Department: Leadership Q&A
Q I was just recruited to be a nurse manager of a busy ICU after being a manager for several years at another facility. What's your advice on how I should prioritize the clinical and human resources (HR) issues I need to work through with the staff?
One factor already in your favor is that you're in a strong position to succeed because you have previous experience as a manager and have already transitioned from staff member to boss. However, being in a new facility does complicate your approach, as you should understand the organizational and unit cultures and dynamics before you can successfully address issues. Prioritizing usually involves striking a balance between what your boss expects, what staff members want, and what patients need. This is really the same process as goal-setting.
In general, clinical issues can be prioritized based on impact to patient safety and quality. Next in line, and often congruent with the above strategy, is advancement of evidence-based and best practices. Another good starting point is to evaluate what has the most effect and is the easiest to do. Collaboration with the multidisciplinary team and joint leadership with your medical director in moving clinical change is essential.
Your HR issues are just as important because it's your unit's "human resources" who are providing the clinical care. I've always believed that the job of nurse leaders has two priorities: patients and staff. I would use the same approach as with clinical issues to prioritize, balancing organizational needs, unit needs, staff needs, patient needs, level of impact, and ease of accomplishment. Always check in with your manager to make sure you're on the same page and, if not, work toward getting there—another priority!
Q Our CNE has asked that we only hire new graduates who are BSN prepared. I'm concerned that we'll disenfranchise local community college graduates and they won't want to work within our organization. Is hiring only BSN graduates now going to hurt us in the long run?
The nursing profession continues to struggle with the issue of educational preparation. Your CNE may not have made the decision to hire only BSN graduates if we were still experiencing a nursing shortage. The current workforce supply gives us more freedom to set the bar higher for new recruits. We know from nursing research on the relationship between BSN-prepared nurses and patient outcomes that this is the right thing to do. In addition, the recent Institute of Medicine Future of Nursing report recommends that 80% of the RN workforce have a BSN degree by 2020.
But how? Only hiring BSN graduates is one way. Supporting state-level legislation to advance the profession of nursing is another. For example, in my state there's pending legislation for a "BSN in Ten," which requires RNs to obtain a BSN within 10 years of licensure, grandfathering in all incumbent RNs. Some organizations have taken that position internally, requiring new hires to have their BSN within a specified period of time. The expectation is supported in a variety of ways, including tuition reimbursement, on-site programs, flexible scheduling, and targeted academic-service affiliations.
To answer your question, disenfranchisement of community college grads may be occurring, but not because of your CNE's position. Stricter hiring practices are a result of high-supply economics combined with firm stands on the educational future of nursing. I've taken a compromise position in my organization, with the BSN preferred for new recruits but not turning away associate degree graduates. For many, it's the only way to enter the profession. Many promising ADN grads have specific skills that match my organization's needs; combined with a commitment to continue their education, these nurses are excellent additions to our workforce.
Do we have the academic and socioeconomic infrastructures to replace community college entry programs right now throughout the country? Probably not. I don't believe your CNE's approach will hurt your organization in the long run; however, the approach we take as a profession will hurt us if we aren't united in making long strides to advance the nursing profession, especially now when the market supports it.