By Rose O. Sherman, EdD, RN, NEA-BC, FAAN
Frontline nurse managers are exhausted and burned out. Many are also frustrated as they try to lead in what one manager described as “a culture of discontent.” The role seems to grow more challenging by the day. Some are seriously thinking about leaving leadership.
Changes in the nursing workforce are have brought changes in the nurse manager role. Nurse managers now feel like NCAA basketball coaches with an ever-changing roster of nurses who stay only short periods of time. Gone are the days when managers could depend on a solid core team who had been on the unit for years. The job has become 24/7 when nurses with as little as one year of experience are left in charge in the manager’s absence. The manager’s control span has also increased in most settings as more and more staff nurses elect to go part-time.
We need to stop thinking of nursing teams as static groups of individuals who work together across time and instead lead with the recognition that team composition can change at any time. Teaming will be a new skill. Nursing leadership will need to be done differently. In a “teaming” environment, the nurse leader provides critical ballast for the team. Learning how to effectively be a nurse leader coach who communicates and offers real-time feedback is essential. Building a psychologically safe environment for nurses is crucial. The nurse leader is a teacher in addition to being a leader. Nurse leaders have to hardwire quality and safety into all that the team does.
I believe the role responsibilities of most frontline managers are now beyond a manageable span of control. It is why so many are so unhappy. We are trying to do the work in the same way when everything in the environment has changed.
I was therefore intrigued when I spoke with two nurse managers this week who were both part of co-management teams in the Mayo Health System in Southwest Minnesota. One had just gotten back from some well-earned time off. He said could not imagine enjoying his vacation without his leadership co-partner covering everything in his absence. They are in a sense each other’s battle buddies talking many times a day with each other as they work to support a staff of nurses – most of whom have less than two years of experience. These two managers are highly satisfied with their roles but both agreed they might not stay in it without their co-manager.
Something does need to happen with frontline nursing leadership roles and a co-manager model might be an initial strategy to pilot. With co-managers, staff nurses get more individualized attention and coaching. With co-managers, more time is spent grooming inexperienced charge nurses. With co-managers, more time is spent with staff who work weekends and evenings. Co-managers can relieve one another on days off.
One co-manager team I spoke with last year began their work together by taking the Clifton Strengths Finder. They felt it was essential to know each other’s strengths to divide and conquer the role successfully. On that team, one manager took responsibility for the staffing and budget. The other manager described herself as “more people-oriented” than her partner and she did much of the human performance management in the unit. What all these co-managers reported was a strong level of real-time leadership support. One told me – sometimes you really need a second opinion from another person who understands the environment.
Redesigning care delivery is challenging right now because of the lack of support staff in most labor markets. Technology solutions will ultimately play a significant role in reducing the work of nurses, but that won’t happen immediately. Why not do something in our circle of influence right now and redesign frontline leadership roles. It might be the single best investment you can make.
© emergingrnleader.com 2022
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