FRACTURE ON THE FAULT LINE: NURSING'S CALL TO ACTION
As the global pandemic ceased in early 2022, the health care industry was shocked back into reality. Without notice, incident command centers closed and health care systems immediately focused on quality, safety, and financial recovery. In the spring of 2022, Rhonda Foster and David Marshall, guest editors for Nursing Administration Quarterly (NAQ), wrote that globally, leaders had responded to the consequences of the pandemic, which included staffing, education, infection control practices, hospital bed capacity challenges, and employee well-being and resilience.
As we reflect upon what nurse leaders have addressed over the past several months, we see that the immediate postpandemic issues identified a year ago are still relevant. In addition, some of these issues in the system are now magnified, requiring nursing to accelerate efforts to address them.
The theme for this issue of NAQ is "Fractures on the Fault Line: Nursing's Call to Action." The contributing authors named the largest current fractures, and by naming them, it allows the profession to move forward in repairing them. The collection of aggregated articles in this issue highlights major current fractures as well as inspiring exemplars of real-time solutions.
This is not intended to be a comprehensive list of fractures. Instead, these fractures illustrate that some of the weaknesses identified a year ago have grown exponentially. Plato famously wrote: "Our need will be the real creator," which over time, evolved to the English proverb of "Necessity is the mother of invention." This issue highlights just a few of the many inventions that nurse leaders have created as our call to action.
First, and perhaps the largest fracture and call to action, is how to effectively lead the current nursing workforce. For example, there are 4 different generations of nurses, a higher complexity/experience gap, and increased desire to become a travel nurse. Dan Weberg writes that the nursing supply-and-demand predictive modeling is weak at best. The reliance on traveling nurses has resulted in price wars for nurses. Health systems and academic institutions alike are paying premium dollars to provide the basics, with market adjustments, pay raises, bonuses, salary negotiation, and special compensation as routine tools for recruitment and retention. Organizations are spending double-digit millions of dollars on recognition and retention of their workforce. Because nurses are attracted to flexible work, job sharing, and work from home jobs, the supply of hospital-based nurses continues to erode even more. Work from home jobs typically pay the same or more than hospital-based nursing jobs, and many nurses are finding this more attractive. Alaina Tellson writes that nurse leaders and recruiters are developing innovative partnerships and strategies as another lever in nursing's call to action for workforce mitigation.
In response to the demand for nurses being lower than the availability of permanent and temporary nurses, health systems are driven to innovate care delivery models as quickly as possible. The use of virtual care, technology, team-based care, reintroduction of licensed practical nurses, and creative support roles such as patient technology techs to both reduce non-nursing tasks from nurses and provide an alternative care model with scarce nursing resources is discussed by Sylvain Trepanier, Sherene Schlegel, Cynthia Salisbury, and Andria Moore.
Another solution-based response from nursing involves nurse leader support and development as a path to leader retention. David Bailey and Giancarlo Lyle-Edrosolo discuss chief nurse executive practices to support, mentor, develop, and retain nurse leaders through research. Susan Winslow shares a leader program evaluation to bolster clinical nurse manager practice.
A third fracture where solutions have developed relates to support for transitioning the newly graduated nurse (NGN) into the stressed practice environment. Martha Grubaugh presents insightful comparison data between NGNs prepandemic and postpandemic. Terry Fulmer writes about a faculty nurse attending model, and Carrie McDermott outlines a reimagined preceptor role to support NGNs due to the shortage of traditional one-to-one preceptors.
Finally, we are reminded and perhaps inspired by Tim Porter-O'Grady's message about leading nursing professionals into a new age for practice and Cynthia Barginere's discussion of a "future-back" mindset to drive a renewed commitment to improving the quality, safety, and equity of health care.
This issue shares many new and effective strategies to combat the fault line fractures related to the nursing workforce. We are grateful for the contributing authors' energy and enthusiasm for naming the fractures and then identifying effective solutions to launch the profession forward. Our call to action is to share this information widely and help accelerate the creation of solutions to address these fractures.
-Noreen Bernard, EdD, RN, NEA-BC, FAAN
-Joyce Batcheller, DNP, RN, NEA-BC, FAONL, FAAN
Guest Editors