Remarkable. That's the word that immediately comes to mind after reading the recent article, "The Real Issues Driving the Nursing Crisis" by Donald and Charles Sus in MIT Sloan Management Review (October 18, 2023). Among the key takeaways: the top two reasons nurses leave an employer: toxic culture; and, a perceived lack of organizational support. Compensation and workload certainly are important but they trail toxic culture and organizational support in their relative significance. Here's another startling finding: temporary staffing agencies ("traveler services") do a better job resolving issues, communicating, and building trust with nurses than do hospitals. Wow! An employer (agency) that relies almost entirely on virtual interactions with its far-flung clients (nurses) does a better job resolving issues, communicating, and building trust than brick-and-mortar facilities with onsite/in-person management and HR staff. Check this out:
The methodology used by the researchers was itself quite interesting. Rather than rely on traditional employer-administered satisfaction surveys, the MIT team used AI to analyze free text comments from approximately 150,000 nurses drawn from the 200 largest healthcare employers who had posted about their experiences on Glassdoor, a third party job search and employer review site. The period analyzed was from the height of the pandemic until June 2023. There are many advantages to this approach: free text allows one to provide more context and specificity about one's experience than the conventional check box used in standard survey instruments. Persistent concerns about confidentiality and "retaliation", often cited by employees regardless of setting whenever standard employer-sponsored survey tools are used, are effectively obviated by relying on voluntary submissions to a trusted third party site. All of this is to say: the findings should be appreciated for the deep, unvarnished insight they provide into the experience, thinking, and concerns of front-line nurses.
Nurses & Hospital Management
There's one more finding that leapt out at me: nurses view hospital management -- senior leaders, most especially, as being distant, disconnected, and unaware of the challenges faced by front-line staff. Here's a quote from the article:
"Nurses view their managers as out of touch with the daily realities of patient care. We categorized their comments about managers into nearly 50 leadership traits. The second most frequently cited trait described managers as being unaware of the challenges that nurses struggle with in the workplace. When nurses discussed how managers understood life at the bedside, their comments were negative 9 times out of 10. Nurses are particularly critical of members of the senior executive team for their disconnectedness. The top team was 10 times more likely than front-line supervisors and middle managers to be criticized for being out of touch. [emphasis added] Our results reinforce a separate survey in which nearly half of hospital nurses said they believe management does not listen to their concerns."
Faithful readers of my blogs know that the schism between the front-lines and the c-suite is not inevitable. The chasm, now seemingly insurmountable, can be rectified. There are specific actions senior leaders can take to more effectively communicate, address salient workplace/practice issues, and build greater trust and alignment with front-line caregivers.
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Are you frustrated by adversarial relationships between front-line clinicians and senior leadership? Organizational Wellbeing Solutions was formed to enable senior leaders to identify the specific drivers of clinician burnout in their organization; and to support leaders in designing and executing a comprehensive plan to stop clinician burnout, increase retention, and improve operating results. A hallmark of our consultancy is correcting the all-too-frequent distrust and alienation clinicians feel toward the c-suite generally and the CEO in particular. Let us help you help your organization and its clinicians develop a more trusting, aligned, and productive working relationship.