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

For generations, nursing had an unwritten rule: start your career in a hospital. New graduates were frequently advised to spend at least a year or two in medical-surgical nursing to “get experience” before considering other career options. Acute care was seen as nursing’s proving ground, where nurses developed assessment skills, clinical judgment, confidence, and credibility. But that traditional career pathway may be changing, according to many nursing faculty I talk with today.

Recent NCSBN data also suggests that the traditional hospital-first career pathway is far from universal. In its 2024 study of newly licensed registered nurses, 77.4% reported working in hospitals—meaning nearly 23% were working outside the hospital setting early in their careers. While these data do not show that these nurses intentionally bypassed acute care, they raise an important workforce question: Is acute care becoming just one of many entry points into professional nursing rather than nursing’s default starting point?

Today’s nursing graduates enter the profession with visibility into career opportunities that previous generations rarely considered at the beginning of their careers. They see nurses working in outpatient settings, public health, home care, behavioral health, informatics, occupational health, long-term care, telehealth, case management, education, and countless specialty roles. Many are also entering nursing with plans for graduate education and advanced practice.

For some new nurses, acute care is a stepping stone. For others, it may increasingly become a step they choose to bypass altogether. We tend to focus on retention and ask: How do we keep nurses from leaving acute care? But an equally important workforce question may be: How many nurses choose not to enter acute care in the first place? And if fewer nurses make that choice, what will it mean for the future experience profile of the acute care nursing workforce?

The Drivers for the Change

There are four key drivers for the change we are seeing:

1. The old career ladder has become a career lattice. Nursing graduates can see far more possible pathways, and social media makes those possibilities visible almost immediately.
2. The value proposition of acute care has changed. The question isn’t whether acute care provides extraordinary clinical development—it does. The question is whether graduates believe the benefits outweigh nights, weekends, holidays, workload, scheduling constraints, workplace stress, and physical demands.
3. Many ambulatory care, home care, and school nurse positions now accept new graduates, sometimes even offering residency programs.
4. Graduate education changes the calculation. 73% of nurses today have BSNs. Most NP graduate programs today don’t require any acute care experience. Many schools now offer a BSN-DNP, and their students stay in the program full-time until they finish the terminal degree. With the Labor Department projecting NP roles as the fastest-growing career opportunity in the US, this trend could accelerate.

The Implications

In the future, as more opportunities open outside of acute care, hospitals may need to compete for new graduates, not merely recruit them. That’s an important distinction. Filling residency cohorts isn’t necessarily evidence that acute care remains the preferred destination. We already see this with over 50% of new graduates leaving their initial roles between the second and third year of practice.

Nurse leaders may eventually have to articulate a much stronger answer to: “Why should I begin my nursing career here?”  Failing to do so could have profound implications for acute care environments already struggling with sustained high patient volumes and acuity. The future challenge for acute care may not simply be keeping the nurses we have. It may be convincing the next generation of nurses that acute care is a place worth coming to and staying long enough to become the experienced nurses we desperately need.

To effectively lead through these challenges and others, nurse leaders need new tools and strategies. Let me help you as I have helped hundreds of organizations over the past five years.  Please contact me at roseosherman@outlook.com to book a workshop or keynote for your team. Not seeing what you want on this list? Feel free to reach out, and I am happy to design a custom program to meet your needs.

Brand New For 2026 and Already Receiving Rave Reviews –  Staying Power: Building a Culture of Retention in the New World of Work

Brand New for 2026 and Already Popular – The Inverted Pyramid: Leading Teams of Novice Nurses  The Inverted Pyramid WS Information Sheet

Our Most Popular Right Now –The New World of Work Workshop

A Leader Favorite – Building Bridges Not Walls: Leading Multigenerational Work Teams – Click Here for More Information   Building Bridges Not Walls

A Must-Read Book in 2026 – Click Here to Buy

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

In novice-nurse-dense environments, the nurse preceptor role is a critical organizational asset for successful new-graduate transition. Preceptor burnout is a growing concern, especially in light of recent Laudio data, which indicates that nurse preceptors who spend more than 20% of their scheduled hours in the role are at higher risk for burnout.

