Management 24/7: Six Skills Every Manager Must Master

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Many of the nurse managers felt disempowered, inadequate, and ignored, resulting in widespread feelings of dissatisfaction and intent to leave. Here is a sample of some of their comments:. The role…must be re-evaluated given turnover rate and dissatisfaction. Nurse manager frustration is ignored. The position has become increasingly difficult to fill adding more stress and responsibility to those who are then asked to cover additional units.

I have learned my responsibilities through negative feedback. I am made to feel inadequate and unable to reach expectations. Rarely is any positive feedback given. With many staffing deficits, I have to work the unit to maintain patient safety.


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Nor is any assistance offered to complete reports. I am expected to work late using personal time without compensation. I am expected to work weekends, evenings and nights if an RN calls out and there is not other RN available for straight pay. I do not believe the nurse executives understand the demands of the nurse manager role.

Manager satisfaction is much neglected; creative ideas to embrace and improve are ignored…. Mutual respect is absent. Example: suggestion presented to offer nurse managers a hour day, having the assistant nurse manager cover on the fifth day. Managers do not work an 8-hour day. This compounds the many job responsibilities and decreases satisfaction.

Executives need to take note that the nurse manager role is the adhesive that holds the organization together, keeps goals in sight, drives patient care, advocates for staff, patients and families, and gets the least recognition for their contribution. Lack of support and the demands of an increasingly regulated environment were other predominant themes in this group of nurse managers. Nurse managers are also saying:. Other departments seem to have more assistants than the nursing management team. What makes me want to leave this job is the fact that, with the ever-increasing demands of finances and regulatory requirements, there have been no additional resources added.

It has gotten worse over the 20 years I have been in this job and at this point I seriously think about leaving this role. Too many reporting statistics programs limit time to do important things like round with patients and staff meetings. If could go back in time and change decision to become nurse manager, would not do it again. Nurse manager studies on creating healthy workplaces suggest desirable components include a framework of shared leadership, participatory management, relationship building, development of nurse managers, evaluation of role expectations, and empowerment.

Additional themes on the importance of the chief nurse executive role and the impact of tenure and employee benefits as investments in the organization were also consistent with the literature. These findings are supported by the nurse manager engagement study by Mackoff and Triolo, which found six elements for future nurse manager engagement.

These were:. No expectation for assuming secretarial duties such as distributing flyers and paperwork to staff. Creating healthy work environments requires a committed participative process for evaluating role options essential to nurse manager retention and recruitment. An immediate, low-cost hospital action may be hardiness training to provide emotional support to the nurse managers.

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Nurse managers need to accept individual responsibility to seek resources that nurture their well-being. Options such as job sharing and separating clinical and administrative roles may work in some organizations. Strategies for stress management, role expectations and role redesign, and processes for creating healthy workplaces, need to be evaluated both in response to broader healthcare and workforce trends as well as within organizational culture and constraints.


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Nurse executives need to reflect on those leadership behaviors that are viewed as more supportive by nurse managers and begin discussion on the predominant themes of work expectations, work-life balance, workload and role expectations, support, education and growth opportunities, acknowledgement and respect for contributions to the organization, and compensation.

Beginning the discussion is the first step in acknowledging change must occur to retain committed and engaged nurse managers. This dialogue can provide the platform for succession planning and broader discussions with different age cohort nurses earlier in their careers who may consider nurse manager roles in the future.

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Succession planning is an immediate imperative; given the reported average age of the nurse manager is 45 years. Supporting discussion of creating healthy work environments can also establish a culture of support and a basis for long-term organizational change. Support, empowerment, and the ability to make change in a timely manner are essential to retaining the nurse manager.

Empowerment should be evaluated as part of the organizational culture as an influence on nurse manager perceptions of control, support, and their ability to address role expectations and demands. Organizational leadership should develop an ongoing process and an environment where nurse managers participate in this creative process.

Succession planning that uses focus groups with potential nurse managers may prove helpful in evaluating job design, role expectations, and workload. Options such as job sharing or separating clinical and administrative roles require organizational assessment for organizational fit.

Organizational support in creating healthy work environments and commitment to an ongoing process to continue to evaluate options and explore new models are essential to retention. Educating hospital leadership concerning the critical nature of the nurse manager role, projected shortages, and the need for support for organizational change is a major challenge for the nurse executive in financially constrained hospitals. The time for committing to action is now. Nursing leaders need to take ownership, perhaps albeit small incremental change initially, of creating the future environment.

In a recent study, senior leaders were challenged to support nurse managers in the following ways:. Although many nurse managers are in later career stages, the recruitment of new managers requires strategic planning for organizational supports and individualized development plans with mentors for each manager. The recent work of Mackoff and Triolo on nurse manager engagement provides a resource with suggested applications.

Implementing strategies to manage work experiences at entry into the organization and at entry into the nurse manager position may prove more effective for enhanced affective commitment and perceived organizational support.


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Acute care hospital survey of RN vacancy and turnover rates in Vision for a treasured resource: part 1, nurse manager role implementation. Journal of Nursing Administration. Fletcher C. Flynn L. The state of the Nursing Workforce in New Jersey: Findings from a statewide survey of registered nurses. Havens D. Nursing Economics. Mackoff B, Tiolo P. Project report: creating a model of nurse manager engagement: A Qualitative study of long-term outstanding nurse managers. Robert Wood Johnson Foundation.

Princeton, NJ. Mackoff B, Triolo P. Why do nurse managers stay? Building a model of engagement. Part 1, dimensions of engagement. Part 2, cultures of engagement. Manion J. Supporting nurse managers in creating a culture of retention. Nurse Leader. Affective, continuance, and normative commitment to the organization: a meta-analysis of antecedents, correlates, and consequences. Journal of Vocational Behavior. Creating healthy workplaces: laying the groundwork by listening to nurse managers.

Rudan V. Where have all the nursing administration students gone? Leadership agenda for change toward healthy work environments in acute and critical care. Critical Care Nurse. Thorpe K, Loo R. Balancing professional and personal satisfaction of nurse managers: current and future perspectives in a changing health care system. Journal of Nursing Management. The shocking cost of turnover in health care. Health Care Management Review.

Zastocki D. I agree with the previous comments whole hardheartedly. However, I believe the biggest problem is the nurse managers themselves. We tolerate the abuse. Our egos are wrapped up in the role because we consider it a step up. We pursue higher and higher levels of education training to feed this monster that pushes us to neglect our families and ourselves. Hello, What a wonderful and interesting topic. Can you help me to find a tool or to develop a new tool for this purpose? I was an administrator who worked with nurses to find a way to empower them to have control over their work place, not a culture that my peers or nurses seem to want.

Yes it has been a while since there has been the ability to make decisions around what you want your work life to be like. It took three years to build trust —in the end — several told me it was too much work to have to think about the impact of the change and all the other crap that came along with it. Details are regulated by a separate agreement to be finalized for the contract extension.

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