The new nurse manager survival guide Part 1 : Nursing Management

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Department: Performance Potential Special

The new nurse manager survival guide Part 1

Cathcart, Eloise Balasco MSN, RN, FAAN

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Nursing Management (Springhouse) 51(4):p 48-53, April 2020. | DOI: 10.1097/01.NUMA.0000657288.87471.76
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Nurse managers are pivotal in ensuring that the organization's mission and goals are realized in practice. They also have the most direct effect on the clinical nurses who are doing the primary work of patient care. There are few other roles that provide the opportunity to have such a profound impact on patient care and the nurses who provide it.1,2

As a nurse manager, you're required to both lead and manage. To be a successful leader, you must earn your staff members' trust and inspire them to leave their comfort zone and try new ways of practicing. Managing well means that you're putting systems and infrastructure in place to bring order and fairness to your program of patient care and your staff. It also means maintaining your connection to the ethical demand of nursing practice; knowing how to do for patients and families what they need while respecting their dignity and concerns can guide your leadership practice.3,4 Your ability to think, perceive, and act ethically as a nurse influences how you understand a particular situation, what strategies and actions you employ to achieve the best outcome, how you implement these actions, and whether your interventions are successful. In addition, you must know how to use data and metrics appropriately to measure a number of variables, chief among them the safety and quality of care.5 A number of other people in your organization are interested in these measures and will be looking to you to report and explain outcomes. Being the leader of nursing practice and patient care on your unit while at the same time working to preserve your organization's mission, goals, and financial viability requires balance, perspective, and a broad range of skills.

To be prepared for the challenging work of leading a discipline in complex organizations, you must be clear about your values, master the delicate relational work that's the core work of leadership, learn the patience to manage change, be ready to embrace and manage conflict, be willing to take risks and make mistakes, develop financial and strategic acumen, and have an unshakable commitment to living out the ethics of nursing practice. In this first installment of the new nurse manager survival guide, we'll talk about some of the basic tenets that are necessary to ensure your success.

First steps

It's important to know why being a nurse manager appeals to you. Is it because you're committed to the practice of clinical nursing and want to make it better? Your ability to be effective depends on the answer being a resounding “yes.”6 Clinical nurses know who respects their practice and understands what's involved in the high-risk work they do. To be able to earn the trust that will allow you to be a successful leader, you must be perceived as someone who embraces the value and worth of patient care. Your ability to make credible judgments about staffing and resources depends on your knowing how patient care is carried out. Your understanding of how nursing practice develops will allow you to make good judgments about skill mix to keep patients and staff safe and appreciate all that's involved in bringing new nurses into the practice on your unit.

Knowing yourself and the values that make you a unique person will help you assess whether your organization will promote your success as a nurse manager.7 As a leader, you're expected to bring about change. The work of change is hard and messy but if your values are in synch with the values of the organization and its CNO, it will be easier. What you're seeking is rightness of fit between you and the leaders to whom you're accountable. Your ability to be authentic and know what matters to you and your willingness to assess the fit between yourself and key organizational leaders are critically important. If this fit isn't a good one, you may feel initial excitement at having taken on a leadership role, but you'll soon feel discomfort and distress as you try to bring about change without support. Your clarity about your personal values and beliefs is the foundation for the ethical comportment that's your most important leadership and management tool. This clarity will help you understand why certain issues create conflict for you and where you can compromise and where you can't.

It's also important to understand the work you're expected to do, the outcomes you're expected to achieve, and whether this work holds interest for you. How you lead a highly functional unit to the next level of practice expertise requires different skills than those required to turn around a highly dysfunctional program.8 The person to whom you report should be able to clearly describe what you're expected to accomplish and his or her failure to do so should be a warning that something is askew. Ask what your success would look like in 3 months, 6 months, and after your first year as a way to determine if expectations are reasonable and if your director understands all that's involved for you in entering a new role, building trust, and leading change.

Identify a trusted, experienced advisor early on who knows you well, understands the work you're interested in doing, and is committed to your success. This person can help validate your assessments about your organization and your director and help you determine whether this is a place where you can grow and flourish. Good coaches can help us see things we may miss in a conversation or situation, reframe issues, and think about the right language to express questions or concerns. A coach can also help you learn from the mistakes you'll inevitably make on the road to becoming more competent in your role.9

Remember that making mistakes is a normal part of being new, and you should expect that you'll make at least a few. A combination of needs, people, and problems on your unit may present situations that you've never encountered before but you'll be required to address.10 Remember that you're learning to be a strong leader on a public stage, so developing psychological hardiness, a good sense of humor, and healthy compassion for yourself is necessary.11,12

Relational work and practical wisdom

You've probably already observed that mature and seasoned nurse managers in your peer group have acquired two hallmark skills of expert leadership practice: the skill of involvement, or what's referred to as relational work, and the skill of practical wisdom.