So whenever I have the opportunity to speak with a group of experienced nurse preceptors, I use it to learn more about their experiences. Last week, I spent time with nurse preceptors at the University of Rochester Medical Center. I was there for their graduation from a one-year preceptor academy, which is a true exemplar of preceptor development and coaching. I asked them what they wanted nurse leaders to know about their role. Five clear themes emerged from our discussion:

1. Precepting is a challenging role, and it doubles the preceptor’s cognitive load.

Too often, staffing grids or assignment models treat a preceptor-preceptee pair as two productive nurses or assign them heavier patient loads, assuming preceptors can manage multiple acute admissions while teaching the new nurse. Precepting actually doubles cognitive load. The preceptor simultaneously assesses the patient, thinks aloud, observes every step the novice takes, anticipates errors, and teaches clinical judgment in real time. Nurse leaders should design assignments that allow time for teaching. Assigning a preceptor a maximum-acuity or complex workload while training a new graduate is a recipe for rapid burnout.

2. Preceptor fatigue is real, and they need a break from their preceptee. 

A real ah-ha moment for me in our discussion came when preceptor Janine Miller talked about fatigue while precepting. A 12-hour shift on a busy unit is physically and mentally demanding for any nurse, but for a preceptor, it is 720 minutes of continuous performance, hyper-vigilance, and constant narration. For many preceptors, particularly introverts who naturally recharge through solitude and quiet, being tethered to an orientee every single minute is emotionally depleting. By midday, decision fatigue sets in. Expecting a preceptor to spend their 30-minute meal break answering more questions, debriefing, or maintaining social energy robs them of their only opportunity to reset. They want leaders to support unit norms that separate preceptor and orientee breaks. Ensure the charge nurse or a partner covers the orientee during meal times, giving the preceptor permission to step off the floor, disconnect in silence, and genuinely recharge for the second half of the shift.

3. Leaders and preceptors need to be on the same page about preceptee performance. 

Preceptors take immense pride in bringing new colleagues along, but they also feel deeply accountable for patient safety. Create formal pathways for targeted remedial support or orientation extensions rather than defaulting to hard timelines about when certain tasks should be completed. Preceptors try to build psychological safety for novices, but managers sometimes undermine it. Preceptors understand that managers cannot always share performance plans for new graduates, but they should have regular opportunities to discuss new graduate performance.

4. Don’t default to using the same preceptors all the time. 

When units face continuous turnover and rolling residency cohorts, managers often default to the same small, reliable core of senior nurses. Continuous precepting across consecutive cohorts drains clinical passion. Without intentional rest cycles where experienced nurses can simply care for their own patients without teaching, your best clinicians will eventually step down from the role or leave the unit. Track precepting hours systematically. Normalize scheduled off-cycles so senior staff have dedicated stretches of independent practice to refresh before taking on another orientee.

5. Recognize the work of preceptors. 

Preceptors want their managers to see the invisible emotional labor involved: managing novice anxiety, navigating generational communication differences, having hard feedback conversations, and fostering psychological safety. Close the feedback loop. Check in specifically about how the teaching relationship is progressing, publicly credit preceptors when orientees launch successfully, and actively advocate for their professional growth and development.

Under pressure, leaders can easily view preceptorship through an operational lens as an orientation checklist to complete or a staffing pipeline to fill. But in reality, your preceptors are the cultural and clinical anchor of your unit. Every patient safety standard upheld, every crisis calmly navigated, and every novice nurse who chooses to stay past year one rests on the quality of that preceptor relationship.

When nurse managers actively protect their preceptors by defending their workloads, respecting their need for shift-level mental downtime, and honoring their clinical assessments, the return on investment is unmistakable. Precepting is high-stakes emotional and clinical labor. When you invest in safeguarding your preceptors’ energy and well-being, you aren’t just making their 12-hour shifts more sustainable; you are building a resilient, high-performing culture that outlasts every staffing challenge.

