This leader outlines the dissatisfaction of nurses across the industry.
On this week’s episode of HL Shorts, we hear from Katie Boston-Leary, Director of Nursing Programs at the American Nurses Association, about the factors leading to nurse dissatisfaction and the increase in union and strike activity across the country.
What are the underlying causes of the recent union and strike activity happening in the U.S?
There's a generalized dissatisfaction of the current state of [nursing] from nurses. There are a number of things that nurses that have historically [and] traditionally struggled with, and I think that the phenomenon that's happening right now is nurses are really saying “no more.” There was dissatisfaction, but it was a dull roar, and now a lot of what's bubbling is manifesting in a lot of this organized activity. That is a big concern for a lot of administrators and hospital executives, but in some respects, nurses are using this as a last resort. [Some are having a] “tried everything and this is where we are” kind of approach to this, and then there's some that are saying, “you know, maybe this is the way for us to have a voice, so getting unionized is probably the way to go.”
There is a lot under the surface that's causing this, starting with the staffing and the crisis that we're in. Then you have the well-being piece where [the] nurses’ overall health and well-being is compromised because of everything that's happening, and we have data that actually links those two, staffing and well-being, together for nurses. Then there's everything else after that, that's a close second, third and 4th and 5th. There's workplace violence, there's unmanageable workloads, there's [the] hierarchical structure of healthcare systems. There's the feeling of not being heard, the feeling of exhaustion and not being able to do what you figure patients deserve, and leaving everyday feeling that moral distress. All those things have brought us to this point, unfortunately.
Recruitment and retention are particularly difficult right now in healthcare, especially in nursing.
Health systems are struggling to find new nurses who will stay at their hospitals permanently. Many veteran nurses are retiring and taking their knowledge and experience with them. This combined with the overall shortage of staff leaves new nurses feeling overworked and without the guidance and mentorship of their predecessors.
Maribeth McLaughlin, vice president and chief nurse executive at UPMC, says the COVID-19 pandemic also contributed to this issue.
“During the pandemic, if you think about back in the beginning in 2020,” McLaughlin says, “for many of us, our pipelines with the schools of nursing, our academic partners…really kind of fell apart.”
Students moved to remote settings, relationships were strained, and curriculums changed, she says. And it affected academic partnerships all across the healthcare industry.
Establishing partnerships
A crucial first step for CNOs dealing with this issue is to reestablish academic partnerships with nursing schools to help create clear pathways into the industry for students who are working to become nurses.
McLaughlin says UPMC partners with about 140 different schools, and a senior nurse leader runs point with each of those relationships. UPMC also created an academic affairs office, with oversight from a CNO, that helps with finding placements for students, building relationships, and partnering on new and innovative programs.
Additionally, health systems can take certain measures to support their own employees going back to school.
McLaughlin says UPMC expanded the diploma at its schools of nursing, and partnered with other universities so their students can become nurses and continue to work towards bachelor’s degrees. UPMC also has a tuition reimbursement program, in which many of the participating students are UPMC employees who are in entry level positions and want to become nurses.
“There are an overwhelming number of people who want to still become nurses,” McLaughlin says. “The challenge is helping them, not just with tuition, [but also with] going back to school, and with trying to work and go to nursing school.”
CNOs should focus on pipelines and targeted recruitment, and ensure that there are good student experiences in the health system. McLaughlin says UPMC created student ambassadors in all of the units across all the hospitals, as well as the student nurse internship program. Both programs allow students to get clinical experience before they graduate, making them better candidates for recruitment.
The education of future nurses can go far beyond university and collegiate experience as well.
“[We have started] to think about how to get into the middle schools and high schools,” McLaughlin says. “Not just for nursing, but for all of our patient care roles in a hospital, to be able to really grow our professions for the future.”
Support from outside agencies can also make these pipelines possible. For instance, the Vanderbilt School of Nursing was recently granted funds from the Health Resources and Services Administration’s (HRSA) Bureau of Health Workforce to help build the new Nurse Education, Practice, Quality, and Retention Simulation Education Training Program. The $1.5 million grant is intended to help expand offerings for students, faculty, and other health professionals and to provide them with more learning and career-building opportunities.
The grant is funded by the Department of Health and Human Services and is part of the HRSA’s Nurse Education, Practice, Quality and Retention (NEPQR) grant program. The goal behind the grant program, according to the HRSA, is to forge a pathway for students to enter the clinical environment by creating and implementing Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN) to Registered Nurse (RN) bridge programs, and the employment of clinical nurse faculty. The funds can be used for program development, direct LPN/LVN to RN student support, curriculum and partnership development, and for recruiting faculty and clinical preceptors.
