Editor’s Note: This is an excerpt from Nurse Manager’s Guide to Retention and Recruitment by June Marshall, DNP, RN, NEA-BC; Cole Edmonson, DNP, RN, FACHE, NEA-BC, FAAN; and Victoria England, MBA, BSN, RN, RN, NE-BC.
Nurses are often encouraged to pursue leadership roles because of their strong clinical expertise. While frontline nursing roles certainly require specific leadership skills, formal leadership roles in nursing call for additional knowledge and competencies. The art and science of nursing leadership hinges on authenticity, accessibility, communication, relationship building, collaboration, transparency, recognition, accountability, and trust.
The nurse manager role has become increasingly complex and filled with multiple responsibilities and accountabilities for unit and/or department operational, quality, and human resource outcomes. Additionally, economic influences are dictating that managers often face increased demands, with multiple units and ever-increasing numbers of direct reports. At the same time, nurse managers are expected to have 24/7 accountability for staffing and patient care on the units they lead. All in all, jobs in the nursing operational structure.
Deborah Zastocki RN, MEd, DNP points out that many nurse managers are acclimated to their roles and responsibilities through negative feedback, often better known as trial by fire. In her study, managers reported that, in addition to their managerial responsibilities, they often worked long hours on a variety of shits to fill staffing gaps and rarely received positive feedback for a job well done. Managers reported that they wanted better work-life balance, better support for their roles, recognition and acknowledgment, better compensation, and increased empowerment and autonomy for managing their units.
If nurse managers are expected to be responsible for nurse engagement and retention, then senior-level nurse leaders and chief nurse executives must first implement, evaluate, and, when necessary, revise strategies to attract, develop, support, and retain nurse managers. How then do organizations and leaders best develop and support nurse managers to achieve success in this challenging leadership role?
LEADERSHIP DEVELOPMENT PROGRAMS
A number of organizations provide formal internal leadership programs for supervisors, managers, and directors, particularly when they are either new to their roles or new to the organization. Additionally, professional organizations, such as the American Nurses Association and the American Organization of Nurse Executives, also offer formal leadership training or structured fellowships to develop nurse leaders. These leadership development programs are delivered in a variety of methods, from computer-based modules and webinars to formal educational workshops and structured year-long programs.
One such leadership development opportunity for managers through AONE is the Nurse Manager Fellowship program, a formal year-long program that not only provides education from prominent nurse leaders but also creates a networking and reflective learning environment for participants from across the nation. Additionally, AONE offers the Emerging Leader and Nurse Manager Institutes, 3-day programs that combine didactic education with experiential learning and self-assessment.
ANA’s Leadership Institute offers a series of computer-based modules that provide nurse leaders at all levels an opportunity to develop and refine leadership skills. One course specifically for nurse managers is "10 Steps to Becoming a Successful Nurse Manager." ANA also offers periodic 2-day "New Nurse Manager" workshops that provide a "Road Map to Success."
Organizations with the greatest internal resources are also often able to tailor onboarding and ongoing education for nurse managers that are individualized to their specific identified needs. Nurse managers can benefit greatly from mentoring relationships, and while many may be assigned a mentor, preceptor, or buddy during their initial onboarding phase, those relationships may not be sustained or available/accessible over time. Nurse managers can benefit from continuing that one-on-one relationship with the individual, as initially assigned, or finding another mentor within the organization to provide ongoing guidance and support. The nurse manager’s developmental needs will also evolve over time, so having access to a network of mentors and collegial resources is as important as any leadership education and training an organization can provide.
Creating reflective learning environments and communities for nurse managers is another tactic that works to assist managers in problem solving, finding creative solutions to problems and challenges, networking, and peer support. In an environment where managers are expected to implement shared governance principles and practice, all too often these same managers are not necessarily part of environments where they have opportunities to practice those same principles with their peers to carry their voices forward to organizational leaders in shared decision-making.
NURSE MANAGER SUCCESS
So how do all of these professional development programs, opportunities, and strategies impact a nurse manager’s ability to recruit, engage, and retain the best nursing teams? Much has been written about leadership, and even nurse manager, competencies. There is a body of literature that also tells us that confidence influences competence. Though the majority of work related to competence in nursing has focused on students and new-graduate nurses, the IOM Future of Nursing report in three of the key messages specifically challenges nurses in all roles to:
- Practice to the full extent of their education and training.
- Achieve higher levels of education and training through an improved education system that promotes seamless academic progression.
- Be full partners, with physicians and other healthcare professionals, in redesigning healthcare in the United States.
Nurse managers’ competencies are as crucial to success in their roles as technical skills and clinical competencies are for frontline nurses that provide direct patient care. The challenge, however, is that organizations do not have the same models of competency assessment and validation in place for nurse leaders as those required for clinical staff. Nurse managers also have greater ability to engage their teams in problem solving, decision-making, and accountability for unit outcomes, if they personally demonstrate confidence and competence in their leadership roles, or in other words, lead by example.
Empowerment, self-efficacy, and self-determination are also components of effective leadership that can be taught, learned, and also subsequently translated into practice by midlevel and even frontline nurse leaders.