By Cathryn Domrose
For the first 12 years of her career at University of North Carolina Hospitals in Chapel Hill, Betsy D. Driggers, BSN, RN, CCRN, never thought of herself as a leader. Then her new nurse manager asked her why not. “She said, ‘What are you doing? You’re good at this and you’re such a leader,’” recalled Driggers, who works in the newborn critical care center. “That little bit of confidence meant the world to me.”
When UNC started its Nurse Leader Fellowship Program, Driggers’ manager suggested she apply. As she participated in discussions of topics such as emotional intelligence, listened to other leaders’ stories and met with her mentor, Driggers, now an assistant nursing manager on her unit, found herself agreeing more and more with her manager’s assessment. “I thought, ‘Maybe this is me.’”
As baby boomers retire and a changing healthcare system puts an increasing emphasis on value-based care, nursing administrators are rethinking the way they choose and nurture their successors. Magnet facilities such as UNC are working to identify potential leaders early on and involve them in programs designed to bolster their confidence and show them the larger world of healthcare. By building a strong cadre of leaders who understand and embrace the idea of efficient, high-quality healthcare, they hope to be ready for an expected wave of retirement among nurses in current leadership roles.
‘Chief’ expectations shift
The American College of Healthcare Executives reports an 18% turnover of CEOs in 2014, continuing a high turnover trend in the last several years. A 2013 survey by the American Organization of Nurse Executives shows 67% of responding CNOs planned to leave the position within five years, with retirement as the top reason for leaving.
Rose O. Sherman, EdD, RN, NEA-BC, FAAN, director of the Nursing Leadership Institute at the Christine E. Lynn College of Nursing at Florida Atlantic University in Boca Raton, said she often receives calls from people looking for new leaders for their organizations. An improving economy and healthcare reform may be contributing to the turnover, as nurse leaders are being asked to take on new responsibilities and roles, she said. “It’s much more challenging,” she said. “It really almost demands a different type of skill set than leadership demanded 10 years ago.”
Today’s nurse leaders need to understand the financial situation of their facility and grasp concepts like value-based purchasing, Sherman said. They need to anticipate the impact of political changes, such as the elimination of federal healthcare funds. They must be able to evaluate healthcare technology and decide what products and systems they need, and how to best implement them. And they must be able to communicate the importance of all of the above to their staff, she said.
Gone are the days of tapping a good clinician on the shoulder and making that person a manager, said Patrick R. Coonan, EdD, RN, NEA-BC, FACHE, dean of the College of Nursing and Public Health at Adelphi University, Garden City, N.Y. Nurse leaders need to know how to operate in teams and manage teams composed of staff members from different departments. “You need to have people who are much broader thinkers,” he said, with the skills to run and evaluate projects, put new policies into place and constantly adapt to change.
To do all this, nurse leaders need education, training and support, Sherman said. Facilities that want to keep their potential leaders need to provide opportunities for them to take on new roles, whether chairing hospitalwide committees, running quality improvement projects or conducting research at the bedside, said nurses who design leadership programs. “The challenge is to make sure the organization doesn’t move people into a role without support,” she said.
Magnet spreads message
Leadership succession and building a strong bench of nurses ready to take on new roles has long been a focus of the American Nurses Credentialing Center’s Magnet program. The message of the need for succession planning, presented at Magnet conferences, hit home with Ann M. Barrett, MBA, RN, NE-BC, director of nursing resource management at The Miriam Hospital in Providence, Rhode Island. Five years ago, Barrett asked if she could start a program for charge nurses at her facility.
She had noted how charge nurses were expected to take on important responsibilities like patient flow and staff scheduling, but the job and the skills needed to do it had never been clearly defined. Nurses took turns at the job and received little training or support. “It was kind of like, tag, you’re it,” she said.
After nearly two years of combing through the literature and talking to hospital staff, she created a charge nurse job description and designed a training and support program that started in 2012. Sessions included leadership basics, such as how to deal with conflict and give effective feedback; simulations of various scenarios such as a blizzard or a systemwide computer crash; and shadowing nursing supervisors to see how and why they make certain decisions. Nurses in the program learned how to support their staff and draw on the resources available to them. Most importantly, Barrett said, they learned how to relate staffing requests to a bigger picture by explaining to supervisors why a certain level of staffing would provide optimal patient care.
The program led to the establishment of a charge nurse council that is working on standardizing shift reports, improving communication through mobile technology and creating established work breaks for nursing assistants. Of the 140 nurses who have gone through the program, Barrett said, nine have gone onto higher management positions. Others are leading committees or their own unit councils.
