Onboarding New Leaders During COVID-19

By Rose O. Sherman, EdD, RN, NEA-BC, FAAN

Transitioning to a first formal leadership role is tough during the best of times. COVID-19 has introduced new challenges that make both the position and onboarding new leaders more complex. Recently, several directors have asked my advice as they navigate situations where their health systems have completely curtailed leadership development programs. The orientation of these new leaders is now often left in the hands of those who supervise them. With no clear end in sight, these leaders are doing their best to orient new leaders to roles that have become more complex and challenging.

First-time nurse leaders are often amazed at the depth and breathe of responsibilities in a leadership role. It is like becoming a novice nurse all over again. Taking a formal role in leading a unit, department, or clinical service is in many ways, like running your own small business. The average nurse manager in the United States today has roughly 60+ direct staff reports and manages a multi-million dollar budget. It is a complex role, and knowing where to focus your time and energy to meet all the challenges can be difficult. Now add to that what is happening with COVID-19. There has been so much change and uncertainty that many nurses have lost faith in their leaders. New leaders face even more obstacles building trust with staff who are fearful and sometimes angry.

My research indicates that even in the best of time, more than half receive no formal leadership development before their transition, and fewer have mentors to help them in the process. The unfortunate reality is that we continued to spend more time worrying about new graduates transition than that of the managers who supervise them. Yet, we know from the data that front line leaders are the linchpins in their organization that drive recruitment, retention, and performance of staff.

In talking with these directors, I recommended a few things. It is vital that especially now, new leaders have time to spend observing a proficient leader who has a similar role in their organizations. Leadership competency should be the key concern rather than a specialty area. I also recommended that the directors look for good continuing education online programs that have leadership content. One leader mentioned she was using my book in her orientation of a new manager. It can be a great strategy to discuss a chapter with the new leader at each coaching session. To assist with this, I developed The Nurse Leader Coach Book Club Guide

I am also a firm believer in laying out a leadership action plan to help in the orientation process. A sample of what I recommend is outlined below:

The First 100 Days Nurse Leader Action Plan

Competency Area	Action Steps
Personal Mastery	1. Meet 1:1 with your boss to clarify his/her expectations 2. Request a leader-mentor in the organization 3. Review your position description & evaluation criteria 4. Determine what committees/meetings you should attend 5. Avoid making any major changes
Interpersonal Effectiveness	1. Meet 1:1 with each direct report and ask what is going well on the unit, what needs to change, what are their unique strengths, and what do they expect of you. 2. Schedule meetings with key stakeholders such as pharmacy, central supply, ED, nutrition, quality improvement 3. Hold your first staff meeting 4. Inform staff of your communication style
Human Resource Management	1. Review the position descriptions of each staff position and evaluation criteria 2. Learn about the recruitment process to fill vacancies 3. Review unit/department turnover data 4. Determine how performance management challenges should be managed 5. Read the union contract 6. Evaluate the staffing/scheduling process 7. Compile a staff profile – generation/years of experience/time on unit/certifications
Financial Management	1. Clarify your role in the budget process and the budget cycle 2. Review every cost center in your budget and get help if needed from the CFO 3. Assess the use of overtime on the unit 4. Determine how equipment is requested
Systems Thinking	1. Review six months of performance data and the top 5 DRGs for the unit/department 2. Focus on solving at least one frustrating process or problem.in your area to achieve an early win 3. Do an assessment of the political and cultural issues in the organization 4. Review the strategic plan/payer mix for the organization 5. Review the organizational chart
Caring for Self	1. Set work hours to maintain your equilibrium and a sustainable pace. Choose at least one resiliency behavior to implement into your daily schedule. 3. Establish a routine for patient rounding 4. Develop a process to regularly recognize staff

We owe our new nurse leaders a better transitional experience. Both AONL and the ANA have good resources for organizations that may not have their own. If we expect our next generation of nurse leaders to survive and thrive, effective onboarding is needed especially during COVID-19.

Virtual Workshops for Nurse Leaders are now available. Learn more at Virtual Workshops

Read Rose Sherman’s book – The Nurse Leader Coach: Become the Boss No One Wants to Leave