Relational work is much more than cordial conversation or being a nice person. It's the ability to create, sustain, and effectively manage relationships with staff, patients and families, peers, interdisciplinary colleagues, and organization executives.13 Practical wisdom is the tacit know-how that enables us to make ethically sound judgments and take prudent actions in specific situations. It's a moral skill that helps us discern the best way to do the right thing.14

Because your relationships with others are fueled and guided by your moral obligation to always do the right and good thing for them in ways that build on their strengths and respect their individual concerns, mastering the skills of relational work and practical wisdom is necessary for you to grow as a leader over time and with experience. Developing these skills requires that you can see what's really happening in a particular situation—what matters and what's at stake—and be able to draw on the correct knowledge, evidence, and experience to guide your response in effective ways. You must be focused, attentive, engaged in the situation, and humble and open to having your beliefs turned around. You also need to understand the concerns of each person involved, overt or implicit biases at play, and the cultural context in which the situation occurs. Rules, policies, and protocols may be helpful in providing answers when the situation is straightforward, but rules can never predict the right and good thing to do in complex high-risk situations that require interpretation and balancing of many facets at once.15

Managing your personal anxieties is necessary to stay open to a challenging situation without becoming overwhelmed or shutting down prematurely. Knowing the right kind and level of involvement requires experiential learning and coaching, and you should expect that you'll get it wrong at first. But if you honestly reflect on a situation that didn't go well and try to understand why things broke down and how you would handle a similar situation the next time it occurs, you'll build your mastery of relational work and practical wisdom, bolster your confidence, and diminish your anxiety.

This is one place where your coach can be very helpful; don't hesitate to reach out to him or her. We can develop our practice skills in dialogue with others who can help us think through challenging situations. Knowing how to navigate important or challenging relationships can't be learned from a book or in the classroom. Theories of human behavior or rules guiding skilled communication can provide a framework for dealing with others, but rules can never prescribe the right way to respond in a high-risk situation with specific individuals.

Embracing and managing conflict

Sometimes there's a clash of opposing values, interests, or belief systems among two people or within the team that pits people against each other, creating a conflict. We all know the distress that comes from conflict—we feel a knot in our stomachs, our BP rises, and we generally feel anxious and uncomfortable. Conflict occurs when something that feels very important to us is challenged or disregarded. The stakes feel high and no amount of data or facts can resolve the dispute.

No one likes conflict and it's sometimes tempting to ignore the disagreement in the hope that it will go away or resolve itself. But that's not a wise choice because unresolved, buried conflict will erupt when you least expect it. More important, if conflict isn't resolved, nothing happens. Things stay stuck and no improvement occurs. When you're brought into an organization as a leader, the expectation is that you'll make things better for patients and staff. If there's no conflict, you need to wonder if anything is happening and if you're doing your job.

Research has shown that when we feel conflict with another person or persons, our natural tendency is to attribute unflattering motives to them. We believe that we're right, they're wrong, and our views are more common than they really are. We think that we know best and if others weren't so uninformed or stubborn, they would agree with our point of view. We tend to stop seeing the other person as someone with a right to his or her own values and beliefs and stop hearing them. During conflict, we often find ourselves saying the same thing repeatedly in a louder voice each time.16

There are ways to resolve conflict that center on managing yourself and your own response. The first thing to do is stop the conversation, take a breath, and try to figure out what's unnerving to you. Observe your own emotional reactions and try to determine any interpretations of the situation or others' intentions that you're making. Remember, conflict occurs when our values and beliefs are threatened; the more in touch you are with your values, the easier it is to determine the cause of your distress and clearly articulate what matters to you. Try to bring the other person or persons back into the conversation. Be genuinely curious and open and try to see their point of view. Be generous enough to imagine that they have an intention that's more acceptable to you. Are you missing something that others might see?

Acknowledge that others have a right to their own perspectives, even though they may feel wrong to you. Stay open to the big picture and try to see where the possibilities for good outcomes are; don't get stuck on details. Focus on the common good—who and what's really important—so perhaps the conflict can be reframed and progress made. Clearly and dispassionately state the concerns, interests, beliefs, and data that shape your views as you work to manage your own anxiety, disappointment, or frustration. In other words, pay attention to your own comportment, which is defined as a dignified manner or conduct. This is critical to determine your effectiveness in relating, communicating, and collaborating with staff, colleagues, and healthcare team members.17 Comportment encompasses how you look, act, speak, hold yourself, and engage with others. Your comportment determines, in large part, how others will relate to you.

It's important for nurse leaders to learn to embrace and manage conflict. When working together to provide care to people whose lives are turned upside down because of illness, fear, anxiety, or pain, it's inevitable that conflict will occur. When nurses want to give the best care despite the myriad competing demands occurring every day in most contemporary healthcare settings, conflict is bound to occur. When disengaged colleagues find secondary gains in uncivil behaviors that create drama and havoc among the staff, ensuing conflicts and tensions must be resolved.

If you practice these ways to manage conflict and use the resources available to you, you'll be successful most of the time. But there are those times when stubborn conflicts can't be resolved and it's necessary to escalate the situation to a third party who can help sort out the disagreement. Engaging a third person should always be transparent and agreed to by both parties. Doing an end-run—going behind the back of a colleague to a higher authority—is never a good idea. This is a sure-fire way to lose your credibility and an immature way to solve disagreements.

Being prepared for the journey

By now you have a sense of how challenging leadership can be and why it's necessary to take good care of yourself so you can be a leader for the long run. Anchoring change into a culture takes at least 3 years and is often about taking three steps forward and two steps back, so you need to be prepared for the journey. Having positive life habits—eating well, sleeping well, engaging in physical exercise, and doing things and being with people who bring you joy—are all necessary for replenishment so you'll have the physical and emotional stamina that leadership requires.18 Practicing good boundaries—being appropriately open, honest, and available—is one way to preserve your physical and emotional stamina while helping others grow and learn to take responsibility for themselves.19,20

Being a nurse manager will bring you so many rewards. By developing the skills to engage authentically with others at all levels in your organization, you'll become a better and more generous leader who can't help but affect the lives of patients and families on your unit. Join us in June for part 2 of the new nurse manager survival guide, where we'll focus on how to build a healthy work environment and develop professional growth and expertise within your nursing staff.


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