The Nurse Manager's Circle of Influence

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

As I talk to frontline nurse leaders, they have many frustrations and feelings of helplessness about aspects of their work environment that are not in their control. Some familiar sources of distress include the following:

Organizational pay/benefits package
Competitor sign-on bonuses
Staffing ratios/acuity guidelines
Health system recruiting practices
Health system onboarding and residency programs
Lack of childcare support for staff
Internal transfer policies
Organizational communication transparency
Admission/transfer and discharge practices
Organizational tuition reimbursement/loan repayment programs
Organizational/Union contract work rules

All of these factors are definitely in the nurse manager’s circle of concern but not necessarily their circle of influence. The late Dr. Stephen Covey first proposed the concept of the Circle of Influence versus the Circle of Concern in his book, Seven Habits of Highly Effective People. Dr. Covey points out that if we want to be proactive in a crisis rather than reactive – we will focus on the things we can control, also known as our circle of influence. In other words, control the controllable and let go of those that we can’t influence– those in our circle of concern – we care about them – we worry about them, but we can’t control them. In this era of instability, it is essential to go back to the basics and focus on what you as a leader can control, which includes the following:

Unit/team culture
Unit recruitment practices
Unit scheduling and work accommodation
Team inclusion/psychological safety
Leadership communication
Leader responsiveness/a bias for action to fix problems
Unit-based onboarding of new staff
Nurse recognition
Career coaching
Strategic offboarding of valued staff

There are aspects of staff turnover that leaders have no control over, BUT there are some key areas outlined above where leaders can make a difference in whether staff leave or stay. It sometimes surprises me in retention workshops that nurse managers don’t always know what the organization has placed in their circle of influence. In today’s chaotic environment, I advise beginning with those opportunities in your circle of influence. What can you do versus what can’t you do? This is where you, as a leader, will have the most control and impact.

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