I recently attended a meeting in a room filled with nurse leaders of all levels, from the bedside to the boardroom. A series of presentations by high-level nurses in elected state government positions and by icons of our professional organization focused on the nursing workforce crisis and potential solutions.

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Expanding the capabilities of nursing schools to admit more students, pushing for more nursing student clinical placement sites, and adding funding to support tuition and other school expenses are the primary areas of effort on a state and national basis. Tangible goals to improve the actual workforce experience of nurses at work were introduced for discussion, but only a few attendees offered input that mostly focused on professional development programs.

Then the moderator asked a pivotal question: "What keeps you awake at night?"

I waited patiently to hear attendees point to staffing gaps, nurses carrying heavy patient workloads that threaten patient safety, morale issues, and nursing job turnover. A few shared being unable to recruit enough nurses, and the challenges of orienting and mentoring new nurses, especially with far fewer experienced preceptors and mentors available. No one, however, raised issues at the heart of why nurses are leaving; but all knew those reasons and dared not speak them aloud.

Not one who can stay silent very long, I requested the microphone and voiced the concern that keeps me up at night: Do nurses and nurse leaders have the courage to speak up professionally, advocate, and take action to champion crucial changes? Increasing the nursing workforce by expanding access to nursing schools is essential, but boosting the supply of new nurses who enter and then go right back out of the workplace door because of a dysfunctional work environment means that at least an equal focus on the work environment is also needed.

There are risks and challenges of standing up to colleagues and systems deeply rooted in the "we have always done it this way" mindset. Some leaders may not share the vision because of the perceived financial impact. Corporate structures can erect barriers that block the approval of essential changes. Nonetheless, we must have the courage to lead, devise strategies, and push forward anyway.

Frontline nurses and formal leaders must partner on change efforts. Leaders represent their staff in institutional frameworks, but the voice of frontline nurses at the table is critical. Both must champion and prioritize transforming workplaces in impactful ways that will attract and retain nurses, not just through adding window dressing.

Until next time,

LINDA LASKOWSKI-JONES, MS, APRN, ACNS-BC, CEN, NEA-BC, FAWM, FAAN

EDITOR-IN-CHIEF, NURSING2023