Turnover rates amongst nurse leaders are projected to be high, and CNOs need to strategize.  

The staffing shortage affects not only the bedside nurse, but also the nurse leader.

A new report from AMN Healthcare found that 31% of nurse leaders said they plan to be in a different role a year from now.

AMN Healthcare's 2024 Survey of Nurse Leaders also says that 17% of nurse leaders will look for a new place to work, 9% will leave nursing, 3% will stay in a non-administrative position in nursing, and 1% will retire.

The survey consisted of several different kinds of nurse leaders, at various levels of health systems. CNOs made up 36% of participants, 37% were nurse managers, 20% were directors of nursing, and 4% were CNEs. The remaining 3% were made up of associate CNEs, interim CNEs, senior VPs, and VPs of patient care services.

While this does mean that most nurse leaders will remain where they are, a 31% turnover rate is alarming. As seen with regular nurse turnover, this phenomenon at the CNO level has the potential to greatly impact the nursing workforce and overall efficiency.

The why

Nurse leaders are facing the same workforce challenges that they are responsible for handling.

The nurse leaders who participated in the survey reported that the top three challenges they are facing in the workforce: 43% said recruitment and retention, 32% said staff burnout, and 32% said labor shortages.

The survey emphasizes the impact of burnout, stating that 72% of the nurse leaders who responded reported sometimes, often, or always experiencing burnout in the jobs, while only 28% said they rarely or never experience burnout.

According to Allison Guste, Chief Nursing Officer at University Medical Center and Corporate Vice President of Nursing and Clinical Services for LCMC Health, workforce shortages and burnout are two of the biggest issues following the COVID-19 pandemic that CNOs have to face, along with rapid technological changes.

"We know that healthcare is always changing," Guste said, "and if you're not changing, you're probably going to fall behind."

The fix 

So, what should CNOs do?

There are many strategies for addressing workforce shortages, including staying competitive with compensation, building academic partnerships, and offering professional development, according to Guste.

"Recruitment and retention is the name of the game these days," Guste said.

As for burnout, CNOs need to take care of themselves as well as their nurses, and make sure they are still engaging with their nursing as a practice.

"What fills my cup every day is not when I'm in a lot of meetings," Guste said, "it's really going out there and just rounding on the floors and seeing the nurses do what they do best."

Guste believes it is a big mistake for nurse leaders not to go be with patients, as well as with nurses. She said hearing patient stories helps her remember her goals as a nurse and a leader.

"Being out on the units, not just with the patients, not just with the nurses, but with all the staff has really enabled me to realign my vision every day [and] give me purpose," Guste said, "and align me back to why I became a nurse in the first place."

Her advice to CNOs is to be authentic and listen to staff, and to lead with empathy.

"Don't every forget why we became nurses," Guste said, "so inspire collaboration and push towards transformation and everyday excellence."

The success of AI varies, and depends largely on proper implementation.

AI is currently being implemented in many aspects of nursing, including documentation, admission and discharge processes, measuring and monitoring vitals, and data collection and analysis.

According to Betty Jo Rocchio, Senior Vice President and Chief Nurse Executive at Mercy, a lot of thoughtful planning goes into ensuring that AI won’t become a disruptor to nurses.

Here's what CNOs need to know about AI in nursing. 

Click here to read the accompanying article. 

AI can be a huge disruptor, but it has a lot of potential.

AI is currently being implemented in many aspects of nursing, including documentation, admission and discharge processes, measuring and monitoring vitals, and data collection and analysis.

However, the success of AI varies, and depends largely on proper implementation.

According to Betty Jo Rocchio, Senior Vice President and Chief Nurse Executive at Mercy, a lot of thoughtful planning goes into ensuring that AI won’t become a disruptor to nurses.

“It’s not just automated intelligence, but how we augment that intelligence that the nurse brings to the bedside,” Rocchio said.

Solving problems

Ultimately, the goal of any CNO wanting to implement AI in their workforce is to solve problems and make the delivery of care more efficient and effective.

“We can never replace the care that we deliver and the critical thinking of a nurse,” Rocchio continued, “but we can help nurses be much more equipped to be able to deliver… care in a much more streamlined fashion.”

Rocchio said Mercy is partnering with Epic and Microsoft, along with other resources, to implement new processes and smaller innovations that will lead to larger future projects.

One problem that the team at Mercy is trying to solve is handoffs between departments. Typically, according to Rocchio, when a patient arrives in the emergency department and is admitted, there is typically a handoff from the emergency department nurse to the inpatient nurse.

To make this process more efficient, Mercy is exploring the use of AI to first develop a note from the emergency department record, then develop the key points in an AI automated fashion. The last step would be to deliver that note to the inpatient nurse via the nurses’ mobile phones.

“We’re trying to use AI to scour that record and deliver the most important points up to the inpatient nurse without nursing having to intervene,” Rocchio said.

AI is also assisting CNOs, not just bedside nurses.

