A new approach to building a strong leadership bench

Abstract

Planning for the nurse manager of the future

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Succession planning in nursing leadership roles has traditionally resulted in the selection of the most experienced direct care nurse, regardless of the candidate's leadership potential.¹ Leveraging a strong succession plan or leadership bench may help mitigate issues that stem from inexperience or a lack of confidence to lead. Succession planning is defined as a strategy used by healthcare organizations to maintain leadership stability.¹ A critical component of nursing leadership succession is planning to ensure key roles remain filled with competent leaders who are in alignment with the mission, vision, and values of an organization.

Nurse leaders work in highly charged environments, adding to the challenges of maintaining critical roles. At NYU Langone Health (NYULH), the nurse manager (NM) is one of the most critical roles in the health system. According to the American Organization for Nursing Leadership (AONL), the NM has 24-hour responsibility and accountability for a direct care unit or multiple units.² In most organizations, the progression to an NM can be developed by focusing on a midlevel manager role. One strategy for creating and developing a pipeline for future nurse leaders at NYULH is the Nursing Leadership Bench Strength Project (NLBSP), which focuses on the assistant nurse manager (ANM).

The NLBSP was established at NYULH-Long Island's campus, an American Nurses Credentialing Center Magnet^®-recognized suburban medical center in the academic health system. The impetus for this innovative succession program was concern about the vacancy and turnover rates of the critical NM role. The program was created collaboratively by senior nursing leadership partners, including the Director of Nursing for Acute Care (a Doctor of Nursing Practice-prepared nurse leader with extensive nursing leadership experience) and the Director of Professional Nursing Practice & Education (a Doctor of Philosophy-prepared nurse leader with professional development and research experience). Through this partnership, each leader could bring their unique skill set to the development of the NLBSP. The purpose of this article is to demonstrate how NYULH created and sustained a robust pipeline of NMs using the NLBSP to develop individuals in the ANM role. It will review and describe implementation strategies and implications for the development of future nurse leaders.

Background

When hospitals establish a strong leadership bench, it can help leaders anticipate and plan for leadership turnover. Fostering the development of midlevel managers in the ANM role may reduce or prevent attrition and loss of internal talent among those seeking additional growth opportunities. Investigators conducted a review of the literature and found that information on succession planning strategies for the ANM role was limited. A curriculum to develop a robust leadership bench for the ANM role was clearly a gap that required the team to evaluate the role and design strategies to maximize leadership potential for successful succession.

Focused discussions between senior nurse leaders and ANMs identified a lack of leadership development opportunities for ANMs in their current role. According to Church, building and sustaining a strong leadership bench is critical in succession planning.³ When organizations support a strong leadership bench process, talent is cultivated from within the organization and future leaders understand and are committed to the culture.⁴ A solid leadership bench plan can produce vision-focused leaders who develop confidence and competence for the demanding expectations of the role. Researchers suggest that organizations fail to create a solid leadership bench because there's a lack of leaders available with the potential to assume the position successfully.^4,5 Glassman and Cummings and colleagues posit that strong nurse leaders can impact quality patient outcomes and staff satisfaction.^1,6 Therefore, developing successful nurse leaders is critical for the future success of any healthcare organization.

Most recently, nurse leaders and nurses across the country have witnessed and continue to confront the emotional, physical, and economic challenges of the COVID-19 pandemic. Nurse leaders need to consider external factors (social, economic, environmental, and political) when bringing about internal change. Sustaining and building a strong leadership bench during a pandemic requires resilience, empowerment, and flexibility. Luis and Vance assert that the time for leaders to demonstrate their transformational leadership skills is during a crisis.⁷

During the pandemic, ANMs witnessed leadership in action on many levels as rapid decisions had to be made regarding the use of resources, including changes in staffing availability, deployments to newly created ICUs, and periodic shortages of personal protective equipment. Nurse leaders had to inform staff members that their patient population would be different from what they may have been used to, delivering the message while maintaining composure and directness during the evolving crisis. The ability to lead, not manage, through a crisis requires resilient and fearless leaders. This is sustainable only by fostering leadership growth and establishing bench strength that ensures, when there's attrition, the gap can be filled rapidly even during times of crisis.

The development process for NMs, shift supervisors, or charge nurses is well documented in the literature.^1,8-11 Natan and Noy described the most common, necessary NM competencies as effective communication, retention strategies, effective discipline, and decision-making.¹⁰ Additionally, they identified change process, conflict resolution, and problem-solving as gaps in leadership development that should be addressed to maintain success in the role.¹⁰ In contrast to the NM role, there's limited attention paid to ANM leadership development, and there's little information in the literature about how to develop the midlevel manager such as the ANM. The NLBSP addresses this need.

