Formal nurse manager succession planning programs are beneficial strategies for recruiting and retaining intellectual capital internally within an organization. External leadership candidates may be less successful than internally promoted leaders.1 Promotion of internal candidates who've been adequately prepared can positively impact employee morale, role transition, organizational culture, and retention.2
In an effort to encourage nurses to further their professional development and shape potential leaders from within, a large urban safety net medical facility implemented the Career Advancement for Registered Nurse Excellence (CARE) program, which grew out of a previous clinical ladder initiative phased out in the mid-1990s due to the managed care movement and a process that was deemed cumbersome for nurses.3 Based on input from an advisory group consisting of nurse administrators, clinical nurses, and human resources, nurses in the CARE program can choose between different professional roles, such as clinical, education, and management tracks, as they meet specified criteria and achieve identified goals.
The patient care coordinator (PCC) is one role in the CARE program's management track. Recognizing that organizations need to invest in leadership development to enhance quality, create career path development, and improve employee empowerment and retention, this role is intended to develop and mentor future nurse leaders from within the organization.4 Nurses who are accepted into this role function as permanent charge nurses, providing daily clinical leadership of the unit in collaboration with the nurse manager and director of nursing for their specialty area. (See Table 1.) The PCC also identifies opportunities to expand professional development and leadership experiences and works with the nurse manager and director of nursing to achieve professional goals.
Clinical nurses who apply for this role must have 24 months of consecutive RN service at our organization; hold a position with a minimum of 60 hours biweekly; have a satisfactory annual performance review; and have no progressive disciplinary actions at or above a written warning within the past 12 months, including attendance. Once accepted into the CARE program, PCCs must meet identified individual goals to maintain status and receive compensation.
Although the intent of the PCC role is to prepare nurses to easily transition into a nurse manager role, there was little evaluation of its impact since the onset of the CARE program. And although the role initially consisted of a 2-day workshop to provide applicants with the skills necessary to fulfill the role, as well as 1-day workshops annually thereafter, there was no formal preparation, orientation, or development assigned to the PCC role. It was determined that further understanding of current and previous PCCs' desire to pursue a leadership position and their satisfaction with preparation for the role would be useful for designing a more structured, formal process of developing nurse leaders moving forward.
The purpose of this study was to gather and analyze input from current and past PCCs regarding their perceptions of leadership preparation and development; describe factors that impact PCC leadership abilities; and determine the relationship between factors such as formal orientation, communication with management, and desire to continue in leadership positions. We also analyzed data on recruitment of those who served in the PCC role into assistant nurse manager and nurse manager positions to evaluate the CARE program's effectiveness.
A cross-sectional study design was used. The sample included all RNs currently or previously serving as PCCs from January 1, 2010, to the time of data collection in August 2015. Once the study was approved by the nursing research council and the Institutional Review Board, an investigator-developed survey was sent to the RNs' internal email address. The email included a description of the study, informed consent information, and a link to the survey. Participation was voluntary and anonymous.
Demographic data gathered included years of experience, highest level of education, whether currently in school, certification status, professional organization membership, and number of years as a PCC. The survey included 15 questions regarding the PCC role, chosen based on a literature review. Participants were asked to indicate their selections using a 7-point Likert scale, with scores ranging from 1 (strongly disagree) to 7 (strongly agree) and 1 (never) to 7 (all the time). The survey was open for approximately 1 month. A follow-up study was conducted to determine the number of PCCs moving into nurse manager positions and describe initiatives created to further develop the role.
Data were analyzed using descriptive statistics, including mean, frequencies, and standard deviations (SD) to tabulate the results of the survey. To determine the relationship between factors affecting the desire to pursue a leadership position, bivariate analysis and the Mann-Whitney U test were conducted. Statistical evaluation was performed using statistical software.
The survey was emailed to 155 RNs within the hospital system, with a response rate of 47.7%. Of the 74 respondents, the mean number of years as an RN was 17.62 (range, 3 to 37; SD, 10.33) and mean length of time as a PCC was 3.84 years (range, 1 to 10; SD, 3.11). Most (66.7%, n = 48) were prepared at the BSN level. Other participants indicated the ADN (13.9%, n = 10), diploma (9.7%, n = 7), other (5.6%, n = 4), or the MSN (4.0%, n = 3) as their highest level of education. Most weren't currently enrolled in school (75.0%, n = 54). The majority weren't certified (57.7%, n = 41) and didn't belong to a professional nursing organization (66.7%, n = 48). (See Table 2.)
