative in how you will continue to seek input from your frontline nurses. Connecting with nurses regularly is key to show them that they have a voice and that leadership is serious about incorporating shared decision-making. For example, consider using a virtual Zoom call for rounding on the unit to give nurses opportunities to speak with senior leaders. Ask bedside nurses to participate in these rounding sessions with the CNO, but not the direct manager for the best and most honest feedback. The CNO at Metropolitan Methodist Hospital (San Antonio), for example, invites frontline nurses to spend time with her monthly to connect on issues.

Be sure to give feedback up the ladder as well. Share input from nurses directly with your Boards or Councils! Rather than just high-level nursing reports, share individual nursing stories or internal newsletters. Your organization’s Board will probably love this sentiment.


Put strategies in place to protect, support and retain your leaders, in particular your nurse managers. At Memorial Hospital (California) for example, it was decided that meetings would be less about protocol and more about caring for the leader. By doing this, Memorial Hospital found issues and concerns that had never come up before within a larger group setting. What are other ways to support your nurse managers? Leadership could commit to being easily accessible, rounding regularly, and/or resiliency rounding in concert with pastoral care and social services that are available.


Because decisions made by Pathway organizations are shared, safety solutions often come from the frontline nurses. Nurses at Providence Hood River Memorial Hospital (Oregon) helped solved common PPE dilemmas on their unit. Nurses also helped fix ongoing issues, like the continuous ICU overflow of patients who were going to new teams, and the communication issues resulting from that. Also, at this hospital, the nurses who were in charge of supplies and workflow adjustments found that processes needed to evolve swiftly in dealing with the resuscitation of patients with COVID-19. The CNO at Providence Hood River Memorial stated that “this is a dramatic change to our usual clinical practice. We learned that our staff really are the experts when it comes to defining workflows, so they must be involved.” Staff ownership on the unit level is key, as it empowers staff to be agile and responsive as they address safety in the workplace.


In the Pathway framework, nursing participation and quality in evidence-based practice is key. Pathway organizations involve nurses in the development and implementation of quality initiatives. In 2020, many new processes, innovations, and treatments which were nurse-generated have become standards. Nurses were involved in the development of COVID-19 airway management isolation chamber (CAMIC) for example. When it comes to quality, nursing must be involved; nurses are key stakeholders for quality, innovation, and safety initiatives to be successful.


Well-being includes promotion of a culture that is civil, offers day-to-day recognition, and addresses physical and compassion fatigue, plus nurse resilience. This Pathway standard is even more vital during the coronavirus landscape we’re in now. Nurse executives need to be proactive in finding ways to combat nurse stress, burnout and even PTSD.

As nurses are working through this crisis, living the Pathways standard of Well-Being is a guide to mitigate the conditions that lead to stress and burnout. Consider Memorial Health South (Florida) which lets its staff know that they care about well-being by delivering yard signs to nurses’ homes that say “You Rock” and are actually signed by the CNO and other nurse leaders. The organization also started “Hope Huddles” where staff members read inspirational quotes and stories. Another health organization, St. Luke’s Global City Medical Center, a Pathway organization in the Philippines, has a rotating flower pod that goes from unit to unit with large flower arrangements and inspirational stories. St. Luke’s also turned its own auditorium into a free grocery store for its staff who have less time for shopping. It also offers free laundry and shuttle services, as well as hazard pay and housing accommodations for those in the most stretched units.

Professional Development

Nurses know that learning is an ongoing process, and is important even in the midst of a crisis. Pathway organizations recognize the importance of staff orientation, collaboration, and professional development in providing safe and effective patient care. In this time of COVID-19, most organizations have implemented some form of cross-training to accommodate viral testing needs and the influx of patients.

During a crisis, onboarding and orientation as we typically know it may not always be possible but can be accomplished through less traditional ways such as virtual meetings or online learning. One Texas health organization recognized the need for leadership development and implemented a professional practice transition program. What made it was that its frontline staff was encouraged to participate, without needing to commit to a leadership role in advance.