Planning the workshop

Following the literature review, the senior nurse leaders collaborated to develop a blended learning approach to best meet the needs of the ANMs participating in the NLBSP. A call went out to all ANMs in the organization asking for volunteers to assist in creating the curriculum, selecting the learning platform, and developing additional relevant and contemporary learning material. Two ANMs volunteered to assist the senior nursing leaders and they became the project leads.

Trust is a requisite of any functional relationship. For a relationship to flourish, trust must be the essential core component.¹² The same holds true for a working professional relationship, supported by open and honest communication. Building a trusting working relationship among colleagues can be difficult. In addition, developing trust across multifaceted hierarchies can pose an even greater challenge. When the ANM facilitators were first presented with the opportunity to help develop the leadership workshop, they expressed some trepidation. Each of the ANMs understood in addition to the day-to-day requirements of their role, participation in this project would temporarily increase their workload, but they soon realized that this was a unique opportunity and they wanted to be part of it.

Picking a platform

Uniting a multigenerational midlevel leadership team with a variety of experiences and individual challenges required careful consideration when deciding on the electronic platform for the leadership workshop. McGonigle and Mastrian explain education, social interactions, participation, and communication are all important factors when implementing change in an institution.¹³ A priority for the leadership workshop was that ANMs from both the day shift and night shift could participate in the content, skill enhancement exercises, and online modules. Early in the process, it was decided that having the ANMs participate in an asynchronous program alone wouldn't create a truly enriching experience. A blended format with a variety of learning strategies was selected to support and create lasting positive leadership practice changes.^8,14,15

Accommodating the learning styles and needs of the various ANMs was important to help ensure new leadership concepts and strategies would be incorporated into their daily practice. Bateman recognizes developing a leadership course in a blended format provides a variety of learning strategies such as lectures, online modules, and case studies.⁸ By implementing a blended learning approach, nurse leaders have the potential to create enduring positive effects with educational applications and enhance leadership practice changes, enriching a strong leadership bench.^8,15

Originally the curriculum was going to be offered in person, with accompanying asynchronous material, but the learning format had to be reevaluated when the COVID-19 pandemic hit in March 2020. The NLBSP leads decided to continue using an asynchronous, virtual learning platform to best meet the scheduling needs of the ANMs. In addition to the didactic material, the NLBSP leaders wanted to create a convenient, interactive element to the program. They proposed implementing a discussion board to engage ANMs through the blended learning process. Bleich explains that using discussion boards can enhance the learning experience and assist in leadership development.¹⁶ The next challenge was to find a platform that would meet the needs of the program but also provide ease of use, availability, and accessibility.

Kowitlawakul explains that technology should meet the nurse's intent to use the platform and perceived ease of use.¹⁷ Ideally, the program needed to have an interface that was familiar to the ANMs and allow the content creator to make multiple discussion posts over time. Perhaps most important, the platform needed to allow the end user to discuss experiences and opinions about the content in a nonthreatening environment. After discussion with the Information Technology (IT) department, NLBSP leaders chose to use the WebEx Teams platform for the workshop because it had become widely used for organization meetings and rounds when social distancing during the COVID-19 pandemic. It provided a user-friendly environment and end users were familiar with the platform and could use their current login information.

Luis and Vance affirm new knowledge, innovation, and structural empowerment are required to support a change during a crisis.⁷ After testing WebEx Teams with a few scenarios, the program was presented to the ANMs during a divisional meeting with live demonstrations of the program's basic functionality, and they unanimously agreed to use the platform to support the project. NLBSP leads created a short guide with assistance from the IT department.

Developing the content

The curriculum was based on the Harvard ManageMentor Education Series and the AONL NM competencies listed in Table 1.^2,18 The Harvard ManageMentor is a self-directed digital learning series devoted to the growth and development of leaders.¹⁸ The challenge was how to develop a program with contemporary content that generates a desire to participate across multiple generations of nurse leaders. Each generation has its own values and ideals related to continuous learning. Earle and Myrick identified that an awareness of intergenerational diversity is an important aspect of pedagogic practice when developing content for clinical nurses, improving the quality of education.¹⁹ Notarianni and colleagues recognized that participated learning occurs when learners are keenly involved in cognitively processing new information in an environment that promotes interaction regarding a meaningful task.²⁰

Table 1: - AONL NM competencies used for curriculum development

Team dynamics Relationship management Building trust Leading by example Staff retention

Dewald and Reddy found that new nurse managers who have a desire to transition into positions that require more responsibility often look for guidance and opportunities to improve their skills.¹⁴ They underscore the challenge new nurse managers struggle to overcome, which is shifting their mindset from being an individual sponsor to a facilitator who inspires others to do their best work.¹⁴ In a needs assessment that included focus groups with the ANMs, they requested the following topics: crucial conversations with staff, how to motivate staff, principles of coaching, how to give feedback, and the fundamental differences between managing and leading. The NLBSP took the requested topics and added them to the current curriculum.

