Top 7 Concerns of CNOs in 2018

CNOs have a stressful role – it is tough being the biggest advocate for nurses in a healthcare organization, when up to 35% of the staff are nurses. There is a lot at stake and a lot of associates to lead. CNOs are responsible for quality, safety, patient satisfaction, labor, regulatory,  compliance, budgets and the professional advancement of the members of their team. So during the upcoming dynamic year of 2018, what are the top concerns of CNOs?

LOSING NURSES
Losing nurses is a big worry in 2018. Retiring nurse rates will get headlines, but attrition will come from other sources as well:
• A large percentage of the nursing labor pool will be considering retirement or other employment options this year. According to an AMN Fall 2017 study, 54% of nurses over 50 years of age are considering retiring in the next 3 years, or moving to a part-time schedule. There will be large nursing talent loss in the next 18 months at many U.S. hospitals.
• The outpatient setting is luring specialized nurse clinicians; the Monday through Friday 9am to 5pm shift is considered more low-stress, and more attractive to RNs than a traditional hospital setting.
• Nurse leaders are saying that the demand for psychiatric nurses is on the rise due to increased awareness of mental health issues in the U.S. This high demand is pulling nurses away from hospitals, many fleeing to private practice.
• High competitive salaries, especially in some metro areas, will lead to nurse staff losses from attrition. A new Reuters analysis finds that collectively, hospitals have been paying billions to recruit and retain nurses – offering higher salaries, signing bonuses and even repaying student loans, to address the nationwide nurse shortage. Some CNOs complain that they are even losing their best nurses to other hospitals in their own system, due to signing bonuses and incentives. So CNOs are diligently watching out for their nurses who may leave for better wages, work hours, or benefits in 2018.

DISENGAGED STAFF
A high-stress work environment can cause nurse burnout, which leads to disengagement on the job. Improper staffing levels caused by the nurse shortage is a factor in creating a stressful work environment. Professional growth and proper staffing levels are required to avoid disengagement.

TURNOVER WITHIN THE C-SUITE
Continuous consolidation of healthcare organizations and retiring Baby Boom leaders are influencing these executive turnover rates. Constant change in the apex of an organization negatively affects care planning, and can lead to frustration and confusion on where the organization is headed.

RECRUITMENT AND RETENTION
Competition and high salaries are a few hurdles that hospitals face in nurse recruitment. There is a trend at some facilities of nurses not seeing the value in longevity at an organization, they stay for a few years and go on to another opportunity. Offering flexible schedules and shift  preference to experienced nurses is one way to retain good staff, but this leads to difficulties finding seasoned nurses who can work the evening shift. Frequently assigning less experienced nurses to manage in the evenings can create a chaotic environment. And recruiting new nurses often means taking new graduates, which can take time to acclimate to a hospital culture and to get ready to lead.

DECLINING REIMBURSEMENTS
Reimbursement for all health care services has been under pressure for several years. The result has been decreased payments across the healthcare ecosystem. This reduction in reimbursements puts additional stress on hospital budgets.

RISING LABOR COSTS FOR CONTRACT WORKERS
International or travel nurses are filling the gap in staffing for many hospitals. This staffing approach is costly, and doesn’t provide for the long-term retention that healthcare organizations need. Acclimating these nurses to a hospital’s culture, processes, and vision can be tough and take time.

TURNOVER OF NURSE LEADERS (MANAGERS, DIRECTORS, EXECUTIVES)
Constant turnover of nurse leadership at all levels of an organization can disrupt flow of implementing new initiatives or care models from the top down. This means it’s essential that CNOs take a proactive approach to succession planning. Having a pipeline of competent nurses, especially younger ones with time to grow into roles and learn new competencies, is vital.

SOURCES:
• The financial impact of the nationwide nursing shortage: Hospitals pay billions to recruit and retain nurses, FierceHealthcare, October 23, 2017
• Top 10 concerns of Chief Nursing Officers, Ilene MacDonald, December 2017
• Top Concerns CNOs face in 2018, Brian Hudson, CNO Roundtable/Avant News Blog, January 2018

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