Authentic Leadership Strategies to Support the Future of Nursing

In 2005, the American Association of Critical-Care Nurses (AACN) published their healthy work environment standards (HWE), comprising 6 areas of focus important for an HWE1: skilled communication, true collaboration, effective decision-making, appropriate staffing, meaningful recognition, and authentic leadership. The standard for authentic leadership states that “nurse leaders must fully embrace the imperative of a healthy work environment, authentically live it and engage others in achieving it.”1 No one could have predicted what authentic nursing leadership would look like coming out of the pandemic and how to prepare nurse leaders for the future based on where our profession was in 2020.In January 2023, the American Nurses Foundation published its Three-Year Assessment Survey. Conducted by Joslin Insight in November 2022, the survey involved more than 12 500 participants from across the United States and assessed the impact of the pandemic on the nursing profession.2 Nurses were asked to complete the Survey of Perceived Organizational Support, a validated instrument that measures the belief that an organization is committed to survey respondents, values their contributions, and is concerned about their well-being. In addition to this tool, the assessment included a series of qualitative questions. More than 82% of the participants completed more than 80% of the questions; half of them also answered the qualitative questions in addition to the quantitative questions to share their feedback on the changes in the profession in the previous 5 years. Sixty-four percent of the nurses stated that they reported feeling stressed, and 57% reporting feeling exhausted.2 There was a difference in responses based on participant age and experience in nursing. Nurses with less than 10 years of experience stated that they felt less valued, less hopeful, and less supported than those with more experience.2 Eighty-four percent stated that they felt some degree of burnout. The most important need for these nurses was work-life balance. As the nursing shortage grew, nurses reported in this survey that their main issues were sicker patients, incidences of patient and family abuse unaddressed by organizations, care environments that were unsafe, disparities in experience based on nurses’ age, overwhelming patient workloads, inexperienced new nurse colleagues, and management not in tune with their experiences.2 These results and subsequent studies have shown that nurses are looking for work-life balance as well as support in meeting other needs related to their own wellness, reflecting the changing needs of nurses since the pandemic.Nurse leaders surveyed by Joslin Insight during the pandemic in July 2020 reported feeling that their top challenges were responding to the emotional needs of their staff, surge staffing, training and reallocation, and communicating and implementing changing policies.3 Based on the 2024 Retention and Registered Nurse (RN) Staffing Report by NSI Nursing Solutions Inc, the RN turnover decreased from 2022 to 2023, from 22.5% to 18.4%.4 Although decreasing, these numbers remain high, and some hospitals are using overtime and registry nurses to fill the openings, whereas others are working short staffed. The top challenge for nurse leaders moving forward continues to be nurse retention.Older leadership practices no longer work; therefore, it is important for leaders to develop new strategies to support nurses’ well-being and address their current challenges. Never before has the relationship between leaders and frontline staff been more important. Shirey5 states that when leader-member relationships are positive, job dissatisfaction is lower, and staff believe that their managers care about them. Researchers have reported that nurse leaders promote staff engagement by being visible and accessible, understanding the needs of staff, facilitating open-door communication and consistent nurse leader rounding, and taking a sincere interest in staff. Authentic leaders also model the behavior they expect from others.6Strategies to improve nurse leader and staff relationships include purposeful nurse leader rounding, encouraging and facilitating opportunities for staff to provide real-time feedback, and implementing healthy work environments and improved staffing. Each of these strategies are briefly discussed below.Nurse leader rounding is a relatively new strategy that allows nurse leaders to hear staff needs and share information with them in real time. It is a practice that supports nurse leaders connecting with their staff and patients to improve patient experience and nurse engagement. From a leadership standpoint, nurse leader rounding allows leaders to build relationships with their staff, who want to be heard; provide meaningful recognition; and give real-time recognition and problem resolution. Blake and Bacon7 studied the implementation of structured rounding and describe the process in detail. Consistent and structured nurse leader rounding builds trust and relationships with staff.7 Blake and Beacon7 report on one of the first studies to look at the impact of structured rounding using the Practice Environment Scale as a measure of this process. As leaders work to improve their engagement with staff, nurse leader rounding is an effective process to implement.Many leaders are afraid to be vulnerable and receive real-time direct feedback from staff. One of the AACN HWE standards, skilled communication,1 is a key ingredient for an HWE and is just as important as clinical skills. Authentic leaders use skilled communication to be effective when they round and talk to staff and need to model the communication they expect from staff in order to support an HWE. Blake and Joslin8 describe a study of a real-time app that allowed staff at a Los Angeles County hospital to give feedback at any time directly to the chief nursing officer (CNO). Nurses described feeling empowered to share what needed to be improved and what was working. It also allowed the CNO to respond and share what was being done to address their concerns in real time.8 This real-time communication has helped the organization improve staff engagement and decrease turnover rates.There are numerous studies that validate AACN’s HWE standards and how important they are in improving nurse engagement and patient outcomes. With colleagues, I shared the journey in the Los Angeles County hospitals to implement staffing criteria for 1:1 patient assignments by leaders and staff working together.9 This work was an example of using the HWE standards to improve communication between leadership and staff, driving a staffing model that can be seen as best practice. The staff had objective criteria for those patients who really needed to be assigned 1:1 (ie, 1 nurse to 1 patient), which they brought to me as CNO. Between the staff and leaders, we were able to implement objective criteria to improve staffing.New structures and processes are needed to improve the relationship between leaders and staff. The AACN HWE standard of authentic leadership is essential for leaders to implement and embody as role models.1 The nursing work environment is very different than it was 5 years ago as a result of the pandemic as well as other problems that began before the pandemic. Authentic leaders are needed to support nursing staff in today’s health care environment in order to retain valuable nurses and improve patient outcomes.