A novel AI-assisted approach identified issues and developed recommendations.

There have been many articles about the current challenges in nursing and what might be done to improve nurses’ workplaces and retain nurses. While nurses have proven to be resilient long before, during, and since the COVID-19 pandemic, without changes by the systems in which they work, even the hardiest of nurses will become burned-out.

A recent report notes that the RN vacancy rate is almost 10% and the national turnover rate among hospital nursing staff  is 20%. Surveys cite the familiar reasons: high and intense workload, insufficient staffing, bullying, and lack of support.

Since 2021, the R3:Resilient Nurses Initiative of Maryland has been creating and providing free resources to support nurses and nursing students as they deal with the stress and challenges in health care. Recently the initiative used a unique platform, Slow Talk, to elicit discussions with nurses about their perspectives on nursing and what they think needs to happen so nurses are able to practice in ways that reflect their education and commitments. A resulting report was funded through a Nurse Support Program II grant administered by the Maryland Higher Education Commission and funded through the Health Services Cost Review Commission.

The participants included 78 nurses representing 20 institutions from across Maryland, included 50% clinical nurses, faculty and nursing students. They used an app to participate in 15 facilitated small-group discussions via the Slow Talk platform. The sessions addressed what nurses thought about their profession, how they thought others viewed nursing, what is missing from the public narrative/what the narrative about the profession should be. The participants’ real-time conversations were recorded, transcribed, and analyzed; themes and recommendations were then developed with the assistance of AI, generating both quantitative and qualitative data.

The Findings

Three main themes emerged: 

Although transactional issues (workload, compensation, professional development) remain a serious problem, the primary theme that emerged as essential to retaining nurses was relational issues, “the importance of being heard, supported, and aligned with organizational values for job satisfaction, retention, and performance.” Nurses described feeling undervalued and “forced into a mechanical, task-oriented mode of operation that compromises personalized patient care and overall job satisfaction.”
Another theme was related to the generation gap. While there was no specific finding of intergeneration conflict, there were concerns about the lack of benefit of having seniority, lack of mentorship of younger nurses, and concerns about the risk/benefits of social media for the profession.
And finally, despite the many challenges and stressors, nurses reported “deep pride” in the trust placed in their profession, and belief “that they are qualified and capable professionals with the capacity to contribute to change.”

Key recommendations of the report include:

Leaders must do better to relate to and support nurses in their diverse roles. Key is building trust by being visible, engaged, hearing and taking nurses’ concerns seriously, and being transparent about decision-making. Leaders need to amplify the value nurses bring to the system to bring about organizational changes that increase nurses’ voices in decision-making.
Practicing nurses have been resilient and there are ways they can continue to develop their resilience potential. But the report importantly points out, “It is clear you are already resilient despite the challenges you face. . . . The work you do should be valued, supported, and properly compensated. You should feel heard and understood in your workplaces and communities. You deserve to feel joy and balance in your work life.”

Read the highlights and access the full report here.

Maureen Shawn Kennedy, MA, RN, FAAN, editor-in-chief emerita, American Journal of Nursing; contributing editor, JAMA Health Forum. Disclosure: The author is a member of the R3 Advisory Board; she has was not involved in the development, conduct, or analysis of the above research.

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