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By Rose O. Sherman, EdD, RN, NEA-BC, FAAN

A nurse leader recently asked me how to manage overconfidence with her novice team. She told me that many of her newest nurses had challenges taking feedback. She further explained: “Ironically, some of my new graduates think they are very high performers when they are not. I think they are comparing themselves to other nurses with a similar level of experience on the unit. They don’t seem to know or sometimes care what they don’t know, and this is frustrating our preceptors. How do I manage this on a very novice-dense unit?”

The Dunning-Kruger Effect Defined

The Dunning-Kruger Effect is a cognitive bias in which people who are new to or unskilled at something drastically overestimate their abilities, while true experts often underestimate theirs. Simply put: The less you know about a subject, the less qualified you are to judge how little you know. The challenge for the nurse leader who asked the question is that she now has a unit dominated by novices. If not managed, this cognitive bias among nursing staff could become a major patient safety risk.

The Dunning-Krueger Effect is not new in nursing, but historically, it was not a major issue because we had many experienced nurses in acute care who could rein in overconfident new graduates by pointing out what they had overlooked. On many units today, that built-in safety net no longer exists, and much of this coaching falls to nurse leaders and preceptors.

Coaching Overconfident Staff

Coaching an overconfident new graduate requires leadership finesse. If you push too hard, you risk crushing their spirit and triggering defensive behavior. Other the other hand, if you are too hands-off, patient safety is compromised. The first important concept as you think about coaching nurses who seem overconfident as an outcome of the Dunning-Krueger Effect is to understand that you are not witnessing arrogance. What you are seeing is a biological cognitive limit. Because they lack clinical pattern recognition, they literally cannot see what they don’t know. These nurses are at risk of missing subtle patient decompensations because they assume everything is under control. They don’t call for help because they don’t realize help is needed.

Some Good Leader Interventions to Counter the Dunning-Krueger Effect

• Don’t ask an overconfident novice – “Do you have any questions?” (to which a confident novice will always say no).
• Shift toward active cognitive rounding.  Ask the nurse to articulate their clinical reasoning by using active, inquiry-based dialogue. Instead of saying “Let me know if you need help with this admission.” Instead say, “This patient has a complex history. Tell me the three worst-case scenarios you’re monitoring for during this shift, and what your first action will be if they happen.” 
• Create objective, non-negotiable clinical triggers that mandate a second set of eyes, bypassing a novice’s subjective confidence. Overconfident individuals often perceive subjective feedback as a personal critique or “micromanagement.” To bypass their defensive ego, anchor your coaching in objective data, policies, and evidence-based checklists.  Example – “Our policy requires a dual-sign-off for high-alert meds. It doesn’t matter how comfortable you feel with it; it’s a safety guardrail for all of us.”   
• Coach preceptors to look for the “overconfident new grad” Teach preceptors about the Dunning-Krueger Effect so they can gently but firmly guide the nurse to reality before a clinical error occurs. When an experienced preceptor performs a task, 80% of their critical thinking happens invisibly in their head. The overconfident new grad only sees the physical action and thinks, “Oh, that looks easy.” Coach preceptors to narrate their own internal monologues to expose the hidden layers of clinical practice. Example “I am giving this medication, but notice how I’m checking the patient’s trending potassium levels first, even though the morning lab was normal? I’m doing that because their urine output dropped last hour. See how those two things connect?” By making the invisible visible, you demonstrate to the new nurse just how much nuance they are currently overlooking.
• Praise the Ask. New graduates often view asking for help as a confession of weakness or failure. They overcompensate by acting like they have everything under control. Leaders must actively flip this script. It is important as a leader to normalize the Dunning-Krueger Effect and work with new graduates to avoid this cognitive bias (as you would any other cognitive bias). When a new graduate actually does ask a question or requests a second pair of eyes, reward that behavior immediately and publicly. Say – “I love that you called the charge nurse to double-check that rhythm. Recognizing when a situation requires a team approach is exactly what highly competent, safe nurses do. Great catch.”

The Inverse Pyramid of Experience is the reality of the modern healthcare workforce. But an inexperienced staff only becomes a dangerous staff when leadership fails to manage the gaps in confidence and competence.

Cindi M. Warburton, DNP, FNP-BC, and I are partnering with the New England ONL to offer an Advanced Practice Provider Leadership program. We are looking for some APP leaders to participate in one of two focus groups to review the curriculum and make suggestions for the program. If you are interested, please email me at roseosherman@outlook.com

By Rose O. Sherman, EdD, RN, NEA-BC, FAAN

I am hearing from an increasing number of nurse managers, clinical managers, and charge nurses that many nurses are vigorously pushing back on patient care assignments they have been given. One permanent night charge nurse gave the following case example during a program:

Jason is an RN on your unit who recently completed his first year of practice. As a charge nurse, you are pleased with the progress he is making with his skills and competency development. The challenge you have with Jason is that he routinely complains about the patient care assignments he receives, contending that you give him the most difficult patients, and is resistant to taking new admissions when it is his turn. He has accused you of being unfair to him and has threatened to contact the union representative on several occasions. You have discussed this and reviewed his assignments with your nurse manager, and she sees no issues of unfairness.