Support after recruitment
How can CNOs build upon this progress?
Creating the pipelines is only half the battle. CNOs must provide support for incoming nurses and make sure they feel valued and have opportunities for advancement in their careers.
“Rotating shifts is not easy,” McLaughlin says. “Being a nurse in a hospital, you’re going to work off shifts, you’re going to work weekends, [and] you’re going to work holidays.”
The support needs to go beyond just the clinical.
McLaughlin says UPMC is restructuring the onboarding and education processes to be more supportive at the bedside, and to consider what nurses need in a residency beyond the support that is typically provided. New nurses need help learning how to rotate shifts and how to take care of themselves throughout their shifts. They should be given advice on how to sleep in different patterns, eat properly, wear the right shoes and clothing, look at their schedules, and know how many shifts they should be working.
“We have a wellbeing committee of frontline staff and we’ve been working with our own health plan to develop a tool kit,” McLaughlin says. “That’s where we’re now very focused, trying to support those nurses.”
There are other kinds of support as well that must be made available to new nurses. Nurses need to have the right teaching skills and know how to deescalate situations, delegate, work in teams, and process what they are going through on an emotional level, McLaughlin states.
She says UPMC created “condition support,” which is a resource that nurses can use to get help with deescalating situations.
“Those are all things that are really important for all our staff,” McLauglin says, “so that we can help them as they transition to the workforce, [and] learn the skills they need. …We’re trying to give them as many of those tools and support as we can.”
CNOs should focus on academic partners and making sure student experiences are positive, and then focus on first year turnover. McLaughin recommends checking in with employees and asking more targeted questions to find out how they are doing.
“Try to create mechanisms for identifying people who are beginning to be at risk or are struggling [with] anything from the work to emotions or situations,” McLaughlin says. “And then [look] at scheduling, and [look] at the ability to be as flexible as you possibly can be, so that people feel like they have that work-life harmony.”
Here’s how CNOs should be preparing for nursing strikes, according to this CNO.
Nurses have been going on strike all throughout the United States.
The recent union activity is indicative of large, widespread problems in the nursing industry with staffing, work environment, and nurse wellbeing. While it is the CNO’s responsibility to address those issues and to facilitate those conversations, it can be quite difficult.
To learn how CNOs should handle these situations, we sat down with Dr. Chaudron Carter, Executive Vice President and Chief Nurse Executive at Temple Health, to hear how her health system avoided a strike, and how to build a plan for continuing operations during a strike.
The goal is to provide better patient care, say CNOs and CNIOs in the know.
With nursing tech disruption at a fever pitch, savvy CNOs and CNIOs are putting their heads together to ensure their investments make real impact. And there’s one place in particular where they’re setting their sights: virtual nursing.
Here's what CNOs should keep in mind when developing and integrating virtual nursing into their programs.
This CNE has advice on how to create and foster a more diverse workforce.
On this week’s episode of HL Shorts, we hear from Dr. D’Andre Carpenter, Senior Vice President and Chief Nursing Executive at Allina Health, about strategies to improve recruiting and retention efforts by including diversity, equity, and inclusion (DEI) principles into the workplace culture.
What are some of the strategies CNOs can take to embed DEI into recruitment and retention culture?
I'm getting inspired by some work that I did at my previous system, [including] some [ideas] that we're talking about here at this system around promoting internal equity for team members that already exist in our organization.
We look at our supportive staff, our EVS transport, food and nutrition staff, that work elbow to elbow with our clinicians every day. A lot of them have aspirations of becoming clinicians, and [we look at if] we are being intentional about providing and setting up those pathway programs for them to be able to propel themselves into a clinical career, if that's what they desire to do. I think that's one that's just really low hanging fruit and easy, and it promotes internal equity in your organization.
You know, you're treating your family members that are local to your workforce as a part of the team and helping them grow their profession, [which is] another way to recruit and retain staff.
This leader discusses how to bridge the gap between health systems and unions.
Recently, there has been an increase in nursing strikes and union activity throughout the United States.
Nurses are frustrated, and the recent union activity is indicative of large, widespread problems in the nursing industry with staffing, work environment, and nurse wellbeing. While it is the CNO’s responsibility to address those issues and to facilitate those conversations, it can be quite difficult.
To get the bigger picture, we sat down with Katie Boston-Leary, Director of Nursing Programs at the American Nurses Association, to discuss the underlying causes of strikes and how to communicate with unions to achieve better outcomes.
