Monday September 16th 2019

Preparing for the boomer effect

Less experienced nurses may step into nurse manager role sooner

In many ways, the role of a nurse manager requires being a “Jack of all trades.” And as far as the second half of that saying goes — “a master of none” — forget about it. Positive patient outcomes and nurse satisfaction, among other factors, hinge on nurse managers mastering skills that encompass the clinical, people and business sides of health care.

However, to be effective in such a demanding role, new nurse managers need ongoing support and professional development, according to nurse experts. Further with less experienced nurses very likely moving into this role sooner, it is vital that employers and their colleagues provide them with the support they need to succeed.

“Being a nurse manager is one of the most challenging and important jobs in health care,” said Beatrice Kalisch, PhD, RN, FAAN, an expert in nursing teamwork, staffing and missed patient care, and a speaker at the American Nurses Association’s fall 2014 staffing conference. “They’re concerned with staffing and utilizing other resources well, maintaining quality care and retaining staff. And they are sandwiched between meeting the expectations of administration and staff.

“We need to invest in preparing them, especially because the job has changed over the years.”

On the move

Much has been written about the virtual tsunami of nurse retirements based on the projection that about 10,000 baby boomers — those born between 1946 and 1964 — will be turning 65 every day for roughly the next 15 years. Another contributing factor is the improved economy, which makes retirement more financially feasible for many workers.

“It’s not a mass exodus, but an increased and prolonged retirement of nurse managers, CNOs and other nurse leaders,” said Bonnie Clipper, DNP, MBA, RN, CENP, FACHE, a Texas Nurses Association member and author of The Nurse Manager’s Guide to an Intergenerational Workforce. “And generation Xers are about half the size of the baby boomer generation, which means that there are fewer of them to fill those positions. (Generation X is generally defined as those born between 1965 and 1983.)

That said, Rose Sherman, EdD, RN, NEA-BC, CNL, FAAN, offered an interesting statistic about another cohort: generation Y, also known as the millennials, who were born between the early 1980s and early 2000s. (While researchers and opinion-makers agree that they are the largest cohort ever, they disagree on the exact start- and end-dates of the millennial generation.)

“By 2020, 50 percent of the nursing workforce will be generation Y,” said Sherman, a professor and director of the Nursing Leadership Institute at Florida Atlantic University, an American Nurses Association member and chair of ANA’s Curriculum Review Group. “Many of them self-identify as leaders, and they are looking at career development.”

Staff nurses, managers and other RNs addressed a myriad of critical issues at ANA's national staffing conference.

She also reported that they are going to graduate school sooner, which experts say helps to build a more educated workforce to meet patients’ increasingly complex health care needs; for example, more than half of the students in her graduate program are under the age of 30. Further many of the CNOs Sherman has spoken with find these nurses to be sharp, confident and willing to step into leadership roles sooner.

But like Clipper, Sherman said that the long-held paradigm of only considering nurses with greater than five years of experience for nurse manager roles must shift.

“Nursing is still a profession where you have to earn your stripes largely based on tenure,” said Clipper, a Robert Wood Johnson Foundation Executive Fellow. “I think we need to help aspiring leaders ramp up quicker, and work with the existing staff on the issues around ‘street cred’ and skills.”

Filling the void

Nurse experts also agree on another change that must occur in order to fill looming nurse manager vacancies — and that is redesigning the role.

“As good as many of these younger nurses are and interested in leadership roles, the challenge for nursing is, can we make the role of the nurse manager attractive enough?” Sherman said.

During the economic downturn, many facilities started adding more and more responsibilities onto nurse managers’ shoulders.

Beatrice Kalisch

“Many are being strung awfully thin,” said Kalisch, an ANA Michigan member. Although not the norm, some nurse managers have 175 direct reports, which creates an impossible job for them.

And while Clipper described millennial generation nurses as very purpose-driven and mission-driven, she said they also value work-life balance. So a position that might require 24/7 availability and potentially too wide a range of responsibilities may send desirable candidates off on another career track.

Navigating the role

After working as a staff nurse for about three years, Rebecca Walker, BSN, RN, CMSRN, decided to become a nurse manager — first on a telemetry unit and now on an 22-bed interim care unit at St. David’s South Medical Center in Austin, TX.

Wendy Lugo

Wendy Lugo, DNP, RN, PCCN, ACNP-BC, has been a nurse manager for about a year in the Evans-Haynes Burn Center at Virginia Commonwealth University Health System, following a 10-year period in staff development and performance improvement.

Both nurses describe similar responsibilities and challenges. For example, they both are responsible for staffing their units, as well as hiring and coaching employees; meeting quality standards; and ensuring patient and nurse satisfaction, among other duties.

