By Jennifer Thew, RN
On the surface, the settings and locations where nurse executives work may seem vastly different—rural versus urban, safety-net hospitals versus academic facilities, large multi-state health systems versus stand-alone independent hospitals, acute care versus the ambulatory setting to name some. Yet, regardless of these differences, nurse leaders across the nation face many of the same challenges and concerns.
Here are four topics that rise to the top among nurse leaders:
1. Workplace violence
From 2002 to 2013, healthcare workers were four times more likely to experience incidents of workplace violence that required days off for the injured worker to recover than workers in private industry, according to the Occupational Safety and Health Administration.
Nurses struggle with workplace violence. In 2014, the Delaware Nurses Association surveyed registered nurses to assess the perception of violence against nurses. Of the survey findings, 58.15% of the respondents say the most common type of violence in the workplace is patient-on-worker violence, which includes any type of verbal or physical assault.
As Barbara Jacobs, RN, MSN, chief nursing officer at Anne Arundel Medical Center in Annapolis, Maryland, says, nurses are dealing with many factors that contribute to workplace violence. More patients are seeking care as a result of opioid use and mental health issues, and RNs often deal with patients and family members who are upset and angry at a stressful situation. As a result of these intense emotions, patients or family members may threaten the healthcare team. And, with mass shootings regularly in the news, healthcare workers are left feeling vulnerable to violence, she says.
2. Advanced practice registered nurses and specialty medicine
According to the National Council of State Boards of Nursing, there are about 267,000 advanced practice registered nurses in the U.S. While it does not count clinical nurse specialists in its data, the Bureau of Labor Statistics estimates overall employment of nurse anesthetists, nurse midwives, and nurse practitioners will grow 26% from 2018 to 2028.
However, much like acute care bedside nurses, it can be difficult to find APRNs to fill specialty positions.
"Where I'm at, it's not that I don't have enough [nurses], it's that we have a lack of critical care nurse practitioners," Ronda McKay, DNP, CNS, RN, chief nursing officer and vice president of patient services at Community Hospital in Munster, Indiana, says. "We're putting in a program now to have a residency for those nurse practitioners so they will sit for their critical care exam."
3. New care models needed
In the past, nursing care has been acute care–centric. But, to meet the demands of the evolving healthcare environment, nurse leaders will need to use foresight and innovation to develop new models of delivering care in a variety of settings.
As Katie Boston-Leary, RN, MBA, MHA, BSN, CNOR, NEA-BC, chief nursing officer at University of Maryland Prince George's Hospital Center in Cheverly, Maryland, says, new care delivery models to address population health, community wellness, and transitions back to the home setting will be needed.
Technology may also play a role in developing new ways of providing nursing care.
"Virtual nursing [has the potential] to bring high-level [nurse] expertise to complement the newer nurse residents on the acute care side when you don't have enough clinical coaches," Tammy Daniel, DNP, RN, BSN, NEA-BC, MHA, senior vice president and chief nursing officer at Florida's Baptist Health, says.
4. Keeping nurses at the bedside
As more nurses seek to become APRNs and experienced nurses retire, nurse leaders will have to find ways to entice a new generation of nurses to stay at the bedside.
Erin LaCross, DNP, RN, CMSRN, CENP, CNO at Parkview Regional Medical Center and Affiliates in Fort Wayne, Indiana, says that strategies to mitigate the effects of the "experience-complexity gap" should be on the nursing industry's radar. "The concept is that there may not be a national nursing shortage as far as the number of nurses in the future, but a gap in the level of experience needed to take care of the increasing complex medical patient."
One question nurse leaders will need to ponder, LaCross says, is: "How do you have that group be as competent as possible, as fast as possible, and stay as long as possible while the patients are getting sicker and more complex?'"
Nurse executives will gather November 13–15, 2019, for the HealthLeaders CNO Exchange at the Ojai Valley Inn in Ojai, California, to discuss these and other topics during roundtable sessions with their peers. The CNO Exchange is one of six healthcare thought-leadership and networking events that HealthLeaders holds annually. To inquire about the HealthLeaders Exchange program, email us at firstname.lastname@example.org.
Jennifer Thew, RN, is the senior nursing editor at HealthLeaders.