The nurse manager role is pivotal in staff nurse satisfaction and retention, quality of patient care, and achieving organizational goals, which is why the decreasing numbers of qualified nurse managers in the acute care environment is of concern. Show
The American Organization of Nurse Executives (AONE) reported vacancy rates for nurse managers are on average as high as 8.3% nationwide. This fact is compounded by the intent of the largest group of nurse managers with long career and organizational experience and higher levels of organizational commitment to retire in about 10 years. Replacing this number of nurse managers is a daunting challenge that can only be met by understanding the issues involved and the viewpoint of the managers themselves. What’s the problem?The role of nurse managers relate to both management (mobilizing people and resources) and leadership (influence and vision), while they contend with a variety of role stressors and challenges. The widespread availability of personal communication devices lends a sense of being available 24-hours a day, 7 days a week without a break. Working in intense human relations situations 10-12 hours per day with an increasing span of control and dealing with complex issues typically outside of the manager’s control contributes to overall stress. Nurse manager workplace demands include increasing numbers of direct reports, decreased resources, decreased clinical involvement, increased staff diversity, increased coordination across differing nursing units, issues with assistive personnel, changing regulatory requirements, and the need for new management skills coupled with the increasing complexity of hospitalized patients. The time consuming demands of staffing, however, have been reported to be the manager’s greatest challenge, precluding ability to be visible, build relationships with staff, and allow time to engage in those activities directly related to constructing a committed, retained staff. What nurse managers sayZastocki asked a group of 188 nurse managers to comment about their jobs. Many of the comments provided were related to challenges encountered in the work environment. Many of the nurse managers felt disempowered, inadequate, and ignored, resulting in widespread feelings of dissatisfaction and intent to leave. Here is a sample of some of their comments:
Lack of support and the demands of an increasingly regulated environment were other predominant themes in this group of nurse managers. Nurse managers are also saying:
What can be done to retain nurse managers?Nurse manager studies on creating healthy workplaces suggest desirable components include a framework of shared leadership, participatory management, relationship building, development of nurse managers, evaluation of role expectations, and empowerment. Predominant themes from Zastocki’s survey that are consistent with the review of the nursing literature are work-life balance, support, acknowledgement, opportunities growth with support for education, role expectations. Additional themes on the importance of the chief nurse executive role and the impact of tenure and employee benefits as investments in the organization were also consistent with the literature. These findings are supported by the nurse manager engagement study by Mackoff and Triolo, which found six elements for future nurse manager engagement. These were:
Here is a summary of what nurse managers want, based on the Zastocki survey: Work-life Balance
Support
Acknowledgement
Compensation
Leadership/Professionalism
Creating healthy work environments requires a committed participative process for evaluating role options essential to nurse manager retention and recruitment. Personal resources, social support, and mentoring are combination strategies that take into consideration individual nurse manager needs for personal development and for the types of social/professional network(s) considered supportive. An immediate, low-cost hospital action may be hardiness training to provide emotional support to the nurse managers. Nurse managers need to accept individual responsibility to seek resources that nurture their well-being. Options such as job sharing and separating clinical and administrative roles may work in some organizations. Strategies for stress management, role expectations and role redesign, and processes for creating healthy workplaces, need to be evaluated both in response to broader healthcare and workforce trends as well as within organizational culture and constraints. While recruiting new nurse managers is essential, it’s equally important to retain experienced nurse managers as part of the succession plan of the nurse executive. Nurse executives need to reflect on those leadership behaviors that are viewed as more supportive by nurse managers and begin discussion on the predominant themes of work expectations, work-life balance, workload and role expectations, support, education and growth opportunities, acknowledgement and respect for contributions to the organization, and compensation. Beginning the discussion is the first step in acknowledging change must occur to retain committed and engaged nurse managers. This dialogue can provide the platform for succession planning and broader discussions with different age cohort nurses earlier in their careers who may consider nurse manager roles in the future. Succession planning is an immediate imperative; given the reported average age of the nurse manager is 45 years. Supporting discussion of creating healthy work environments can also establish a culture of support and a basis for long-term organizational change. Time to actSupport, empowerment, and the ability to make change in a timely manner are essential to retaining the nurse manager. Empowerment should be evaluated as part of the organizational culture as an influence on nurse manager perceptions of control, support, and their ability to address role expectations and demands. Organizational leadership should develop an ongoing process and an environment where nurse managers participate in this creative process. Succession planning that uses focus groups with potential nurse managers may prove helpful in evaluating job design, role expectations, and workload. Options such as job sharing or separating clinical and administrative roles require organizational assessment for organizational fit. Organizational support in creating healthy work environments and commitment to an ongoing process to continue to evaluate options and explore new models are essential