Great Communication is Key

The common factor in all of these standards is communication. Now more than ever, effective communication is critical to providing high-quality patient care and to staying engaged with all team members. In these demanding times, even giving bad news to staff is better than leaving them feeling left in the dark. But keep in mind that communication overload can cause problems too. As innovations and processes change quickly, be aware of how and when you communicate to avoid overwhelming your team.

ANCC’s Magnet Recognition Program® recognizes hospital organizations for excellence in patient care and superior nursing processes. Bristol Hospital, a small community hospital in Connecticut and Catalyst Learning customer, is extremely proud to be among the elite 7% of health care organizations with Magnet designation nationally. To uphold this high standard, Bristol has embraced dedication to one theme: developing great leaders at all levels of nursing, including charge and other first-level supervisory nurses.

“Critical thinking, decision making, effective communication, and conflict resolution all help to advance our nurses’ practice. The participants were most engaged in the communication and conflict style assessments. I believe it gave them a greater understanding of how effective communication and conflict resolution skills impact patient care. As the charge nurse, these skills are essential.”

Kerry Yeager, Clinical Informatics Specialist at Bristol.

Being a frontline nurse leader is a high-pressure role that is often assumed with little or no formal leadership training. Catalyst Learning’s NCharge: Nurses Learning to Lead is a dynamic, flexible series designed to improve the leadership, business management, and interpersonal skills of frontline nursing leaders. Critical leadership skills like communication, delegation, and conflict resolution require ample practice time. That’s one of the key reasons up to 70% of the time in NCharge courses is spent in group discussions and interactive activities. Learn more.

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What Your Nurses Didn’t Learn in Nursing School

For nurses, especially those who are new to peer leadership positions, “soft skills” are important in career development. Being the best clinical and bedside nurse may mean little if other nurses are not buying into a new leader’s vision. “Soft skill” development is vital for new Charge RNs, and these skills can quickly help set a new nurse leader apart from others. But these skills are hard to quantify and are not widely taught. Most nurses get into the profession to help patients, not to lead teams. HCA designed its Charge Nurse Leadership Program to address this critical skills gap:

“The vision was to build a program based on the voice of nurses. The program would incorporate what the front line needed and wanted from a leadership perspective, with attention to meeting their needs and providing support for their careers.”

Nurse Leader, Volume 17, Issue 4, p.331-334, “Investing in the Front Line: Preparing the Best Nursing Leaders for the Next Generation”

So how can we encourage our nurses to develop these skills? And what are the top skills or techniques that should be learned?

Ways to Encourage Your Nurses

Change the entire “soft skill” dialogue

The first way to encourage nurses to have a positive attitude towards soft skill development is to discourage the narrative that these skills are actually “soft.” These qualities can sometimes be interpreted as less valuable by team members, but try to keep that from happening. Tell the team that in today’s super complex healthcare environment, and especially during the pandemic, that skills like communication, critical thinking, and teamwork are the skills that will yield big results when it comes to achieving organizational and team goals. Bristol Hospital builds on its Magnet success by teaching charge nurses these key skills:

“Critical thinking, decision making, effective communication, and conflict resolution all help to advance our nurses’ practice,” stated Kerry Yeager, Clinical Informatics Specialist at Bristol. “The participants were most engaged in the communication and conflict style assessments. I believe it gave them a greater understanding of how effective communication and conflict resolution skills impact patient care. As the charge nurse, these skills are essential.”

Teach nurses to write down goals, and find motivation to obtain them

Any newly learned skill or technique needs motivation behind it, and soft skill learning and development is no different. Teach nurses to write down reasoning for learning new techniques. For example, if your nurse wants to learn how to delegate work more efficiently, have her write down past situations where that skill would have helped the team, how it can help her lead in the future, and how she can practice that skill in the future.

Encourage working individually on each desired “soft skill,” – intentionality about practicing them

Like any skill learned, practicing helps us to improve. Encourage nurses to think small at first, gradually increasing intentionality until a desired outcome becomes easier. For example, if there is a charge nurse on your team who generally is quiet and stays in the background in a group meeting, ask her to share a few more opinions at the next meeting. This may help with learning and may lead to her more actively contributing, and this skill may become more natural for her later.

