A novice chief nurse executive (CNE) usually is selected for larger responsibilities by decisive past management and is expected to perform with comparable skills in a primarily unfamiliar role. Healthcare organizations and systems lack the luxury of many staff to allow "team" decisions while the novice learns and carries out newly acquired and developing roles and responsibilities. Equally rare is the opportunity to work for an extended period of time with an outgoing CNE.
In a society as inclined-and a business as vulnerable-to lawsuits as healthcare, there is little latitude on the learning curve for any healthcare provider. Mistakes or inappropriate decisions by a novice CNE are not tolerated for an extended period of time. Healthcare organizations are complex and demanding and cannot afford, nor are they willing, to forgive or postpone critical decisions until a novice CNE feels competent making them.
How does a novice CNE learn the intricacies of responsible management within an acceptable learning curve? A mentor may be the answer. This professional, experienced manager becomes the essential tool for a new CNE's survival.
The mentor/novice relationship can be likened to that of master craftsman and apprentice. Being able to transfer knowledge from theory to practice is a journey that must be guided by those with experience. There is a close committed relationship that develops between the two. This relationship goes beyond the usual role-modeling and teaching relationship. It grows into one that is more collegial, in which the mentor possesses the skill, knowledge, and accomplishment that the novice hopes to acquire.1
Expert nurses sharing ideas, experiences, and successful behaviors with novice nurses results in widening knowledge, increased self-confidence, and improved care for patients. Mentors provide a sounding board with judgment based on experience and are able to encourage actions that the novice might not have had the courage to try alone.
A mentor relationship has been described as chemistry driven and has been likened to falling in love. There has to be a mutual attraction or magnetic quality that draws us to a particular individual.2 Some distinguish the mentor from the role model in that the mentor makes a personal investment in the growth of those he or she guides. R.Anderson, an Executive Vice President at a large hospital, described the mentoring relationships that helped her grow as the most important part of her life's journey and described their leadership as "having a vision and motivating others to buy into it..."3(p8) Each mentor must be secure in his or her professional role and must have attained the level of skill requisite for leadership. The assumption is that one teaches from a depth of knowledge that only years of experience can bring.
The novice CNE tells her story:
I had entered graduate school to prepare for future advancement within the healthcare organization where I was the emergency department director. My promotion from middle management into the role of chief nurse executive came unexpectedly. Although I had gained proficiency in my earlier role, the demands were much broader, covering a wider perspective than the department that I had directed.
Mentors fulfill their destiny by helping others fulfill theirs.4 Yoder5 defined mentoring as a structural role, primarily emphasizing role development of a novice within an organization or a discipline. Within this framework, it is recommended that one find a mentor involved in a comparable position in a similar or closely related industry. Competition between organizations is a very real factor; therefore, there must be a mutual commitment to initiate such a mentoring relationship. There also has to be support from the employers of both parties before entering this relationship.
The novice continues:
My journey began when an experienced CNE approached the dean of the community nursing graduate program (in which I was a student in the administration pathway) with the idea of mentoring a novice. Her criterion was: a novice currently in an executive position in a healthcare organization with a corporate culture similar to her own organization-one who expressed a willingness and a desire to learn. Based on my previous role and my evolving advanced knowledge base, I quickly realized that a mentor could help me decrease my learning curve, increase my self-confidence, and provide support in reaching my professional and personal goals. The essence of leadership is best captured by working with a successful leader, observing behavior patterns, and sharing ideas and professional experiences.
May et al.6 described mentoring as a role development strategy that assists with role clarification, role rehearsal, and role modeling. The structure of a mentoring relationship is, by nature, that of teacher and student. It is built on mutual trust and respect for the teacher's abilities and the student's possibilities. Placing oneself in a student position may require setting aside the ego that is necessary in performing daily work duties. It requires a delicate balance of asking without prying, of understanding the feelings behind an action without invading the privacy of the mentor, and exposing vulnerabilities hidden from others.
To maintain the mentor structure, a time convenient to both for regular meetings should be established and the purpose that both wish to achieve should be outlined. The mentor must provide information and assign projects that promote the growth of the novice, and the novice must make a commitment to follow through.
The novice remembers:
Our first meeting was arranged to identify areas of similarities, such as personal and work philosophy, and our conceptualization of the mentoring relationship. We discussed the scope and standards for nurse administrators set forth by the American Nurses Association. I shared my objective in attending graduate school, and we discussed the school deadlines I faced. We explored what we felt could be gained from our relationship and agreed that we had the necessary "chemistry" for a successful mentoring relationship. We established a weekly meeting to continue for one semester in a formal mentor relationship. I left the meeting with certainty that this was the way I would gain the knowledge I needed!
Because my mentor and I worked at competitive institutions, confidentiality was a concern. We resolved this in the following manner. When sensitive information was shared, I would clarify whether the information was"for my eyes only" or could be shared within my organization. Rather than breech our trust, we agreed that certain areas of confidential information would only be shared in broad terms. On this basis, we built the trust that had to exist between us.
Common problem among newly promoted executives is defining the role and meeting the higher expectations of management and peers. Frequently, a novice CNE moves from a hands-on operational role limited to departmental concerns to a conceptual or strategic planning role with a focus on the entire system. The role dissonance between actual versus desired skills and knowledge has to be managed. No better tool is available than the experience of one who has worked through it-the mentor.
