Nurse managers have a major influence on patient care and staff outcomes, as well as on the success of their healthcare organizations.1 Responsible for unit culture and expected to be transformational leaders, nurse managers influence staff to align with organizational goals.2 With RN shortages expected to reach 510,394 by 2030, healthcare organizations need to focus on developing strong nurse manager leadership to redesign recruitment, retention, and delivery of quality patient outcomes.3 As older nurse managers retire, it's crucial to consider what skills new nurse managers need in today's healthcare market.4
Although many nurse managers are chosen for their role based on their clinical expertise and experience, many are given little to no formal education and training as they assume leadership responsibility. Ramseur and colleagues reported that 56% of nursing leaders surveyed perceived that appropriate training and resources weren't available.5 Unclear expectations can lead to feelings of incompetence, disempowerment, and job dissatisfaction not only for nurse managers, but also for their staff members.1
Nurse manager orientation should provide a systemized approach to education and training and promote clarity of expectations and organizational consistency. The purpose of this pilot study was to evaluate the effectiveness of a system-wide new nurse manager orientation program. Goals of the program included increased nurse manager competency and improved feelings of empowerment.
New nurse managers may experience challenges prioritizing and managing the multiple tasks associated with their role. When a new nurse manager takes over a vacant role, he or she may only be given a brief handoff from the person serving as interim nurse manager; the new nurse manager may be left “floundering,” unsure of expectations and lacking the knowledge needed to meet organizational metrics, which can lead to job dissatisfaction.
High levels of stress are reported when nurse managers lack needed knowledge, and role stress is a main reason for nurse manager burnout and turnover.6 Role stress is attributed to the following factors: unknown expectations, insufficient training to meet expectations, work overload, conflict, and responsibility over other people. Although these factors always exist, a training program can help new nurse managers navigate these challenges successfully.7 According to one study, burnout was reported to be the top reason for nurse managers leaving their position.8
Healthcare organizations have reported barriers to implementing and sustaining nurse manager development programs.9 The programs that do exist aren't tailor-made for the individual and may incorporate inexperienced leaders as preceptors.10 Higher degrees, such as a master of science in nursing or a master of business administration, are recommended for those wanting to enter the nurse manager role; however, many new nurse managers don't pursue this type of degree until they assume their new role.11
Providing nurse managers with a systemized, well-developed orientation gives them adequate training and support during the transition into their new position.6 Studies focused on the value of nursing leadership development programs have shown that they provide education on necessary skills and competencies that managers didn't have before completing the courses offered.5,12 And managers who feel supported and engaged by their organizations are more likely to provide the same support to their staff.6
Nurse managers are high-impact stakeholders faced with the challenge of mastering new skills to manage in complex organizations during times of change.13 Not having a systemized orientation program for new nurse managers has direct effects on staff retention, patient satisfaction, quality outcomes, and succession planning.6,13,14 On the other hand, offering a manager training program may result in increased psychological empowerment in the workplace.
Psychological empowerment is defined as a motivational concept of self-efficacy involving a person's intrinsic beliefs about his or her capacity to be more effective, including meaning, impact, self-determination, and competence.15-17 When individuals feel psychologically empowered, they're more likely to take an active role in the workplace.16 Empowered people set more challenging goals and remain committed to achieving them even if the goals become more difficult. Efficacious people feel a strong commitment to these goals, whereas those lacking strong self-efficacy view challenges as threats.18
Design. This pilot study used a one-group, pre-/posttest design that evaluated the outcomes of providing a new nurse manager orientation program. It was approved by the Institutional Review Board of an affiliated university.
Sample and setting. Nine participants were recruited from a five-hospital system located within the South Central region of the US. Three of the hospitals were adult facilities, one provided services to both adult and pediatric patients, and one was a pediatric-only facility. Inclusion criteria included participants who were in current nurse manager roles and had been in their role for less than a year. Exclusion criteria included nurse managers who were new to their current role but had been in a nurse manager role previously.
Procedures. The new nurse manager orientation program included five sessions completed over an approximate 5-month period. Each potential participant was contacted to determine if he or she was willing to participate in the pilot study and, if so, to provide consent. Participants were asked to complete a survey in a secure web application for building and managing online surveys and databases before the first orientation session. The survey included demographic information, American Organization for Nursing Leadership (AONL) nurse manager competency components, and items from Spreitzer's psychological empowerment scale.16,19,20 At the end of the orientation program, participants were asked to complete the postsurvey, which contained the same survey questions as the presurvey with an additional descriptive question soliciting their opinion regarding the program's value.
