Readers Write: Revitalizing Healthcare’s Backbone by Empowering Nurse Leaders

Revitalizing Healthcare’s Backbone by Empowering Nurse Leaders
By Russ Richmond, MD

Russ Richmond, MD is co-founder and CEO of Laudio. 

Nursing remains one of the most challenging parts of the healthcare ecosystem. Frontline nurses who are contending with understaffing and concerns for patient care continue to raise alarms and exit their roles.

Beset with high turnover and burnout rates, nurse managers constantly grapple with handling high spans of control and associated challenges without sacrificing patient care, quality, and organizational outcomes. A recent report noted that 20% of nurse managers are contemplating leaving their positions, and that the average nurse manager stays in their role for just two years. These figures point to deeper structural issues with the current state of nursing leadership roles and the overdue need to bring technology to these problems.

Another recent report that was co-published by the American Organization for Nursing Leadership (AONL) noted that the median span of control for nurse managers is 46 direct reports, making genuine engagement with team members on a day-to-day basis nearly impossible. Even more startling, 25% of all inpatient nurse managers have over 78 direct reports, further hindering meaningful manager-employee engagement.

The report also drew a direct correlation between nurse managers with large spans of control and higher rates of burnout, turnover, and incremental overtime on their teams. These consequences have real financial implications for health systems, especially as staffing costs and turnover continue to be some of the largest detractors from financial and organizational stability in healthcare. Better support for nursing leaders results in higher engagement scores among their teams and reduced turnover, both of which are targets of numerous initiatives among health systems.

As an industry, we frequently discuss transformation in healthcare, especially in a post-COVID environment, and how we need to work differently to improve outcomes for our patients and organizations. Yet the people who have the most direct impact in linking C-suite goals with frontline action are often overlooked. Few tools exist today to directly enable frontline nurse leaders to handle increased workloads while maintaining strong connections with their teams, which drives positive outcomes across the board. The same report referenced above noted:

• A strong correlation between the number of purposeful leader engagements (e.g., regular check-ins, recognition, celebrations) with team members and crucial metrics like higher team retention.
• A lack of span-breaking assistant managers with roles that are designed to share administrative burdens and support people processes.
• An absence of deep HR, IT, and nursing department partnerships to enable nurse leaders with the right tools to achieve broad job responsibilities.

To date, innovation in nursing has primarily centered on clinical areas, with novel technologies like virtual nursing and remote monitoring of patients taking priority over investments that enable leaders to propagate broad operational and people-based positive change within their teams. This focus must expand and transition to a holistic approach that is aimed at easing the burden frontline nurses and their leaders face today.

A few examples of how organizations can use new approaches to create a broad positive impact across nursing teams include:

• Use intelligent technology to automate much of the rote people work that frontline leaders perform today to allow them to their time where it matters most – on purposeful engagements with their teams.
• Automate clinical documentation wherever possible to reduce administrative burden through solutions that simplify EHR workflows.
• Introduce innovative leadership models to reduce spans of control and enable leaders to have more humanizing relationships with their team members and the work they do (e.g., dividing large departments into multiple parts, leveraging assistant nurse managers to break spans of control, utilizing nurse educators to lead professional development activities and continuing education around the nursing profession).
• Allow flexibility for team members by implementing new and improved staffing and scheduling practices that center on team member preferences and wellbeing needs versus long-standing industry norms.
• Build the right programs that frontline leaders can use to guide team members through established career paths and advocate for the professional development and skill expansion of team members.

Supporting nurse leaders has a quantifiable impact on organizational outcomes. Senior leadership teams have the opportunity to significantly improve metrics around nursing engagement and retention through purpose-built innovation. Moving the needle at the highest levels requires change that starts at the foundation – supporting, enabling, and empowering nurse leaders with the right processes and resources to drive success. Technology has the ability to redefine work and to scale the impact of leaders on organizational outcomes. Our nurse managers need these solutions now more than ever.