to retention. Educating hospital leadership concerning the critical nature of the nurse manager role, projected shortages, and the need for support for organizational change is a major challenge for the nurse executive in financially constrained hospitals. Developing opportunities for education, growth, and mentorship require assessment of the basic competency levels of nurse managers, support of academic achievement at the master’s degree level, horizontal growth opportunities, and ongoing continuing education, and supportive professional networking. The time for committing to action is now. Nursing leaders need to take ownership, perhaps albeit small incremental change initially, of creating the future environment. Focusing on the many circumstances outside of one’s control will result in a leadership crisis in the near future. In a recent study, senior leaders were challenged to support nurse managers in the following ways: <blockquote “know which leader behaviors make the difference and support managers in carrying them out; help the manager deal with polarities; help the manager set realistic boundaries; negotiate for a strong supportive role from Human Resources; remove organizational barriers to results; encourage managers to develop a supportive network; listen to what the managers tell you; and encourage managers to learn from each other…” (Manion, 2005; p. 54). The nurse executives’ understanding of what is important to nurse managers individually, and collectively, remains a critical component in designing organizational strategies. Although many nurse managers are in later career stages, the recruitment of new managers requires strategic planning for organizational supports and individualized development plans with mentors for each manager. The recent work of Mackoff and Triolo on nurse manager engagement provides a resource with suggested applications. Implementing strategies to manage work experiences at entry into the organization and at entry into the nurse manager position may prove more effective for enhanced affective commitment and perceived organizational support. Deborah Zastocki RN, MEd, DNP, is president & CEO of Chilton Memorial Hospital in Pompton Plains, New Jersey. Cheryl Holly RN, EdD, is associate professor and director of the New Jersey Center for Evidence Based Practice and director of the DNP Program at the University of Medicine and Dentistry of New Jersey, School of Nursing in Newark. American Organization of Nurse Executives (AONE). Acute care hospital survey of RN vacancy and turnover rates in 2000. 2002. American Organization of Nurse Executives, Washington, DC, USA. Aroian J, Horvarth K, Secatore J, Alpert H, Costa M, Powers E, & Stengrevics S. Vision for a treasured resource: part 1, nurse manager role implementation. Journal of Nursing Administration. 1997;27:(3):36-41. Fletcher C. Hospital RN’s job satisfaction and dissatisfactions. Journal of Nursing Administration. 2001;31(6):324-331. Flynn L. The state of the Nursing Workforce in New Jersey: Findings from a statewide survey of registered nurses. 2007. Newark, NJ: New Jersey Collaborating Center for Nursing. Havens D. Comparing nursing infrastructure and outcomes: ANCC magnet and nonmagnet CNEs report. Nursing Economics. 2001;19(6):256-266 Mackoff B, Tiolo P. Project report: creating a model of nurse manager engagement: A Qualitative study of long-term outstanding nurse managers. Robert Wood Johnson Foundation. 2007. Princeton, NJ. Mackoff B, Triolo P. Why do nurse managers stay? Building a model of engagement. Part 1, dimensions of engagement. Journal of Nursing Administration. 2008;38(3):118-124. Mackoff B, Tiolo P. Why do nurse managers stay? Building a model of engagement. Part 2, cultures of engagement. Journal of Nursing Administration. 2008; 38(4):166-170. Manion J. Supporting nurse managers in creating a culture of retention. Nurse Leader. 2005;April, 52-56. Meyer J, Stanley D, Herscovitch L, Topolnytsky L. Affective, continuance, and normative commitment to the organization: a meta-analysis of antecedents, correlates, and consequences. Journal of Vocational Behavior. 2006;61:20-52. Parsons M, Cornettd P, Golightly-Jenkins C. Creating healthy workplaces: laying the groundwork by listening to nurse managers. Nurse Leader. 2006;June (34):34-39. Rudan V. Where have all the nursing administration students gone?: Issues and solutions. Journal of Nursing Administration. 2002;32(4):185-188. Shirley MR, Fisher ML. Leadership agenda for change toward healthy work environments in acute and critical care. Critical Care Nurse. 2008;28(5):66-79. Thorpe K, Loo R. Balancing professional and personal satisfaction of nurse managers: current and future perspectives in a changing health care system. Journal of Nursing Management. 2003;11:321-330. Waldman J, Kelly F, Aurora S, Smith H. The shocking cost of turnover in health care. Health Care Management Review. 2004;29(1):2-7. Zastocki D. A Study of the relationships among nurse managers’ organizational commitment, perceptions of nurse executive leadership behaviors and intent to stay. 2008. NJ: UMDNJ Unpublished Capstone. Which strategy of the nurse leader regarding the quality improvement process requires revising?Which strategy of the nurse leader regarding the quality improvement (QI) process requires revising? Focus is on correcting errors.
Which responsibility of the nurse manager differs from the responsibilities of the nurse leader?Which responsibility of the nurse manager differs from the responsibilities of a nurse leader? Budgeting is the responsibility of a nurse manager. The role of nurse leader is to motivate the nursing subordinates. Resolving conflicts is the responsibility of both the nurse leader and the nurse manager.
Which action of the nurse leader supports implementing Gardner's task of achieving workable unity effectively?Which action of the nurse leader supports the senior nurse's finding? Gardner's task of "achieving workable unity" can be implemented by inculcating the unity in the team. This can be achieved by developing the conflict resolution skills effectively.
Which skills would be essential for an effective nurse manager to develop and improve?If you're keen on becoming a nurse manager yourself, ensure you have the following set of skills:. Communication. Nurse managers know how to effectively communicate with their staff and patients in addition to the doctors and administrators with whom they work closely. ... . Team Player. ... . Positive Attitude. ... . Leadership. ... . Mentoring.. |