Preparing for the Profound Challenges of 2023: Lessons Learned and Looking Ahead

The end of the year beautifully serves as a natural marker for preparing for the upcoming year with a fresh set of eyes. The past two years have been tumultuous, making this pausing, reflecting on the past, and resetting even more crucial than most years.

While we have been through a lot, it’s equally important to recognize that the tumultuous forces we are experiencing in nursing have been brewing for a long time. We have known for at least a decade that:

• There was an impending wave of baby boomer nurses retiring, coupled with an insufficient number of nursing students in the pipeline.
• This impending staff shortage was occurring even as the demand for health care was rising, with 10,000 people becoming Medicare-eligible every day.
• A least a third of nurses were experiencing burnout.
• Our electronic health records sucked nursing time away from patient care; nurses were spending at least a third of their time on documentation.
• Younger nurses were not interested in assuming nurse manager roles, watching their predecessors suffer in roles that demanded more than what was reasonable for any person to do.

So, as much as we’d like to believe that the issues we are facing were a result of the pandemic, the fact is that we would have been facing them anyhow. Although that offers little consolation, it does help us find a clear path forward.

We can all tick off the steps and actions necessary to tactically address these issues, but before we do, it’s valuable to reflect on lessons and strengths discovered during the pandemic.

• Structure matters. We couldn’t respond to the pandemic without building new environments for delivering care and creating daily (even three times a day) huddles to assess and respond to what is happening.
• When nurses understand the circumstances, they will rapidly rise to the situation. We redesigned units, creatively staffed (with nurses floating and the use of travelers in previously unimaginable ways), launched emergency standards of care, and tapped into creativity at all levels of the system.
• Health care needs to be healthy for the people working within it. We understood how fundamentally mentally, physically, and emotionally challenging our work is and what it takes to keep ourselves and our teams healthy and well.
• We, along with an increasing number of people, understood the intellect that nurses bring to patient care. We all learned how core and instrumental nurses are to the health care system and the quality of patient care.

As we plan for 2023 and beyond, we can apply all that we learned to our current challenges by:

• Revisiting structures, processes, and operations with a fresh set of eyes in light of these new realities. Staffing recruitment with the same approach you used when you had an 8% vacancy rate will not be effective in filling your 18% vacancy rate with the speed you need. Orienting novices in an environment where there is a loss of tenured colleagues requires rethinking how to develop critical thinking and maturation in practice.
• Creating structures and processes to remove the pebbles in the clinicians’ shoes, including working together to systematically unravel and remove nonvalue-added steps in the electronic health record. Just like hotels have one number to call for guest services, we can have one number for nurses to report issues with everything from a broken light to an unnecessary step when ordering labs—as long as there is a legitimate infrastructure to address the issues brought to our attention. Whatever the approach, removing the barriers to quality practice is essential.
• Preparing nurses to adapt to changing technology can better support their practice in the future. We can build on the rapid adoption of learning and innovation that occurred during the pandemic, but we need to ensure that nurses understand and are prepared for artificial intelligence, machine learning, and robots supporting their work in the future—and to have nurse involved from the start in designing these solutions to ensure that they legitimately add value.
• Rethinking the role of the nurse manager. The contrast between what we expect of managers in coaching and engaging their team and the reality of how they spend their time is striking. Certainly, there is an opportunity to better educate nurses as they enter the role of manager as well as to offer further support to managers to unload tasks that could be done just as well by others and focus their time on coaching and developing their team. Coaching and mentoring nurse managers reap magnificent rewards in their ability to engage their teams.
• Rebuilding our professional governance structures to ensure that nurses have the structural empowerment to address the complex issues facing the profession, their practice, and patient care. Empowering nurses is more than eliciting their voice in solving problems; it is about recognizing and supporting nursing expertise and their autonomy to address their education, competence, practice, and quality.

The future of healthcare relies on a strong, healthy, engaged nursing workforce. So, in 2023, I hope we can apply all that we have learned to address the current realities, establish healthier work environments, leverage technology to support practice, and create greater professional autonomy to bring the best of nursing to patient care. I know this won’t be easy, but it is critically important.