© emergingrnleader.com 2026

Great for New Ideas Around Staff Retention –  Staying Power: Building a Culture of Retention in the New World of Work

Brand New for 2026 and Already Receiving Rave Reviews – The Inverted Pyramid: Leading Teams of Novice Nurses  The Inverted Pyramid WS Information Sheet

Always Popular –The New World of Work Workshop

A Leader Favorite – Building Bridges Not Walls: Leading Multigenerational Work Teams – Click Here for More Information   Building Bridges Not Walls

A Must-Read Book in 2026 – Click Here to Buy

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

I have been surprised by how many nurse leaders have recently told me they are having trouble getting staff to speak up and ask questions. As one leader explained it to me:

I am not sure what is going on. I used to not be able to suppress my staff’s curiosity. They asked so many questions. I tell my new grads today that my door is always open and that they should ask questions whenever they aren’t sure. But they don’t ask. They either struggle in silence, look things up on their phones, or make an avoidable error because they didn’t want to bother anyone. I am not sure what is going on, but people are speaking up less and asking far fewer questions. It worries me. How do I build a culture where my staff feels more comfortable asking questions? 

It is easy to misinterpret this hesitation as indifference, overconfidence, or disengagement. But for many younger nurses, particularly Gen Z and recent graduates entering complex, high-acuity environments, the reluctance to speak up rarely comes from a lack of care. It comes from fear, self-doubt, and what they see as the unspoken rules of hospital culture.

 Why They Don’t Ask 

If we want new nurses to ask questions, we have to understand what it costs them emotionally to do so:

1. The “Imposter Syndrome” Trap: New graduates are terrified of looking incompetent. Many worry that asking a foundational question will confirm a preceptor’s or manager’s suspicion that they “aren’t cut out for this.”

2. Fear of Being a Burden: Today’s healthcare environment is chronically busy and short-staffed. Younger nurses see their colleagues running at full capacity and genuinely do not want to add to another nurse’s heavy workload.

3. Digital Reflexes vs. In-Person Inquiry: As digital natives, younger generations are accustomed to finding answers instantly on their own devices without risking social awkwardness or perceived judgment. In a hospital, however, relying on quick online searches can never replace contextual, clinical wisdom.

4. The Ghost of “Nurses Eating Their Young”: Even if your unit is warm and supportive, nursing school lore warned them about toxic workplace dynamics. A single eye-roll, sigh, or curt response from a senior peer during a stressful shift can permanently close the door to future inquiries.

Telling staff, “You can ask me anything,” puts the burden of vulnerability on the least powerful person in the room. An “Ask Anything” culture isn’t created by passive availability; it requires deliberate, proactive leadership behaviors. Here are four concrete strategies nurse leaders and charge nurses can use to make speaking up natural and expected:

1. Frame Questions as a Sign of Safety

Flip the script during onboarding, daily huddles, and 1:1 check-ins. Make it clear that a nurse who never asks questions is a major safety concern, while a nurse who asks frequently is demonstrating clinical vigilance.

• Try saying: “In our unit, the strongest nurses are the ones who verify and clarify. If you aren’t asking 5–10 questions a shift right now, you’re carrying too much in your head.”

2. Reframe How You Ask Questions

When senior nurses or preceptors ask, “Do you have any questions?” the default answer from an anxious novice is almost always “No, I’m good.” Closed questions create pressure to appear in control.

• Shift to targeted prompts:

  • “What is not clear to you in this patient’s care plan today?”

  • “What is one thing you’d like us to double-check together before the patient is discharged?”

  • “If this patient’s blood pressure drops, what is your immediate next move?”

3. Show Vulnerability as a Leader

When was the last time your experienced nurses or leaders openly admitted they didn’t know something? When leaders model curiosity, it removes the stigma of not knowing. Encourage preceptors and charge nurses to say out loud: “I haven’t seen this protocol in a while—let’s look it up together,” or “I made a mistake like that early in my career, here’s what I learned.”

4. Designate Times for Question Asking

Designate intentional moments where asking is expected rather than requested.

• The Post-Huddle Micro-Check: Dedicate 60 seconds after shift change for the charge nurse to ask: “Does anyone have a gut feeling or question about an assignment they want a second set of eyes on?”

