Evolution of the Role
The Nurse Manager’s (NM) role has evolved over time. Their workload has increased, as most are responsible for multiple departments. They are now “mini-CEOs” of their areas. Responsible for workforce management, financial stability, patient care-quality outcomes, associate engagement, physician relations and recruitment, patient relations, supply chain management, education, professional development, human resources (as many organizations have moved to offsite HR, with performance management, recruitment of staff, and relations left to the NM), and the responsibilities go on and on. In addition, the current nurse staffing shortage has pulled many NM into direct patient care roles, while the expectations of their NM role remain.
Impact
The increasing complexity of the role has created a crisis in nursing leadership. The lack of recognition, low compensation, the demanding schedule, the overwhelming nursing shortage, and the impact it all has on NM-staff relationship, has deterred many nurses from pursuing a leadership career path. A study by the American Organization for Nursing Leadership found the 33% of NM reported poor wellbeing, and 20% were contemplating leaving their positions (not for another NM position but leaving the role altogether.)
Organizational attrition has eliminated support roles, and the responsibilities have shifted to the Nurse Manager. These “tasks” remove the NM from staff visibility, creating a false narrative that the NM “is never on the unit.” This has led to leadership distrust amongst the staff, which contributes to the staffing crisis.
Lack of supervisory support and recognition of the hard work and commitment of the NM has also lead to the NM shortage.
What should we do?
The workload must be addressed. It is more than a mere headcount of staff reporting to the NM. Although the sheer number of staff requiring HR support is important, the scope and complexity of the unit must factor into the decision.
Avoid stretch coverage! Giving a NM “interim” responsibilities of a vacant NM role is not a testament of your faith in their abilities! The goal for providing coverage for a vacant NM position should be stability and mitigation of “slippage.” Assigning the responsibilities to another NM creates mediocracy at best, frustration and turnover at worst.
Support from supervisors. Leaders must acknowledge the work and commitment the NM brings to the organization. Compensation should reflect the responsibilities. However, compensation is just the beginning. The demanding schedule must be balanced. Implementing a four-day work schedule creates opportunity for the NM to disconnect from the role and focus on wellbeing. Look for other benefits that promote personal wellbeing and a balanced life.
Failure to provide the NM with resources they need to successfully do their job could be construed as lack of support. Providing support staff to assist with the “tasks” would give the NM more time to focus on staff and patient care and outcomes. These “tasks” include payroll, scheduling, monitoring time and attendance, HR tasks (new employee non-clinical onboarding, paperwork, benefits, etc. Yes, this is happening in organizations), just to name a few.
Onboarding, competencies, and training are essential to the newly hired NM. A good clinical nurse doesn’t always make a good leader. Organizations need strong, evidence-based, onboarding programs that equip the NM to handle the demanding role. Establishing competencies and training that supports the current demands of the NM are essential in retaining leaders. Educating leaders about the importance of creating a culture of diversity, equity and inclusion, and the impact this has on staff retention and wellbeing, as well as health equity for patients.
Another way to support the NM is to provide a mentor to support and guide them throughout their journey. A mentor creates a safety net for the new leader, allowing them to seek advice on all aspects of the position. A good mentor provides constructive feedback that promotes growth and maturity.
Professional development for the NM is essential. Supervisors should encourage professional growth and career development. An excellent leader is aware of the career goals of their direct reports and is actively seeking growth and career advancement opportunities for them.
Action
Healthcare organizations must adopt an approach to mitigate the unmanageable role of the NM and acknowledge the impact a successful NM has on the overall success of the organization.
