An experienced health care executive recently noted in an interview, “We have weathered many storms in health care, but this has been the most challenging time in my 40-year career.”
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And while undoubtedly executive roles in health care have been taxing over the past 3 years, the burnout and exhaustion among leaders at the frontlines of care are even more significant. Supporting our nurse managers in their roles in 2023 is a critical imperative.Kaufman Hall. 2022 State of Healthcare Performance Improvement: Mounting Pressures Pose New Challenges.
https://www.kaufmanhall.com/sites/default/files/2022-10/2022-State-Healthcare-Performance-Improvement.pdf
Date: October 2022
Date accessed: November 2, 2022
The seismic demographic shifts in the nursing workforce and changes in how nurses view their post-Pandemic have significantly impacted the role of nurse managers. For many, their span of control has expanded as budgets tightened and more nurses shifted to part-time. Skyrocketing turnover and recruitment challenges have changed how managers allocate their day, with up to 60% to 80% of their time on staffing and scheduling.
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NSI Nursing Solutions
2022 NSI National Health Care Retention & RN Staffing Report.
2022 NSI National Health Care Retention & RN Staffing Report.
https://www.nsinursingsolutions.com/Documents/Library/NSI_National_Health_Care_Retention_Report.pdf
Date: 2022
Date accessed: November 2, 2022
Many of today’s frontline leaders are relatively new to their roles, with minimal leadership development. These leaders report a lack of work-life balance as staff tenure has dropped, and nurses need more coaching and reassurance 24/7. In research conducted by AONL and the Joslin group in August 2022, 45% of nurse managers reported they are considering leaving their roles, with burnout and lack of work-life balance being the primary drivers. Less than half (47%) of nurse managers reported that they are emotionally healthy or very emotionally healthy—significantly lower than either directors or chief nursing officers (CNOs)/chief nursing executives (CNEs).
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As currently designed, many nurse manager roles are no longer doable. Spans of control above 100 staff are not unusual. The leadership structures that worked in a pre-pandemic environment don’t provide the leadership support and ballast needed on units today with high turnover. Additional roles, such as assistant nurse managers, unit-based educators, or administrative assistants, are required to support nurse managers in environments lacking strong core teams. Like other staff, nurse managers want flexibility in their scheduling with options such as 4 10-hour days and the ability to do some work remotely. They also want fair compensation for the responsibilities they assume.
New nurse managers now struggle with the expanded role expectations. My research indicates that even in the best of times, more than half of all nurse leaders receive no formal leadership development before their transition, and fewer have mentors to help them. Unfortunately, we spend more time worrying about new graduates’ transition than the managers who supervise them. Yet, we know from the data that frontline leaders are the linchpins in their organization that drive recruitment, retention, and staff performance.
As we move out of the pandemic in 2023 and work to improve our cultures and work environments, let us not forget our nurse managers, who will play an essential strategic role. As the leader of an AONL subgroup that carefully studied nurse manager recruitment and retention, we made the following 10 recommendations
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to provide better support for our nurse managers:AONL Nursing Workforce Leadership Compendium (November 2022).
https://www.aonl.org/resources/Nurse-Leadership-Workforce-Compendium
Date accessed: November 22, 2022
- 1.Re-evaluate the span of control and scope of work for frontline nurse managers in your organization, as it is significantly different today than in the pre-pandemic environment.
- 2.Conduct STAY interviews with nurse managers to determine retention challenges and job embeddedness factors unique to your setting.5
- Finnegan R.
How to Conduct Stay Interviews: 5 Key Questions.https://www.shrm.org/resourcesandtools/hr-topics/employee-relations/pages/how-to-conduct-stay-interviews-part-2.aspxDate: 2017Date accessed: November 2, 2022 - 3.Recognize the need for the CNO to have regular conversations with frontline managers to assess the role challenges and provide support.
- 4.Seek ways to improve nurse manager support through strategies such as nurse manager councils, peer support groups, and coaching.
- 5.Evaluate requirements for nurse manager attendance at meetings and look for opportunities to reduce time spent in meetings.
- 6.Look for opportunities to offload time-consuming leadership tasks such as staffing, scheduling, and pulling performance metric data.
- 7.Assess the level of human resources support for nurse managers in their recruitment and performance management activities.
- 8.Re-evaluate your frontline leadership structure and what additional roles may be needed to support nurse managers in environments that no longer have strong core teams.
- 9.Focus on helping nurse managers to improve their work-life balance through remote workdays, ten-hour shifts, or flexible scheduling.
- 10.Be willing to take small bets versus waiting for evidence or research to support new initiatives in this rapidly changing environment.
References
- Kaufman Hall. 2022 State of Healthcare Performance Improvement: Mounting Pressures Pose New Challenges.(Available at:)https://www.kaufmanhall.com/sites/default/files/2022-10/2022-State-Healthcare-Performance-Improvement.pdfDate: October 2022Date accessed: November 2, 2022
- 2022 NSI National Health Care Retention & RN Staffing Report.(Available at:)https://www.nsinursingsolutions.com/Documents/Library/NSI_National_Health_Care_Retention_Report.pdfDate: 2022Date accessed: November 2, 2022
- AONL. Longitudinal Nursing Leadership Insight Study Part 4: Nurse Leader’s Top Challenges and Areas for Needed Support, July 2020 to August 2022. October 2022.(Available at:) (Retrieved November 2, 2022)
- AONL Nursing Workforce Leadership Compendium (November 2022).(Available at:)https://www.aonl.org/resources/Nurse-Leadership-Workforce-CompendiumDate accessed: November 22, 2022
- How to Conduct Stay Interviews: 5 Key Questions.(Available at:)https://www.shrm.org/resourcesandtools/hr-topics/employee-relations/pages/how-to-conduct-stay-interviews-part-2.aspxDate: 2017Date accessed: November 2, 2022
Biography
Editor-in-Chief Rose O. Sherman, EdD, RN, NEA-BC, FAAN, is Adjunct Professor of Nursing at Marian K. Shaughnessy Leadership Academy, Case Western Reserve University, in Cleveland, Ohio, and is the author of The Nuts and Bolts of Nursing Leadership: Your Toolkit for Success. She can be reached at [email protected]
Editor’s Note: This issue includes thought leader articles written by members of the 2022 class of Coldiron Fellows. The Coldiron Senior Nurse Executive Fellowship was created by the Marian K. Shaughnessy Nurse Leadership Academy at Case Western Reserve University in partnership with the American Nurses Association, The American Organization for Nursing Leadership, and the Healthcare Financial Management Association to enhance and expand the development of senior nurse executive leaders. This innovative Fellowship Program empowers executive nurse leaders to make health care more patient-centered, cost-effective, accessible, and quality driven.
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Publication history
Published online: November 28, 2022
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2022 by Elsevier Inc. All rights reserved.
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