Two leaders share their insights and strategies to help CNOs work together with staff and problem solve.
Right now, it seems like every day there are new cases of nurses striking or unionizing at health systems all across the country.
Nurses are frustrated, and the recent union activity is indicative of large, widespread problems in the nursing industry with staffing, work environment, and nurse wellbeing. While it is the CNO’s responsibility to address those issues and to facilitate those conversations, it can be quite difficult.
Here's what CNOs should know about preparing for strikes.
CNOs must be ready to strategize and solve key issues in nursing this year.
On this week’s episode of HL Shorts, we hear from Lisa Dolan, Senior Vice President and Chief Nursing Officer at Ardent Health Services, about the top five challenges CNOs are facing in the new year. Tune in to hear her insights.
What do you predict will be the top 5 biggest challenges in nursing in 2024?
Dolan: Well, of course, at the top of the list is just the supply of nurses. The demand is far outpacing the supply. So that'll be a key piece.
Second to that is stabilization of support roles. As nursing becomes more and more taxed, it's especially important that we have a support team around the nurse. We're finding it more and more difficult to be competitive in our staffing of support roles. That's a that's a key worry and concern as well.
I think another key piece is innovation. There's so much great innovation going on, but how we incorporate that so that it's helpful to the nurse and not adding additional burden to the nurse is especially important.
Frontline nursing leaders and being able to retain the nursing leader. That's a very difficult position, in fact, I always say it's one of the toughest positions in the hospital. Being able to retain and support those frontline leaders will be key.
And then last but not least is really just burnout in general of the clinical staff. The roles are so difficult at times, and so [having] a healthy work environment for people to feel comfortable and not experience the rate of burnout that they have over the past several years [will be critical].
Two leaders share their insights and strategies to help CNOs work together with staff and problem solve.
Nurses everywhere are going on strike.
Right now, it seems like every day there are new cases of nurses striking or unionizing at health systems all across the country.
Nurses are frustrated, and the recent union activity is indicative of large, widespread problems in the nursing industry with staffing, work environment, and nurse wellbeing. While it is the CNO’s responsibility to address those issues and to facilitate those conversations, it can be quite difficult.
Underlying causes
According to Katie Boston-Leary, Director of Nursing Programs at the American Nurses Association, there are several reasons that nurses have been going on strike, starting with the staffing crisis and its impact on overall nurse wellbeing. Workplace violence, unmanageable workloads, exhaustion, and the feeling of not being heard are also contributing factors.
“There is a generalized dissatisfaction of the current state [of the industry] from nurses,” Boston-Leary says, “and I think that the phenomenon that’s happening right now is nurses are really saying ‘no more.’”
Due to staffing shortages and heavy workloads, nurses are not able to spend as much time with their patients as they want to, and according to Boston-Leary, they often leave work feeling like they did not provide the best possible care.
“We have unintentionally set up a system that pulls nurses away from what matters most to them,” Boston-Leary says, “which is spending time with their patients.”
COVID-19 exacerbated the issue. It forced nurses and other healthcare professionals to be introspective, and to reassess what their priorities were in terms of job structure and how work should balance with their personal lives.
“I think COVID is an accelerator and illuminator,” Boston-Leary says, “and it just adds fuel to everything that we [already] knew.”
Boston-Leary believes that nurses are using unions as a last resort to find their voices in health systems, and that they are voting to make sure that things are changed for the better, for themselves and for new nurses. If they do not see the issues being addressed, nurses might feel a need to turn toward the more compulsory, structured approach.
Boston-Leary also states that in all her experience leading and working in unionized hospitals, the unionized environment does not impact the dedication that nurses have to their profession.
“Nurses have a right to voice their concerns,” Boston-Leary says, “and [they] find a number of different ways to do that through shared governance, through leadership, and in some cases through unions.”
Are strikes avoidable?
Last year, Temple Health was close to a nursing strike, and the issue up for negotiation was staffing. According to Dr. Chaudron Carter, Executive Vice President and Chief Nurse Executive at Temple Health, they were able to avert the strike by sitting down with the nurses and adjusting staffing based on acuity and many other criteria.
“We essentially averted a strike by really just getting together and agreeing to some changes in our staffing guidelines,” Carter says.
Temple implemented a new set of staffing guidelines that do not include ratios, and they developed a process where the guidelines are looked at on a monthly basis, and any necessary adjustments are made. Leadership focuses on a different unit each month, and they provide the union with updates about new staff and other information. The meetings last for eight hours, four are dedicated to discussing topics on a shared agenda, and the other four are spent assessing the staffing guidelines and making changes if needed.
