How nursing leaders are currently feeling

For the study, AONLF surveyed nursing leaders across the United States between Nov. 8 and Nov. 23, 2023. In total, 2,477 nurse leaders responded to the survey, and 72% were either VPs, CNOs/CNEs, directors, or managers in their organizations. The majority of respondents were white, over the age of 45, and worked in urban acute care hospitals.

When asked about their daily tasks over the past week, respondents said they spent most of their time on administrative work (91%), meeting with their direct reports and colleagues (77%), quality improvement (75%), and employment engagement and retention efforts (70%).

The most rewarding tasks for nursing leaders included employee engagement and retention efforts (55%), awards and recognition (54%), and mentoring, guiding, and reviewing the performance of their staff (50%). In comparison, the most frustrating tasks were dealing with capacity and constraint issues (47%), incident reports/injuries/complaints (38%), and conflict resolution (37%).

According to respondents, the top three challenges facing their organizations right now are staff recruitment and retention (69%), the emotional health and well-being of their staff (45%), and the availability of financial resources (34%). Since July 2020, both emotional health and well-being and staff recruitment and retention have been top challenges for nursing leaders. 

Many leaders also reported witnessing incidents of workplace violence (53%), intimidation (72%), incivility (77%), and bullying (68%) at work. According to AONLF, the growing prevalence of workplace violence "can lead to increased stress, burnout, and a sense of insecurity" among healthcare workers.

Between 2022 and 2023, there was marginal improvement in nurse leaders' intent to leave, with a 5% decrease. Overall, 12% of nurse leaders said they plan to leave their position within six months, and 23% they would "maybe" leave their position.

The largest cohort of leaders reporting an intention to leave was CNOs/CNEs at 15%, followed by managers at 12% and directors at 10%. Among those who are considering leaving, 25% said they are thinking of leaving nursing altogether.

The top reasons respondents gave for leaving their position include work negatively affecting their health and well-being (44%), desire for a promotion or new opportunity (42%), and challenges with other leaders or colleagues (28%).

More support is needed for nursing leaders

According to Advisory Board's Allyson Paiewonsky, the study's findings underscore an urgent need to address nurse leaders' current environment. The status quo that they're operating in is no longer sustainable, and action needs to be taken to prevent further disengagement and burnout.

Nurse manager overload has been a persistent problem and can negatively impact a unit as a whole. Managers experiencing burnout can create an unhealthy work culture and environment, which in turn decreases staff engagement and performance while increasing staff turnover.

"We can't expect disengaged or burned-out leaders to effectively support their teams," Paiewonsky said.

Organizations also need to do more to support their nurse leaders. Currently, most engagement and retention action plans focus on how to support frontline staff, disregarding leaders' potential need for similar resources.

In the report, respondents outlined several solutions their organizations had implemented to improve their work satisfaction, including allowing them to take time off when needed, providing professional development opportunities, and more.

This resource can also help executives become more resilient and adaptative leaders. By practicing and modeling self-awareness and vulnerability and learning to prioritize taking time to restore themselves, leaders will be able to guide and support their teams more effectively. 

If you're interested in learning more about how to create a beneficial work environment for leaders, you can sign up for our "Fostering Resilient and Adaptive Leaders" presentation. (Taylor, Becker's Clinical Leadership, 1/16; AONL Nursing Leadership Insight Longitudinal Study, accessed 1/17)

COVID-19 illuminated the fact that the way we are asking our healthcare leaders to operate is not sustainable. Moreover, leaders must continue to operate in an increasingly uncertain and volatile environment well beyond the end of the pandemic. This reality requires adaptive leaders who practice and model self-awareness and vulnerability, prioritize taking time away to restore themselves, and take risks to lead their teams through uncertainty. Read on for three strategies executives should take to foster an environment that supports and reinforces these leadership behaviors.