Succession planning has long been a staple term in the business arena, but it has been lacking in the leadership areas of nursing, especially in nursing middle management, according to Maria R. Shirey, PhD, MBA, RN, NEA-BC, ANEF, FACHE, FAAN, assistant dean, clinical and global partnerships and professor, department of family, community and health systems at the University of Alabama at Birmingham School of Nursing.
“There is a greater awareness of the need for nurse manager succession planning, but we are not yet where we need to be,” Shirey said.
Shirey studies the work of nurse managers. Her research focuses on nurse manager work complexity and delves into the nature of their work and what facilitates their performance. In that research, she said, it became evident that nurse managers have a number of supportive needs.
“One of those needs is not only to prepare them for when they take the role, but it’s also to be thinking of the future and preparing a leadership plan to fill that role in the future,” she said.
Shirey and colleague Jennifer L. Titzer, MSN, RN, RT(R), RCIS, an assistant professor of nursing at the College of Nursing and Health Professions, University of Southern Indiana, Evansville, have written multiple articles on succession planning in nursing management. In “Nurse Manager Succession Planning: A Concept Analysis,” published in Nursing Forum in 2013, Shirey and Titzer examined literature reviews regarding the subject and proposed that healthcare has failed in providing a strategic success plan for nursing leadership.
Evolution of the role
“Historically, the role of the nurse manager has changed,” Shirey said. “Since the period of re-engineering in the 1990s, nurse managers have effectively become the chief executive officer of the patient care unit, and, in many institutions, the leaders of more than one. In that capacity, they have responsibility for the entire scope of what goes on in those nursing units, including human resources responsibilities like hiring, counseling, developing and mentoring staff who report to them; financial responsibilities in terms of generating and monitoring a budget for those units; and responsibility for the quality of patient care and the safety of the patient care that’s delivered.”
Shirey added that the more recent dynamics in healthcare, such as how organizations will be reimbursed for services, have resulted in a shift from volume to value. Reimbursement is based on how well an institution performs, and from a nurse manager perspective, she said, it’s crucial that staff are able to deliver patient care that not only addresses quality and safety, but also ranks highly in terms of the patient experience.
“As healthcare continues to shift and reimbursement requirements change, more pressure is put on the nurse manager role because there are more variables to consider,” Titzer said. “Not only outcomes, but also patient satisfaction, staff satisfaction and how staff are retained.”
All of these factors have created the need for strong and effective leadership at the nurse manager level that must be seamless when the torch has been passed, and it’s just not there yet, Shirey said.
“Research suggests that even for CEOs, succession planning isn’t embedded in the institution like it should be,” she said. “As you go down the hierarchy, typically, succession planning does not reach the level of the nurse manager and it needs to.”
Titzer agrees. “If you look at some of the landmark studies, such as the one conducted by Garmin in Taylor in 2007, just 30% of surveyed hospitals had a succession plan in place, and of those, only 17% were at the middle manager level and 14% at the department manager level,” she said. “If you look at the majority of succession planning practices that are in place, very little have been at the first-line level. That area is usually neglected.”
A plan that works
So what does a good succession plan look like? A highlight, Shirey said, is the identification of high-potential employees in whom the institution is going to invest money to develop. Some facilities with good nursing management succession plans in place understand the importance of creating a culture of continuance. This may be evident by the increasing number of chief executive officers who also are nurses, Shirey said.
Titzer’s research conducted in 2010 revealed some programs in place, but she warned there are many confusing aspects in succession planning.
“A lot of institutions say that they have a succession plan in place, but what they’re talking about is putting the nurse manager through a leadership program after they have already assumed the role,” she said. “For it to be true succession planning, the plan needs to have a few antecedents. It needs to be very strategic and there should be a very targeted set of competencies for which these leaders are being developed.”
Titzer’s research looked at succession plans of Fortune 500 companies and compared that information to nursing management. These companies answer to their stockholders and they don’t want their productivity to decrease while a manager is transitioning. She found these companies identified high-potential individuals as long as 10 years out to prepare for leadership roles.
“A key is to have a very deep nursing management leadership bench,” Titzer said. “Once these key individuals are identified, they are groomed and developed so that when they assume the role, the stress of transition to the role is decreased.”
If you look at the talent management literature, Shirey said, there are plenty of models that consulting firms use to help health systems to identify high potential employees. For example, a 2002 Executive Update article by Andre N. Mamprin, director of customized leadership development programs for The Banff Centre in Canada, explained a five-point plan that any organization can use to help chosen employees effectively transition into leadership positions.
“However, before any of that happens,” Shirey said, “there has to be a fundamental belief that one, it’s important, and two, that it’s worth investing in.”