• The “Question of the Day” Board: Put up a white dry-erase space in the breakroom where staff can write clinical questions or procedural doubts anonymously for the clinical educator or manager to answer without judgment.

New nurses will not speak up simply because we give them permission. They speak up when they feel psychologically safe and when they trust that admitting what they don’t know will be met with coaching rather than criticism. When we intentionally replace the fear of being seen as incompetent with a culture of curiosity, we don’t just protect our patients; we develop our next generation of nurses into strong critical thinkers.

To effectively lead through these challenges and others, nurse leaders need new tools and strategies. Let me help you as I have helped hundreds of organizations over the past five years.  Please contact me at roseosherman@outlook.com to book a workshop or keynote for your team. Not seeing what you want on this list? Feel free to reach out, and I am happy to design a custom program to meet your needs.

Brand New For 2026 and Already Receiving Rave Reviews –  Staying Power: Building a Culture of Retention in the New World of Work

Brand New for 2026 and Already Popular – The Inverted Pyramid: Leading Teams of Novice Nurses  The Inverted Pyramid WS Information Sheet

Our Most Popular Right Now –The New World of Work Workshop

A Leader Favorite – Building Bridges Not Walls: Leading Multigenerational Work Teams – Click Here for More Information   Building Bridges Not Walls

A Must-Read Book in 2026 – Click Here to Buy

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

In most leader development workshops I do today, experienced nurse leaders now discuss how challenging it is to recruit nurses into charge nurse roles. Fewer experienced nurses want to take charge, and charge nurse burnout is now a major concern. A nurse manager recently shared this story:

So our hospital recently announced a charge nurse development course. No one, and I mean no one, on my unit volunteered to take it. I started lobbying my best candidates individually, but even that was challenging. Several told me that they were prioritizing their well-being and saw risks in taking the role. Today, they observed, everyone argues about their assignment; the demands are overwhelming, and you often have to take a patient assignment. It is a no-win role. Paying extra each hour helped at first, but it doesn’t anymore. I really can’t blame them. 

What has changed?   

If you walk onto almost any acute care unit today, the shift in the team’s demographics is striking. Ten years ago, a charge nurse oversaw a team where the median bedside tenure might have been five to eight years. Today, it is not uncommon for a charge nurse with barely two or three years of experience to lead a shift where 70% or more of the staff are in their first eighteen months of practice. In the Inverted Pyramid of Nursing Experience, most hands-on patient care rests on clinicians who are still developing pattern recognition, clinical prioritization, and situational awareness.

At the center of this delicate balance, especially on nights and weekends, are charge nurses. Often compared to air traffic controllers, these frontline leaders assign patient care, manage admissions, discharges, and transfers, facilitate unit communication with other departments, and handle patient and family complaints when a nurse manager is absent. But if we continue to treat the charge nurse role as merely administrative rather than deeply developmental and protective, the entire structure of the Inverted Pyramid risks collapse.

Charge nurses once relied on the informal, distributed vigilance of seasoned bedside peers. If a patient began to subtly decompensate, an experienced nurse down the hall usually caught it. But when the majority of your team is now novice nurses, your role changes. Novice nurses “don’t know what they don’t know.” The charge nurse must now act as the primary safety net, anticipating complications and scanning the entire floor for early warning signs rather than assuming staff will self-identify and escalate distress.

The nurse manager above made a good point about the challenges of assigning patient care in this environment. Matching patient acuity to nurse competency has become exponentially harder. When most of the unit is at the novice or advanced beginner stage, traditional patient-to-nurse ratios lose their meaning. The charge nurse must balance cognitive overload, skill mix, and emotional reserve across a team that has little buffer for unexpected emergencies.

Reimagining the role

Charge nurses have shifted from administrative coordinators to real-time clinical coaches. They are doing all of the following:

• Helping newer nurses prioritize when everything feels urgent.

• Validating assessments before calling rapid responses or attending physicians.

• Debriefing difficult moments at the bedside to accelerate clinical judgment.

