Onboarding New Nurse Leaders - Emerging Nurse Leader

By Rose O. Sherman, EdD, RN, FAAN

Over the past two years, I have had the opportunity to teach and talk with large numbers of new millennial nurse leaders about their experiences transitioning into leadership at conferences and as co-facilitator of the ANA new nurse manager program. How did you decide to become a nurse leader? is an interesting question to ask these nurses in leadership roles because you often learn that they “fell into leadership” rather than seeking out a leadership role. For some leaders, they take their first position on an interim basis and discover that they have leadership talent. Others may be tapped by senior leaders or sometimes by their peers who see potential in them that they may not see in themselves. Every leader’s path is slightly different but once they take that first leadership role, they quickly learn that being a nurse leader requires a far different skill set than what is expected in a clinical staff role.

First time nurse leaders are often amazed at the depth and breathe of responsibilities in a leadership role. It is like becoming a novice nurse all over again. Taking a formal role in leading a unit, department or clinical service is in many ways like running your own small business. The average nurse manager in the United States today has roughly 60+ direct staff reports and manages a multi-million dollar budget. It is a complex role, and knowing where to focus your time and energy to meet all the challenges can be difficult. What is amazing to me is how few organizations invest time, energy and intention into how these new leaders are being appropriately on-boarded.

My research indicates that more than half receive no formal leadership development prior to their transition and fewer have mentors to help them in the process. The very sad reality is that we spend more time worrying about new graduates transition than that of the managers who supervise them. Yet, we know from the data that front line leaders are the linchpins in their organization that drive recruitment, retention and performance of staff. My concern about these new leaders who tell me that they are often handed the keys to their office with no next steps discussed has led to my development of a 100 day action plan as outlined below:

The First 100 Days Nurse Leader Action Plan

Competency Area	Action Steps
Personal Mastery	1. Meet 1:1 with your boss to clarify his/her expectations 2. Request a leader-mentor in the organization 3. Review your position description & evaluation criteria 4. Determine what committees/meetings you should attend 5. Avoid making any major changes
Interpersonal Effectiveness	1. Meet 1:1 with each direct report and ask what is going well on the unit, what needs to changed, what are their unique strengths and what do they expect of you. 2. Schedule meetings with key stakeholders such as pharmacy, central supply, ED, nutrition, quality improvement 3. Hold your first staff meeting 4. Inform staff of your communication style
Human Resource Management	1. Review the position descriptions of each staff position and evaluation criteria 2. Learn about the recruitment process to fill vacancies 3. Review unit/department turnover data 4. Determine how performance management challenges should be managed 5. Read the union contract 6. Evaluate the staffing/scheduling process 7. Compile a staff profile – generation/years of experience/time on unit/certifications
Financial Management	1. Clarify your role in the budget process and the budget cycle 2. Review every cost center in your budget and get help if needed from the CFO 3. Assess use of overtime on the unit 4. Determine how equipment is requested
Systems Thinking	1. Review six months of performance data and the top 5 DRGs for the unit/department 2. Focus on solving at least one frustrating process or problem.in your area to achieve an early win 3. Do an assessment of the political and cultural issues in the organization 4. Review the strategic plan/payer mix for the organization 5. Review the organizational chart
Caring for Self/Staff/Patients	1. Set work hours to maintain your equilibrium and a sustainable pace 2. Choose one resiliency behavior to implement into your daily schedule. 3. Establish a routine for patient rounding 4. Develop a process to regularly recognize staff

We owe our new nurse leaders a better transitional experience. Both AONE and ANA have excellent new nurse manager development programs for organizations that may not have their own. At the least, every new manager need to be assigned to an experienced mentor and have a leader development plan. If we expect our next generation of nurse leaders to survive and thrive, effective on-boarding is essential.