We expect much of nurse managers – above all, that they perform. They must continuously achieve safe patient care; build and maintain an engaged, empowered staff; run a safe, financially stable unit; achieve low staff turnover and high productivity; and wow their patients.
How do we prepare nurse managers to do all this? Do we provide training and proper orientation, or do we “wave our magic wand” and hope for the best? While any healthcare organization can present its policies and procedures for training new nurses and graduates, I am concerned that proper orientation of nurse managers often goes by the wayside.
Consider how a nurse manager position is filled. Frequently the best staff nurse with an advanced degree is identified and enticed to management for increased power and pay, greater authority, more flexible schedules, and the opportunity to create positive change. This process does not always involve a discussion of the tough realities of transitioning from a strictly operational role to a strategic operations role.
Once the manager is hired, orientation usually focuses solely on administrative tasks, quality and safety issues (hugely important), and meetings with colleagues, such as other department heads, human resources directors, and fiscal representatives to review budgets and capital protocols.
A Better Approach
I recommend integrating the following elements into any nurse-manager orientation. Nurses: If you are considering a jump to management, ask about these issues:
- The difficulties of transitioning from staff to manager
- What it means to be a “transformational leader” and how to apply transformation theories to patient safety
- How to empower staff and, in turn, improve patient care
- The difference between operational planning and strategic planning, and when to do which
- How to translate the CEO’s vision to staff in meaningful ways
- How to effect and evaluate change beyond verbalizing the tenants of change theory learned in graduate school
Patricia Benner, R.N., Ph.D.* has developed a five-stage model for how staff nurses learn skills and advance: novice, advanced learner, competent, proficient, and expert. I believe we should apply this model to nurse managers as well. The key is experiential learning; nurse managers must learn more than administrative tasks. They need:
- Mentorship from an expert manager (and not just for three months)
- Exposure to and discussion of applying leadership theories to their specific roles (i.e., How can transformational leadership help me improve patient care?)
- Mentorship from an expert manager (and not just for three months)
- Exposure to and discussion of applying leadership theories to their specific roles (i.e., How can transformational leadership help me improve patient care?)
- Guidance on how to effect and sustain change and evaluate staff
- Assistance with verbalizing and applying the CEO’s vision a hundred different ways for each unique staff member
- Guidance on strategic planning in coordination with the organization’s goals and objectives
These skills do not come automatically, nor by waving a magic wand. Strengthening managers’ leadership competencies needs to become a priority for healthcare organizations, especially in today’s economic turbulence and amid the mounting challenges to provide safe patient care.
References
Benner, P. From Novice to Expert: Excellence and Power in Clinical Nursing Practice. Prentice Hall; 2001.