
Nursing Leadership COVID-19 Study
The American Organization for Nursing Leadership (AONL) partnered with Joslin Marketing to conduct a third longitudinal study on the impact of COVID-19 on nursing leadership in key areas over time.
Nurse Leaders’ Top Challenges, Emotional Health, and Areas of Needed Support
July 2020 to August 2021
The August 2021 Longitudinal Study focuses on new data and major shifts that have occurred in health care going back to the first survey conducted in July 2020. The new data from this survey indicates access to PPE and the ability to communicate and implement changing policies have improved, while staffing shortages and the emotional health and well-being of nurse leaders have worsened. The August report also offers new insights into nurse leaders’ needs and tactics being used to address the growing staffing shortage. The report continues to identify a gap between roles, with focus on chief nursing officers, directors, and managers.
Presentation of Report
Top Challenges During the Pandemic: July 2020, February 2021 and August 2021
Challenges in July 2020:
54% communicating and implementing changing policies
53% surge staffing, training, and reallocation
49% mental health and wellbeing of staff
46% access to PPE
Challenges in February 2021:
67% selected mental health and wellbeing of staff
65% surge staffing, training, and reallocation
44% communicating and implementing changing policies
31% staff retention, furloughs, layoffs
Challenges in August 2021:
75% emotional health and wellbeing of staff
61% Surge staffing, training and relocation
47% Staff retention, furloughs and layoffs
34% Communicating and implementing changing policies
Of note, the percentage of nurse leaders who selected access to PPE dropped by 24% since July 2020.
Nearly 2,500 nurse leaders completed the February 2021 survey with findings indicating a change in the primary challenges nurse leaders faced since last summer: access to PPE improved while mental health and staffing issues have worsened.
As stated by one nurse leader:
“We have seen nurses leaving the profession due to moral distress, burnout, and fatigue. I believe if we can address the root cause of this problem, we will retain more nurses and begin to stabilize the numbers in the workforce.”
Respondent Profile

Survey respondents include nurse leaders at all levels across the continuum of care. The vast majority of respondents were either chief nursing officers or executives (17 percent) vice presidents, directors (34 percent), or managers (32 percent).
Fifty-two percent of respondents came from acute care hospitals, while 14 percent are from health system facilities and only four percent came from long-term care or post-acute care facilities. The respondents skewed to urban settings (51 percent) versus 29 percent suburban, and 20 percent rural.
The survey, conducted in late July 2020, studied the impact of the COVID-19 pandemic on nursing leadership. After conducting interviews with nurse leaders from across the country, AONL and Joslin Marketing launched an online survey to measure nurse leaders’ perceptions of key concerns, primary challenges, lasting changes and preparedness for future pandemics or surges.