Welcome to the Nurse Executive’s COVID-19 World: Staffing Shortages, Stress, and a Struggle for Support

Chief nurses are traditionally strong for their team, so the study, which was sponsored by Cipher Health, was an opportunity to “allow them to be vulnerable and share how they were actually doing,” Boston-Leary says.

The top 3 takeaways illustrate the depth of those chief nurses’ challenges:

1. The COVID-19 pandemic exacerbated existing stresses in the nursing workforce, resulting in unprecedented levels of burnout and turnover that threaten recovery and rebuilding.

Some 62.5% of the CNEs who responded to the survey did not have adequate nursing staff to care for COVID patients, with the most critical shortages in the intensive care unit (ICU), emergency department (ED), and Med/Surg, the study says.

And 79.1% of respondents experienced high nurse turnover and had to amend or create new care models:

• The most-used models of care were team models and use of non-nursing personnel.
• Staffing models most applied were nurse-to-patient ratio and patient acuity models.
• The most-used scheduling practice was consecutive, staggered 12-hour shifts.

Some 81% of CNEs who responded to the survey named staffing as their biggest problem, followed by burnout (58%) and turnover (40%), according to the study. Other challenges addressed in the study included capacity (33%), workload (23%), new protocols (17%), and personal protection equipment (PPE) (15%).

Despite those hardships, nurse executives were reluctant to talk about themselves and their well-being.

“When we asked how they were faring, a number of them said they were okay,” Boston-Leary says. “They would give maybe one sentence of response in terms of how they were, but then they would shift to talk about how their team was doing.”

2.  Nurse executives have felt a deep-seated personal impact from supporting and leading their teams through the pandemic.

This impact has resulted in a duality of increased loyalty to team and mission but also to stress, dissatisfaction, and thoughts of leaving their roles.

Asked how they were feeling, executive nurses answered:

• Stressed (52%)
• Satisfied/content (25%)
• Intend to leave role (10%)
• Dissatisfied (8%)
• Other (4%)

But despite stress and difficulties, nurse executives are up to the challenges that COVID-19 has unleashed, says the second of the principal investigators, Linda Hofler, PhD, RN, clinical assistant professor at East Carolina University College of Nursing and former chief nurse executive of Vidant Health.

“We’ve got part of the population of nurse executives who have worked long in their careers, and they want to get to the point where they get past COVID-19 and have handoff to the next generation,” Hofler says.

“And then there’s this newer group we saw on our study who have said, ‘If it’s not me, then who?’ and, “I still have a legacy to leave and I’m even more committed than ever,'” Hofler says.

“As long as they are managing their emotional and mental health and well-being, and they’re getting nurtured to be their best, I think that the future can be bright for people in those senior leadership positions,” she says.

When asked what the nurse executives need to do now to ensure they are prepared for future crises, many responses focused on ensuring a prepared workforce moving forward, says Michelle Messing, lead researcher for HealthLeaders Exchange.

“A lot of these people are going to retire or phase out of this part of their career and want to ensure there is playbook for a future crisis or the next pandemic,” she says.

For example, some nurse executives kept journals of their COVID experience of how they responded to particular challenges, she says. They also saved all their communications and kept notes on their thought processes so they could provide a guide for future nurse leaders, Messing says.

3. Nurse representation in C-suite decisions and internal support for nurses is inadequate to address the workforce shortage, nurses’ well-being needs, or prepare for future pandemics.

The study’s respondents barely mention support from other C-suite executives, which is not a surprise, Boston-Leary says.

Chief nurses typically are women in a mostly male C-suite, and they’re usually the only nurse, Boston-Leary says. Additionally, she says, chief nurses of color may be the only minority in the room, as well.

“So those factors alone bring about some dynamic that has to be navigated for a lot of nurse executives, because it is a challenge,” she says. “The pandemic really revealed that being in the room doesn’t necessarily mean that you have a strong voice.”

“[This takeaway] revealed what really feels like a gap or weakness or a link that needs to be strengthened in the chain,” she says, “for nurses to be able to make the case for what they need and have some support around what they need.”

Looking ahead

COVID-19 most definitely has impacted chief nurses, Messing says.

“Nurse executives have one of the toughest jobs in the world right now,” she says. “They are leading an American nursing workforce through one of the most taxing challenges in modern day history, and they really had to pick themselves up by the bootstraps and figure out what needed to get done.”

But despite the challenges faced by the largest workforce in the healthcare sector, its leaders are more than capable, Messing says.

“There’s a lot of hope within this group,” she says. “They shared different quotes like, ‘If not us, who?’ and ‘I love my work and I love my team and I still have a legacy to leave,’ so their love of nursing and their love of the profession will win at the end of the day.”