Encourage your team to take care of themselves

Let your nurses know that taking care of themselves requires thought, time, and practice. It might mean finding a nutritionist, therapist, mentor, or trainer. Identifying nursing “needs” and devising a plan to fulfill them requires a mix of soft skills, including time management, confidence, and adaptability. Investing in oneself is crucial.

Which ‘Soft Skills’ Should You Encourage Your Team to Improve?

Encourage practicing conflict resolution techniques

Better conflict resolution helps the entire team. In healthcare facilities, navigating conflicting personalities between coworkers, patients, and their families is hard, but a good nurse leader can resolve issues and minimize stressors. Healthcare delivery is stressful enough, even without personality differences. So with your team, practice resolving issues. There are many frameworks which can be used.
See this article to learn more, “Nurse Conflict Resolution Strategies.”


For any nurse, and especially for nurses new to leadership, it is crucial to be able to listen, understand, and give instruction. When communicating with patients or colleagues, getting a point across without being condescending or uncompromising is a skill that should be practiced. Voicing suggestions and opinions with peers or those in a position of authority requires practice.
According to Wellstar’s JONA case study on “The Effectiveness of Charge Nurse Training”:

“Among the leadership skills that were identified as being important to the role, communication was the most consistently reported area in which charge nurses needed to demonstrate effectiveness.”

Positivity and professionalism

When Nurse Managers and Directors are looking for young nurse talent for future leadership roles, they value those who lead by example, and are looking to improve. Encourage your team to practice positivity and professionalism by showing initiative and by thriving under direction. Let nurses know that serving as a good example and demonstrating a strong work ethic, flexibility, and positive attitude will help pave the way to future leadership positions.

The truth is, skills usually labeled as “soft” will impact the “hard” issues like organizational financial goals, patient outcomes, and patient experience which healthcare systems are eager to impact.

NCharge®: “Nurses Learning to Lead”

Are you interested in preparing your nurses to lead, especially those new to frontline leadership roles? NCharge® is an evidence-based curriculum that gives first level supervisory nurses the insights, interpersonal skills, and business knowledge they need to more effectively manage, inspire, and lead. Our customers use NCharge to build nurse leader pipelines, increase nurse engagement and retention, and impact financial awareness and results. Critical leadership skills like communication, delegation, and conflict resolution require ample practice time. That’s one key reason that up to 70% of time in NCharge courses is spent in group discussions and interactive activities. Courses like “Supervisory Skills for Positive Outcomes” teach a collaborative approach to managing conflict, and Critical Thinking Skills for Charge Nurses teaches using a process to make informed decisions. Learn More!


“The Importance of Soft Skills In Nursing,” Eastern Illinois University RNBSN literature, May 10, 2019

“Soft Skills That Deliver Hard Results,” Health Leaders Media, Jennifer Thew RN, November 26, 2019

“The Importance of Soft Skills in Nursing, Hondros College of Nursing, Beth Smith

“Fostering soft skills among new nurses,” Wolters Kluwer, January 28, 2019

“Top ten soft skills for nurses,” Lippincott Nursing Center, Valeria Dziados MSN, CRNP, ANP-C, AGACNP-C, March 9, 2019

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How Could Nursing Change in a post-COVID-19 World?

A new era of health care preparedness is upon us. For the healthcare industry in general, scaling up can happen when backs are against the wall. We know we can quickly add capacity, or have the ability to add capacity when care delivery needs are vast (ICU for ex.) With this new can-do spirit, we’ll see new approaches to how healthcare will be organized, delivered and distributed. And it can be led by nurses.  Here are a few hypotheses of what some of those changes could be:


Increased Talent Supply from Younger Clinicians

Even before the pandemic, many clinicians were frustrated by the limitations of overstretched health systems. Some of these clinicians will leave the profession for good, or scale back hours. This experience also will inspire many young adults to pursue a career in medicine. We surely need them. Besides recent optics showing how important this field is, young adults now see how large the demand is for nursing services, and how much job security they would have in an otherwise uncertain world. Expect more males to enter the nursing profession. There hasn’t been a “nursing profession surge” since the 1970’s, but expect one in 2021 and the immediate future.