The common activities conducted as a PCC included charge nurse duties (100%, n = 62), acting as a staff resource (95.2%, n = 59), assisting staff with coverage (87.1%, n = 54), orienting new staff members to the charge nurse role, facilitating adequate supplies and equipment, and daily equipment checks (79.0%, n = 49). Most PCCs reported being oriented to the role (53.2%, n = 33); 30.6% (n = 19) selected “agree” to indicate that they would be interested in pursuing a leadership position in the future, with 14.5% (n = 9) selecting “strongly agree.” (See Table 3.)
The Mann-Whitney U test showed significant differences among those oriented to the PCC role (m = 5.48, SD = 1.43) versus those not oriented to the role (m = 4.31, SD = 1.51) regarding interest in pursuing a leadership position in the future (U = 253, P = .001). Bivariate correlations were significant between the following questions and interest in pursuing a leadership position in the future: attending offerings in leadership role development (P = <.001, r = .482), meeting with the manager regularly to establish goals (P = .032, r = .272), altered/manageable assignments (P = .007; r = .350), interest in a monthly PCC meeting (P = .015, r = .314), interest in attending professional development activities (P = <.001, r = .523), interest in a PCC blog (P = .007, r = .341), interest in a PCC newsletter (P = .008, r = .336), and interest in PCC emails (P = .015, r = .307).
Results of the study indicated the importance of professional development activities to foster future leaders, frequent communication between PCCs and management, and formal orientation to the role. Bivariate analysis showed that PCCs were interested in professional development activities and attending offerings on leadership role development. For this reason, hospitals seeking to improve succession planning should offer professional development activities, such as workshops on budgeting and staffing, human resource management, health policies, and communication.5
Results also revealed that having an interest in frequent communication between managers and PCCs led to an increased interest in pursuing a leadership position. Because of this finding, we added monthly meetings to discuss bedside leadership development, concerns, and practices to the PCC role. We also introduced two to three representatives to be part of the shared governance branch of the nurse management council to further communication between PCCs and management.
Based on these meetings and feedback from the PCC group and management, a formal orientation to the PCC role was developed. Included in the orientation are five online learning modules: introduction to leadership, customer service and service recovery, change management, interprofessional communication, and putting prevention strategies into practice (HIPAA). There are an additional 10 suggested, but not required, modules that focus on hospital resource management, communication, delegation, and use of preceptors.
During the first monthly PCC meeting, discussions were held regarding splitting the role into two separate functions. This was brought forth while noting that from 2012 to 2018, 48.9% of 45 open management positions were filled by nurses in the PCC role; 51.1% were filled by nurses who weren't previously in the PCC role. This highlighted the fact that many PCCs weren't pursuing a leadership role. After discussion, two options were presented to the group: a charge nurse incentive or keeping the PCC role in the CARE program with a larger professional development expectation. An overwhelming majority voted to keep the PCC role within the CARE program. Implementing these changes may serve to increase actual pursuit of a leadership position, which was the initial intent of the PCC role.
This study had limitations, including instrumentation and sample size. The instrument was investigator developed due to a desire to evaluate the professional development program at a single institution. Further, the instrument was self-rated, introducing the possibility of response bias. Because the intent of the study was to evaluate the professional development program and determine its effect on participants' decision to pursue a leadership position, the sample only included past and present PCCs who had exposure to succession planning opportunities, which doesn't represent all clinical nurses.
Implications for nursing management
In the absence of formal coaching, guidance, and mentoring, many of today's nurses may decide not to pursue leadership positions.6 Our findings underscore this, specifically highlighting the impact of professional development activities, frequent communication with management, and formal orientation to the role on PCCs' interest in pursuing a leadership position. Strong leadership has been linked to reduced turnover and intent to leave among nurses; therefore, succession planning remains an important area for hospital administration to develop.7 However, formal preparation for leadership roles is often overlooked.8 As our study indicates, a greater focus on leadership development activities and communication may foster an interest in nurses to pursue a leadership role.