Six Steps to Ensure New Nurse Manager Success

How are vacant nurse manager positions filled at your hospital? Too often, nurses are promoted to managers because they are excellent clinicians, critical thinkers, and communicators.

In their new role, they suddenly have to deal with finance and budgeting, patient safety concerns, quality improvement projects, recalcitrant staff, and many other tough topics. And they are expected to achieve a blend of clinical and business management with little to no training.

"We tend to eat people alive," says Mary Ann Holt, partner, operations improvement at IMA Consulting. "It's not unusual for a person to be promoted into a management role because of their effective leadership in a clinical arena. But not everyone with clinical expertise can transition to being an effective leader."

Holt says organizations must set expectations for new nurse managers so they understand their role and that it is vital to invest in training, coaching, and mentoring for new managers. "We can't just take it on face value that because they are an experienced individual they don't need explicit managerial education," she says.

Holt's advice is echoed by Shelley Cohen, president of Health Resources Unlimited, an educator who often leads new nurse manager boot camps. Cohen recommends organizations follow six principles to help their new managers adjust to their roles.

1. Have realistic expectations. One of the biggest hurdles new nurse managers face are unrealistic expectations from the person they report to, usually a director of nursing.

"They expect them to have no transition period," says Cohen. "They haven't even been oriented to the department and we expect them to go in there and start battling the battles. We don't give them the time they need to make a transition."

2. Provide time for orientation. For the first two weeks, new managers should spend time as a staff nurse observing and learning the unit and not spend any time in management tasks.

"This will help them get a grip on how the department functions from a staff nurse's eyes," says Cohen. "You need two weeks to do that so they can work all shifts. It gives them a chance to get to know the staff, the demographics of the patients, and gets them to see in real time what the issues are and better understand them."

During this time, the director can handle the typical management responsibilities on the unit.

3. Plan the first 30 days. Nurse managers are set up to fail when administrators don't communicate their expectations. "Give them a piece of paper with ‘here's what I expect in the first 30 days of you on the job," says Cohen. Include the formal time for orientation on the unit and the most important issues you want nurse managers to become familiar with and devote their time to.

4. Manager support. New managers need support from their director in the form of uninterrupted time.

"The person they report to typically talks a good story at the beginning about how ‘I'm here for you' but in 30 days that's gone. It's just lip service," says Cohen, and managers are left on their own.

Directors should schedule 30 minute meetings twice a week with new managers. "That means no texting and no email while they are talking," says Cohen.

Transition to once-a-week, hour-long meetings. After the first month, work out a schedule for how often and how long to meet. Cohen says these meetings are important.

"Even if the new manager says 'I don't need to meet anymore,' that's not true," she says. "This is a clue there's a bigger problem. They need to force the meeting."

5. Learning leadership principles. New managers who are promoted from within the organization must make a difficult transition from "one of us" to "one of them." Every new nurse manager wants to be liked by the staff and one of the biggest challenges for the person they report to is to teach them that it's not being liked by the staff that counts, but how effective they are in their role.

"It takes time to teach this," says Cohen, "but it is one of biggest jobs of the person they report to."

Both internal and external managers find the volume of work overwhelming when they do not receive training on how to deal with problems.

"They just put Band-Aids on everything so they can get through the day," says Cohen. "They need to be taught how to solve the problems so they permanently go away."

Organizations should invest the time and money and send them to fundamental leadership classes, or find someone in house who can teach the ABCs of leadership. "Without a grasp of the underpinnings of effective leadership, the new nurse manager is being set up for failure," says Cohen.

6. Find a mentor. Being fresh to the role, coupled with a lack of trust from staff because they are new, can leave managers feeling like they are on their own. Find a mentor who can offer support and encouragement and help them find their way. The mentor may be another nurse manager in the organization or from a sister organization who can mentor remotely. They do not need to be in the same specialty, it just needs to be someone who can provide support and help build leadership skills.

Just because new managers have mentors doesn't mean directors can relinquish this area of responsibility. Mentoring nurse managers should be a vital part of their job.

"My greatest mentor was the person I reported to," says Cohen. "He felt that was part of his job and he took ownership of it. And that was the key to my success in leadership."

The key to success and retention of new nurse managers is the time and support put in at the beginning. Investing in these crucial managers will pay dividends in staff satisfaction and the competent management of their units.