Your First 100 Days in a Nursing Leadership Position

By Rose O. Sherman, EdD, RN, FAAN

When you are selected for a leadership position that you really want, it is very exciting. While celebrating career success is important, many leaders don’t give enough thought to how to manage their own transition to the role. How you spend your first 100 days in a leadership position can help set the stage for the rest of your tenure in the role. Those you lead closely watch how you orient yourself to the organization, how you spend your time and what relationships you begin to build. Five key activities that you will want to build into your action plan include the following:

1. Learn as much as you can about the department and organization prior to your first day

Carefully study the website of the organization so you know the mission, vision and range of services provided by the health care agency. If the hospital or agency is part of a larger system, go to the systems website as well. Review any publicly reported data available about the agency such as what is on the hospital compare care site in the United States. Many nursing services today use specific theoretical frameworks such as Watson’s Caring theory to guide care – be familiar with it. If the hospital is Magnet designated and you have not worked in a Magnet hospital, review the forces of magnetism. You will be expected to know the role of leadership in promoting a healthy work environment.

2. Meet with all your direct reports

Whenever there is a change in leadership, nursing staff will worry about how a new manager will affect them. A key success factor for the new nurse leader is to be proactive in alleviating this concern by scheduling a meeting with each staff member during your first 100 days. These meetings will provide you with an opportunity to build a relationship with each staff member, find out about their concerns and seek support from them. Some good questions to ask during these meetings include the following:

What are three things that you are proud of about this unit/department/organization?
What are three things that we need to change?
What do you most need me to do as your leader?
What are you most concerned about that I’ll do?
What advice do you have for me?

3. Gain trust by listening and observing

To gain the trust of staff, you need to avoid rushing to judgement about “what is wrong” based on your observations. At the same time, you do need to take note of what you see. Listen during your conversations with staff and carefully observe what happens on the unit when you make rounds. During the first 100 days, new leaders should also reach out to stakeholders including patients, interdisciplinary team members and other department leaders. They will provide you with important insights into your work setting, and you will want to build strong working relationships with them.

4. Learn the culture and politics of the organization

Every organization has a unique culture and organizational politics. New leaders can damage their credibility by being insensitive to the politics of the unit and organization. You may have grown up in another organizational culture that has become so familiar to you that it is like the air that you breathe. When you come into a new culture with different norms, the differences can be profound. Take time to learn the norms. A good example of this involves meetings. Meeting norms, behaviors and standards vary widely across organizations. In some organizations, meetings are very formal while in others, they are casual and informal. Take time to observe, adapt and learn. New leaders can alienate members of their organizations by talking excessively about how things were done on their previous units, so avoid doing this.

5. Find a Mentor

You will want to build strong relationships with your staff but remember that they are not your leadership peers. You should not use members of your staff as sounding boards particularly when the topic is confidential. Look for an experienced leader in your organization who can help mentor you during your transition.

6. Avoid Acting too Quickly

Wise nurse leaders don’t announce huge changes during their first 100 days and don’t turn their departments upside down. It is important to let staff know that you have high standards and expect their best work. You can lower the level of what you expect if it turns out the demands are too high but it is almost impossible to raise it if you have started too low.

For many new leaders, the first 100 days will be challenging but exhilarating. What if your feel during this first 100 days that you have made a mistake accepting the leadership role? This is a difficult question to answer because you may feel overwhelmed during these first 100 days, but it may not be a good indication of how you will feel in six months. If you feel you have made a mistake, it is important to have the courage to discuss the situation with your supervisor. It is often said that success is becoming who you already are. Using this first 100 days to build this success will set the stage for a great leadership career.