My mentor clarified the role expectations of chief nurse executive withinber organization, thus decreasing the ambiguity and lack of congruence I felt in mine. I could ask, "What do you see as my responsibility in this situation?" and rely on her guidance. Although she did not make decisions for me, she certainly guided me to find my own answers. Because she had "been there, done that," I could trust her to steer me away from the detours to which I was blind.
As we each develop a predominant, personal management style, we vary our business management style, depending on the situation and personnel involved. For instance, President Nixon's management style was exclusive. He preferred to gain all his information through a small group of trusted assistants. He allowed them to speak for him and to act in his stead--a style that eventually led to his downfall, politically. President Carter's style was inclusive. He sought input almost ad infinitum. Obviously, finding a middle ground between these extremes may require outside influence.
Part of developing a workable management style is gathering information and determining how and with whom to share that information. For the novice, comprehending how the mentor gathers information, and following her/his example, can open unexplored avenues for problem solving. The novice then becomes aware of potential stumbling blocks within her/his own organization. How one uses the information gathered and how it is communicated through the staff is the other side of the management coin.
An example of how this novice learned:
My mentor chose a unique approach to information gathering. When problems were reported, she would don appropriate attire and go to the unit reporting the problem. When she isolated the problem and traced it to the source, she had indisputable, firsthand facts with which to begin resolution. As soon as her management style became known by her staff, she was able to gather facts through others' input because they knew she wouldn't hesitate to do whatever it took to discover the truth for herself.
Networking is encouraged in healthcare settings as a means of learning. It is, however, an absolute necessity for the novice CNE. Mentoring is not networking; it is a one-on-one relationship. The mentor can, however, facilitate the novice's introduction to "the right people"-people internal and external to the organization, who can provide information and assistance on a wide range of subjects. For example:
When my mentor suggested widening my community involvement, I felt I lacked the time. Her insistence on the importance of representing thenursing staff, as well as the hospital, convinced me to become actively involved in additional professional organizations, nursing schools, and community activities sponsored by the hospital. The rewards came when I was able to exchange information with others in similar positions. Having established a rapport with these individuals at various meetings, I was at ease asking how they were handling specific problems and reciprocating by responding to their calls. It became a comfortable two-way street. The exchange of information quickly increased my knowledge and furnished important feedback about my ideas and potential solutions. I appreciated the valued peer recognition that came with being sought out as one who could supply answers. It also provided the necessary motivation for continued improvement and growth and openness to being a mentor in the future.
The lack of adequate financial background and experience has been the downfall of many a novice CNE. With an experienced mentor, a novice CNE begins to make sense of financial data and understand the implications, in terms of continued organizational growth or stagnation, that such data foretell. Going from managing a small departmental budget to overseeing an organization's budget is often a frightening experience. Understanding the cost of nursing or translating man hours per patient day into the full-time equivalent (FTE) per unit of nursing is basic.
Scheduling budgeted projects to provide the most return in patient care and satisfaction is a CNE's decision that can only be based on judgment tempered with experience.
Maintaining vigilance over the income and expenditures of the organization on an ongoing basis is an essential skill that the novice CNE must develop for successful role enactment. Discerning an impending financial demand, sifting information (available or hidden) to reach what is pertinent, and understanding how it all fits into the whole requires experience. By capitalizing on the experience of a mentor, the novice CNE can avoid dangerous pitfalls. Although actual figures may not be discussed, the concepts of financial management can be learned in a safe and effective environment.
In her work on moving from novice to expert, Patricia Benner points out that skilled performance shows "movement from reliance on abstract principles to the use of past, concrete experience as paradigms ... a change in perception and understanding of a demand situation so that the situation is seen less as a compilation of equally relevant bits and more as a complete whole in which only certain parts are relevant."7(p402) Nowhere is this more important than in the financial management of an organization.
Participation in a nurturing mentor relationship provides long-term benefits for the novice CNE. Not only does the participant acquire significant knowledge and skill concurrently while enacting a new role, but she acquires them prospectively, as well. Learning to learn within the mentor relationship, the novice CNE continues to acquire skills needed for future practice and role competence. The process of development is unending. As newly acquired skills are perfected, the novice CNE is comfortable experimenting with new ideas and strategies built on and flowing from these skills.
The mentor and novice CNE enter the mentoring relationship from different environments, lending differing viewpoints to similar situations. The teacher learns from the student as the student shares her experiences. The novice challenges and stimulates the expert with the latest conceptual ideas gained in her studies and as she interacts with a diverse staff. According to Vance,8 it is clear that some type of support relationship is important in the career development, success, and satisfaction of professionals. Mentoring brings with it reciprocal benefits. When a professional nurse with broad knowledge bases and different experiences shares that knowledge, the profession is elevated and the professional status of the community benefits as a whole.
The obligation of the CNE who has been successfully mentored is to continue to grow, learn, and offer the same benefits to another novice CNE. The ever-widening circle of capable executives ensures the education and professionalism of each following generation of healthcare professionals.
The author thanks Donna Rheault, Chief Operating Officer of St. Francis Hospital, Tulsa, Oklahoma, and Dr. Betty Kupperschmidt of the University of Oklahoma Graduate Nursing Program for their invaluable support and advice.
© 1998 Lippincott Williams & Wilkins, Inc.