Field Notes Newsletter #2 - June 2026

Keith Washington
Jun 7
7 min read

Retention, Recognition, and Reality: What Healthcare Is Missing About Workforce Stability

By Elizabeth Jeanes, MBA-HM, BSN, RN, NPD-BC, EBP-C, LSSBB

Healthcare Leader, Educator, and Advocate focused on workforce sustainability, leadership development, and healthcare innovation.

Healthcare organizations across the country continue searching for solutions to burnout, staffing shortages, and workforce instability. Most conversations focus on recruitment: how to bring more people into healthcare and fill vacancies faster.

But after more than two decades in nursing, education, and leadership development, I believe the conversation must become bigger than hiring alone.

One thing that stood out after my recent podcast conversation was how strongly healthcare professionals responded online with the same message:

“Pay nurses more.”

“Improve staffing ratios.”

“Protect bedside staff.”

And honestly? We have every right to feel that way.

Healthcare professionals are carrying increasing emotional, physical, and operational burdens while still being expected to deliver exceptional care in systems that often feel unsustainable.

But I also believe the workforce crisis is bigger than staffing numbers alone.

The issue is not simply whether organizations have enough people on paper. It is whether we are building systems that allow healthcare professionals to sustainably do the work they were called to do.

That means examining whether healthcare has become too operationally and administratively heavy while frontline caregivers and bedside leaders continue absorbing growing demands with fewer resources and less support. It means strengthening career pathway programs, leadership development, mentorship, and preceptor programs that help people feel invested in long-term careers within healthcare.

It also means using technology more intentionally.

Innovation should not be about asking fewer people to do more. It should be about removing unnecessary burdens that pull caregivers away from patients and purpose. Technology, automation, AI, and workflow redesign should create more time for connection, critical thinking, education, and compassionate care.

Compensation matters deeply. Safe staffing matters deeply. Workplace safety matters deeply. But workforce sustainability must also address psychological safety, flexibility, communication, leadership development, and the daily realities shaping the caregiver experience.

Healthcare is also managing one of the most generationally diverse workforces in history, and I believe that diversity can become one of our greatest strengths if we choose to lean into it intentionally.

Different generations bring different perspectives surrounding leadership, adaptability, technology, collaboration, and problem-solving. In a healthcare environment facing constant disruption and increasing complexity, we cannot afford to approach challenges with only one lens or one way of thinking.

Some of the most innovative solutions emerge when experienced clinicians, emerging leaders, frontline staff, educators, and technology-driven thinkers are all empowered to contribute their unique strengths together.

Healthcare is built on the skill, compassion, resilience, and sacrifice of healthcare professionals who continue showing up for others every single day. Appreciation should never be limited to one week, one campaign, or symbolic gestures alone.

Recognition matters, but recognition without meaningful investment will never create long-term workforce sustainability.

The future of healthcare will not be determined solely by how many people we hire. It will be determined by how well we value, support, develop, and invest in the people who are already here — not through occasional pizza parties or temporary recognition efforts, but through meaningful investment in their careers, their wellbeing, their growth, and their ability to live the kind of lives that people who dedicate themselves to saving others deserve to live.

Beyond the Blueprint: When Data Rules Are Unclear, Clinicians Inherit the Risk

By Gregg Malkary, Co-host of Beyond the Blueprint

Data governance sounds like a technical or operational issue until a clinician is forced to make a decision with incomplete, conflicting, or unclear information. In that moment, the problem is not whether the data exists somewhere in the system. The problem is whether the care team knows which source to trust, what the information actually means, and what action should happen next.

That was the focus of a recent Beyond the Blueprint conversation with Dr. John Lee, President of HIT Peak Advisors; Dr. Howard Landa, CMIO at Adventist Health; and Dr. Mark Pierce, former CMIO at Parkview.

What stood out most during the discussion was how quickly governance problems become frontline problems.

Healthcare organizations spend enormous amounts of time discussing interoperability, analytics, dashboards, AI, and digital transformation. But underneath all of those conversations is a much more practical question: Are we giving clinicians clear, reliable rules for the data they use every day, or are we leaving them to sort out unresolved conflicts on their own?

When governance is unclear, the system does not pause to wait for leadership to catch up.

Care teams still have to move forward. Nurses still have to administer medications. Physicians still have to make treatment decisions. Operators still have to coordinate care and capacity.

Our conversation intentionally moved beyond governance language and into the realities clinicians face every day: conflicting medication histories, inconsistent definitions across departments, external records lacking sufficient context, and dashboards that may be technically correct but still fail to support real-time decision-making.

One of the most important observations came from Dr. John Lee, who described what he called an “error of opacity.”

“The data is there, but no one actually sees it.”

