Why Nurse Managers Matter

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

Historically, we have had evidence that indicated the impact of nurse managers on nurse retention, satisfaction and engagement. What we have lacked is research demonstrating linkages between nurse manager ratings and the impact on specific patient and nurse outcomes. A 2017 Press Gainey Study on Impact of Nurse Managers released last week indicates that nurse managers exert substantial influence on the work environment of nurses which translates into variances on performance measures of safety, quality, the patient experience and nurse engagement.

Researchers at Press Gainey used big data sample sets that the company collected on NDNQI measures and the Press Gainey patient experience surveys during 2016. Their analysis focused on 8 work environment mediators including: nurse autonomy, professional development, nurse-nurse interaction, nurse-physician relationships, participation in quality improvement activities, safe handling and mobility practices, appropriate staffing levels and unsafe practices. They examined the direct effects of the nurse manager on aspects of these aspects of care in adult critical care, adult step-down, adult medical-surgical units, adult rehabilitation units, emergency departments, ambulatory care and perioperative departments. The findings indicated statistically significant relationships between the rating of the nurse manager and the 8 work environment mediators across all but one type of unit – rehabilitation where unsafe practice was not significantly influenced by effective nursing management.

Other Key Findings Include the Following:

Nurse managers have strong impact in most clinical areas on job enjoyment and intent to stay.
Nurse managers have direct impact in step down and med-surg units on the level of missed nursing care.
Nurse managers have direct impact in rehabilitation units on patient falls.
Nurse managers impact how patients evaluate their experience through their impact on nurse-nurse relationships, nurse-physician relationships and appropriate staffing levels.
High performing nurse managers who were further surveyed indicated they had a mean of 53 direct reports, 60% managed more than one unit, most worked in Magnet facilities, had at least a BSN and 6 years experience as a manager. 80% had 4 weeks or less orientation to the role and 43% had received no further leadership development.
On a scale of 1-5, these high performing managers had a mean score of 3.51 on “able to disconnect from work” – making them vulnerable for burnout.
Nurse managers surveyed indicated they spent 20% of their time on staffing resources.

Strategies of 12 High Performing Managers Who Were Interviewed Included:

A focus on leader visibility through rounding
Use of data to support decisions and drive practice
Collaborative self-staffing procedures
Implementation and ongoing support of shared governance
Promotion of staff autonomy
Adoption of unit-based leadership councils
Unit specific orientation and onboarding
Linking staffing to patient acuity and volume
Implementation of retention councils
Scheduling of charge nurses with no patient assignment
Use a round robin approach to encourage input of all staff
Use of huddle boards as visual evidence of QI progress
Nurturing of a just culture
Appointment of a unit-based nurse quality and safety advocate
Adoption of a Transformational style of leadership
Attention to team functioning
Connection with staff in a caring and empathetic way

It is evident from this large-scale study that nurse managers directly and indirectly impact patient outcomes. In this study, 80% of the high performing managers had received at least some leadership development but other evidence indicates that this is not the experience of most new manager today. The nurse manager role is clearly too critical to not be intentional about developing and supporting our leaders at this level. We have a responsibility to recognize the linchpin role that nurse managers play in the delivery of care and provide them with the support that they need.

Read to Lead

Press Gainey (2017). 2017 Press Gainey Study on Impact of Nurse Managers The Influence of Nurse Manager Leadership on Patient and Nurse Outcomes and the Mediating Effects of the Nurse Work Environment.