To Carter, it is crucial that the nursing staff show up for these discussions, and that they continue to deliver on quality of care, as part of the effort to foster shared governance.
“Leadership can make decisions,” Carter says, “however, if it is not the right decision to drive the change that we want, it won’t work.”
Communication and action
With the principles of shared governance in mind, the responsibility falls on CNOs and other nurse leaders to be able to strike a balance between the unions and health systems in a way that is beneficial for everyone.
According to Boston-Leary, the nurses will know that the CNO is listening when their questions and concerns are answered and addressed.
“I’ve learned the hard way that it’s not enough to have an open door,” Boston-Leary says. “You have to walk the walk and talk the talk and really show people that you’re listening.”
CNOs can find out what their nurses are going through by asking them directly. Boston-Leary recommends setting up a shadow board in the department so that nurses can give feedback in a structured way. It is also vital that leaders give feedback to nurses about actions being taken to make progress and to keep them updated on that progress.
“We have to get to a point of resolving a lot of these issues and managing these pain points, because it’s at the point of being unbearable for nurses,” Boston-Leary says, “which is why we’re seeing all the [union] activity that we’re seeing.”
Additionally, CNOs can maintain relationships with their nurses without always involving the unions. Boston-Leary states that nurses are a part of a CNO’s team regardless of union presence, and it’s important to still have conversations with them.
“You should have relationships with the people that are under your leadership because those relationships are important,” Boston-Leary says, “and the unions don’t necessarily have to come between [those] relationships.”
For Carter, communication is also key. She recommends stepping onto the hospital floor and spending time listening and talking to staff to better understand the pain points that might arise in union discussions. That way, CNOs can get ahead of the curve and develop strategies before negotiations that will help move the problem-solving process along.
“If you could develop a strategy before you get to go into negotiations around what those topics may be, and the organization develops a strategy on how to combat those issues,” Carter says, “I think you’ll position the organization better as it relates to going into negotiations and averting a strike.”
Trust is another important ingredient. Carter believes that open dialogue and transparency can help create a trusting relationship between the two parties, so that even when there are disagreements on approach, there are still shared goals.
“We don’t always see eye to eye,” Carter says, “[but] we’re here for the same reason, we’re here for safe patient care, [and] to make sure that the staff is taken care of as well.”
Have a contingency plan
For CNOs working in union environments, preparation is essential.
Carter highly recommends that any organization embarking on contract negotiations should have a contingency operations plan in place. The plan should detail how to continue operations at the hospital if the nurses go on strike.
Carter suggests that this could involve pulling from other departments within the health system, such as housekeeping or radiology, or hiring an agency to bring in a contingency workforce. CNOs should determine where and how to downsize and distribute staff so that they can still provide the same quality patient care.
“The plan is huge because nursing touches all aspects of an organization,” Carter says, “and so you have to think of the most minute things to the larger scale items.”
At the end of the day, unions are an inevitable part of dealing with the workforce.
In her time leading in a unionized environment, Boston-Leary took the approach of enlisting the support of the unions and keeping them informed in order to help tackle nursing issues. She found it important for nurses to see their leaders working together for their benefit, rather than an adversarial relationship where no progress is made.
“I learned that I cannot treat unions as if they were the bad guys, because that was a non-starter,” Boston-Leary says. “If they’re here, they’re here, and you have to work with them and partner with them.”
Allina Health's new chief nursing executive has a background that includes leadership positions at Jefferson Health, Baylor Scott & White, VCU, and UnityPoint Health.
D'Andre Carpenter, DNP, RN, knew he wanted to be a nurse at age 13. For a while, he was convinced not to go into nursing, and worked in computer science and software engineering instead. However, he never stopped thinking about his dream of being a nurse, and so he decided to pursue becoming a registered nurse full time while working and raising a family.
Carpenter has held leadership positions at Jefferson Health in Philadelphia, Baylor Scott & White Health in Dallas, and the Virginia Commonwealth University Health System in Richmond, Virginia. He also served as senior vice president and chief system nursing officer for UnityPoint Health in Iowa.
He was recently appointed senior vice president and chief nursing executive at Allina Health, where he will be developing strategies to improve retention rates and patient satisfaction.
For our latest edition of The Exec, we sat down with Carpenter to discuss his thoughts on recruiting and retention strategies, diversity, equity, and inclusion (DEI), technology in nursing, and how to prevent workplace violence. Tune in to hear his insights.
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