Secondary Logo

The balancing act

Cohen, Shelley, MSN, RN, CEN

doi: 10.1097/01.NUMA.0000436373.37516.94
Department: Manager matters

Shelley Cohen is a founder and educator at Health Resources Unlimited, LLC, in Hohenwald, Tenn.

The author has disclosed that she has no financial relationships related to this article.

Note: All people mentioned in the three-part Hank story are fictional, and the examples used have been embellished to make points clearer.



Hank, the new nurse manager introduced in the August issue, closes out his first year as a novice leader facing the daily challenges of sorting out his personal and departmental priorities.

During the middle of the week, Hank is usually feeling like there are never enough days to accomplish everything on his “to do” list. He's been a nurse manager for about 10 months now and has been working hard to earn the respect of his staff members and manager. Thinking back to when he was interviewed for the role of medical-surgical nurse manager, he now realizes how much he underestimated the job's workload. In addition to departmental responsibilities and activities, he has found himself involved in multiple organizational committees and initiatives.

Hank's days are packed with little room left to do the things he enjoys most, such as touching base with new hires and new graduates. It seems that as soon as some time opens up in his day, an unexpected issue arises to fill the slot. Hank always thought of himself as being a great juggler, meaning he could easily multitask activities and tasks. However, he now realizes that prioritizing and organizing his day as a clinical nurse is very different from his responsibilities as a nurse manager. He stays late at work 3 days each week to catch up with daily responsibilities, but this has resulted in him feeling more tired and his family feeling left out. As he heads off to the quality review meeting, he sends a text to Sara Beth, a seasoned obstetrics manager who agreed to mentor him. He shares how he feels overwhelmed trying to sort through all of the demands placed on him and they agree to meet the following morning.

In preparation, Sara Beth asks Hank to make a list of the following:

  • meeting schedules of the committees he's on
  • a “must do” list (payroll, performance reviews, and so on)
  • activities he wishes he had more time for (such as time “on floor” and mentoring)
  • activities he perceives to be either inefficient or of limited value to him and the department
  • the most common reasons he's interrupted during the day
  • any tasks that may be appropriate to delegate to a staff member.

Hank thought it would be easy compiling this list; however, he found that writing the items out felt different than actually “living them” every day. (See Hank's responsibilities.) He feels unable to make a change in his set of routine activities, and realizes the last item is going to be the most difficult for him to write. Although he has progressed with delegating the staff meeting process (see Creating 'Worthwhile' Staff Meetings” in the August issue), he's been hesitant to delegate other responsibilities. Hank assumes that if staff members are interested in taking on added duties, they'll approach him.

Back to Top | Article Outline

Tipping the scales

This balancing act challenge isn't just experienced in the world of healthcare leadership—64% of 1,800 global executives were surveyed and reported conflicting priorities. The survey noted the relevance of strategic priorities and how they should align with individual leadership's top concerns.1 This brings to light the following questions:

  • Were Hank's priorities in line with organizational initiatives and priorities?
  • Should he have approached Tracy, his manager, with his concerns?
  • Does Hank have a good understanding of his organization's strategies and priorities?
  • How did Hank communicate his priorities to his staff members?
  • Were Hank's top priorities in the best interest of staff members, the department, and the organization?

Hank connects with Sara Beth the following morning and she hands him a book called The Advantage: Why Organizational Health Trumps Everything Else in Business. This is typical of Sara Beth because she started a reading club for novice managers to help expand their leadership knowledge. Sara Beth explains that this book is Hank's latest assignment and that author Patrick Lencioni reminds leaders of the relevance of creating clarity in all aspects of work.2 The book discusses what's known as the “six critical questions” that leaders must be able to answer in order to provide the clarity employees need: Why do we exist? How do we behave? What do we do? How will we succeed? What's most important, right now? Who must do what?

Sara Beth tells Hank that his ability to answer these questions and discuss them with staff members will help create the clarity needed to direct his priorities. Hank hands her the list she asked him to develop and remarks how difficult it was coming up with some of the responses. As they went through each item in detail, Hank felt confident that he could change his priorities and made notes about suggestions to try and implement.

Back to Top | Article Outline

Hank's notes


Identify staff members who are interested in designated meeting topics and consider alternating attendance with them after getting clearance from your director. Engaging staff members in some of these committees (as appropriate) serves as criteria for clinical ladders.



