The Disconnect Between Nurse Leaders and Staff

By Rose O. Sherman, EdD, RN, FAAN

When I interview our Generation Y nurses asking why they are pursuing a Master’s Degree in Nursing Administration, I inevitably receive the same answer —– I want to bridge the gap between nurse leaders and staff. Our research work with new emerging nurse leaders indicate that they have little understanding and appreciation of the role of nurse leader. It is not unusual to hear, “Well management doesn’t understand how we feel” or “We are like into the middle of it, we are like in the front line fighting the war, and we are not getting the ammunition from them”. Spending just one day in the life of a nurse manager provides a whole different level of insight. As staff nurses, they have limited opportunity to observe their own managers and had no idea about the scope of the role. The manager or director is someone who seems to spend a great deal of time in the office or at meetings. Young nurses today complain about a lack of advocacy from their leaders who seem more focused on costs and performance measures than on care. I have found through my work with graduate students that our younger nurses are often stunned at the responsibility of their managers when they have that exposure.

Bridging the Disconnect

1. Educate our nurses about the business of healthcare

Both education and practice settings have done an inadequate job of educating our nurses about the business of healthcare. Whether we like it or not, healthcare is a business and under tremendous pressure to reduce costs and improve value. Nurses need to become more financially savvy and understand both the costs of care and reimbursement penalties that are applied when there are performance gaps. Payment for health care in the United States is a complex web that includes many different insurance companies, governments and out of pocket payments by consumers. I find that most staff nurses have no idea of the case mix on their units and little understanding about how Medicare reimbursement cuts could impact their units. Payment incentives are quickly moving away from volume toward a greater focus on value of services and health outcomes, including fewer hospitalizations. The reality that care could quickly move from hospital to community-based settings is not well understood by our staff. Nurses need to better understand how patient care outcomes impact the financial bottom line of their institution. In recent research that I conducted with Generation Y nurses, responsibility for budgeting did not make the top five responsibilities of nurse leaders today according to nursing staff interviewed yet their managers would tell a very different story.

2. Maintain visibility especially in tough times

Purposeful nurse leader rounding on patients is quickly becoming a best practice in hospital throughout the United States. When it is done well, it can have a positive direct impact on both patients and staff. It has been shown to improve both patient and staff satisfaction. It is an organized way for nurse leaders to be visible. This can lead to an openness with staff that will build trust and facilitate communication. As a leader, you will learn what is working well on your unit and department, and where there may be need for improvement. It provides a great opportunity to scan the environment for equipment and supply issues that concern staff. Nurses sometimes have the impression that when times get tough – their leaders withdraw. That is why consistency in rounding is so important and should be a regular part of every leader’s schedule.

3. Talk about leadership roles and responsibilities

When nursing staff look at their managers, they often see leaders who appear stressed and overworked but they have little idea about what they do. The roles and responsibilities of leaders should be more broadly discussed. Staff nurse work is very task driven but the role of leaders is not – rather you are often responding to a myriad of challenges that staff often don’t see. In my research, I have found that if you ask most nurse leaders what is the most satisfying aspect of their roles, they will tell you it is the greater impact that they are able to have on patient care and staff development. Yet staff often lacks appreciation for these contributions unless the manager intentionally discusses what he/she is doing with their staff.

In a recent blog on nursing staff engagement , I discussed the growing disengagement of nurses working at the front lines of care. Feeling disconnected from leaders is a major part of the engagement problem. The nurse leader role today is a challenging and staying connected with our staff is of critical importance to our success.

Read to Lead

Sherman, R.O., Dyess, S.M., Hannah, E. & Prestia, A. (2013). Succession planning for the future through an academic-practice partnership: A Nursing administration master’s program for emerging nurse leaders. Nursing Administration Quarterly, 37(1), 18-27.