The tension and reason so many nurses now back off from taking charge is that you cannot provide just-in-time coaching if the charge nurse is also carrying a full or partial patient assignment. Charge nurses carry immense psychological weight. They are acutely aware of the fragility of the safety net under their watch. They worry about professional liability. Without deliberate leadership backing, formal charge preparation, and shifts without patient care assignments, charge nurses quickly burn out from the constant vigilance required to protect both patients and colleagues.

A Call to Action for Nurse Leaders:

Leaders can take three action steps to support their charge nurses.

1. Redesign the charge nurse role so patient care assignments are not part of the role. A charge nurse with a patient load in an Inverted Pyramid unit cannot maintain the situational awareness and level of patient surveillance necessary.
2. Invest in and expand charge nurse training so that nurses feel confident when they take the role. We cannot simply assign the nurse with the most longevity by default; they need explicit coaching in situational leadership, conflict management, and psychological safety. These roles have become more complex, and nurses need the skills to be effective. This development should not be a one-and-done activity but should be done quarterly to address new challenges as they surface.
3. Establish Charge Support Structures and Provide Mentorship so they feel supported without feeling isolated. Expand the administrative supervisor’s role on nights and weekends to include real-time coaching for charge nurses. Nurse managers should meet monthly with every charge nurse to evaluate their activities and challenges.

In an environment shaped by the Inverted Pyramid, expecting a charge nurse to act as shift coordinator, clinical mentor, crisis responder, and patient caregiver all at once is a direct path to cognitive overload, burnout, and turnover. If we want resilient units, we must intentionally design the charge role for today’s workforce. That means protecting unassigned charge shifts, prioritizing just-in-time clinical coaching over administrative friction, and recognizing that safeguarding our charge nurses is the most effective way to safeguard our bedside staff and our patients.

To effectively lead through these challenges and others, nurse leaders need new tools and strategies. Let me help you as I have helped hundreds of organizations over the past five years.  Please contact me at roseosherman@outlook.com to book a workshop or keynote for your team. Not seeing what you want on this list? Feel free to reach out, and I am happy to design a custom program to meet your needs.

Brand New For 2026 and Already Receiving Rave Reviews –  Staying Power: Building a Culture of Retention in the New World of Work

Brand New for 2026 and Already Popular – The Inverted Pyramid: Leading Teams of Novice Nurses  The Inverted Pyramid WS Information Sheet

Our Most Popular Right Now –The New World of Work Workshop

A Leader Favorite – Building Bridges Not Walls: Leading Multigenerational Work Teams – Click Here for More Information   Building Bridges Not Walls

A Must-Read Book in 2026 – Click Here to Buy

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

If you ask a group of nurse leaders what keeps them awake at night, staffing will usually top the list. But in 2026, the leadership agenda has become far more complicated than filling open nursing positions. Today’s nurse leaders are managing a workforce that looks very different from the one they led just five years ago. Teams are clinically younger. Generation Z is changing workplace expectations. Experienced nurses are retiring or leaving traditional acute care roles. Artificial intelligence is entering clinical practice at remarkable speed. Patient complexity continues to rise. Workplace violence and incivility remain troubling concerns. And nurse managers themselves are struggling under increasingly demanding spans of accountability.

At the same time, health systems are asking nursing leaders to improve quality, safety, patient experience, retention, and productivity—often with fewer resources. When I talk with nurse leaders today, I hear less discussion about getting “back to normal.” There is growing recognition that normal has changed. I think the more important question has become: What should nurse leaders be paying attention to now?

Here are ten priorities that I believe are shaping the nursing agenda for most leaders today:

1. Retaining Experienced Nursing Staff

Most but not all health systems can successfully recruit new graduates. But retention of nurses beyond that 2nd year in the hospital setting is a whole different challenge. Nurse leaders are fighting a revolving door. That is why retention, engagement, and creating reasons to stay are gaining ground.

2. Successfully Leading Teams of Novice Nurses

Many leaders are facing teams with less experience, which changes the amount of coaching, surveillance, precepting, and leader presence required. The Inverted Pyramid has now become widespread. The leadership question has become: “What has to change when novice nurses are no longer surrounded by experienced nurses?”

