With the aging of the nursing workforce, more than 500,000 seasoned RNs are expected to retire by 2022, raising concerns about a pending shortage of nurse leaders.1 At the same time, there are indications that currently working nurses have a low interest in filling leadership roles. For example, one recent study of 203 RNs with no supervisory experience—48% of whom had a bachelor's degree—found the highest levels of leadership aspirations among the nurses with less than 2 years' experience followed by declining aspiration scores among those in every subsequent career stage.2 One explanation for the decline of leadership aspirations for nurses in advanced career stages may be “continued exposure...to the stress of the healthcare environment and greater understanding regarding [leadership] role expectations.”2
If organizations face many nurse manager vacancies, they “may feel pressured to fill the void” with nurses who've received little training for the nurse manager role.3 Although clinical nurses moved quickly into management roles may have excellent clinical and bedside leadership skills, would they be adequately prepared in topics such as finance, managing a budget, human resources issues, and implementing quality improvement initiatives?
Nurse manager effectiveness can profoundly affect frontline staff effectiveness. Many studies have linked stronger nurse manager relationships and support to RN reports of lower emotional exhaustion, higher job satisfaction, decreased intent to leave the organization, less intent to leave the profession, and better care quality.4-10
Examples from the literature
Some studies have found supportive evidence of the value of structured nurse leadership development programs. For example, in one study, two cohorts took part in the Leadership Education and Development Program (LEAD), comprised of six 4-hour sessions that covered concepts such as personal awareness and leadership, communication skills, leading change, leading individuals and teams, enhancing patient and provider experiences, and frontline clinical nurse leadership roles in outcomes management.11 One nurse cohort included full-time direct care providers; the second included nurses spending more than half of their time in assistant nurse manager roles. Both cohorts scored higher on self-reported leadership practices frequency and importance following the program. These scores remained substantially high 3 months later, indicating that the leadership traits and actions promoted during the training were sustained.
Another study implemented an online leadership development program for nurses working in specific roles who were identified as future leaders.12 The training included modules on business management, leading people, and personal development, augmented by executive nursing mentorship and monthly sessions to reinforce content and discuss reflections. From pre- to postassessment, participants' perceived levels of competence increased significantly, indicating that the program was a successful leadership development method.
Leadership development standards
Committed to creating positive practice environments and recognizing the critical role of nursing leadership, the Pathway to Excellence® Program requires organizations to invest in their leadership team. Organizations that have achieved Pathway designation have structures and processes in place to provide robust onboarding and leadership development activities.
The two Pathway standards that speak directly to nurse leaders' development needs—Leadership and Professional Development—recognize that leaders must continuously strive to increase their knowledge and competency through development activities, the guidance of mentors and other nursing experts, and feedback provided by colleagues and nursing staff. For new and emerging nurse leaders, professional development activities that build on a foundation of comprehensive orientation and include personalized learning experiences can create a smooth transition to practice in leadership roles.
Baptist Health Corbin is one example of a Pathway organization displaying commitment to long-term support of nurse leaders through structured professional development activities.∗ Over a 24-month period, Baptist Health Corbin supported nurse managers through a leadership development program to facilitate basic and advanced leadership skills acquisition and improve evidence-based leadership principles to promote organizational quality initiatives. During this leadership development program, nurse leaders gained essential competencies to be more effective leaders, meeting the organization's goals for the program to continually support nursing practice and care delivery at the unit level, lead the nursing and interdisciplinary workforce through change events, and demonstrate exemplary nursing and patient outcomes in keeping with the nursing and organizational strategic plans.
Baptist Health Corbin also shared an example of a supportive mentoring experience for a nurse manager new to the organization who was moving into an area with staffing and conflict issues.∗ The organization arranged for the nurse manager to meet with departments such as finance and human resources to learn about processes she would need to know to function in the role. In addition, a director in the organization with many years of management experience extensively mentored the nurse manager on how to handle conflict management and work with staff members who were resistant to change. The mentor acted as a listener and provided examples and ideas for how to foster teamwork and understand hospital budgets, full-time equivalents, service line expansion, and daily operations. As a result, the nurse manager experienced growth in her professional skill set and more confidence as a leader, began to see changes in the climate of her department, and ultimately came to be viewed as a resource and mentor for others based on her successes.
At the intersection of care delivery and management
Today's healthcare organizations face constant pressures to improve patient outcomes, meet productivity metrics, maintain operating budgets, reduce staff turnover, and ensure customer and provider satisfaction. It's essential for organizations to provide ongoing leadership development so nurse leaders are adequately prepared and supported to be effective. Located at the interface of care delivery and strategic management, nurse leaders are “ideally positioned to develop a proactive workplace culture.”13 Managing the demands of being a nurse leader is daunting but when organizations invest in nurse leaders at all levels, they sustain and develop nurse leaders who feel a stronger connection and commitment to the organization and have a positive influence on the organizational culture.
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