Top 5 Nurse Leadership Issues for 2020

 Where should nurse leaders direct their focus this year? One CNO shares her thoughts.

This article appears in the March/April 2020 edition of HealthLeaders magazine. 

2020 will be a big year for nursing. It's the goalpost date that was set for the recommendations to come to fruition in the National Academy of Medicine's landmark report, "The Future of Nursing: Leading Change, Advancing Health," and 2020 has also been designated as the Year of the Nurse and Midwife by the World Health Organization.

So, what issues will rise to the top this year for nurse leaders? To understand where nurse executives should focus during 2020, HealthLeaders spoke with Shela Kaneshiro, MBA, RN, BSN, NEA-BC, CPHQ, vice president, patient care services and CNO at MemorialCare Orange Coast Medical Center in Fountain Valley, California and an attendee of HealthLeaders CNO 2019 Exchange event.

According to Kaneshiro, there are five issues that CNOs should have in their line of sight during 2020, ranging from succession planning to the work environment to workplace violence.

1. Succession planning

The upcoming retirements of baby boomer nurses are causing concern among many. One particular fear is that when this generation departs the profession they will take their years of knowledge and skills with them and a gap will be left. However, if CNOs plan for the future through succession planning they'll be able to utilize the talents of Generation X and millennial nurses to continue to deliver quality patient care. 

"Sometimes there is this picture that it's all just new grads [to replace the baby boomers]. But if you look at the ages of millennials, some of them can be as old as their mid-thirties, and some have been practicing since their mid-twenties. I think sometimes we don't give them enough credit. Some of our new grads are second- career nurses and that gives them a competitive advantage because they've been in the workplace and already have time management and coping skills.

"And don't forget about the Gen Xers who've been practicing for 20-plus years. Even though we may have this mass exodus of our boomers, we have a good couple of generations in the workforce that's available to take on these new challenges. I think we need to look at more similarities and not so just the generational differences. And I hear this from all of the generations, they want to be valued for the work that they do," Kaneshiro says.

2. Work Environment

There's no doubt that stress is inherent in the nursing field. Nurses are on the frontlines during life-and-death situations, for example. But that doesn't mean they should bear stress alone. Nurse executives should commit to creating environments that help nurses process stressful events in a healthy manner.

"One of the things that we did because it's becoming more stressful for staff, whether it's a traumatic event or compassion fatigue or moral distress, is we worked with Johns Hopkins to develop a confidential peer-to-peer support program. We just launched it in August [2019] and did a modified version because we're building our program. We had [representatives from] John Hopkins come out to our hospital and train our peer responders. They're nurses, they're volunteers, some of them are managers, respiratory therapists, and occupational therapists. They are available from 8 a.m. to 4:30 p.m., Monday through Friday.

"Those who wanted to be peer responders went through training. We have our employee assistance program, but this peer-to-peer support program is something that [nurses] can tap into during the day when [they] are having a difficult shift; for example, they had a traumatic event or they had a death of a patient they had been caring for for a while, or they've had issues with physicians or coworkers. They can call [the peer responder] confidentially and … the peer responder can meet with them or just be on the phone so that they can talk and unload. We just take very minimal information to keep it confidential. We just [note] the date and the time and the unit that you're calling from, just because we want to identify any trends. For example, ED is having a rash amount of calls or oncology because they have a lot of end-of-life issues. We want to capture that data but nothing very specific because we want to stress that [the conversation] is confidential," Kaneshiro says.

3. Workplace Violence

As violence seems to become more prevalent in society, nurse leaders cannot ignore that it is occurring at their organizations. Nurse executives must support staff who are victims of workplace violence and find effective ways to decrease its occurrence.

"Workplace violence is a big thing. I don't think you can escape it. It doesn't matter where you work. [It's important to check in] with those who've had some kind of [violent] interaction. It means a lot to the staff to know the organization puts it at a high priority. We have signs [around the building that] basically state that there is no tolerance for specific types of behavior.

"I don't think we've emphasized enough that you have patients who are not necessarily violent in terms of their aggressive behavior, but, for example, you may have patients with dementia or patients waking up from withdrawal, and they may kick staff and it doesn't hurt any less. So, it's just circling back with them when there's some kind of incident and checking in. It's not always easy because sometimes [nurses are] reluctant to report it.

"Through our town halls, staff have asked for active shooter drills, so we did another set of active shooter drills. It's important that if they want information or education that we at do that," Kaneshiro says.

4. Span of Control

It's becoming increasingly common for nurse managers to have a large amount of direct reports. But is this a best practice? This is something nurse executives need to contemplate.

"We need to make sure that we give them the tools [to be successful] and that we give them support by making sure the span of control is manageable to some degree," she says.

5. Alternative Ways to Keep Nurses at the Bedside

With so many new opportunities for RNs, retaining nurses with excellent clinical skills and knowledge at the bedside is a challenge. By being creative with positions and learning opportunities, nurse leaders may entice those with expertise to stay at the bedside.

"I think sometimes we need to step out of our traditional models of nursing positions. There are some nurses who are nurse practitioners but still want to provide bedside care. We're looking at how we can still keep them at the bedside for those who want to stay and looking at succession planning for some of our special expert NPs, like those in palliative care and cardiac care. We have a telemetry nurse who just earned her nurse practitioner degree and we have a palliative care nurse practitioner who is willing to train her because she'll eventually be retiring. Before we even get to that (retirement), there is some time to have her shadow and learn," Kaneshiro says.

Editor's note: This article has been updated for quote clarification.