Back to Top | Article Outline

Must do

It's comfortable and easy to get into a routine of tasks and priorities, never recognizing how they may be detrimental to your performance as a leader. Learn to delegate some of these functions to staff members. Talk with them and determine if anyone has an interest in writing the time schedule. (Before delegating this task, the department would have to develop written guidelines for writing the schedule.)

For communication issues, decide on three specific times during the day to check and respond to e-mails, phone calls, and text messages. Communicate these details to staff members, other managers, and so on. Request to be paged for emergency/urgent situations.

Finally, for hiring new employees, teach staff members basic principles of interviewing and have them interview prospective hires before you do.

Back to Top | Article Outline

The day isn't long enough

Educate staff members on the importance of making time to develop departmental suggestions, as well as keeping abreast of evidence-based practices related to medical-surgical nursing. Schedule specific days/times in advance for connecting with new hires, high-performing staff members, and so on. At the start of each day, determine what time is best for rounding on the floor. Don't make these items an afterthought—be proactive and schedule them into the day. (See I wish I had more time for ...)

Back to Top | Article Outline

Prioritizing tasks

At the next nurse manager meeting, ask about perceptions of personal e-mails going out (such as outside department birthdays and graduations). Check with information technology personnel to determine if those specific messages can be automatically redirected from the inbox to another folder so you don't have to view them if you don't have time. (See Limited value tasks.)

Back to Top | Article Outline

Excuse me ...

At the next team leader meeting discussion, talk about who has authority to make certain departmental decisions. Provide team leaders with specific criteria related to staff member performance issues/concerns that you don't need to be immediately notified about. Communicate to medical staff members the most efficient method for them to share concerns, complaints, and so on. Inform them that it may take 1 to 2 days before you get back to them because of the time needed to investigate their concerns. (See Most common interruptions.)

Back to Top | Article Outline

What can staff members do?

Talk with managers on units where they practice self-scheduling. Identify staff members who are interested in learning how to write the schedule. Add suggestions for new scheduler guidelines to the next staff meeting agenda.

Back to Top | Article Outline

An even distribution

Sara Beth encourages Hank to share his concerns with Tracy about feeling overwhelmed with so many priorities. Once his notes turn into a definitive plan, he'll also share those with her. Tracy e-mailed him a link to a tool created by the American Organization of Nurse Executives and the American Association of Critical-Care Nurses for nurse managers to take inventory of their leadership skills.3 Hank completed the inventory and shared the results with Tracy; the information will be used to shape his ongoing leadership development.

As Hank and Sara Beth went their separate ways, he reflected on how he thought he was supposed to know everything and be able to “do it all.” Throughout his first year as a novice nurse manager, Hank has learned to define his success in many ways. His new definition includes knowing when to reach out for help and guidance. The best complement to any leadership textbook, article, or other educational resource is a successful, experienced nurse manager who has utilized these tools to become a great leader. Recognizing this information has been Hank's greatest discovery, and as his journey in leadership progresses, he learns a new approach to balancing the various responsibilities within his role.

Back to Top | Article Outline

I wish I had more time for...

  • mentoring
  • following up with new hires
  • commending positive staff member behaviors and achievements
  • being on the floor, engaging staff members, patients, and other caregivers
  • brain storming new ideas for improving the department
  • researching evidence-based practices
Back to Top | Article Outline

Most common interruptions

  • unacceptable staff member behavior
    • - unwillingness to resolve conflict independently
    • - excessive absenteeism or tardiness
    • - nonadherence to policy and procedures
  • lack of individual staff member accountability
  • team leader seeking support for a decision
  • countless e-mails and text messages
  • physician complaints
Back to Top | Article Outline

Limited value tasks

  • Reading through e-mails about employees outside of the department who are celebrating birthdays, births, graduations, and so on.
  • Attending every disaster preparedness meeting.
  • Writing the time schedule.
Back to Top | Article Outline


1. Leinwand P, Mainardi C. Stop chasing too many priorities.
2. Lencioni P.The Advantage: Why Organizational Health Trumps Everything Else in Business. San Francisco, CA: Jossey-Bass; 2012.
3. American Organization of Nurse Executives, American Association of Critical-Care Nurses. Nurse manager skills inventory.
Copyright © 2013 Wolters Kluwer Health, Inc. All rights reserved.