Nurses are finally getting the credit they have deserved all along; the words “thank you for your service” have probably never been spoken more in history. We hope this positivity and compassion keeps nurses going, and inspires the next wave of talent.


Distance Work….. and Distance Learning

The pandemic showed that more nursing work experiences can be taught digitally, so more nursing schools are offering some online learning. And many believe a rise in digital nursing jobs will emerge from the pandemic, in telehealth and work-from-home settings. These roles could be aesthetics nursing, medical writing, home healthcare, legal nurse consultant, insurance case manager RN, for example.

Leadership development for bedside nurses will change too. Instead of classroom-based Charge Nurse or Nurse Manager development, much will move online and be available when nurses are not needed at work. NCharge: “Nurses Learning to Lead” for example is now offering fully digital nurse leadership development for Charge Nurses. Courses like Charge Nurse Fundamentals, Critical Thinking Skills for Charge Nurses, and Supervisory Skills for Positive Outcomes are fully available online.


Allowing Nonphysicians (Nurses, NP’s, PA’s) to Play a Larger Role

This pandemic put a large strain on emergency rooms and ICU’s. The non-physician support team has never been more important. But this situation only spotlights a problem that predates COVID-19 by decades. Many hospitals, particularly rural hospitals, are struggling to financially keep the doors open, and many could provide care at lower costs by leaning more heavily on non-physician practitioners. We may see Congress, state legislatures, and state medical boards start to ease restrictions, to allow these clinicians to provide more care. Needing nurses to be frontline leaders is more important than ever.


“Investigator-in-Chief” is officially added to the Nursing Job Description

Nurses have always worn many hats, some they haven’t always received proper credit for. But the pandemic, with a virus that sometimes has undetectable symptoms, has brought to light the new role of “investigator.” Nurses have had to play the role of screeners and contact-tracing investigators, enforcers of high-risk group prevention procedures, run surveillance on nosocomial infection prevention, and decoders on how to communicate to isolated/stressed patients through cultural differences.


Clinical Cross-Training, Especially for Critical Care Skills

As some health systems saw high quantities of COVID-19 patients, nurses of all specialties are turning into critical care nurses. Any nurse treating the virus needs to quickly cross-train in ICU procedures, especially being trained to care for patients with ventilators and other oxygen-delivery systems. While nurses from various units in some hospitals were floated to the ED to assist with patient volume during the outbreak, some will want to stay with that focus and appreciate working in an essential service.

Currently, of 4 million trained U.S. nurses, only 15% work in critical care units. Look for nursing schools to ramp up clinical experience curriculums in the near future.


Labor Supply Chain Shifts, and Scaling Up

The pandemic has shown that healthcare is in need of more reliable supply chains. You might think this trend will only affect pharma and device/equipment companies, but it will affect us all. In nursing, this could affect labor. Relying on international nurses for example may be relooked. And we’re already seeing travel nurses struggling to find contracts, as many hospitals cut much non-essential care. Many hospitals are re-looking at finances, cutting overtime, cutting per diem nurses and managing through hiring and wage freezes. Elective procedures are coming back, but will the international and travel nurse trend be the same? In the pandemic, we’ve seen that nurses can learn ICU skills quickly and with limited orientation. So health systems may think more about retraining of local full-time nurses to fill future labor gaps, instead of relying on a more uncertain supply chain of traveling/seasonal nurse labor.

Because of the pandemic, federal and state governments are shifting more government-aid to train new healthcare workers in late 2020 and 2021. As many people have been laid off during the pandemic, the federal government will roll out programs to train left out labor pools into higher demand healthcare roles. Some nursing school admissions may be waiving certain entrance requirements as well, including flexible start times. With standardized testing centers shut down, universities are reassessing testing requirements, which could help more students to be admitted to nursing programs.

As we witnessed society nearly close down this Spring, empty streets in our busiest cities, and desperate city officials begging people to stay home, there is no doubt that the world has changed.  While most of us were at home, nurses have been fighting on the front lines. Stories of heroism are almost too many to count. As we eek into a new reality, some changes will come to the nursing industry, affecting nursing perceptions, processes, skills needed, and talent pool. Nurses will be where they have been throughout the pandemic; caring, advocating, leading, adapting, and innovating.


