A dearth of nurses seeking to move into administrative ranks convinced HCA East Florida Division executives they must ease the transition by equipping nurses with the skills and tools needed to succeed in management. Ten nurses completed the first Nursing Emerging Leadership Program and are now successfully functioning in their new roles.
“We need to be cognizant of where we want patient care to go and how we will deliver it. And we need to grow future leaders,” says Debra Brindley, RN, BSN, MSN, CNAA, LHRM, chief nursing officer (CNO) at Westside Regional Medical Center in Plantation.
The HCA East Florida Division had many open manager and director positions and turnover was high, says Charlene M. Ingwell, RN, MSN, program director of workforce and organizational development for the division.
HCA is not alone in experiencing difficulty securing nursing leaders. A study by the Florida Center for Nursing found the nurse administrator position was the third most-difficult position for hospitals to fill, after master’s prepared clinical nurse specialists and nurse anesthetists.
Developing existing staff
After noting how difficult it was to find clinical nurse managers willing to step into management roles and how little formal training was available to them, Beth Brill, vice president of human resources for the East Florida Division, came up with the idea for a leadership program and applied for an HCA grant to develop curricula and launch the initiative in 2006.
“We were to look within our hospitals for the best and the brightest, with front-line supervisory experience, that we thought were ready to go to the next level,” says Nancy Hilton, RN, MN, chief nursing officer at St. Lucie Medical Center.
The facilities covered participants’ salaries but did not count them in staffing totals, so the nurses could devote all of their time to learning and putting that knowledge into practice. Participants gave up the position they were in for the opportunity to advance into a leadership role at their hospital or another division facility.
“They were giving up their jobs not knowing 100% they would be selected or there would be a job,” Hilton says. “They were taking a risk.”
The first cohort included 10 nurses and two laboratory employees. Each month, they attended classes designed to increase their leadership skills, promote positive thinking, and foster talent while building a team.
“It was a fantastic course and a phenomenal experience,” says Tami Speed, RN, now the manager of the ED at St. Lucie Medical Center in Port St. Lucie. “What they gave us, you cannot get anywhere else.”
Executives from HCA corporate offices and local facilities, university faculty, and a leadership coach taught the classes on a variety of topics, including time and risk management, change process, data collection, preparation for the Joint Commission, and human resources issues.
HCA purposely invited a range of faculty to expose the novice leaders to different management techniques and people who were successful in different pursuits, so they could develop their own style.
Julie Millar, RN, MSN, ED director at Aventura Hospital, found the communication sessions focusing on working with people at all levels of the organization most valuable. She also enjoyed sharing experiences with other participants and talking with current leaders. As an ED nurse at Westside Regional, Millar says she knew she wanted a management role and thought this program offered her the best chance of success.
“You got to grow step by step and work your way into this type of position gradually,” Millar says. “By the time the program was ending or close to half, we were pretty independent in the roles we were in but still under the supervision of a mentor and CNO, which gave us the confidence we needed to take on more and more responsibilities.”
Learning about multidisciplinary relationships and risk management in human relations piqued the interest of Jennifer Oulman, RN, BSN, director of perioperative services at Westside Regional. She also found it a great networking opportunity and appreciated the chance to ask top HCA leaders important questions.
For three weeks each month, the emerging leaders returned to their hospitals and, guided by a mentor, practiced putting what they learned into practice. For instance, if the leadership topic was handling difficult situations, the nurses had to have a difficult interaction with a physician, a patient, and a staff member.
Ingwell says the program created a safe environment in which the participants could learn from each other. “What was stated in the room was kept in the room,” she says. “There wasn’t a question that was stupid or anything out of line. We accepted each other.”
Nurse leaders emerge
If they did not find a position and chose not to continue in a leadership role, participants would have had to pay HCA back for the training. As it turned out, failing to find a position was not a problem. All of the nurses moved up, and those willing to relocate to another facility had multiple job offers.
At the end of the year, the participants presented Ingwell with a plaque, touting their vision statement, “We will inspire those we lead to reach their greatest potential. In so doing, we shall transform the healthcare delivery system as we know it today.”
Hilton says the nurses who completed the program are doing better than nurse leaders hired from the outside. “They have been in their roles five months and are doing fabulously,” she says.
The next class will increase in size to include up to 30 participants.
Debra Anscombe Wood, RN, is a Nursing Spectrum contributing writer.
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