Job Security in Nurse Leader Roles - Emerging Nurse Leader

By Rose O. Sherman, EdD, RN, FAAN

For the past decade, one of my areas of research interest has been the factors that lead nurses to consider leadership roles. I have found in my work that many nurses have “fallen into the role” by default because there are often few viable candidates when leadership roles are open. To strengthen nursing leadership, we need to build a pool of interested candidates who can be mentored in advance and apply when positions become available. To do more proactive succession planning, it is important to understand what attracts nurses to leadership and what might influence their decision in negative ways. During the past three years in my research work, the lack of job security in nursing leadership roles is now repeatedly mentioned as a reason why some nurses would think twice before assuming leadership responsibilities.

Are nurse leader roles less secure than staff nurse positions?

There is little published research that has explored the reasons for nurse leader turnover below the level of Chief Nursing Officer. Anecdotally, I hear from senior nurse leaders that the turnover in nurse manager and nursing director roles is higher today, especially in the first year. A trend that may be contributing to the perception of staff that these roles are less secure is the flattening of hierarchies in healthcare organizations. To combat reductions in reimbursement, many organizations have looked for ways to reduce costs yet not impact direct nursing care.

An outcome of these cost cutting strategies has been a movement toward multiple unit management by a single nurse leader. When this occurs, staff may observe several leaders competing for the new position. What happens to those who don’t get the role is closely watched by staff. Over time, many nurse leaders naturally lose some of their clinical competence as they work on their leadership skills. Transitioning back into a staff role is not as easy as it was in the past. Often, nurse leaders end up leaving or being asked to leave the organization. I recently spoke with an experienced leader with over 30 years of loyal service to her hospital whose position was eliminated and she was given no alternative placement. It was shocking for her but she told me that her staff was devastated.

A second trend that staff observes is the high level of accountability that nurse leaders are held to on a variety of performance measures. Patient satisfaction scores, 30 day readmissions, never events and core measures are now directly tied to financial reimbursement and measurable at the unit level. If a unit consistently underperforms on these measures, the manager or director may be asked to step down even if there are some factors outside their sphere of control that impact scores.

What could this mean for the future of nursing leadership?

Nurses today base their professional and career decision making on what they observe in their environments. A senior nurse leader can offer assurances about job security but if staff observe their leaders being downsized or fired without the offer of another position in the organization – our future nurse leaders will carefully factor this into their decision making. There are no easy answers to many of the challenges that organizations face in the current healthcare environment but every organizational action has consequences. The perceived lack of job security in nursing leadership should concern us. Clearly, there are enormous opportunities for our future nurse leaders. Whether they are willing to take the plunge into leadership will be driven by whether they feel there will be support, appreciation and job security.