“5 ways COVID-19 will change the future of work,” Cornerstone, Kris Dunn, July 20, 2020

“The backbone of healthcare: 3 CNOs on what COVID-19 has taught us about nursing,” Beckers Healthcare, Mackenzie Bean, May 11, 2020

“How will COVID-19 change the working lives of doctors and nurses? Philips, Jan Kimpen, April 14, 2020

“This is How COVID-19 is Changing The Future of Nursing for Students and Tenured Nurses,”, Kathleen Gaines, June 26 2020

“7 Ways COVID-19 Will Change the Future of Nursing for the Better,” Aspen University, Sarah Jividen, July 21, 2020

“Life after COVID-19: What Will Change?”, Medical Futurist, April 21, 2020

“How COVID-19 will impact the future of nurses,” Local 21 News Pittsburgh, Talia Kirkland, May 1, 2020

“9 ways COVID-19 may forever upend the U.S. health care industry,” Stat News, Lev Facher, May 19, 2020

“How Nurses are Keeping Up with Practice Agreement Changes During COVID-19,” Registered, April 17 2020

“What’s Changed in Nursing During the COVID-19 Pandemic,” Travel, Lee Soren, August 22 2020

“Nursing Perspectives on the Impacts of COVID-19,” The Journal of Nursing Research, Wolters Kluwer Health Inc. – Shu-Ching CHEN, June 2020

“Emergency Nursing, Post-Pandemic: What Changes Can We Expect,” American Mobile, Debra Wood RN

“How COVID-19 will impact the future of nurses,” Local 21 News in Harrisburg PA, news segment by Talia Kirkland and interview with Dr. Mary Glasgow, Dean of Nursing at Duquesne University


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Encouraging Nurse Resiliency Techniques During COVID-19

Health providers experience many stressors and complex situations as they administer patient care. Its estimated that 25%-50% of hospital nurses suffer from some type of burnout even during “normal times,” resulting in stress or work anxiety. But during Spring of 2020, it is probable that these numbers have been higher. Nurse resilience as a concept has been attracting more attention and research in the past couple of years but has never been more important than it is in Spring of 2020. Sustaining nurse resilience requires action and engagement from organizations from the top down.

Nurse resiliency is the ability to prepare for, recover from and adapt to stress, challenges or adversity in the workplace. It is a way to combat and cope with burnout, stress, and feelings of nursing inadequacy by practicing self-care, self-awareness, connectedness, and management of work stressors. While our nation has been dealing with a viral crisis, nurse burnout is also a crisis to our public health community.

How can I Promote Nurse Resiliency from the Top-Down?

One of the best ways to help nurses as they provide care is to promote resilience, and help RNs feel prepared enough to tackle challenges the job throws at them. But how?

First, encourage nurses to foster resilience by taking emotional breaks. During times of personal distancing, you could encourage nurses to take an online class that is stimulating but not work focused. Encourage them to exercise, journal, listen to music, enjoy general hobbies, video chat with loved ones, and enjoy personal spiritual practices. Another way to encourage nurses to take a mental break is to encourage them to spend time outdoors when the weather permits, and hopefully even enjoy the sun.

Another way to help nurses deal with stress or burnout is to offer early interventions by training Nurse Managers to listen and encourage. At Children’s Hospital & Medical Center in Omaha for example, managers are trained to listen and provide safe spaces for nurses to talk through work stressors. Omaha Children’s early intervention program began with a need to address secondary trauma, then saw there was also a need to reduce workplace stress.

Encourage nurses to practice self-awareness. One of the most important steps in being able to stop energy drains is to expand self-awareness and identify unnecessary energy expenditures. There are several quick coherence techniques which you could encourage your teams to do. One is to focus all attention in the area of the heart. Imagine one can see their breath and breathe slow and deep. Another self-awareness technique is to make a deliberate and sincere attempt to experience a regenerative feeling such as appreciation for someone or something. One suggestion is to ask nurses to re-experience feelings of caring, a special place, a proud accomplishment, or special past memory. Heart focused breathing, or activation of a positive or renewing feeling are easy ways to de-stress, even while at work.

