Transitioning into a Leader Role in Turbulent Times

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

Transitioning to a leadership role is tough during the best of times. COVID-19 has introduced new challenges that make both the position and onboarding of new leaders more complex. I recently spoke with an ED department manager who had transitioned from a leadership role in one hospital to another, both within the same system eight months ago. She expected that because she had leadership experience that the transition would not be difficult. “I was wrong about this”, she observed, “it has been so much more challenging than I anticipated. Even within the same geographic area, there are cultural and contextual differences between hospitals. The staff appreciated that I have extensive ED experience, but the trust issues have definitely been there. Some nurses are not their best selves right now, but it is more difficult to discern changes when you don’t know them at all. Social distancing and lack of socialization outside of work have made bonding more difficult. I can’t imagine what this would be like if I had no leadership experience.”

This leader brought up so many good points. Recently, several new leaders have asked my advice as they navigate situations where their health systems have completely curtailed leadership development programs. These new leaders’ orientation is now often left to those who supervise them – leaders who are buy responding to their own challenges. New nurse leaders are often amazed at the depth and breadth 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. Today, the average nurse manager in the United States 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. Now add to that what is happening with COVID-19. There has been so much change and uncertainty that many nurses have lost faith in their leaders. New leaders face even more obstacles in building trust with staff who are fearful and sometimes angry.

My research indicates that even in the best of time, more than half receive no formal leadership development before their transition, and fewer have mentors to help them in the process. The unfortunate reality is that we continued to spend more time worrying about new graduates’ transition than 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 staff performance.

In talking with new leaders, I recommend a few things. It is vital that, especially now, new leaders have time to spend observing a proficient leader who has a similar role in their organizations. Leadership competency should be the key concern rather than a specialty area. I also recommended that the directors look for good continuing education online programs that have leadership content. One leader mentioned she was using my book in her orientation of a new manager. It can be a great strategy to discuss a chapter with the new leader at each coaching session. To assist with this, I developed The Nuts and Bolts of Nursing Leadership Book Club Guide.

I am also a firm believer in laying out a leadership action plan to help in the orientation process. A sample of what I recommend is 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 change, their unique strengths, and what 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 the protocol of how performance management challenges are addressed in your organization.

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 the 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. Assess 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

1. Set work hours to maintain your equilibrium and a sustainable pace. Choose at least one resiliency behavior to implement into your daily schedule.

3. Establish a routine for patient rounding

4. Develop a process to recognize staff regularly

We owe our new nurse leaders a better transitional experience even during these turbulent times. If we expect our next generation of nurse leaders to survive and thrive, effective onboarding is needed, especially during COVID-19.

Launch 2021 by giving your leadership team the gift of a highly rated webinar – Nursing Leadership in 2021: Rebooting after a Life-Quake A Nursing Leadership Reboot Workshop

Read the Nurse Leader Coach – Available at Amazon and Other Book Sellers.

Now Available to Strengthen Your Leadership in 2021 – The Nuts and Bolts of Nursing Leadership: Your Toolkit for Success