Three-and-a-half years ago, nurse leaders at Magnet-recognized Rush University Medical Center in Chicago began creating a set of competencies for nurse leaders at all levels, said Cynthia Barginere, DNP, RN, FACHE, vice president and CNO for the medical center. An important part of Rush’s succession planning gives current nurse leaders tools to identify promising new leaders by looking at performance and potential, she said. “This requires the [managers] to think about that employee and project that employee to their peers” as someone to look to for leadership, and to identify those who are ready for an immediate leadership position, she said.
The process does not end with identifying and training potential leaders. Preparing nurses for leadership positions that are not yet open means they could become bored or frustrated and take their newly acquired skills to another employer, nurse leaders said. For example, some nurses may want to stay at the bedside, but need a challenge, Barginere said, “You really have to talk to them and understand what they want.”
For instance, she said, a bone marrow transplant nurse at her facility researched Schwartz Rounds, a national program to prevent burnout by giving caregivers a scheduled time to discuss social and emotional issues they encounter while caring for patients. He organized the program at Rush, where the sessions are now among the most well-attended at the hospital, she said.
In some cases, nurse leaders may have to reconsider traditional qualifications for management positions. When discussing management candidates at Rush, Barginere said, “We have conversations about leadership competencies, not technical skills.” She has placed nurses and even non-nurse leaders in charge of departments outside their clinical areas because she feels confident in their abilities to communicate, evaluate, support and inspire. These include an orthopedic nurse who became director of a psychiatric unit and a management and finance administrator who oversees the ED. Both have won admiration and loyalty from their staffs, she said, in part because they get things done while respecting the clinical expertise of their teams.
At UNC, Stephanie Bohling, BSN, RN, CHPPN, perioperative services nurse manager, was inspired by a Magnet conference presentation three years ago about creating a nursing fellowship program to empower and support nurse leaders at every level and give them connections to areas outside their clinical expertise.
The program aims to show its fellows how the larger world affects their work and vice versa. Class sessions include discussions of how to apply research to practice, and how to create budgets and business plans. Field trips to the cafeteria, security stations and medical engineering shed light on parts of the hospital nurses normally never see. Fellows are paired specifically with mentors outside their own clinical specialties. Recently, participants were asked to create a small cost savings project for their units and share it with the group. In one project, nurses standardized the location of supplies in patient rooms to avoid wasting time looking for things or bringing in extra items.“I think there’s great value in working with people outside your normal work area,” Bohling said. Fellows have an opportunity to see how nurses in different departments solve common problems.
For instance, she said, nurses in the program discovered peripheral IVs in adult patients were routinely rotated whether they needed to be or not, but on the pediatric unit they were changed only when they stopped working. As graduates of the fellowship program talked, they wondered why, when the frequent changes cost time and resources, and was uncomfortable or painful for the patient? Evidence backed them up, and those conversations led to a hospitalwide practice change scheduled to begin this summer. All IVs will be changed only when they stop working, Bohling said.
The program is intended for nurses who are moving into a leadership role on their unit and for those trying to decide the next step in their careers, she said. Some might choose to go back to school, on a leadership track. Some might aim for becoming a nurse manager. Others might decide to take a leading role in quality improvement at the bedside. “This class helps them further decide,” she said.
The fellowship program proved instrumental in her decision to go back to school for a master’s degree in clinical nurse leadership, said Joy Hazard, BSN, RN, CPRN, a pediatric ICU nurse at UNC. “I never thought I would go back to school,” Hazard said, but found herself invigorated by class discussions in the program that applied directly to what she was doing. Her goal is to become an assistant nurse manager, which will allow her to spend some time doing direct patient care. “I think nurses at the bedside have a lot more power than I previously believed,” she said.
In the past, nurses who wanted to improve the quality of care or worried about excessive waste might have been stymied or found themselves isolated, Driggers said. But now UNC, along with the rest of the country, is committed to the same goals she is. “We’ve got to get better about increasing the value of healthcare we deliver,” she said. “I feel very lucky to be nursing in this era because my passion aligns with what’s going on in healthcare right now.”
Before the fellowship, Driggers said, she thought leaders were put into positions because they were naturally good at them. “Now I know that leaders develop all the time, with the right classes and the right guidance.” She seeks to pass on the confidence her manager gave her, asking the nurses she supervises, “‘Are you ready to be certified? Are you ready to take on something new?’ I do it,” she said, “because it really meant a lot when [my manager] reached out to me.” •
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Cathryn Domrose is a staff writer.
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