When huddling with your work teams, remember to tell nurses to recognize what they can and cannot control. Remind them to focus on the optimistic ways they help people rather than all the possible negative outcomes which could occur. Tell your nurses that when they are doubtful, scared, or feeling inadequate, to remember that every other nurse feels the exact same way. There has been much we’ve been unable to control in 2020. Ask nurses to give themselves mental empathy, and when self-doubt creeps in, give themselves compassionate words.

To encourage nurses to pursue emotional support and connectedness to peers, have your work teams find a buddy who they can reach out to when workload is intense. Maybe instead of a buddy, connect nurses to a nurse mentor, counselor, or other Employee Assistance Programs which your health system has for support. Or bring nurses together and let them feel the social support they have in their hospital; for example, a debriefing session can help nurses bond and learn from each other, while sharing stories and experiences. Consider bringing in someone to lead a session who is trained to structure reflection, learning, and healing.

You may have the best Nurse Managers or Charge RNs in the country, in leading, administering, and organizing care. But that doesn’t mean these leaders are trained to build resilient teams. So, encourage these leaders to engage staff, rollout, and coordinate these nurse interventions to provide a sense of camaraderie, teamwork, and trust. And if you show that building nurse resiliency is important to you, your mid-line managers will probably follow your lead.

Keeping nurses safe and supported during the ups and downs of the COVID-19 pandemic is a major priority. Even as the country is giving support for these vital members of our workforce, stressful situations generally make people feel isolated, not supported. Prioritize helping nurses with resiliency building techniques to help their physical, mental, emotional, and spiritual domains. The consequences of not doing so are too high. The country desperately needs to prioritize nurse satisfaction, productivity, health outcomes, and stress. Not doing so will cause the next public health crisis; a stressed and burnt out nurse workforce.


“How to Measure Resilience With These 8 Resilience Scales,” Positive Psychology, Courtney E. Ackerman, MSc, April 5, 2020
“7 Habits of Highly Resilient Nurses,” Reflections of Nursing Leadership, Diane Sieg
“Developing resilience: the roles of nurses, healthcare teams and organizations,” Nursing Standard, Caroline Barratt
“Nurse Resilience: A Concept Analysis,” Wiley Online Library, Alannah L. Cooper, Janie A. Brown M.Ed, PhD, Clare S. Rees BA (Hons), MPsych, PhD, Gavin D. Leslie BAppSc, Post Grad Dip (Clinical Nursing), PhD
“Building Emotional Resilience in Nursing,” Catherine Kelsey from Queens Nursing and blog
“Building personal resilience,” American Nurse, Teresa M. Stephens, PhD, MSN, RN, CNE, August 13, 2019
“A Call to Leadership: Navigating Uncharted Waters,” American Association of Colleges of Nursing, a Webinar by Randolph F.R. Rasch, PhD, RN, FNP, FAANP, March 20 2020
“Nurses well-being: Supporting staff and encouraging resilience,” Becker’s Healthcare, Jackie Drees, May 30 2019
“Help Hospital Employees Find Resilience and Reduce Burnout,” Children’s Hospital Association, Kelly Church, October 24 2019

Top CNO Worries: A Fall 2020 Update

2020 sparked what will forever be looked at as the year of the nurse. Our nation’s frontline health heroes answered the call when the world started changing in early March. Chief Nurse Officers had to push aside competing internal priorities and get to the root of their leadership role: advocating for the nursing profession. As we prepare for an end to summer, what are the top concerns of our nation’s CNOs?

Gauging the Impact of COVID-19 on Nurse Staff

Even before the pandemic, healthcare organizations were facing growing challenges in finding the nurses they need to compete and provide great care. But not CNOs really need to gauge the impact on staff. How did this event affect nurse stress and resiliency? What can be done to make positive steps to coping as a system/team. Nurse Directors and CNOs will likely spend months or years helping to give emotional first-aid to nurses who were on the front lines, as they process what has happened.

Prioritizing Nurse Resiliency from the Top-Down

Nurses are stressed! With the pandemic, recent nursing furloughs that led to employee financial issues, political unrest, or stress from children not being in school, nurse stress management and resiliency is more important than ever. How will CNOs help RNs feel prepared to tackle challenges the job throws at them?

