Top 5 Issues Affecting Nurse Leaders


Here are the top five issues your colleagues have identified as having the most impact on your facility and our (sometimes surprising) recommendations for tackling them.

From financial concerns to staff planning, there are a myriad of challenges and opportunities on your plate every day.  Based on our own primary research of hundreds of nurse leaders from across the country, Soyring Consulting is pleased to share with you the top five issues your colleagues have identified as having the most impact on your facility and our (sometimes surprising) recommendations for tackling them.

    1. Budget
      Despite the claims of your Economics 101 professor, much of healthcare expenditure does not come from inelastic, necessary goods.  Instead, the “just in case” procedures are put off as patients adopt an “only-if-I-have-to” mentality.This all begs the question: What do I do when my hospital system/facility/department/unit has had a budget cut? Here are a few tips to consider:

      • Look for innovative ways to reduce your budget.  Ask yourself these questions to brainstorm ideas:
        Do you have the opportunity to consolidate nursing units?
        Can charge nurses care for a limited number of patients?
        Can you reduce the time that new employees spend in orientation?
        Is there any way you can improve employee retention
      • Acknowledge to your leaders that you are aware of the problem. Whether you answer to the Board or to a charge nurse, it is important that they know you are both aware of the problem and working to do your part.  A good start is providing your higher-ups with budget status reports and possible resolutions.
      • When you have a budgetary need (whether it’s a new MRI scanner or extra overtime), make sure it is in context. For example, say, “Based on current volumes, we will easily pay for this machine in X months,” or in the case of overtime, “It may be cheaper to temporarily use some overtime shifts rather than hire another nurse.”


  1. Quality & Safety
    When facilities are operating as leanly as possible and budget cuts abound, the first and foremost concerns remain (and should remain!) quality of care and safety of patients.  How can you ensure that your quality and safety standards are up to par?

    • Push your specialty nurses to get certified and involved with their local specialty organizations.
    • Ensure that you have a monitoring process to evaluate standards of care; Specialty nursing organizations are an excellent resource.
    • Monitor key metrics for quality and safety and address any deficiencies.
  2. Patient Satisfaction
    More often than not, operational issues are a major contributor to patients’ overall satisfaction, and we’ve compiled a list of key indicators you should consider at your own facility:

    • With a large percentage of patients admitting from the emergency department, ED satisfaction is a key part to the equation. Number one on this list is improving patient flow and reducing length of stay (read more: Your ED: 5 Steps to Shorter Stays & Happier Patients).
    • The other major admitting point is surgical services. Ease of the admitting process, communication, education, and discharge are key factors for increasing patient satisfaction in the perioperative arena.
    • Last, but definitely not least, are inpatient units. Some of the same rules apply including communication and education, however timeliness of treatments and medication are also considered significant patient satisfaction indicators.
  3. Staffing
    Getting the right person into the right position can be tough, especially when discussing management vacancies. A few tips to ensure you have the appropriate staffing model include:

    • Evaluation of alternative staffing models based on existing resources in your community. Rather than relying heavily on traveling nurses, how can you more effectively use existing staff and recruit potential new staff from the community?
    • Management vacancies, whether over a few weeks or several months, contribute to significant staffing and retention issues (read more: Three Ways to Fill a Management Vacancy).
    • A satisfied staff will result in decreased turnover and increased patient satisfaction. Consistency and equity with staff schedules and staff assignments, adequate training of charge nurses, and meeting educational needs all lead to more satisfied staff.
  4. Healthcare Reform
    With healthcare reform in full swing, you need to make sure you are prepared:

    • The impact on hospitals may actually be positive with a larger insured patient population. Make sure you are appropriately prepared to accept a potential increase in patient volumes (with staffing, facility capacity, etc.).
    • Make sure this more expanded patient population knows about your key services. Marketing targeted services is extremely important and should be well under way at this point.  To better ensure success make sure you have a strong line of communications between operations and marketing/strategy.

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Denice Soyring Higman, MSN, BSN, RN

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