Nursing Needs a Reality Check: Changing Expectations

September 23, 2024 ‐ HealthLeaders Media

By G Hatfield

Many things have changed in healthcare in the past few years, since the beginning of the COVID-19 pandemic and the implementation of new technologies and workflows.

Recruitment and retention have become increasingly more difficult for CNOs and other nurse leaders, as both new graduate nurses and tenured nurses are leaving the workforce at alarming rates.

According to the American Nurses Association, almost 18% of newly licensed registered nurses (RN) quit their jobs within the first year. A 2024 study found that new graduate RNs are leaving for a multitude of reasons, including their age, health status, supervisor and peer support, job demands, job competence, organizational commitment, job satisfaction, and work environment.

Why are nurses leaving?

Melanie Heuston, chief nurse executive at the WVU Medicine and HealthLeaders Exchange member, explained several additional reasons for this departure from the workforce, including the attitude toward nursing on social media.

“Social media has not been our friend,” Heuston said, “I think it’s absolutely been a place where people can talk about the negative and not necessarily the positive.”

Heuston recommended that health systems focus more on social media and use strategies to improve the nurses’ experiences.

“I do think that we as leaders need to own the work environment and I think that there’s been some bullying in nursing, which I’m not proud to say,” Heuston said, “but it’s there, and we’ve got to get strategies to get that under control.”

Heuston also cited the nursing shortage, and how more nurses are necessary to create a better work environment.

“It’s a little bit of a chicken and egg problem,” Heuston said, “you need more nurses to make the work environment better, as it’s one of the ingredients.”

According to Gloria Carter, vice president and chief nursing officer at St. Mary’s Medical Center, and HealthLeaders Exchange member, another contributing factor is the prioritization of work-life balance.

“It’s not just the new nurses, I think overall individuals have learned about having resiliency and focusing on work and life balance,” Carter said. “I think when you look at it from that lens, there are individuals that are saying ‘I need to be mindful and take that time out for me.'”

Changing expectations

Additionally, there has been a generational shift in what to expect from nursing as a profession, according to Heuston. New generations of nurses want to take advantage of new technologies to advance their nursing practice.

“They want the ease of technology,” Heuston said, “and we need to be better at responding to that.”

Along with many other organizations, Heuston said that WVU Medicine has piloted virtual nursing to support their nursing staff.

“I like to actually call it virtual patient care, so nurses don’t believe we’re replacing nursing, we’re trying to support it,” Heuston said. “It’s warmly received by newer nurses. In fact, they’re starting to expect it.”

Heuston also explained that new nurses want to have a supportive environment where nurse leaders check in frequently and deliberately, and provide feedback.

“Generationally, I think that is more the expectation,” Heuston said, “to get a lot of feedback, both positive, and what we need to do to improve.”

Building resiliency

CNOs are in the position to bridge the gaps between new expectations and the realities of nursing, which involves building resiliency among new graduate nurses while also improving the work environment.

Now more than ever, according to Heuston, nurse managers have been acting as coaches and counselors due to more generational anxiety and depression caused by the COVID-19 pandemic.

“I think equipping [nurse managers] with better tools to be in that role, because they weren’t trained to be in that role,” Heuston said, “I think we could do better at getting more resources for them to be better.”

For nurses, Carter said it’s all about having awareness and accessing your support systems.

“It’s also [about] connecting within the community and networking with your friends and family, and just bringing awareness and being open to having the dialogue about what you need individually,” Carter said. “Then also being a part of that solution in terms of communicating for others that may be having similar challenges.”

St. Mary’s Medical Center has implemented a wellness app that nurses can use to track physical activities, such as walking, strength training, and other exercises, and obtain nutrition recommendations and other wellness practices that focus on mental and physical well being.

“Participants receive points that accumulate for submission for a reward card of their choice,” Carter said.

Heuston suggested using podcasts, since many nurses engage with that medium rather than old fashioned communication methods.

“I’m very interested in doing [a podcast] with a younger generational nurse who can help to educate me on the needs of the workforce,” Heuston said. “I think it’s [about] being open to all the wellness support that we can offer our staff other than just a relaxation room where they don’t even have time to go, or putting structures in place where they can go there and feel like they can recharge.”

G Hatfield is the nursing editor for HealthLeaders.

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