That idea captures a growing challenge across healthcare. Data does not have to be missing to fail the care team. It can exist in a record, live in a report, or sit in a policy document, and still be operationally useless if clinicians cannot find it, trust it, understand it, or apply it quickly enough during care.

And when that happens, clinicians do what healthcare professionals always do: they compensate.

They double-check. They re-enter information. They create workarounds. They pause to verify. They override alerts. They rely on memory or side conversations because the system itself has not earned enough confidence.

Those moments may seem small individually, but over time, they create friction, cognitive burden, and operational risk across the organization.

This is where data governance stops being an IT conversation and becomes a system design conversation.

If leadership teams do not clearly define what happens when data conflicts, clinicians inherit the responsibility during care. They are left deciding which source to trust, whether to escalate concerns, whether to delay action, or whether to work around the system entirely.

And AI only raises the stakes.

There is enormous excitement surrounding AI in healthcare right now, but every model, alert, dashboard, and recommendation engine depends on the definitions, workflows, ownership structures, and governance rules already embedded within the organization.

If those foundations are weak, AI does not solve the problem. It accelerates it.

One thing became very clear during our discussion: healthcare organizations do not necessarily need more data. They need clearer ownership, stronger definitions, better workflows, and systems that clinicians can trust without constantly second-guessing the information in front of them.

A few practical questions emerged from the conversation:

Which data elements are clinicians expected to trust without rechecking?
Who owns recurring data conflicts before they reach the bedside?
What should staff do when systems disagree?
Where are clinicians already creating workarounds because trust has broken down?
And before deploying AI tools, have organizations identified the governance gaps those systems will inherit?

These are not abstract governance questions anymore. They are operational questions, leadership questions, and increasingly, patient safety questions.

The reality is that healthcare will continue becoming more digital, more connected, and more dependent on AI-supported decision-making. But technology alone will not create clarity. Organizations still have to decide what good data governance actually looks like in practice and how those decisions support the people delivering care every day.

Watch the full episode HERE

From the Field

Notable conversations you need to hear

https://www.youtube.com/watch?v=bz8IDHYuKIA

EP48 - Healthcare Doesn't Have a Staffing Problem: Rethinking Workforce Design

Elizabeth Jeanes is asking a question many healthcare leaders are quietly wrestling with: what if the workforce crisis isn’t really about staffing shortages at all? In this episode, she joins Keith Washington to unpack why healthcare may actually have a workforce design problem, and why throwing more people at the issue won’t fix burnout, disengagement, or retention challenges. From onboarding and preceptor programs to leadership development, generational dynamics, and workplace culture, the conversation gets candid about what’s working, what’s broken, and where organizations need to rethink the employee experience. It’s thoughtful, practical, and refreshingly honest, especially for healthcare leaders trying to build stronger teams in an increasingly demanding environment. If workforce retention, culture, and the future of healthcare leadership are on your radar, this episode is well worth a listen.

Listen on Spotify

Watch on YouTube

Sound Bites

The moments that made us hit rewind.

Footnotes

Further reading for curious minds

Burnout continues to shape nearly every workforce conversation in healthcare, but a growing body of research suggests the issue is deeply tied to organizational structure, onboarding, communication, and workforce design — not simply individual resilience. Recent studies have linked clinician burnout to patient safety risks, turnover, and staffing instability, while evidence around mentorship, preceptor, and transition-to-practice programs points toward a more practical path forward: investing earlier in support systems, professional integration, and care team design. As Elizabeth Jeanes discusses in EP48, sustainable workforce models are often built through operational design choices long before staffing pressures become visible downstream.

Further reading:

Physician and Nurse Well-Being and Preferred Interventions to Address Burnout in Hospital Practice: Factors Associated With Turnover , Outcomes, and Patient Safety

JAMA Health Forum (2023) — Linda H. Aiken, Karen B. Lasater, Douglas M. Sloane, et al. Examines burnout, turnover intent, and patient safety risks across hospital clinicians, including findings that many nurses planned to leave their roles within two years.
Burned Out on Burnout—The Urgency of Equity-Minded Structural Approaches to Support Nurses

JAMA Health Forum (2023) — Tim Cunningham, Rosa M. Gonzalez-Guarda

Argues that burnout should be approached as a structural and organizational challenge rather than an individual resilience problem alone.
Core competencies for Registered Nurse preceptors: A mapping review of quantitative studies
Journal article (open access via PubMed Central) - Colleen L. Ryan et al. Integrative review aligned with the Ulrich Preceptor Model. Synthesizes evidence on RN preceptor competencies and organizes them using the Ulrich Preceptor Model, validating seven core preceptor roles (teacher/coach, role model, leader/influencer, facilitator, socialization agent, evaluator, protector).