Nearly 75% of hospital and 64% of health system-based chief nurse executives (CNEs) are “stressed, dissatisfied, or intend to leave their role,” with staffing as the top challenge as CNEs lead their nurses through the interminable COVID-19 pandemic, reveals a unique recent study by HealthLeaders Exchange.

While staffing shortages aren’t a new concern for healthcare executives, it took the No. 1 spot last year as the top issue that hospital CEOs faced in 2021, according to The American College of Healthcare Executives’ (ACHE) annual survey.

On the frontlines of the pandemic, nurses have faced staffing shortages, an early lack of personal protective equipment (PPE), intense fatigue, and being witness to unparalleled suffering, death, and grief, and these ongoing stressors have taken a toll on their mental health and well-being.

When COVID-19 brought chaos to nurse leaders at Allegheny Health Network (AHN)’s 14 hospitals, a time management course designed just for them helped them feel less overwhelmed about their day.

Engagement also affects a hospital or health system’s bottom line. Fifteen of every 100 nurses are considered disengaged, with each disengaged nurse’s lack of productivity costing an organization $22,200 in lost revenue annually, according to a 2016 study published in the American Nurses Association’s Online Journal of Issues in Nursing.

The survey was conducted by Trusted in October 2021 with a sample of 3,357 nurse respondents, of whom 54% currently work as travel nurses, 37% as staff nurses, and 9% in per-diem or other types of nursing roles.

Because good leadership is key in retaining nurses, Leanne Salazar is taking the culture of nursing excellence she built as chief nursing officer for nearly seven years at HCA’s Oak Hill Hospital in Brooksville, Fla., before becoming CNE in early 2020, and expanding it throughout the division’s 15 acute care hospitals.

For nurse and hospital leaders to help their nurses handle and heal from trauma, they must create a trauma-informed culture. A trauma-informed program, system, or person has a knowledge and understanding of trauma and its far-reaching effects, which, in some nurses is caused by seeing patients die; tending to patients who can’t get relief from symptoms; patient and family aggression; feeling overextended because of inadequate nurse-to-patient ratios; frustration; and helplessness, according to a 2017 study.

Hospitals and health systems should foster nurses’ resilience by integrating support and education—not only to help them successfully cope with their high-stress job, but to provide high-quality care, the study says.