Revamp Your Nurse Managers' Job Scope

Jennifer Thew, RN, February 1, 2018

Changes to Cincinnati Children's Hospital's nursing management structure led to increased professional development opportunities and greater interest in nursing management positions.

This article first appeared in the January/February 2018 issue of HealthLeaders magazine.

Many healthcare organizations expect nurse managers to have 24/7 responsibility for their nursing units.

Additionally, managers are increasingly overseeing more than one unit, resulting in large numbers of direct reports.

But is it realistic to place an enormous scope of responsibility on nurse managers and expect them to succeed?

Cheryl Hoying, RN, PhD, NEA-BC, FACHE, FAAN, senior vice president of patient services at Cincinnati Children's Hospital Medical Center, asked herself that about seven years ago; her answer was no.

Hoying came to this conclusion after noticing two concerning trends among her staff.

"I was seeing all the directors getting out of here at 7 or 8 o'clock at night and not being able to get home in a timely manner," she says. "And we were hiring from the outside for every nurse manager position that came along."

As a result, Hoying implemented changes to create a more reasonable scope of responsibility and make the positions in nursing management more appealing.

Here's what she did.

Created a manager-to-FTE ratio

To address the issue of work overload, Cincinnati Children's established a 1:25 ratio of managers to FTEs. To achieve this ratio, Hoying first had to create nurse manager roles to support the medical center's nursing directors.

"I approached the CEO at the time and said, 'Jim, I need $1 million,' " she says. "He said, 'What for?' I said, 'I want to put in managers for the directors.' "

Jennifer Thew, RN

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

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