By Rose O. Sherman, EdD, RN, NEA-BC, FAAN
One of the benefits of working with health systems across the country is that you gain insight on both best practices and areas where leadership practice could be strengthened. I was therefore interested to hear the perspective of Jonathan Uugno Delmundo, a seasoned nurse leader who has spent the last eight years of his 35-year professional career in travel nurse leader roles in health systems across the country. Jonathan has had a front-row seat to the changes in the post-COVID environment and their impact on leaders.
He noted the following:
- Nurse managers used to have 1 unit to manage with manageable FTEs, but now it has expanded to 2-3 units with more FTEs and yet the same expectations to produce results. Productivity is the standard measure and the daily buzzword.
- Administrative meetings can last all day, and since no one is doing your work while you are attending meetings, nurse managers now have to work longer hours to catch up.
- There seems to be an expectation that managers should work 50-60 hours (or even more), which has become the norm. Work-life balance has become very challenging.
- Some successful organizations have a “Leadership Succession Program” and a continuing education program for frontline managers. They hire a resident coach/mentor to spend time with the managers on 1:1 (and small groups) and guide how knowledge is translated to workable and effective skills.
- The “Dunning-Kruger” effect is prevalent among frontline managers because “You have to perform and just cannot fail.”
Jonathan offers the following recommendations for nurse executives based on his travel leader experiences:
- Executive nurse leaders should regularly engage with their managers to discuss their challenges and opportunities to understand what is happening at the frontlines of care in this volatile environment.
- Frontline managers should spend more time rounding patients and families and less time in meetings. I’ve seen successful organizations with only one meeting in the morning (one hour for a Safety meeting), and the rest of the morning is spent on the unit. Most of the meetings are in the afternoon.
- Work-life balance. Frontline managers cannot be on call 24/7—calls should only be for urgent matters. The off-shift Nursing Supervisors should be empowered to make decisions and equipped to handle conflicts and other operational issues. I don’t have any issues with 24/7 accountability, but how it is translated in the real world varies.
- More operational support for the frontline managers is needed. While it is good to be aware of what is happening in your unit, managers should not be bogged down on tasks that could be delegated, like scheduling (and making changes as per staff request), payroll reconciliation, going through to look for expired items/supplies, accounting for unit supplies, doing all unit audits (restraints, pyxis, environmental checks, etc.). I do my unit audits as a pulse check, but I’ve been in organizations where you must collect and submit unit data. Budgeting FTEs should not be so tight that the managers feel suffocated and hands tied.
- If you are promoting from within, there should be a “leadership succession program” where the charge nurses can transition from a charge nurse thinking (shift thinking) to a unit leader. Leadership qualities should be a focus of leadership development.
- If they have a leadership program, organizations should invest in having a resident coach/mentor who monitors progress (or lack thereof). Inviting speakers is nice, but someone (outside of the organization) should monitor the program’s processes and outcomes.
Jonathan enjoys his work and sees each travel leader’s experiences contributing to his leadership growth. Yet, he understands the demands of the nurse manager role and sees a need for change in the level of support and what is invested in nurse leaders today. There is wisdom in the advice that he provides here.
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