At this time in history, the American nursing profession and its leadership are in a state of flux. The November 2023 American Organization for Nursing Leadership (AONL) Nursing Leadership Insight Longitudinal Study leverages nursing leaders’ perspectives to shed light on where we are and where we’re headed as a nursing collective.
In coordination with the AONL Foundation and Joslin Insight, five longitudinal studies have been conducted since 2020. The collective data are a fascinating avenue into the hearts and minds of nursing leaders and how they perceive the healthcare industry and nurses’ places in it.
Leadership Identifies Top Challenges
According to the 2,477 nurse leaders surveyed for the current AONL study, the top ten challenges facing the profession are:
Focusing on workplace behaviors such as violence, bullying, and incivility, 68% responded that they had witnessed one or more incidents of bullying at work. In terms of having seen one or more incidents of violence, 53% said they had. When it comes to incivility and intimidation, a stunning 77% and 72% had witnessed such aberrant behavior, respectively.
AONL concludes:
Nurses frequently encounter verbal abuse, physical assaults, and other forms of violence and intimidation from patients, patient families, the public, and coworkers, including physicians, other nurses, administration, managers, supervisors, faculty, and other staff (Figure 6). This hostile environment not only jeopardizes the safety and well-being of healthcare workers but also impacts patient care. The rising instances of workplace violence can lead to increased stress, burnout, and a sense of insecurity among healthcare professionals.
Addressing workplace violence, intimidation, incivility, and bullying requires comprehensive strategies, including enhanced security measures, de-escalation training, fostering a culture of safety, and providing trauma-informed care to healthcare workers. It also requires advocacy to raise broader public awareness.
Assessing nurse leaders’ emotional health, whereas 44% rated themselves as emotionally healthy in 2021, 52% now see themselves as such, and the number who viewed themselves as emotionally unhealthy dropped from 14% to 11% as we get further from the height of the COVID-19 pandemic.
The researchers state:
Regarding emotional health, there has been a slight improvement from last year. However, the data still shows a mix of emotional health states, ranging from very emotionally healthy to not at all emotionally healthy….. It’s crucial to recognize the need for continued efforts to support nurse leaders, especially nurse managers who fare worse in cultivating and maintaining healthier emotional well-being. Creating a nurturing environment for nurse leaders is vital to ensure their resilience, support, and effectiveness in their roles.
Intent to Leave
Attrition from the nursing profession and the attempt to retain top talent continues to be a struggle. Reports of nurses’ intent to leave either a current position or the profession as a whole are constantly troubling, especially in light of the ongoing nursing shortage that can be found in many healthcare labor markets around the country.
The AONL longitudinal study reveals the following:
This survey shows a marginal improvement in nurse leaders’ intent to leave with a 5% decrease in those planning to leave from 2022 to 2023. The survey examined intent to leave based on roles. The largest cohort of nurse leaders reporting intent to leave exists in the C-Suite with 15% of CNOs/CNEs planning to leave their positions within the next six months, contrasting with 12% of managers and 10% of directors. Among nurse leaders contemplating leaving, a notable 25% report considering leaving nursing altogether. Previously, 27% of respondents reported considering leaving nursing altogether.
The most often reported reasons for nurse managers and CNOs/CNEs leaving their roles include:
The negative impact of work on health and well-being
Pursuit of new opportunities
Challenges with other leaders or colleagues
Identified strategies for nurse leader retention include facilitating time off for work-life balance, opportunities for professional growth, and the perception that the employing organization understands leaders’ concerns, cares for their well-being, acknowledges and responds to their concerns, notices their contributions, and takes pride in their accomplishments. In fact, employers would do well to enact these strategies universally for all staff consistently in the interest of retention and employee satisfaction.
Conclusions Abound
Many conclusions can be made from the data available from the ongoing series of AONL longitudinal studies. As AONL concludes, there is a “nuanced landscape for nurse leaders, tracking shifts in their challenges and perceptions since July 2020”, with a focus on well-being, retention, financial resources, and workplace violence.
This study demonstrates the need for interdisciplinary collaboration, innovative solutions, and consistently addressing challenges of staffing and retention. And while cookie-cutter solutions can sometimes be helpful, progressive and forward-thinking healthcare organizations would be prudent to create tailor-made solutions based on their challenges on the ground.
