New Nurse Manager Challenges - Emerging Nurse Leader

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

When you have been in leadership for many years, it can be hard to remember what it is like when you begin in your first nurse manager role and the challenges you face. Last week, I once again had an opportunity to work with many new nurse managers in the leadership development course sponsored by the American Nurses Association. Most were in their first year in the position and many clearly felt overwhelmed. These roles are very challenging especially in today’s environment.

Over time, these leadership roles have become very complex as managers pick up more and more responsibilities incrementally. Staff nurses have little real exposure to what their leaders do on a daily business so when they move into these roles, it can be very shocking. As frontline leaders, they run the equivalent of a small businesses and also serve as chief retention officer for their organizations.

In my discussion with these new managers, I learned that their transition was often very abrupt. For a number of nurse managers in our session, it was not really even an intentional choice on their part. They were often the most seasoned and capable person on the unit to accept the responsibility and drifted from interim to permanent. One week, they were working three 12 hour shifts as staff nurses and then the next they found themselves working five days a week uncertain about how to even plan their day. Few were given any structure about how to get started, a topic we have covered on this blog about what to do in your first 100 days in a leadership role. We need to do a much better job with onboarding new managers and not leave it to chance. The following are the challenges that they reported to us:

Meeting productivity measures – very challenging.
My current staffing mix – few experienced RNs but many new graduates.
Recruitment and retention of experienced staff – more areas now have sign on bonuses.
Burnout among my preceptors – too many new staff and the preceptors are constantly orienting new staff.
Managing units outside my own area of clinical expertise.
Change and initiative fatigue – the level of change is hard for both me and my staff to stay on top of.
Leadership turnover in our organization – I am the 4th manager on my unit in a 2 year period of time.
Staffing and scheduling – sometimes I find myself not having an RN to staff a shift and unable to get one.
Retaining my staff – even my best and most satisfied want to advance their careers.
Managing union issues – quite overwhelming especially when you are new. It is easy to make mistakes.
Managing performance – I am so busy, I have to make choices about what to deal with.
Staffing up and down with a labile census and rapidly changing volumes.
Managing former peers.
Managing clinically strong nurses with interpersonal issues – I need them and they know it.
Working the unit because you lack experienced nurses in a high risk area such as L&D.
Burnout and Caregiving fatigue in my staff.
My own anxiety and stress level.