Nurse leaders are worried about the quality of care provided by both the current workforce and the new generation of nurses entering the profession. They anticipated this decline in care quality will be attributed to three key factors: regulatory requirements, unsafe staffing levels, and a widening experience-complexity gap.

Leaders identified the tension resulting from increased documentation and reporting requirements stressed an already overextended workforce. These requirements were perceived as unnecessarily burdensome, contributing to burnout, nurse dissatisfaction, and eventual turnover.

When nurses are burned-out, leave the workforce, or lack appropriate support, it impacts quality, safety, and the patient experience. Quality was also impacted from increased care complexity with fewer (and less experienced) staff. Therefore, greater and more complicated responsibility is placed on remaining care team members of less tenure. In addition, nurse managers, directors, and executives alike shared concerns on nurses’ readiness for practice and the downstream effects on quality. Some described the need for extensive orientation as burdensome for the hiring organization.

To mitigate reductions in care quality, health systems can audit organizational practices in partnership with their nursing workforce and eliminate unneeded processes², streamline workflows, redelegate responsibilities, and dismantle care quality improvement silos.

Today's nursing care is complicated by increased demand, unaddressed social needs, and a patchwork of care continuity. Therefore, in addition to workflow improvements, novice nurses will need extra support to care for increasingly complex patient populations. Systems may ease the transition to practice by building out a nursing residency program or fostering stronger partnerships with colleges of nursing.

Across all positions, increased workplace violence was identified as a top concern — and nurse leaders felt health systems were not adequately addressing the issue. Nursing executives, managers, and directors also expressed concerns around incivility and bullying occurring within care settings. Specifically, managers and directors perceived a decrease in interpersonal skills among staff, resulting in a poor working environment. 

Executive-level nurses also identified disrespect from physicians as an issue — a sentiment echoed by other nurse leaders. Differences in professional culture, position objectives, limited interprofessional education, and assumptions of scope, are all reasons why healthcare professionals may have misunderstandings about the roles of their care team colleagues. As a result, this miscommunication leads to the eventual breakdown of teamwork.

Workplace violence is increasingly common within healthcare settings and must be addressed through organizational interventions. However, efforts to improve the working environment should not stop there. Consider addressing staffing culture by:

• Identifying epicenters of hostility, and periodically surveying staff perceptions to intervene preemptively.
• Introducing unit-specific codes of conduct, informed by bedside staff and leaders (see practice 12 to view an organization’s example here).
• Instilling a culture of care, reporting, and documentation of abusive behavior — starting at the top³.
• Communicating expectations of interprofessional collaboration, respect, and role understanding.

For more resources on reducing point-of-care violence, see our best practices to address workplace violence in hospitals.

According to survey comments, the newer generation of nurses was overwhelmingly criticized for their “lack of compassion,” “lack of competency,” and their focus on different priorities like work-life balance. As a result, some leaders shared that these divergent values, and “unrealistic expectations” detracted from the professionalism of nursing.

C-suite nursing executives, nursing managers, and directors differed in their concerns about the generation of nurses entering the profession, likely because of their different purviews. Executives seemed particularly frustrated with novice nurses’ turnover, lack of compromise, and reduced interest in professional development, while managers and directors questioned new generation nurses’ work ethic, ability to communicate, and motivations for joining the field. 

It’s time to reframe this tension and avoid placing the blame on younger nurses. In actuality, the issue lies with factors that surround them, including increased care complexity. In particular, new nurses are expected to know much more now than before.

Additionally, leaders should avoid conflating a shift in values, including an increased emphasis on work-life balance, with a diminished work ethic or a lack of commitment. The nurses joining the profession today are the new workforce— so regardless, organizations, and leaders must implement practices that meet their needs to protect the sustainability of the nursing workforce. Organizations may bolster support by:

• Honing skill development through rigorous residency and comprehensive education initiatives.
• Introducing an emotional and social support system for nurses that buffers job demands.
• Creating clear career pathways for advancement.

For more resources on retaining new nurses, see our nurse retention toolkit.