This charge nurse is far from alone in her experience. One of the trickiest operational challenges facing nurse leaders at all levels today is managing assignment pushback. The contemporary nursing workforce is highly vocal, much more willing to speak up, and increasingly comfortable pushing back on assignments they perceive as unfair or unmanageable. When a nurse reacts with displeasure or resistance to a shift assignment, it can easily feel like a personal challenge to leadership authority. However, in today’s complex clinical environments, the goal of a nurse leader shouldn’t be to “shut down” pushback, but rather to navigate it constructively while maintaining unit safety, equity, and accountability.

The reality is that there are many things that could be driving Jason’s behavior. Several workforce studies indicate that male nurses do report feeling that they are more frequently given the “heavier patients” and those who present behavioral management issues. This charge nurse met with her nurse manager who reviewed the assignments and felt they were fair so this perception may not be the problem in this situation. Jason may feel very underappreciated in his role and could be lashing out and pushing back in response to this. If this is part of the issue, the night nurse needs to provide more frequent affirming feedback and recognition.

But the reality is that for some nurses, pushing back on assignments has become habitual. Here are strategies nurse leaders can use in these situations to have the difficult conversation and handle assignment pushback effectively:

1. Always begin with the WHY. 

When staff nurses do not understand the rationale or logic behind an assignment, they frequently default to assuming favoritism, unfairness, or managerial oversight. The challenge today is that unlike hospital patient populations in the past – there are NO easy patients. Leaders must share their “why” upfront. Briefly explaining the complex puzzle required to build the schedule—balancing patient acuity, clinical continuity of care, and overall team skill mix—instantly defuses the feeling of being singled out. One leader in the session said that her manager sometimes gives nurses paid time and a shadowing exercise with charge nurses to better understand how assignments are made.

2. Separate the emotions from the facts.

Assignment resistance is rarely personal although it can certainly feel that way. It is often fueled by underlying anxiety, physical exhaustion, or a genuine fear of a heavy workload. De-escalate high-emotion situations by stripping away the emotional language and pivoting entirely to objective, data-driven facts. Instead of arguing about the abstract concept of fairness, look at the concrete details together. Use phrases like: “Let’s look at the acuity scores together. You have two total-care patients and one discharge. Tell me specifically what part of this clinical mix feels unsafe.”

3. Carefully listen to the nurse whether or not you agree with what is being said.

The natural human reaction to pushback is defense or immediate refusal. When confronted by a frustrated staff member, leaders must actively resist the urge to interrupt or double down on their authority. Implement a mandatory “pause” and actively listen for at least 60 seconds without interrupting. Sometimes, a nurse simply needs to feel heard and validated after a grueling week. Acknowledging their current baseline stress (“I know you had a brutal shift yesterday, and I see why you’re worried about this assignment”) lowers psychological defenses and opens the door to an objective, professional conversation.

4. Manage pushback as a coaching opportunity with novice staff.

Often, vocal pushback from newer or novice staff stems from a fundamental lack of clinical confidence rather than defiance or bad behavior. They may feel genuinely overwhelmed by a specific, highly complex patient type because they haven’t encountered it frequently. Dig deeper by asking a targeted coaching question: “What specific support or resources would make you feel comfortable and supported taking this patient today?” OR “Let’s talk through how you will prioritize the care over the next hour.”

5. Agree on next steps and how you will support this nurse during the shift.

Despite excellent communication, there will inevitably be shifts where an assignment simply cannot change due to strict staffing constraints, call-outs, or immediate patient safety needs. In these moments, leaders need a firm, highly professional script to hold the line without burning bridges. An example would be to tell the nurse, “I hear your concern, but based on the layout of the unit and our staffing numbers today, this is the safest configuration we have. I cannot alter the assignment right now, but I will prioritize checking in on you first during my rounds to help you catch up and ensure you have the support you need.”

Given the escalating volume and acuity level of patients across the United States today, nurse leaders should expect but also learn to effectively manage pushback on patient care assignments. Keep in mind – these reactions from nurses are not a personal reflection on the leader, but rather often reflect the burnout and exhaustion that nurses are reporting.

