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