CNOs will be encouraging nurse emotional breaks and stress management techniques. When huddling with work teams, nurse leaders will worry about how to teach self-awareness and how to teach nurses to recognize what they can and cannot control. CNOs know they desperately need to prioritize nurse satisfaction, productivity, and stress management, but it is an uphill climb.

At Children’s Hospital and Medical Center in Omaha for example, managers are trained to listen and provide safe spaces for nurses to talk through work stressors. Omaha Children’s early intervention program began with a need to address secondary trauma, then saw there was also a need to reduce workplace stress. CNOs across the U.S. are looking for the right resiliency strategies for their own organizations.

Preparing Staffing Models for a COVID-19 and Influenza Surge in Fall/Winter

No one knows what will happen in late Fall or Winter, but history shows that a non-vaccinated virus can have secondary spikes, more probable in cooler weather. CNOs are figuring out how to expand the acute care workforce as much as possible before this possible surge starts. Organizations are relocating staff from a variety of other care sites such as outpatient procedural areas, ambulatory care sites, and low volume clinics. CNOs are also increasing temporary staffing options: recruiting from pools of retired nurses, independent NP’s under temp contracts, student nurses, and recruiting faculty from academic partners.

After workforce expansion actions are taken, the next priority is to optimize deployment of this expanded workforce. CNOs are figuring out how best to ensure staff are prepared and that potential learning needs are addressed, and worried about how to best deploy staff to optimize staff experience and clinical competency.

Once staffing volume for a virus resurgence is addressed, preparation evolves to figuring out the stressful details of how to support that staff. For example, is the 12-hour shift excessive while staffing this pandemic? Can staggered shifts be supported? How can nurse leaders best leverage preceptors and nurse mentors? How is hazard pay addressed? How are new nurse graduates prepared? How can leadership best prepare ICU space and equipment/supply issues? And how can emotional support and stress-mitigation strategies be put in place before any surge hits? These are all questions our nurse executives are hoping to find answers for.

There are a lot of questions that have no answers for CNOs this winter that will affect staffing models. Will it be a bad flu year? Will populations, tired of distancing and putting off leisure activities, let their guards down near the holidays and cause mass viral outbreaks? Will a COVID-19 vaccine come, and will high-risk populations have adequate access to it? Or will they even trust it? Will pent up demand for non-essential/preventive care in Spring and Summer cause spikes in care volume needed later in the year? And how will a divisive election season affect population health?

Nurse Shortages and Attrition Leading to Erosion of Patient Care and Staff Morale

Healthcare organizations are facing growing challenges in finding the nurses they need. According to the AMN Healthcare Study “Worsening Shortages and Growing Consequences: CNO Survey on Nurse Supply and Demand,” many CNOs cited that the nurse shortage at their organization is moderate to severe, and most say that this problem will become worse instead of better in the next five years. Some sources are showing that understaffing nurses can degrade the work environment and HCAHPS scores. Nurse recruitment is becoming more competitive now too, with salaries rising higher and higher. Nurses demand more perks, like flexible schedules. Hospitals are seeing nurses leaving for easier 9-5 shifts in outpatient settings. Read our related article, “Millennial Nurse Retention Strategies.”

 Changing Technologies/Processes, plus Training to Manage it

EHR, automated IV pumps, portable monitors, medication bar code scanning, smart beds, and centralized command centers are just a few recent tech upgrades. Besides just frustrations with scheduling constant training sessions, health IT can contribute to nurse burnout, as it demands more of nurses’ time. Work interruptions from constant alerts and alarms is challenging, and if nurses see added IT processes with no measurable impact, it leads to more frustration. Systems are looking to technology to streamline work and increase efficiency in 2020, but there are growing pains as this happens. And what new technologies or processes will arise because of the pandemic? Will some of the restrictive new rules from long-term facilities make it to acute care hospitals?

Turnover Within the C-Suite

Continuous consolidation of healthcare organizations and mass retirements of Baby Boom age leaders increase executive turnover rates. Churn in the C-suite can have a negative impact on financial performance, organizational development, and employee engagement. C-suite turnover creates a toxic environment of competing priorities that can distract organizations from providing high levels of patient care.