3. How Do We Meet the Needs of a Changing Workforce?

Gen Z is no longer the “future workforce.” They are increasingly the workforce nurse leaders are managing every day. Nurse leaders now struggle to meet expectations around flexibility, feedback, career progression, boundaries, technology, communication, and willingness to leave positions that don’t meet those expectations.  The question now is: what is this generation telling us about how nursing work needs to change? 

4. Redesigning Care Delivery Models

Leaders are asking how RNs, LPNs/LVNs, nursing assistants, virtual nurses, APPs, technology, and centralized resources should work together. AHA identifies redesigning staffing models and team-based care as a major 2026 workforce shift. The issue has shifted from how many nurses we need to how we can organize care with the talent we have.

5. Implementing AI without Losing the Human Side of Care

AI has quickly moved from an interesting innovation to a leadership issue. Nurse leaders are thinking about documentation, ambient listening, staffing and scheduling, clinical decision support, education, predictive analytics, workflow, and administrative burden. The question has become: what should we automate, and what shouldn’t we automate? Nurse leaders are also challenged with how to prepare nurses to use AI safely. And how do we make sure technology gives nurses more time for human connection, not less?

6. Rebuilding Teamwork, Workplace Civility and Psychological Safety

Turnover, inexperienced teams, individualism, incivility, and weakened relationships have changed unit cultures. Workplace violence is also a significant leadership concern; AHA’s 2026 environmental scan reports that 42% of nurse leaders say they have witnessed violence at work. Nurse leaders now ask how we can build an environment where nurses feel safe speaking up, asking questions, admitting mistakes, and challenging decisions.

7. Protecting the Nurse Manager Role

Nurse manager burnout and exhaustion continue to grow. Accountability and span of control are being actively debated as the leadership intensity in these roles increases. A manager overseeing 70 experienced nurses is not carrying the same leadership load as a manager overseeing 70 nurses when half the team is clinically novice. Span of control alone may be an inadequate metric.

8. Getting Back to the Basics on Quality and Clinical Safety

AONL President Ena Williams recently emphasized that rising patient complexity, workforce pressures, and rapid innovation make nurse leadership’s role in quality especially consequential. With an inexperienced workforce, leaders cannot assume that safety practices will simply be transmitted organically from experienced nurses to novices. They increasingly have to engineer the conditions for safe practice.

9. Building the Next Generation of Nurse Leaders

Succession planning is becoming an urgent issue for many health systems.  Nurse leaders are finding it harder to get nurses to want management positions because staff see the workload their managers carry. The question isn’t simply “Who will be our next nurse manager?”It is“Have we designed a nurse manager job that talented nurses actually want?”

10. Doing All of the Above with Significant Financial Constraints

The tension is palpable as I talk with nurse leaders across the country. Nurse leaders are expected to improve retention, patient experience, quality, safety, and engagement while controlling labor costs and increasing productivity.

I think an 11th issue lies beneath all ten of the above, and that is leadership capacity. Nurse leaders know many of the things they should be doing, such as coaching, rounding, developing staff, building psychological safety, and improving retention—but the real question is whether they have the time, span of control, organizational support, and cognitive bandwidth to do them.

To effectively lead through these challenges and others, nurse leaders need new tools and strategies. Let me help you, as I have helped hundreds of organizations over the past five years.  Please contact me at roseosherman@outlook.com to book a workshop or keynote for your team. Not seeing what you want on this list? Feel free to reach out, and I am happy to design a custom program to meet your needs.

Brand New For 2026 and Already Receiving Rave Reviews –  Staying Power: Building a Culture of Retention in the New World of Work

Brand New for 2026 and Already Popular – The Inverted Pyramid: Leading Teams of Novice Nurses  The Inverted Pyramid WS Information Sheet

Our Most Popular Right Now –The New World of Work Workshop

A Leader Favorite – Building Bridges Not Walls: Leading Multigenerational Work Teams – Click Here for More Information   Building Bridges Not Walls

A Must-Read Book in 2026 – Click Here to Buy