Expanding Nurse Leaders: Is the Nursing Shortage Due to Nurses Moving into Leadership Positions?

Deborah Chiaravalloti - 05/16/19

There is a nurse shortage looming in the coming decade and there are several forces at play. Many nurses are part of the Baby Boomer generation, born between 1946 and 1964, and they are retiring in greater numbers each year. The second factor is that more nurses are moving into management roles. This movement in the workforce is leaving gaps both at the bedside and in leadership and it’s causing debate – and rancor- in the nursing profession.

It’s an interesting dynamic that has champions and detractors on both sides of the conversation. On the one hand, healthcare organizations want nurses who are interested in leadership to further the organization. On the other hand, some nurses believe that colleagues with advanced degrees look down on those who hold only RN certification.

The argument for rising to leadership

Healthcare organizations need to ensure succession plans are in place for leadership. As nurse leaders retire, skilled professionals need to be rising through the ranks to fill those positions. If nurses don’t have the training and advanced degrees necessary, organizations can face a risky vacuum at the top.

An opinion piece in the American Journal of Nursing says that nurse manager roles are going to have to be redesigned if Millennials are to assume the positions. Muriel R. Moyo, a nurse manager in the radiology department at Keck Hospital at the University of Southern California in Los Angeles said, “Nurses associate the nurse manager role with increased stress related to the scope of responsibility and organizational politics. Without role redesign, it may prove challenging to recruit and retain nurse managers from younger generations.” She suggests that healthcare organizations adopt the following strategies to ensure that nurses want to rise through the ranks:

  • Identify younger nurses who aspire to leadership roles and promote them
  • Provide structured nurse manager training that is specific to an organization's culture, policies and procedures as well as training on administrative tasks, such as payroll and scheduling
  • Offer flexible scheduling so nurse managers can have a better work-life balance
  • Provide professional development and mentoring programs as well as support for continuing education
  • Offer meaningful recognition and creative feedback that helps young nurses know they are doing well

Nurses who are interested in leadership need support as well. They may receive conflicting advice from colleagues regarding their leadership aspirations. It’s important that nurses have support and mentoring in order to climb the ladder.

Tyler Faust, MSN, RN, a nurse manager at the Mayo Clinic says that successfully seeking higher positions in leadership depends on having strong career strategies early on. They include:

  1. Get advice from the right source. Older nurses may come from a different background and perspective. Different generations hold vastly different outlooks on work. That’s not to say their opinions aren’t valid, but they may not be as informative or supportive as needed. It’s best to rely on human resources and nursing leadership for guidance on a career path within the organization.
  2. Make yourself known. Ask nurse managers, supervisors or other leaders about opportunities for advancement. Make sure they know you are interested and eager to advance.
  3. Pursue education. If you want a master’s degree, start now. Don’t wait. It is highly beneficial to study while working so you can apply newly acquired skills to the job each day.
  4. Join a professional association. Networking is invaluable and will increase opportunities exponentially.
  5. Learning includes constructive criticism. Seek it out for growth. However, make sure to seek it out from supportive colleagues who will deliver constructive, rather than destructive feedback.

There’s a problem with that

However, many nurses believe that seeking leadership positions instead of staying at the bedside is a problem. They feel it’s an indication that those with higher degrees believe that patient care is somehow a lesser role. They see that it leaves an exhausted, highly pressured workforce left to care for patients.

Brie Gowen is a nurse with more than ten years’ experience in the field. She wrote about her observations in her blog, Savor the Essence of Life. From her point of view, fewer nurses are left at the bedside, responsible for caring for a population that is outnumbering nurses by the day.

“What I’ve discovered is that fewer and fewer nurses are staying in the trenches, and those of us who do are a fading minority. Even the new graduates are leaving fairly soon compared to previous years. Now everyone is either pursuing higher education right off the bat or waiting their turn in line for a managerial position, and while I’m all about furthering one’s future and career, the bedside is being left pretty empty as a result.”

Brie articulates the ongoing frustration that is emptying the bedside workforce; “Nurses are leaving the bedside because nursing is hard, and it’s only getting harder. People are getting sicker, and nurses are getting fewer. Required documentation is becoming lengthier, and the time a nurse can spend actually enjoying the bedside is getting shorter. In the end it’s no wonder the newer nurses entering the field are leaving the bedside sooner than their predecessors. So what about those who stay behind? Well, I guess you could say we’re pretty tired.” 

This isn’t a recent debate. In 2011, American Nurse Today, posted a blog discussing the value of advanced degrees. The author argued that “higher education can only enhance the bedside experience for the individual nurse rather than repel her or him from it.”

Guest blogger Donna Cardillo, MA, RN, went on to say, “There is no evidence to support the belief that higher education lures nurses away from direct patient care. And perpetuating that belief demeans the true value of what we do. If you think nursing care is only wiping, cleaning, administering medication, doing procedures, and following orders, I could understand that you might think that way. But if you see bedside care for what it truly is—the high level, critical thinking, life-saving, clinically astute, evidence-based, complex, collaborative, primary care role—then anyone could see how an advanced degree would only support and enhance that role.”

Other nurses are much more skeptical. One commenter on Cardillo’s blog said, “Why would a nurse further their education past a BSN degree, when there is no pay incentive? We would all love to be the best nurses we can be, but until hospitals offer more tuition reimbursement or a pay increase, it simply isn’t feasible for most of us. The only reason that many nurses are even going back for their BSN, is because hospitals are making them sign contracts upon hiring.”

Nursing leadership versus bedside practice is a prickly debate and one that probably won’t be solved any time soon. Suffice it to say that nurses should pursue their own calling. Choose the specialty and the practice environment that makes you want to get up in the morning. Pursue your own career path, one that will give you personal and professional satisfaction. Nursing is a grueling yet satisfying job. Doing it on your own terms is the only way to stay in the profession for the long term.