Title : What Keeps Nurse Leaders Up at Night

 When I was a chief nurse, I thought I was the only one up at night worrying about what was going on at the hospital. But as the years went by, I learned I wasn’t alone in my wakefulness; many of my nurse executive colleagues had the same problem. I recall one of them, in fact, telling me she always had so much on her mind that she often had to set aside time just to worry.

Staffing was right up near the top of our worry lists, along with patient and staff safety; cost control; strategic planning and goal setting; recruitment, retention and turnover; education; quality; satisfaction; ethics; policies; and so much more. We knew they all were important and all in need of our attention.

That was a couple of decades ago. The world has changed since then, and so has healthcare and nursing. As a nurse leader in today’s world, you have a variety of new challenges to include on your worry list, from HCAHPS patient surveys and other hospital “report cards” to healthcare reform issues, new payment models, rapid changes in technology, and of course continuing mergers and acquisitions.

Hiring the right people is always on your mind, engaging and enculturating them into your staff and giving them the training they need. Their career growth and advancement are important to you.

You work hard on staffing and no doubt worry whether your nurse-to-patient ratios are correct, if your facility is providing a healthy work environment for staff and the best quality care for patients. You question if you too often need staff to work overtime or back-to-back shifts, and if that’s causing decreased workforce satisfaction rates or lowered morale. You’re concerned about staff fatigue and burnout and preventing falls, infections and medication errors.

 

You work hard on staffing and no doubt worry whether your nurse-to-patient ratios are correct, if your facility is providing a healthy work environment for staff and the best quality care for patients.”

 

And I know you worry about finances. As a chief nurse, I knew collaboration with our finance teams was very important, and today that collaboration remains crucial. Nurse leaders oversee the largest portion of the hospital budget and need to be fully conversant with organizational and healthcare financing, expenses and the bottom line. They need to have strong strategic plans based on organizational goals and resources. How many nights do you lay awake thinking about that budget presentation you’re working on, or how you’ll get the dollars you need approved?

You even worry about the future — about the impact of the aging nursing workforce on our profession, the “brain drain” it will cause in education as well as in service, and the need it will create for better succession planning and leadership training. You know that without enough nurse leaders in the hospital and educators in the classrooms, both patient care and student clinical experiences will suffer.

But at the very least, nurse leaders should be able to get a good night’s sleep, even when you haven’t solved every problem, right?

In my case, I would make up my mind to tackle whatever problem I had head on in the morning, but I knew I wouldn’t be able to sleep well until I figured out a plan. When I got to work, I’d focus right in on what needed to be done. I’d think about the different resources available to me, and who I could turn to for some answers to my questions or advice. And usually in the light of day, the problem seemed less overwhelming.

When my worrying was at its peak, I would find a quiet place to sit, think and plan. I would remind myself of the importance of work/life balance and would work on being more present when I was home. I would attend programs to update myself on current news in nursing to make myself feel more prepared for the issues I might have to face.

 

When my worrying was at its peak, I would find a quiet place to sit, think and plan. I would remind myself of the importance of work/life balance and would work on being more present when I was home.”

 

If your worries weigh heavily on your mind, consider stress reduction classes or seminars, exercising or meditation to get help through the tough times. After all, this is advice nurses give to patients every day, so why not practice what we preach?

What are some of the things that show up frequently on your worry list and keep you up at night, and what do you do about them? Tell us what you think. We’d love to hear from you!