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American Organization for Nursing Leadership Releases Longitudinal Nursing Leadership Insight Study

The latest study by the American Organization for Nursing Leadership (AONL) finds improvements in the emotional health and well-being of staff compared to two years prior but also identifies staff retention as a growing concern.

Since July 2020, AONL has conducted five surveys under its Longitudinal Nursing Leadership Insight Study, which has provided data from nurse leaders at all levels across the continuum of care. The latest study — released in January — addresses effective solutions for various aspects, such as interdisciplinary collaboration, listening to direct care nurses, and work-life balance.

The survey series is designed to track nurse leaders’ top challenges, effective solutions, mental health needs, and areas for needed support. Conducted in November 2023, 2,476 nurse leaders completed or partially completed the survey with 90% complete submissions.

Workplace Violence

One of the top challenges faced by healthcare workers today is workplace violence. Results of the survey indicated that the percentage of respondents who have witnessed violence remained unchanged since 2022. Yet, when asked to gauge the top challenges overall, nurse leaders’ view of the issue of workplace violence has increased 20% since the previous year, which could signal an increase in the severity of the violence.

The report reinforces the importance of addressing workplace violence, intimidation, incivility and bullying, which requires comprehensive strategies, including de-escalation training, providing trauma-informed care to healthcare workers, and fostering a culture of safety.

Currently pending in Congress and supported by the American Hospital Association, the Safety from Violence for Healthcare Employees (SAVE) Act (H.R. 2584/S. 2768) is bipartisan legislation that would provide healthcare workers the same legal protections against assault and intimidation that flight crews and airport workers currently receive under federal law. H.R. 2584 would also provide grants to hospitals for programs to help reduce the incidence of violence in healthcare settings.

Additional Challenges and Improvements

Of the survey participants, 69% identified staff recruitment and retention among their organization’s top three challenges. In July 2020, during the first of the five longitudinal surveys, recruitment and retention was named by only 24% of respondents. Since then, it has been cited by a growing proportion of respondents in each subsequent survey.

While at 45% emotional health and well-being of staff was the second most-cited concern by survey participants, this is down from a high of 75% in August 2021. Rounding out the top three, more than a third – 34% – named financial resource availability as a significant concern.

Among the factors that have seen improvement are communicating and implementing changing policies – named by 20% most recently compared to 54% in July 2020 – and access to personal protective equipment, which was a concern of 46% of leaders in 2020 but was not cited by any respondents in either of the last two surveys.

Solutions for Improving Staffing

Nurses were asked to rate the effectiveness of solutions their organization implemented to improve staffing and rank them on a scale of 1-5, 5 being the best.

The list of solutions include:

• Allowing days off when necessary (3.5).
• Listening and responding to nurse feedback (3.5).
• Increasing nurse recognition (3.4).
• Offering flex scheduling (3.3).
• Increasing support services (2.8)
• Adding non-clinical staff (2.7).
• Implementing fatigue countermeasures (2.7)

The findings signaled a need for tailored approaches to meet staffing needs.

Intent to Leave

While reports indicate the emotional health and well-being of nurse leaders is currently at its best since July 2020, the results show a considerable number of leaders intend to exit the industry. The largest group of nurse leaders with intent to leave exists in the C-Suite with 15% of chief nursing officers (CNO) or chief nursing executives (CNE) planning to leave within the next six months. This is in contrast with 12% of managers and 10% of directors.

The survey shows a marginal improvement in nurse leaders’ intent to leave with a 5% decrease in those planning to leave from 2022 to 2023. Among nurse leaders considering leaving their current job, 25% reported considering leaving nursing completely. Negative impact of work on their health, the pursuit of new opportunities, and challenges with other leaders or colleagues ranked as top reasons to intend to leave. These same reasons were reported by CNOs/CNEs as their top reasons.

The results provided insight into why individuals would consider exiting the healthcare industry and provided tips for improved retention, including fostering a work-life balance and offering professional growth opportunities. The report also provides tips for directors, managers and CNOs/CNEs.

You can view the full report here.