The researchers’ conclusions say a great deal regarding what lies ahead:
In conclusion, while certain issues have shown improvement over the course of this survey series beginning during the pandemic in July 2020, nurse leaders continue to face complex challenges. Addressing work-life balance, navigating staffing shortages and innovating models of care remain pivotal. This requires a blend of strategic interventions, policy support and inclusive organizational cultures to strengthen nursing’s future and, ultimately, improve the equitable delivery of quality patient care.
The Magnet Recognition award was developed in the 1980s by the American Nurses Credentialing Center (ANCC) to highlight standout healthcare organizations that strive for nursing excellence. The Magnet Model recognizes nursing achievements, quality patient care, and innovative thinking within the practice of nursing care.
Magnet Hospital Practices
There are many benefits to the Magnet Model when used within hospital practices — not only for nursing staff but also for patients. All Magnet hospitals earn this award when they become certified by the American Nurses Credentialing Center (ANCC). When a hospital demonstrates that its patients receive high-quality care, it is due to superior nursing leadership, patient outcomes, coordination, collaboration across specialties, and implementation processes that measure and improve the delivery of care.
More than 570 Magnet hospitals worldwide are publicly recognized for their consistent efforts in providing quality care to patients. The hospitals that achieve this recognition must meet the foundational elements of the Magnet model, which include structural empowerment, exemplary practice, transformational leadership, innovation, and improvements. These foundational elements promote collaboration and teamwork, continual improvement, and a culture that awards nursing excellence.
Shared Decision-Making in Nurse Leadership
When hospital nursing leaders implement the Magnet model into their everyday tasks and culture, it creates an environment of shared decision-making. Nursing teams are encouraged to meet daily with support from their Chief Nursing Officer rounding on units. Due to open communication and more face-to-face time with leadership, nurses can learn about and develop skill sets to improve patient outcomes in all units. Nurses at Magnet hospitals are offered continued advancement in their education and skills, which leads to better work conditions and culture. Overall, this method benefits the patients at each Magnet hospital and results in less nursing turnover and a safer environment.
Advancement Programs Within the Magnet Model
To recruit and retain the best medical professionals in the nursing field especially, hospital leaders must encourage and foster the growth in advancement programs within the Magnet model. Incorporating this model into the hospital system mobilizes leaders and enables different leadership styles to thrive. In addition, nursing leaders are encouraged to inspire their nursing staff within the Magnet model to recognize their true potential in the healthcare field of nursing.
A Magnet model supports highly educated nursing staff and leaders with advanced training to stay updated with the latest healthcare initiatives. When the nursing staff is supported in increasing their education, it, in turn, creates an advancement program and promotions. As a result, the Magnet model hospitals are equipped to develop and transform leaders from entry-level nurses to senior-level managers and future Chief Nursing Officers.
Overall, the Magnet model has shown that, when implemented in the hospital setting, it can improve not only the nursing leadership team, employee retention, and decision-making but also the quality of patient outcomes — which is a win-win for everyone.
We’ll be at the 2022 ANCC National Magnet Conference® October 13-15 at the Philadelphia Convention Center in Philadelphia, PA. Stop by booth 2018. We look forward to seeing you there!
Vanderbilt University School of Nursing created a new leadership development program for nurses new in health care leadership and academic positions who are from groups historically underrepresented in nursing and/or those who support them. The Academy for Diverse Emerging Nurse Leaders will be held in Nashville from November 14-18. Applications for the inaugural class of fellows are now being accepted.
“The need for nursing faculty and nurse leaders from groups historically underrepresented in nursing is well established, but research shows a need for career development resources that address the specific needs and challenges of diverse nurse leaders,” says Pamela Jeffries, PhD., FAAN, ANEF, FSSH, dean of Vanderbilt School of Nursing. “We believe that the knowledge, mentorship, strategy, and skills that new leaders will attain via the Academy for Diverse Emerging Nurse Leaders will empower them to continue to advance and lead.”
VUSN Associate Dean for Diversity, Equity and Inclusion Rolanda Johnson and Vanderbilt University Medical Center Senior Director for Nurse Diversity and Inclusion Mamie Williams will co-direct the academy, designed for nurses who have been in academic or health care leadership roles for less than three years.
