Building Support: Innovative Initiatives to Retain Nurse Managers

One of the most challenging roles for nurse leaders is the nurse manager position. Nurse managers work on the front line and interact daily with patients, families, their staff, staff of varied disciplines that are involved with the patient’s care and many others. Managers are accountable to ensure quality and safety goals in their department are met while they must also balance productivity and manage a financially viable department. They must routinely deal with ethical issues, staffing challenges, and at times, workplace psychological and physical violence. These managers play a pivotal role in the health care organization, setting the tone for the culture of the department and their teams, and providing oversight for 24-hour care.

Nurse managers impact the retention and engagement of point-of-care nurses. We often hear the statement that happy nurses make for happy patients. The same can be said for nurse managers. Staff who work for highly engaged managers—those that care about their professional growth, are visible in the department and have a transformational leadership style—will be more satisfied and less likely to leave.

Managers are often selected for leadership positions because they are outstanding nurses and have strong clinical skills, but they frequently transition to leadership positions without formal training on how to be effective leaders. Once in the new position, they may feel alone.

Recruiting nurse managers into front-line leadership positions can be difficult. The demands created as a result of the nurse manager’s 24/7 accountability are often a deterrent to attracting nurses to apply for management jobs. Nurses may not feel that they can meet the requirements of a leadership role while at the same time balancing family and personal needs. Encouragement, support and the facilitation of empowerment are essential to recruiting and retaining nurse managers. Research suggests desirable components to retain nurse managers include a framework of shared leadership, participatory management, relationship building, development and empowerment (Zastocki, 2010).

Executive leaders at Norton Healthcare in Louisville, Ky., recognized the crucial value of the nurse manager role and included a goal on the nursing strategic plan to foster the growth, development and retention of this group of organizational leaders. The Norton Healthcare executive team believes health care organizations should invest in the continuing development and retention of nurse managers since this role is vital to the organization’s success. Several initiatives have been put in place to respond to the needs of this group of leaders, including the implementation of a Nurse Manager System Collaborative Council (NMSCC) and initiation of a nurse manager mentor and coaching pilot project.

Using a nurse manager council

Development of a NMSCC in 2018 was a strategic initiative to nurture a sense of connection and trust among nurse managers and to provide a setting for peer support, which could improve job satisfaction and inspire nurse managers to continue in their roles. The NMSCC drew 18 managers, coming from all five hospitals within the health system. The goal was to evaluate the effectiveness of the council by assessing job satisfaction, intent to leave, and resilience prior to the initiation of the council and after the council had been in place for a period of time. A secondary objective of the project was to assess whether participants felt that participation in the council added value. The NMSCC was based somewhat on the concept of shared governance. In larger organizations, managers may not feel they have the decision-making power to impact decisions made within the overall organization, and thus it was felt that an adaptation of a shared governance council might offer value. Shared governance is based on the concept of shared decision-making and the “principles of partnership, equity, accountability, and ownership at the point of service.” This process model “empowers all members of the health care workforce to have a voice in decision-making, thus encouraging diverse and creative input that will help advance the business and health care missions of the organization” (HCPro, 2006).

The NMSCC involved a monthly forum, providing an avenue for sharing successes and an opportunity for nurse managers to learn from each other, understand how to make better decisions and tap into the knowledge of their Norton Healthcare colleagues. In addition, participants wanted to learn from each other how to build better teams and successfully coach employees.

Council representatives set goals for the group during the initial meeting and determined at each session what they wanted to talk about at the next meeting. They invited Norton Healthcare leaders to talk about the system’s initiatives or issues causing concern for front-line and middle managers. Council members then communicated applicable information to managers in their home organizations.

The NMSCC initiative proved to provide a valuable return on the investment of time. During the first six months the council met, job satisfaction improved slightly for council participants and resilience scores increased by four points, although the change was not significant. No managers that were members of the council left during the six-month period of council meetings, and one manager that had originally verbalized a desire to leave decided to stay. In the post-intervention assessment, 90 percent of NMSCC participants classified the council as adding value. Managers reported an improved sense of learning, networking and collaboration as an outcome of participation in the meetings. Additionally, managers verbalized feelings of connectedness, sharing and unity as the most significant gains as a result of the council. The results underscore the importance of fostering connections and collaboration among nurse leaders and illustrate the need for further study to demonstrate the value of an adapted shared governance-like structure for nursing managers. It is also important to note that the meetings occurred during a time of high change within the organization.