By Rose O. Sherman, EdD, RN, NEA-BC, FAAN

Nursing turnover is a complex issue for health systems that are spending considerable sums to improve their work environments. Two recently released studies (one published in Health Affairs using the 2022 Nursing Sample data and one published by Press Ganey using data from their NDNQI database) provide some additional insight into what we are seeing

As we navigate 2026, data from these studies indicate a meaningful shift from acute crisis to the early stages of recovery. However, this positive momentum is not evenly felt, and nurse retention remains a top-tier operational challenge. When looking at national benchmarks, enterprise-level averages can hide the real areas of vulnerability. Turnover clusters within specific cohorts, roles, and shifts:

Turnover is Highest in Early Career Nurses
Turnover is heavily concentrated among early-career nurses. Gen Z registered nurses experience a 22% turnover rate, closely followed by Millennials at 21%. Conversely, Gen X stands as the most stable cohort at 14%. While Baby Boomers also show a 22% departure rate, this is primarily driven by an exodus of retirements, which presents a separate risk: the rapid loss of institutional knowledge and clinical mentorship. A significant challenge for organizations is that nurse engagement experiences a sharp drop-off immediately following the initial professional socialization nurses receive in residency programs. A change in RN engagement in their organization starts to dip after the first six months, plummeting to their lowest levels between years 1 and 2 before recovering later in a nurse’s tenure (after year 5).

Night Shift is Most at Risk

Ironically, many new graduates begin their careers on the night shift because that is where the jobs are. Pockets of vulnerability are highly apparent when comparing day and night shifts. Night-shift nurses report significantly lower scores across multiple dimensions, with the starkest gaps appearing in safety culture prevention, reporting, and organizational pride.

The Actual Drivers of RN Turnover

Historically, much of the research on retention has relied on “turnover intentions” (what a nurse thinks) rather than actual behavior (what a nurse does). A massive multivariable regression analysis of frontline RN data from the National Nursing Sample highlights the heaviest modifiable weights behind actual, self-reported turnover. Not surprising job dissatisfaction is the single strongest predictor of turnover. Frontline nurses who are dissatisfied with their position are over 2.5 times more likely to actually leave. Frontline nurses experiencing chronic burnout also face significantly elevated odds of leaving their primary roles.

Interestingly, nurses enrolled in a degree program or those holding an advanced graduate degree (MSN/DNP/PhD) demonstrate substantially higher actual turnover. Rigid, unyielding work schedules often conflict with academic demands, and higher degrees make these nurses highly mobile and marketable for advanced practice or management positions outside the bedside. Many nurses today have second jobs to meet their economic needs. An analysis of the national nursing sample shows that frontline nurses balancing a secondary paid position in nursing are also far more likely to leave their primary role.

Turnover is rarely a sudden, random event; it is a predictable outcome of the structural environments we place our clinicians in. National unit-level analyses show that perceived staffing adequacy and frontline nurse manager support are the absolute bedrock of retention. When staffing is unreliable, nurses face constant cognitive reprioritization and workflow friction, making it impossible to feel successful. When an immediate supervisor’s span of control is excessive, their capacity to build relationships, provide coaching, and foster social integration collapses. Higher manager-to-FTE ratios are significantly associated with increased RN turnover and a rise in adverse patient outcomes, like fall rates.

Not Responding to A Satisfaction or Engagement Survey is a Risk Factor
We must pay attention to what nurses aren’t telling us. The data indicates that survey nonrespondents are twice as likely to leave an organization as those who respond (29% vs. 14%). Silence does not indicate neutrality; it signals deep disengagement and a total loss of trust.

Flexible and Nontraditional Scheduling is an Important Retention Lever

Because work-life balance and school obligations heavily drive actual turnover, deploying immediate policy changes—such as self-scheduling or non-traditional shift lengths—directly targets job dissatisfaction and curbs costly attrition.

Nurses in Unions are Less Likely to Leave

One of the most interesting data points in the national nursing sample study is the protective effect of representation. Participation in a labor union or collective bargaining unit is strongly associated with a lower statistically significant likelihood of turnover. The researchers speculated that these environments often reflect stronger protections, structured mechanisms to voice concerns to leadership, and clearer guardrails around working conditions.

High Impact Professional Governance Environments Help Retain Nurses
Engagement rapidly converts into authentic ownership when nurses and APPs possess clear, credible pathways to influence practice and work design. High-impact governance structures with clear decision authority and visible feedback loops foster the psychological safety needed to normalize professional voice and retain staff long-term.

These two studies help to provide insight into what has become an intractable problem in so many organizations. Retention programs need to employ multiple strategies which can change over time.

Read to Lead

Witkoski Stimpfel A, Padhye NS, Tran AK, Djukic M. Drivers of frontline registered nurse turnover: evidence from the 2022 National Sample Survey of Registered Nurses. Health Affairs Scholar. 2026;4(6):qxag140. doi:10.1093/haschl/qxag140  Health Affairs 2026 Nurse Turnover Based on National Nursing Sample 2022

Press Ganey Associates LLC. State of Nursing 2026. Press Ganey Associates LLC; 2026. Accessed June 28, 2026. State of Nursing 2026 _ Press Ganey