“What makes this fellows program different from other professional development opportunities is that it incorporates and builds on the lived experiences of diverse faculty and health care leaders who have navigated a similar leadership path,” says Johnson. “It explores the challenges of being a leader from an underrepresented group as well as the challenges of supporting and expanding diversity in nursing leadership.”
Academy for Diverse Emerging Nurse Leaders
Academy for Diverse Emerging Nurse Leaders
The academy is taught by experienced faculty and health care leaders from diverse backgrounds and is specifically designed to serve the needs of new and emerging nurse leaders and faculty. In addition to the initial five-day, in-person meeting, fellows will also participate in virtual sessions, receive mentorship from an executive coach and institutional mentor and develop a leadership project.
Williams said that the idea for the academy resonated with her as she thought about her own nurse leadership journey of more than 25 years. “This leadership academy, based on specialized education, discussions, and interactions with peers and diverse nurse leaders, affords the emerging leader an opportunity to thoughtfully design their leadership journey,” she says.
She and Johnson said the academy was developed to help new nursing faculty and new nurse leaders build skills, gain knowledge, and build a network of colleagues and mentors to help them advance their careers and mentor other emerging nurse leaders.
The American Association of Colleges of Nursing (AACN) is embarking on an initiative focused on building leadership capacity in new nurses with a special emphasis on developing essential skills in resilience, self-care, and well-being. The two-year project, titled A Competency-Based Approach to Leadership Development and Resilience for Student Nurses, was launched with funding from the Johnson & Johnson Foundation in partnership with the Johnson & Johnson Center for Health Worker Innovation.
“As we move beyond the pandemic and consider the future of health care, we arrive at a pivotal time in nursing when new ideas and energy are driving us toward a new way of preparing nurses for contemporary practice,” said Dr. Deborah Trautman, AACN President and Chief Executive Officer. “We applaud Johnson & Johnson for helping us develop the next generation of nurse leaders with the skills needed to adapt work environments to prioritize self-care, healthy behaviors, and well-being.”
A New Standard for Nursing Education
In April 2021, member schools affiliated with AACN voted to endorse The Essentials: Core Competencies for Professional Nursing Education, which outlines a new model and framework for professional nursing education using a competency-based approach. Moving to implement the new Essentials presents a unique opportunity for schools of nursing to infuse innovation into nursing curriculum to better prepare nurses to thrive across practice settings. The new standards call for preparing nurses with specific competencies related to leadership development, professionalism, emotional intelligence, and developing wellness and resilience for themselves and others.
Through this new initiative, AACN will convene an expert advisory group to develop new learning strategies and assessment measures related to personal, professional, and leadership development, including activities and self-reflection that foster health, resilience, and well-being. Once developed, AACN will pilot test the new content at 10 schools of nursing, assess the impact on student competency, disseminate results to all nursing schools, and offer faculty development opportunities to assist with new content integration into curriculum.
“Academic nursing leaders recognize that developing leadership and resilience capacity among new nurses is essential to effective nursing practice,” said Dr. Trautman. “We are excited to have this opportunity to elevate nursing’s role in leading innovation while sustaining provider well-being and impact.”
Expert Advisory Group Formed
To guide this new initiative, AACN has convened an expert group of nurse faculty and content specialists to develop new curriculum and learning strategies for building competencies essential to leadership and fostering resilience, wellness, and self-care. This work entails designing innovative clinical learning experiences where students can practice these new skills. Outcomes will include the identification of effective learning assessment measures consistent with the competency-based approach to learning advanced in the new Essentials. Members of this expert group include:
Michael Ackerman, DNS, RN, FCCM, FNAP, FAANP, FAAN
Professor of Clinical Nursing and Director of Master of Healthcare Innovation Program
The Ohio State University College of Nursing
Adejoke Bolanle Ayoola, PhD, RN, FAAN
Department Chair and Professor
Calvin University
Sherry S. Chesak, PhD, MS, RN
Assistant Professor of Nursing
Mayo Clinic
Janie Heath, PhD, APRN-BC, FNAP, FAANP, FAAN
Dean and Warwick Professor of Nursing
University of Kentucky College of Nursing
Teri Pipe, PhD, RN
Professor and Dean Emerita
Founding Director, ASU Center for Mindfulness, Compassion and Resilience
Edson College of Nursing and Health Innovation Arizona State University
Allison P. Squires, PhD, RN, FAAN
Associate Professor and Director, Florence S. Downs PhD Program in Nursing Research and Theory Development
New York University Rory Meyers College of Nursing
Deborah Stamps, EdD, MBA, MS, RN, GNP, NE-BC
Executive Vice President Chief Nursing Education and Diversity Officer
Rochester Regional Health
Cheryl Woods Giscombe, PhD, PMHNP-BC, FAAN
LeVine Family Distinguished Scholar of Quality of Life, Health Promotion, and Wellness and Associate Dean, PhD Division & Program
The University of North Carolina at Chapel Hill School of Nursing
AACN will provide regular updates on this initiative to the academic nursing community as the work moves forward. For more information, please contact Kathy McGuinn, AACN’s Director of Interprofessional Education and Practice Partnerships, at [email protected].