New manager development program

Mentoring in leadership settings involves the establishment of a supportive counselor relationship established between a less experienced leader and a more experienced leader. Mentoring can potentially result in reduced burnout and turnover and increased resilience and work engagement. Mentors share experiences, allow for reflection, function as role models and provide support. As described by Thompson, Wolfe, & Sabatine (2012), mentors do not just verbalize how things should be done; they show the way through their own personal example, thus helping others avoid the same mistakes they have made. Mentoring may add additional support and guidance in navigating the nurse manager role, and may contribute to increased empowerment, resilience, and work engagement. Moore, Sublett, & Leahy (2016) found that nearly 70 percent of study participants, both new and experienced nurse managers, desired mentoring as part of their professional growth. In addition to mentoring, manager professional development through coaching by more experienced leaders may provide benefits to new nurse managers. Coaching differs from mentoring in that coaching helps a new manager translate a mentor’s advice and guidance into action (Thompson, Wolf, & Sabatine, 2012).

Norton Healthcare’s initiative was used to evaluate the effect of a nurse manager mentor program on burnout, resilience, work engagement and turnover intention. Conducted within two of the five acute-care hospitals within the organization, the program included all new nurse managers with less than two years of experience. Expert managers within the organization were recruited to serve as mentors for the new nurse managers, and agreed to connect by phone or in person with their mentee weekly. The coaching sessions were performed by organizational experts in a group setting, and included review of didactic content, such as safety, risk management, employee engagement and employee relations. Coaching classes also featured analysis of case studies and open dialogue about the topics covered in each session.

Outcomes of the six-month coaching and mentoring program included lower burnout scores, slightly increased resilience and reduced intent to leave. Additionally, nurse managers reported high value in participating in the mentor program. Of the nurse managers who were in the program, 88 percent reported the mentor program was “very valuable.” In addition, participants reported several gains from the program, including finding a “great mentor and friend,” feeling they were not alone, feeling supported, building relationships and having someone outside of their hospitals to go to for advice. When asked how the mentor program helped them in their role, nurse managers listed: (1) networking, (2) sharing experiences, and (3) being able to apply things learned from the program. One nurse manager expressed how her mentor “has been there for all of my questions; she has also been very supportive and helped me learn how to work through decisions.” Another nurse manager described how the mentor program has “made me more confident in my position.” Norton Healthcare is continuing the mentoring program with some additional features.

The nurse manager position is an instrumental, critical role in health care organizations, with far-reaching influence that affects many key metrics for hospitals. Anticipated nurse manager vacancy rates and a growing concern over the current aging workforce highlight the need for innovative initiatives to recruit, retain and develop nursing managers. As John Buchan noted, “the task of leadership is not to put greatness into [people], but to elicit it, for the greatness is there already.” These two initiatives suggest ways health care organizations can support nurse managers, both new and experienced. According to their participants, both programs helped foster a return on an investment of experience, commitment, engagement and energy.

References

HCPro, Inc. (2006). Shared governance: A practical approach to reshaping professional nursing practice. Retrieved from http://www.strategiesfornursemanagers.com/supplemental/4428_book.pdf.

Oliver, H. (2018). The effects of a nurse manager system collaborative council on job satisfaction, engagement, and resilience. UKnowledge. Retrieved from https://uknowledge.uky.edu/dnp_etds/217/

Moore, L. W., Sublett, C., & Leahy, C. (2016). Nurse managers’ insights regarding their role highlight the need for practice changes. Applied Nursing Research, 30, 98-103.

Thomas, J. (2018). The effects of a mentor program on burnout, resilience, work engagement, and turnover intentions of new nurse managers. UKnowledge. Retrieved from https://uknowledge.uky.edu/dnp_etds/218/

Thompson, R., Wolf, D.M., & Sabatine, J. M. (2012). Mentoring and Coaching: A model guiding professional nurses to executive success. The Journal of Nursing Administration, 42, 536-541.

Zastocki, D.R. (2010). Retaining nurse managers. American Nurse Today, 5(12).