The Case for Supporting Nursing Directors

Jennifer Thew, RN, September 12, 2017

Providing the correct ratio of directors to managers is a good start toward positioning nurse managers to develop their leadership skills.

Nurse managers, 300,00 strong, represent the largest segment of the healthcare management workforce. Yet their potential to influence clinical outcomes and strategic goals has been overlooked by healthcare organizations for decades.

But that is changing, says Cheryl Hoying, RN, PhD, NEA-BC, FACHE, FAAN, senior vice president of patient services, at Cincinnati Children's Hospital Medical Center.

Now, she says, CNOs should be asking themselves this question: "What are the supports that nurse managers need to be resilient in that role?"

Make Management Manageable

Hoying says one area that leaders should evaluate is the expectations placed on nurse managers.

About seven years ago, she noticed a troubling trend among the nursing directors at her organization.  "What I was seeing was all the directors getting out of here at seven or eight o'clock at night and not being able to get home in a timely manner," she says.

Hoying approached the CEO at the time and successfully made the case to add nurse managers in order to support the directors. The organization also implemented a one-manager-to-25-FTE ratio.

"Depending on how many employees were on their unit, that's how many managers they got. If they had a staff of 50, there was a nurse director and then they got a nurse manager. If it was 75, they got two nurse managers and a director," she explains.

"By that [ratio] you're able to work with the staff and do all of the education with the staff that's needed and vice versa. It allows the manager to be successful and be the nurse leader that that individual could be."

Having a large amount of direct reports is not uncommon for nurse managers, but leadership needs to consider whether the practice is in the best interest of nurse managers.

"I've heard some stories where managers have had 100 people that they're responsible for. How do you begin to do 100 evaluations?" she says.

Jennifer Thew, RN

Jennifer Thew, RN is the senior nursing editor at HealthLeaders Media.

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