The findings from a recent survey conducted by the American Organization for Nursing Leadership (AONL) have prompted us to pause and reflect. It’s clear that one challenge facing nursing leaders stands out above the rest: staff recruitment and retention. This comes as no surprise as RN turnover, vacancy, and time-to-fill rates remain at elevated levels.

While it’s important for nursing leaders to address immediate staffing concerns, this laser focus may be inadvertently diverting attention away from the underlying causes of their recruitment and retention struggles. The AONL survey sheds light on additional challenges that, although not ranking highest, are crucial underlying factors contributing to recruitment and retention problems. These challenges include the emotional health and wellbeing of staff, workplace violence, bullying, incivility, and the adoption of new technologies and innovation. Nurse leaders must prioritize these issues in 2024 (and beyond) to truly address the staffing crisis.

By understanding and addressing these underlying issues, nurse leaders can create a more supportive and engaging work environment. They’ll also be able to better attract and retain talented nurses and provide the highest quality of care to their patients.

45% of nursing leaders identified poor emotional health and well-being of staff as a top challenge. Recent studies have shown that RNs need to feel that they are doing meaningful work if they are to stay in their positions. Staff members want to be appreciated for their daily contributions and valued as both professionals and individuals. When emotional health and well-being are compromised, nurses may become disengaged, leading to increased turnover rates and difficulty in attracting new talent.

The AONL Foundation asked nurse leaders to rate the effectiveness of various solutions to improve staffing situations. According to the response data, listening and responding to nurse feedback and increasing nurse recognition had the most positive impact on improving staffing situations. Below are two ways to help staff feel valued at your organization:
 

1. Create dedicated avenues for staff input: Consider implementing an idea progress board to collect feedback from staff and show staff how you’re using their ideas. This approach ensures that nurses feel heard and can share their ideas, and it increases their investment in the organization.
2. Build a culture of recognition from both leaders and peers: Consider creating a boost board at your organization to help nurses celebrate the little things. It's a place they can go when they need a boost, whether that's by sharing something positive from their day or reading about others' bright spots. 

The AONL findings indicate that this issue is on the rise. 24% of nurse leaders identified workplace violence, bullying, and incivility as a top challenge in 2023, compared to 20% the previous year. The top three culprits include patient families, staff nurses, and patients themselves. This highlights the need for nurse leaders to address not only external threats but also internal dynamics that contribute to a hostile work environment. A lack of security can significantly impact job satisfaction and exacerbate feelings of isolation among staff, leading to increased turnover and a decline in morale. Additionally, when nurses do not feel supported or respected by their colleagues, it becomes challenging to foster a collaborative and cohesive work environment and deliver high-quality care.

For years, violent, aggressive, and disruptive behaviors from patients and families have been considered part of the job, often going unreported. But healthcare leaders can reduce point-of-care violence. Below are three initial action steps to address violence by patients and visitors at your organization:

• Engage executives and clinical leaders: Addressing workplace violence requires organization-wide buy-in. Everyone, from executives to ward managers, must understand the magnitude of the problem. To do this, collect data on point-of-care violence at your organization and create a monthly report to inform leaders of incidents, including hot spots and trends.
• Communicate behavior expectations to patients and visitors: Clearly define workplace violence and disruptive behavior, including both verbal and physical aggression. Then, set and communicate expectations for patient and visitor behavior and enable staff to hold them accountable.
• Empower staff to advocate for their safety: Create a reporting culture by implementing systems for staff to easily detail all instances of violent and disruptive behavior. Escalate instances of persistent disruption to managers and executives to provide support for frontline staff in managing patient and visitor behavior.

In tandem, nurse leaders have a direct influence on how staff treat one another. To identify and address areas where incivility or bullying may be occurring:
 

• Identify hotspots of incivility among staff: Float nurses can provide an outsider’s perspective on work environments and the social dynamics in different units. Use a brief survey to collect feedback from float nurses to detect units with unfriendly or unwelcoming cultures and address problems before they isolate nurses and result in preventable turnover.
• Establish a staff-driven code of conduct: Work with staff to develop and commit to a discrete list of specific, actionable behaviors they will follow in their daily interactions. By letting nurses determine their ideal workplace conduct, nurse leaders can hardwire civility into staff and patient interactions, promoting a more respectful and supportive work environment.

According to the AONL survey, "adopting new technologies and innovation" was identified as a top challenge by 17% of nurse leaders. Many healthcare organizations have previously invested in technology that adds responsibilities for nurses and other staff, leading to increased levels of burnout. These technologies may not allow nurses to work as efficiently and effectively as they could before, further exacerbating recruitment and retention challenges.

As younger, tech-savvy generations enter the workforce, nurses will expect technology to be an integral part of their workflow. Nurses will opt to work for organizations that employ automation, allowing them to dedicate more time to patient care rather than documentation. Consequently, organizations that invest in technology to facilitate efficient and effective work processes will have a competitive advantage in recruiting and retaining clinicians. Organizations that don’t will struggle to attract and retain staff who are used to relying on technology both inside and outside the workplace.

AONL survey respondents reported that two of the top innovations and technologies their organizations will continue to explore include innovative patient care technologies (22%) and virtual nursing (20%). Below, we explore how to effectively apply these advancements to address staffing challenges:

• Implement innovative technologies to ensure top-of-license care: There's potential for technology to reduce nurse burnout by accomplishing administrative and repetitive tasks that take time away from caregiving. Technology solutions can reduce the data that nurses are responsible for collecting at the point of care and entering into electronic health records. Solutions include real-time ambient listening technologies that can transcribe the entirety of a patient-nurse interaction, or asynchronous questionnaires that automatically populate the relevant fields in a patient's medical record. These solutions free nurses to do the patient-facing work they want to do, rather than the administrative work that contributes to overload, burnout, and turnover.
• Scale clinical expertise through virtual nursing: Many health systems are turning to virtual nursing as a solution to the ongoing workforce crisis. By assigning administrative tasks and specific care responsibilities to virtual nurses, bedside nurses can dedicate more time to direct patient interaction, which can enhance job satisfaction and encourage staff to stay. Moreover, virtual nursing positions offer an opportunity to keep experienced nurses who may otherwise leave the workforce entirely. This allows organizations to scale clinical expertise across an organization through specialist oversight, streamlined documentation, and monitoring of high-risk patients.

As part of ongoing efforts to address these challenges, the Advisory Board is conducting research on innovative nurse staffing solutions. Interested in adding to the conversation? Our team would love to hear your thoughts as we continue our research. Please email Coltin Ball at ballc@advisory.com or Marissa Goodall at goodallm@advisory.com to schedule a research interview.