Q I'm concerned about the current status of the nursing workforce and feel like I may need to change my approach. What insights do you have that may guide my thinking for the future?

Although the nursing workforce is in the midst of a revolution, this is a great opportunity for nurse leaders to reframe our thinking about the future. Here are five thoughts on the current market and some ideas on how to be forward thinking in your approach.

1. Yesterday's onboarding and orientation approach isn't working today and won't work for tomorrow's workforce either. Today's environment requires individualized, streamlined, and focused orientation processes. Gone are week-long, in-person, classroom-style orientations with massive competency checklists and endless presentations. Adult learners should be assimilated with a combination of e-learning, self-study, simulation, and real-time education and skills validation. These processes should create a feeling of safe and effective practice among new clinicians and should not be based on a set time frame or rigid framework for completion.

2. The competitive market for talent is not in your backyard anymore. Flexible work options have never been more appealing. Current data suggest that nurses under age 35 who've been with organizations for less than 5 years are five times more likely to leave.1 Current rates for temporary and travel nurses have never been higher. For many nurses, these lucrative pay rates are life-changing. A clinical nurse told me that she left her organization after 3 years and accepted two back-to-back travel contracts making nearly $10,000 per week. For her, this was an opportunity to pay off crushing student loans and save enough money for a down payment on her first home. Organizations that innovate around flexible pay programs will have a competitive edge in this highly volatile market.

3. Organizations that innovate around new care models will be the front runners. Ratio-based nursing care models aren't sustainable and don't fundamentally meet complex patients' changing needs. Organizations that take the bold steps needed to innovate around new care models will ultimately benefit from higher nurse engagement, improved retention, and better patient outcomes. For flexible models to work, administrators must trust the decisions of clinical nurses and nurse leaders and back them with the tools and resources they need. One CNO I spoke with committed to adding an advanced practice registered nurse to every inpatient unit around the clock, providing much-needed support to the clinical team at a lower cost than adding additional contract direct care staff.

4. Throw out everything you know about scheduling. A growing body of evidence suggests 12-hour shifts are bad for patients, nurses, and physicians alike. However, not one nurse executive wants to be the first to move away from 12-hour shifts for fear of massive turnover and loss of staff. Innovative models emerging across the country are organizing care around nurses' preferred times to work. One large healthcare system implemented an hours-based approach, moving the bulk of nursing care, medications, testing, and wound care to daytime hours; only minimal, basic care and required medication passes are handled in the evening and at night.

5. There's a reason no one wants to be a nurse manager anymore. Most nurse managers I talk to work an average of 50 to 65 hours a week; they generally make much less than clinical nurses per hour and never get to leave their jobs behind. One nurse manager told me that the moment he steps on the unit, it's one problem after another and endless calls to "wheel and deal" to get the unit staffed to the bare minimum. After he physically leaves work, he receives a constant stream of emails, calls, and text messages. Nurse managers are the lynchpin in our current model of safety, quality, reliability, and service. We must provide managers with the time they need to focus on strategy, workforce engagement and development, and quality care.

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