Recruiting participants

Following curriculum development, recruitment began on all shifts so all ANMs had the opportunity to participate. Recruitment of the ANMs proved challenging because those in the ANM role were multigenerational leaders working varying shifts who had competing priorities and varying levels of competency and self-motivation. The ANM volunteers who were project leads spoke to their interested peers in multiple formal and informal settings. The participants reported that flexibility of the NLBSP was appealing to the various generations of ANMs, which had a major impact on the participation rates.

Prior to beginning the NLBSP, the vacancy rate for the NM role was 31%. When the call for participants was sent out, the response was overwhelmingly positive, and over 23 ANMs expressed an interest and were enrolled. The participants continued to provide their feedback to the program leaders, and the program continued to evolve to meet their needs. At the end of the program, 51% of participants successfully completed the program and the NM vacancy rate decreased to 5%. However, the goal to obtain a 100% completion rate was impacted because the organization faced ongoing pandemic-related challenges. This project was beginning just as the COVID-19 pandemic hit. The NLBSP leaders continued as planned because they anticipated that the pandemic would have a major impact on hospital operations, staffing, and patient care and realized that maintaining skilled leadership was critical to facing these challenges.

Facilitating engagement

The ANM facilitators who worked on the platform and content for the leadership workshop encouraged and reminded the ANMs to participate. Once launched, the ANMs became increasingly comfortable and willing to participate. The moderator would post a question and a flurry of responses would follow in the subsequent days. Examples of discussion board prompts used to drive team interaction can be seen in Table 2. It was encouraging to see when the ANMs weren't only responding to the question posed by the moderator but also to the experiences and thoughts of their peers. This exchange of ideas and experiences yielded robust conversations and a rewarding learning opportunity. ANMs expressed their desire to revisit topics and their appreciation that the leadership workshop was available and provided them with the opportunity to gain new skills and tools to use in their daily leadership practice.

Table 2: - Sample discussion board prompts

Think about the statement: The quieter you become the more you can hear. What prevents leaders from confronting a difficult interaction? Why is it important to display empathy when persuading others' thoughts or actions? When understanding the platform of a rising conflict, is identifying position or interest more important?

Evaluation process

Early in the process of initiating the leadership workshop, the ANMs became fully engaged. The ANMs genuinely appreciated the experience; they expressed that it helped them develop insight into their role as a leader and stimulated thought-provoking conversations, which they could use in their everyday practice. Although the vacancy rate for NMs was significantly high, the program remained a voluntary process because it was in the developmental stages and the organization was still recovering from the first wave of the pandemic.

The final evaluation process for the NLBSP included a formal evaluation of the curriculum as well as the vacancy and turnover rates pre- and postprogram implementation. A summary of the evaluation results is presented in Table 3. Based on the program's overall success, favorable evaluations, and improved metrics, this program is in its second cohort with new, emerging nurse leaders.

Table 3: - Participant evaluation summary

Evaluation questions
Question	% Agree	% Disagree	Comments
Is the online format easy to use?	100	0
Are topics relevant to your daily practice?	95	5
Has your knowledge related to leadership concepts increased after taking this course?	80	20
What is one thought you would like to share about your participation in this program?			“Please continue the program.” ”It is extremely useful.” “very informative” “very impressed with the web-based conversation with fellow leaders”

Implications for nurse leaders

Traditionally, nurse leader succession planning has relied on choosing the most experienced nurses without considering their leadership potential.¹ Building a robust leadership bench for succession planning can minimize issues that stem from a lack of leadership experience or confidence. Programs such as the NLBSP cultivate midlevel talent to seamlessly assume newly vacant positions. Recognition of the gap in formal training of the ANM for the NM role is a tenet of the nursing strategic map for this academic medical center. Discussions have been generated across the system with buy-in among both senior and midlevel leadership at the organization. Bridging the gaps in knowledge and skill for the ANM is necessary for building a successful leadership bench.

The depth and breadth of creating a project like the NLBSP not only impacts leadership roles, but helps to ensure that steady leadership is available, even during times of rapid change. When rapid change occurs, it can affect the frontline nurse's practice and the overall day-to-day functioning of the unit, which can ultimately impact patient outcomes and the nurse's engagement and overall wellness. Effective leadership training requires a generalist's view that can integrate the benefit of lifelong learning and its role for ensuring the continual development of current trends in healthcare. Building a successful leadership bench helps to ensure that nurse leaders remain up to date, progressive, and stable, which is the cornerstone for highly functioning and successful healthcare systems.