CNO Roundtable Overview – Salem, Massachusetts

December 27, 2023

In July 2023, Avant Healthcare Professionals held their bi-annual Chief Nursing Officer Roundtable at the historic Hawthorne Hotel in Salem, Massachusetts. Titled “The Intersection of Culture and Nurse Staffing,” the CNO Roundtable allowed prominent healthcare executives to meet and share their concerns about the industry and what they believe the future of the nursing industry will look like. At the roundtable, healthcare executives discussed cultural humility, challenges they face in nursing, and current trends in nurse staffing in 2023.

The Importance of Cultural Humility

The roundtable began with a discussion on “Cultural Humility in Nursing” by Juliana M. Mosley-Williams. Cultural humility is the attitude toward an individual of other cultures that pushes one to challenge one's cultural biases. The discussion gave attendees a space to be vulnerable and discuss preconceived notions about other cultures and how to prevent cultural bias within their workforce. It was a way for CNOs to understand and develop a process-oriented approach to cultural competency among their nursing staff. Participants also discussed the importance of understanding patients' cultural backgrounds and beliefs to provide effective care. 

During this discussion, the importance of nursing staff having cultural humility was examined. By having cultural humility, healthcare executives draw attention to the unique and complex array of differences many individuals working at their hospitals have. They discussed their roles in honoring an individual's own cultural perspective or worldview. CNO’s understand by having cultural humility means they recognize that culture is unique to individuals, that traditions will differ among cultures, and that, as healthcare executives, they are committed to developing a partnership with their staff to advocate for individuals and respect their culture. 

Current Trends in Nurse Staffing

Attendees at the CNO roundtable discussed the current trends in nurse staffing, led by Avant Healthcare Professionals Director of Marketing, Christy Puller. One attendee shared that 80% of her nursing staff are travel nurses. Among the group, there were discussions about the bill rates decreasing, but not as much as expected. Unfortunately, the reduction of rates is not resulting in a massive return of nursing staff. Another issue they noted is the difficulty in filling vacancies for night shifts, as there are already challenges for filling day shifts.  

Some CNOs noted that they believe their staff is working to live, not living to work, and that the idea of a team mentality among their staff is no more. Nurses are now working with a “gig economy” mindset and no longer have the call to nursing as more experienced nurses once did. They are seeing limited energy and emotion being exerted by their staff. Although many have attempted to increase bonuses to keep staff, the constant competition between facilities is making the issue of staffing even more difficult.  

Participants also discussed nurses' challenges in maintaining a healthy work-life balance, particularly amid increased workloads and stress. The emotional toll of the pandemic and its impact on nurse burnout was emphasized. One participant shared that to bridge gaps in staffing they are using a pool of per diem nurses to cover certain shifts each month. However, implementing such strategies had mixed success due to the issue's complexity. 

Some solutions were discussed by the group, including the idea of 100% tuition buyback, scholarships for nursing students, higher pay incentives, and sign-on bonuses. Robust interpreters and local sign language schools were also highlighted as essential resources to enhance communication with patients from different linguistic backgrounds. There was also one facility using robots for housekeeping duties such as food delivery at their facility.

Discussion Around Concerns in Nursing

As the healthcare landscape continuously evolves, CNOs face many challenges that demand their attention and strategic solutions. The following sections highlight the top concerns of CNOs, as discussed at the CNO Roundtable.

Knowledge Gap

One pressing concern for CNOs is the knowledge gap among nursing staff. As medical technologies and treatments advance, there is a need to ensure that nursing staff stay updated and well-informed. CNOs must invest in continuous education programs and training to bridge this gap and provide the best possible care to patients. COVID-19 affected the nursing skills gap, significantly impacting new nurses' onboarding and clinical training opportunities limiting their learning capabilities. There is an even greater need now for hospitals to hire more experienced tenured nurses to fill these instructor roles. This has caused some facilities to hire international nurses as a long-term solution, as many international nurses come with years of experience and improve retention and stability at healthcare facilities. International nurses bring a wide range of expertise, as many have worked in different sectors of the medical field nationwide. 

Lack of New Graduates

Another challenge is the low number of new graduates who choose to remain in their bedside careers. Many nursing graduates opt for non-bedside jobs due to the increasing opportunities in diverse healthcare settings, such as telehealth, research, and education. CNOs must implement retention strategies and create an enticing work environment to encourage new grads to stay at their positions and contribute to direct patient care. There has been a decrease in the number of nursing students admitted into programs due to the lack of available instructors and courses. Also, current nursing graduates who study in more rural states often end up leaving the state after graduation to work in a more desirable and higher-income state. Leaving rural states even more vulnerable to limited nursing staff.

Decrease in Available Preceptors

The decrease in the availability of preceptors and instructors adds to healthcare executives' increasing concerns. As experienced nurses retire or transition to other roles, CNOs must focus on developing mentorship programs and incentives to attract and retain skilled preceptors and instructors to nurture the next generation of nursing professionals. Unfortunately, with more nurses retiring and burning out at facilities nationwide, limited staff are left to train and teach a new generation of nurses. This creates an unfortunate cycle for healthcare facilities trying to retain new and tenured talent.

Violence in the Nursing Profession

With the rise in violence within healthcare settings, enforcing safety measures becomes a major challenge for CNOs. Protecting staff and patients from violent episodes requires adequate security measures and appropriate training. Still, CNOs often face obstacles in gaining the necessary support and resources from decision-makers and leadership. Healthcare executives have recently seen a correlation between increased violence in hospital settings and the lack of nursing staff. This leaves current nursing staff vulnerable to physical assault, threats of assault, and verbal abuse.

Increase in Staffing Shortages

Staffing remains a consistent concern for CNOs, as fluctuations in patient volumes and staff shortages can affect the quality of care. Balancing core staff with travelers while maintaining high-quality outcomes poses a significant challenge. CNOs must employ data-driven staffing models, foster nurse autonomy, and develop strategies for workforce planning to optimize patient care. These staffing challenges also pressure CNOs to find alternative solutions to aid their staffing levels, such as hiring international nurses, travel nurses, or working with temp-to-perm staffing agencies.

Limited Financial Resources

Financial constraints are a recurrent issue for healthcare institutions, impacting operational and staffing decisions. CNOs must navigate limited budgets while ensuring appropriate nurse-to-patient ratios, maintaining safe workloads, and investing necessary resources to uphold patient care standards. Also, with the increase in bill rates of nursing staff in recent years, many healthcare executives are struggling to keep up with standard rates for nursing staff that are higher than it has ever been.

Lack of Successful Integration Among Staff

Integration of nursing staff is also a concern for healthcare executives. The nursing shortage has caused many healthcare executives to look at alternative staffing solutions for their hospitals. The introduction of new staff members also requires strategies on how to properly integrate them. This will improve nurse retention among the current staff and reduce nurse turnover in the future. It is essential to provide mentors for new nursing staff and have adequate training available for them to find success at healthcare facilities. Healthcare executives should be welcoming and have proper onboarding strategies in place to help their new staff get adjusted quickly and successfully to their facility. 

The Bottom Line

To complete the CNO Roundtable, all attendees expressed their inspiration from each other's stories and passions. They emphasized their gratitude for the opportunity to forge relationships in the healthcare industry and understand the unique needs and challenges nursing leaders face. Attendees viewed the CNO Roundtable to foster continuous improvement and drive positive change in nursing. Attendees believe with more conversations like this one, the nursing industry can thrive and meet the growing diverse needs of patient care nationwide.