This is part of a regular series about side gigs—nurses with interesting side jobs or hobbies. This month, we spotlighta nurse who is a leadership coach.
Rasheda Hatchett, MN, RN
Ever wanted to pursue your passion, even if you’re doing it as a side-gig? That’s exactly what Rasheda Hatchett, MN, RN, did when she became a leadership coach.
As part of our side-gig series, we wanted to know how she got into it and how you can, too.
How did you get interested in being a leadership coach? What drew you to it? How long have you been doing it?
I think like most people, you find you passion in what you do innately. I have mentored and coached many women in my career—I just never charged for my time and effort. Once I began to see the clear value I was adding to women’s lives, the light bulb went off, and I knew I had found the thing that I could do that didn’t feel like work and was fulfilling in ways I had never dreamt of.
Explain to me briefly what a leadership coach is. Did you have to get additional training/education to do it?
Leadership coaching is personal for me, I believe in what I call “Whole life Leadership,” so my coaching is centered around leading in your home, career, community—and most importantly—leading yourself. One of the largest predictors of your leadership style is how you lead yourself. Just like people who don’t tend to give themselves grace when they make mistakes, similarly you’ll find that you may need to work on extending grace to your team. So for me, we have to dig into how you lead yourself to truly understand where we need to work on growth and goal setting.
I was coaching for a long time as a lay person and decided I wanted to get some additional certification, so I recently completed a coaching academy course and am working toward ICF certification.
What types of people/clients do you serve? What are they looking for and what do you provide for them?
The women I work with are true unicorns—they are leaders in health care, nonprofit, and corporate spaces. Women come to me who are ready to increase their confidence and really cultivate the skill of expressing their organizational value and communicating to garner results. I work with them to create a 360 vision for their lives and flush out exactly what they are working toward in life: including career, self-care, finances, and family.
Do you find that this is hard to do while working as a nurse?
Because I love what I do, no, it’s not hard to create harmony in my nursing career and the leadership coaching that I do. I own my nursing company in the Seattle area that provides education for caregivers of adult family homes caring for the elderly population. Being the CEO of my nursing business allows me a level of freedom to also work on my passion and help female leaders grow to the next level.
What do you like most about working as a leadership coach?
I love the transformation that I get to witness in the women I work with. Watching them take on new challenges, become more confident in themselves, get promoted, start new ventures, win contracts, and collaborate with other women in our circle—that’s why I do this. I love to see women win. Getting an up-close-and-personal view really sets my heart on fire. Knowing that I have made a difference in the way that women show up in the world is an amazing feeling.
What are your biggest challenges as a leadership coach? What are your greatest rewards as one?
My biggest challenges are helping the women I work with change their mindset around what they believe is possible for them in the world. I think this is a challenge for so many reasons, but the largest reason is the part society has played in defining a woman’s role in the world and doing all it can keep us in a box. My desire is to help women break every glass ceiling and tear down every wall that limits women in leadership and business.
Part of how I do that is guiding women to have the confidence to express their value as leaders and business owners in a way that resonates with decision makers.
Leading from the inside out requires a level of vulnerability that will challenge you out of your comfort zone, but the transformation on the other side is so worth it!
In April 2021, member schools affiliated with AACN voted to endorse 