Mercy has launched a workforce platform that allows the team to get the right clinician to the right spot without manual intervention. Rocchio said they are using AI in the background to calculate the number of necessary shifts and set the rate on incentive shifts for nurses who want extra work.

“Just like [how] Uber and Lyft use a supply-and-demand model and use data in the background,” Rocchio said, “we’re starting to use that in healthcare to be able to develop our workforce and get them in the right spots at the right time.”

AI technology can also help with hiring and recruiting processes.

“We use platforms now for hiring and recruiting that [help] candidates get to the right spot for interviews quicker,” Rocchio continued, “as well as deliver information to the candidates and collect [candidate] information… [that helps us] prioritize the areas we want to focus on.”

Challenges and concerns

As with any new technology or trend, there are challenges that come along with implementation, that CNOs should carefully consider before moving forward.

“An office is a very dangerous place to start making decisions about clinical areas from,” Rocchio stated.

The nurses themselves do have concerns about AI, but not about the use of it. The concern lies with understanding how AI will fit into their nursing practice. Nurses want to make sure that AI is going to actually be incorporated into their workflows.

“There’s no concern as long as [implementing AI] isn’t done to [nurses], but it’s done with them,” Rocchio said.

Patients, on the other hand, are very excited about AI technology. According to Rocchio, patients want information to come to them quickly and completely, and if AI can accomplish that, then they view it as a positive.

“It’s just frightening to [patients] if [information] comes in pieces,” Rocchio said, “but if it’s a part of their standard care and they can see it, they’re embracing their piece in helping us reach their healthcare goals.”

Solutions

To help test new AI and mitigate some of these concerns, Mercy has launched innovation units where frontline staff can also give their input. The innovation units are there to help not only nurses, but also staff in other departments, to see where the technology could help them in their workflows.

“It’s not just AI off to the side, it’s AI embedded into the workflows and how that comes together with the frontline giving us their feedback on how it works,” Rocchio said. “We’re doing some rapid cycle improvement processes with this and making sure that we’re taking the frontline into account.”

Alongside innovation units, Mercy has put up electronic boards in every patient room that provide a connection point for information between the patient, the family, the nurse, and the physician. The boards also help speed up communication and set goals with the patient, said Rocchio.

“We’re finding [that] the power of those boards and connecting [them] into the electronic health record is helping nurses think about how they plan their day better,” Rocchio said, “and I think that’s going to be a real game changer.”

Additionally, Mercy has been using AI in the background to monitor the blood sugar of patients living with diabetes, Rocchio said. The AI tool pushes information to the patient and allows physicians and nurses to see that information as well. Clinical staff can then clearly communicate with patients in a timely manner and help them manage their blood sugar. The data can also be g used to monitor health trends for the patient. 

“If it’s buried in a medical record, somebody has to dig it out to have communications,” Rocchio said, “but when AI serves it up to the physician, the nurse, and the patient, we’re able to stay on top of it in real time.”

Measuring outcomes and success

According to Rocchio, Mercy has already seen great outcomes from the testing they’ve done in their innovation units, and in other areas of the health system. In general, the team has been able to take information and compare it with other metrics.

“We export that data into dashboards and allow our frontline nurse leaders to make good decisions around filling shifts [and] how often they need help,” Rocchio said, “in a very automated fashion, so they don’t have to manually do it.”

The same thing is true for patients, the data is aggregated, and both patients and providers are able to track, trend, and monitor patient health conditions.

Mercy has been measuring how many EHR clicks are being saved i through a mobile platform that nurses can use to chart at the bedside.

“To date, we’ve saved over 200,000 clicks in the electronic medical record,” Rocchio said, “which is important because that keeps nurses by the bedside, not spending time in documentation.”

Advice for CNOs

The implementation of AI technology can be overwhelming, so it’s important that CNOs approach it carefully and strategically.

“Get a partner that’s been working in the AI lane, like Microsoft or Google, or somebody that’s used it outside of healthcare first,” Rocchio said. “[Somebody] that understands the limitations as well as the power of it, because we’re just dipping our toe in and we want to make sure we use it in the right way.”

Rocchio recommends looking at the problems in workflows and addressing them in ways that do not involve manual intervention, but use technology or analytics to present the problem in a different way.

“It takes us leaders thinking about things differently and how to solve them,” Rocchio said, “because today the world’s moving in a while different direction.”

Click here to listen to the full interview.

Safe patient handling programs help reduce nurse injuries. 

Working in healthcare poses many safety concerns, including exposure to illness, physical injury, and workplace violence.

According to the Occupational Safety and Health Administration (OSHA), in 2020, hospitals recorded nearly three times more work-related injuries and illnesses for every 100 full-time employees than in all industries combined. 

CNOs must ensure that there are proper safe patient handling procedures in place so that nurses avoid sustaining injuries. Here's what you need to know about safe patient handling. 

Click here to read the full article.