The Dilemma with the Nurse Manager Role

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

A significant number of nurse managers today are struggling with the demands of the role. In a recent article in the Becker Hospital review, Tom Olivio (CEO of Success Profiles) notes that the data from his work indicates that 42% of nurse managers are not performing at the levels expected by their organizations. The role has changed so dramatically over the past decade that the clinical and interpersonal skills that led to the selection of many managers are simply no longer enough to ensure good performance. The role has a strong business component that needs to be both acknowledged and embraced. The dramatic shift in role expectations has left many seasoned nurse managers less satisfied with their positions. In my current work with nurse managers, the following are cited as major challenges:

Maintaining Unit Performance Measures (which they often don’t have total control over) above national benchmarks
Assuming risk for what patients do at home after discharge with the strict penalties for 30 day re-admissions
Baby Boomer retirements and with them a loss of both knowledge and loyalty
Increasing consumer demands and complaints about care
Recruiting experienced nurses capable of managing complex patients
Helping staff understand the business of healthcare and movement to a value-based care environment
Lowering costs by decreasing staffing while maintaining quality
Stimulating staff engagement
Managing their own stress levels
Promoting more effective interdisciplinary teamwork
Recruitment and retention of staff with turnover now increasing among Gen Y nurses

Olivio reports that the average nurse manager is now working 56 hours per week at a pace that is not sustainable. My research indicates that they manage an average of 62 FTE and have budgets between 5 million and 25 million dollars often without adequate administrative support. Their performance criteria not only includes their ability to retain and coach staff but also a wide range metrics such as operating costs, staffing, agency labor, quality and safety.

On many levels, the success of a healthcare organization is extremely dependent on the performance of these frontline leaders. Yet, the massive changes in the role have received little acknowledgement by most health systems and managers often receive little in the way of leadership development. Olivio urges in his article that there is a need for a systemic change that acknowledges that this role is not what it once was and the competencies needed by nurse managers today are far different than a decade ago. I could not agree more with this observation. I have become very concerned as I watch nurse managers struggle in a role for which they are not prepared. It is time for organizations to rethink these positions and the candidates that are selected. The Graduate Commission on the Graduate Education in Nursing Administration (CGEAN) has been advocating for a requirement that nurse managers should be Master’s prepared in programs that include business skills. The complexity of the role not only demands a higher level of education but may also need to be restructured in many organizations.

As we begin to recruit our next generation of nursing leaders, we owe it to them to place them in leadership roles for which they are qualified, well paid and can be successful.

Read to Lead

Olivio, T. & Jiloty, J. (July 28th, 2015). Making the Cut in Healthcare Leadership Today: The Nurse Manager Dilemma. The Becker Hospital Review