Measures. Various demographic variables were included. Nurse manager competencies were evaluated using the AONL nurse manager competency tool.19 For survey questions related to competency, participants were asked to rate their skill level in the categories of “the science,” “the art,” and “the leader within.” For each item, response options followed a 5-point Likert scale. Responses ranged from (1) novice to (5) expert. An overall mean score was calculated for each subcategory. “The science” subcategories included financial management, human resource management, performance improvement, foundational thinking skills, technology, and strategic management. “The art” subcategories included human resource leadership skills, relationship management and influencing behaviors, and diversity. “The leader within” subcategories included personal and professional accountability and career planning.
Psychological empowerment was measured using Spreitzer's psychological empowerment tool, which is comprised of 12 questions categorized into the four subcategories of meaning, impact, self-determination, and competence.16,20 Overall mean scores were calculated for each subscale, as well as for overall psychological empowerment. For each question, response options followed a 7-point Likert scale, ranging from “very strongly disagree” to “very strongly agree.”
Data analysis. Descriptive statistics, including mean, standard deviation (SD), and frequency distribution, were used to express the participants' demographic information. Competency and psychological empowerment before and after the intervention were compared using a paired sample t-test. All analysis was conducted using a statistical software platform.
Seven of the nine participating nurse managers completed both the pre- and postsurveys. All participants were White women. The mean age of the participants was 37.7 years, with a mean of 6.86 months of experience in their current role. (See Table 1.)
Table 1: -
||Mean (SD) or n (%)
|Months in current role
Nurse manager competencies. A score for the mean overall competency wasn't computed. However, a mean score was calculated for each subcategory of the AONL nurse leader competencies of “the science,” “the art,” and “the leader within.” (See Table 2.) Posttest scores for all competencies increased from pretest values. Scores increased the least for technology (0.44) and the most for financial management (1.61).
Table 2: -
Nurse manager competencies
||Preintervention mean (SD)
||Postintervention mean (SD)
||Difference in mean
|Human resource management
|Foundational thinking skills
|Human resource leadership skills
|Relationship management and influencing behaviors
The leader within
|Personal and professional accountability
Psychological empowerment. The pretest mean for psychological empowerment was 5.25 (SD, 0.579) and the posttest mean was 5.64 (SD, 0.655), which represented an increase of 0.39. Posttest psychological empowerment scores increased for all domains, with impact having the smallest increase and self-determination the largest. (See Table 3.)
Table 3: -
||Preintervention mean (SD)
||Postintervention mean (SD)
||Difference in mean
|Overall psychological empowerment
The purpose of this pilot study was to evaluate the effectiveness of a new nurse manager orientation program on nurse manager competencies and psychological empowerment. Competency levels improved in all components of competencies that were assessed. Increases in overall psychological empowerment were also noted, with the greatest increase in self-determination. This finding is understandable; as an individual's competency and skills increase, he or she feels more able to complete tasks. Feelings of competency and psychological empowerment also increase self-efficacy.18
Minimal change occurred in the psychological empowerment dimension of impact, which relates to a person's belief in his or her ability to influence outcomes. This finding is consistent with the literature, which indicates that although employees may have the knowledge needed to do the work, they may not feel a sense of control over organizational outcomes.21 However, nurse managers attending an orientation program should be more effective in their job because they have increased knowledge and may feel more enabled to respond to the daily challenges of their role.
This pilot study's findings justify the need for a systemized orientation program. Similar studies have illustrated the benefits of nurse manager orientation programs, the value of having a preceptor, and the need to provide educational sessions for more tenured nurse managers.12,22,23 Further research should be conducted to better understand the impact of nurse manager orientation programs on competency and psychological empowerment.
Limitations and strengths
A few limitations were identified for this pilot study. The sample size was small and homogeneous. Because attendance at the orientation sessions wasn't mandatory, participation wasn't 100% for all sessions. Given that the sessions were held over a span of 5 months, participants may have gained more on-the-job experience that added to their feelings of competence and psychological empowerment. They may also have been exposed to other educational moments during their leadership meetings and one-on-one meetings with their direct supervisors. Additionally, it's natural for people to feel more comfortable in their roles as they settle into them.
Participants in the new nurse manager orientation program obtained several benefits. First, they acquired knowledge to assist them in better performing their job. In addition, they were more enabled to be effective leaders, as evidenced by their increased level of empowerment. The group also bonded and found new resources in each other for future networking. They experienced camaraderie in knowing that they weren't alone in lacking knowledge in areas expected for their job role. Moreover, they were exposed to experts from the organization who provided them with further access to resources and contact information of key organizational leaders. Six participants stated that they found the program to be “valuable,” and two of the participants indicated a desire for the program to be continued within the organization moving forward.
Increasing value, improving outcomes
Leaders who have increased knowledge and competencies are poised to perform their jobs more effectively, thus adding value for the organization. Managers who have higher levels of empowerment are more effective in fostering the achievement of organizational outcomes.24 Based on the findings from this pilot study, an orientation program for nurse managers can increase the perceived competency and psychological empowerment of those who are new to the nurse manager role.
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