As the nation gets up from this gut-punch in 2020, will it lead to an even larger mass exodus in our systems’ C-Suite? That is uncertain, but we do know that hospital CEOs are taking pay cuts as COVID-19 financial losses mount, and capital projects are being terminated or postponed. With some bans on high margin non-emergency surgeries, workers being furloughed, and soon-to-come regulatory changes looming to prepare for future pandemics, it would not be unprecedented to see turnover within the C-Suite later this year.

Lack of Transformational Nurse Leaders – Young Nurses Not Pursuing Leadership

As Baby Boom nurses are retiring or cutting back hours, there is a void in leadership and experience. It makes sense that young nurses should apply and fill these leadership voids, but often times they do not. Hopefully when we look back in time, we’ll see that the COVID-19 pandemic helped CNOs identify leadership potential where they had not yet seen it in junior staff (and perhaps the converse, re-evaluate where they thought senior leadership potential was present). One way to prepare young nurses is to equip them with leadership development opportunities. Making sure a first-time Charge RN has a good leadership experience is crucial for filling future Nurse Manager roles. Managers are responsible for staff, overseeing patient care, scheduling, meetings, and personnel and budget decisions. It comes with stress and work-life balance issues. See our related article, “Why Are Many Young Nurses Not Applying For Manager Roles?”


BONUS – All About Nursing with Dr. Joyce Batcheller

Dr. Joyce Batcheller is an Executive Nurse Advisor with The Center for the Advancement of Healthcare Professionals for AMN Healthcare and is responsible for the development and delivery of two Chief Nursing Officer Academies: CNO Academy I, which was developed for new and aspiring CNOs and CNO Academy II, which was developed for experienced CNOs. Having served as a Chief Nursing Officer for more than 19 years in one of the largest healthcare providers in Central Texas, she has extensive experience in leading large system changes within a complex multi-hospital organization.

Dr. Batcheller’s podcast, “All About Nursing” explains how nurses play a significant role in providing healthcare in multiple care settings. You will be able to hear from some of these key nurses who work in practice, academia and other practice settings. You will hear about challenges nurses are engaged in as healthcare continues to experience an unprecedented need to decrease costs and improve outcomes. Recently, Dr. Batcheller interviewed Robyn Begley CEO of AONL and Kim Glassman who is leading work in NYC related to COVID-19. Listen to the podcast here.


“Dealing with COVID-19 Anxiety & Stress on the Front Lines,” Wolters Kluwer Podcast, April 13 2020

“Key actions CNOs should take now to staff for a Covid-19 surge,” Advisory Board, Carol Boston-Fleischhauser, JD, MS, BSN, CNO and Managing Director

“Healthcare News: Nurse Leaders Say Nurse Shortages Erode Patient Care and Staff Morale,” AMN Healthcare

“Hospital CEOs take pay cuts amid COVID-19,” Modern Healthcare, Stephanie Goldberg, May 11, 2020

“Working without a Playbook,” Emerging RN Leader, Rose O. Sherman, April 2, 2020

“The backbone of healthcare: 3 CNOs on what COVID-19 has taught us about nursing,” Beckers Healthcare, Mackenzie Bean, Gabrielle Masson, Anuja Vaidya, May 11 2020

“Maintaining hospital culture through C-suite leadership turnover,” Beckers Healthcare, Brian Hudson, April 23, 2018

“Second Victim Syndrome and COVID-19,” Emerging Nurse Leader, Rose O. Sherman, April 30, 2020

“Worsening Shortages and Growing Consequences: CNO Survey on Nurse Supply and Demand,” AMN Healthcare

“10 things keeping health system CEOs up at night,” Beckers Review, Molly Gamble/Ayla Ellison

“Top CNO Concerns,” Kristin Whitehead, HealthLinx

“Worries of the health system CEO,” Medi Leadership, September 27, 2019

“Nurse burnout? Try telehealth, clinical decision support and analytics tools, experts say,” Healthcare IT News, Bill Siwicki

“COVID-19 Hits Some Health Care Workers With Pay Cuts and Layoffs,” NPR, Martha Bebinger, April 2, 2020