One of their most time-consuming and challenging responsibilities involves staffing appropriately. For Walker, the staffing needs on her step-down ICU — with eight ICU swing beds — can shift greatly.

“We can get three patients who need 1:1 care within a couple of hours, which means I need several additional nurses,” said Walker, a Texas Nurses Association member.

Lugo’s staffing needs also are complex.

“Staffing consumes a large part of my role, and it is what I stress over,” said Lugo, a member of the American Association of Critical-Care Nurses, an organizational affiliate of ANA.  Nurses on her unit take care of pediatric and adult burn patients who may need general, progressive or intensive care, so it’s critical that she is able to match the number and competencies of RNs to patients’ diverse needs. And she needs to make sure that quality doesn’t “slip” — no matter what the staffing level is.

Demographics and churn

Another common challenge involves the staff, themselves.

“I’m constantly trying to figure out what motivates and engages the different generations of nurses,” Lugo said. “Those moving toward retirement think and are motivated differently than millennials. And their expectations from a nurse manager are different, too.”

There are other issues that nurse managers increasingly face.

Because there is so much more data, there is more scrutiny on how facilities deliver care and the financial implications of falling short on that care, according to Sherman. So meeting the demand for value-based purchasing is a growing responsibility for nurse managers.

Further, they must meet the needs of a more diverse and demanding patient population.  As a result, interpersonal skills are even more crucial, and many nurse managers spend much more time on patient rounding each day.

Yet another challenge for all of nursing — and a trend also fueled by nurse retirements — is how will particularly less experienced nurse managers staff their units as more baby boomer nurses leave?

“That’s knowledge lost, and you can’t staff a unit with all new grads,” Sherman said.

Additionally, millennial nurses typically stay only three years in one position. But it takes time for new nurse managers to develop bonds with staff, and nurse satisfaction, especially among younger nurses, is dependent on having a relationship with their manager.

“Management churn also affects unit performance,” she said.

All is not lost

Nurse experts said that succession planning — and doing it now — is key to ensuring the next generation of effective nurse managers and other leaders.

“We all need to identify nurses who have great potential and good ideas early on, which also will help health care change for the better,” Sherman said.

Mentorship for any new manager, but especially those with less experience, is vital.

“Younger nurses really fear failure,” Sherman said. “They need mentorship starting right when they take the job, which also will help them manage their expectations and relieve stress.”

Ongoing support is equally important, according to Lugo, who despite her previous leadership experience still had a “high learning curve” when it came to feeling effective as a nurse manager.

“My director is very supportive,” Lugo said. “She knows my strengths and weaknesses, and is always willing to give feedback. And I know what I don’t know, and reach out to others when I need to.”

Self-assessment actually is a good place to start for budding nurse managers.

The American Organization for Nurse Executives offers the Nurse Manager Inventory Tool, in which nurses can assess their skills in a number of areas, such as budget and finance, and employee interviewing and other human resource-related issues.

Besides being grounded in management concepts, new nurse managers also need leadership development.

“Leadership requires a different set of skills and competencies,” said Kalisch, the 2013 Institute of Medicine Nurse Scholar-in-Residence. Effective nurse managers and leaders want people to do the best work they can and will do what they need to remove any obstacles that prevent staff from doing their best.

There are many ways that nurse managers can gain the management and leadership skills they need. Sherman pointed to ANA’s Leadership Institute, which has webinars and other resources available for emerging nurse leaders.

AONE, in partnership with the AACN, also offers a 40-hour online program on the essential skills for nurse managers. Further, nurses can build their skills by accessing resources at their specialty organizations, through TED talks, and via many journals.

Sherman also believes that nurses should consider gaining management and leadership expertise through academic programs, especially because many employers are requiring that nurse managers have at least a BSN degree.

Finally, despite the demands, Lugo and Walker enjoy being nurse managers and encourage other nurses to explore this role.

“It’s really a special position,” Walker said. “I can still stay close to the patients at the bedside and effect change for my nursing staff.”

— Susan Trossman is the senior reporter for The American Nurse.


ANA Leadership Institute:

American Organization of Nurse Executives:

Rose Sherman’s Emerging Nurse Leader blog:

TED talks on leadership:

More from category

Stepping into a culture of safety
Stepping into a culture of safety

Onboarding programs help retain nurses, strengthen patient care Retaining newly hired, competent nurses — whether new [Read More]

Higher education
Higher education

Learning what it means to provide spiritual care Providing spiritual care may seem as ethereal as the term implies. It [Read More]

A challenging road
A challenging road

Nurses discuss complexities, ways to address rural health care Registered nurse Sharon Webster, manager of the Hannibal [Read More]

Without a home
Without a home

Nurses offer care, hope to those in need Tent cities — generally unsanctioned encampments for homeless individuals [Read More]

Optimal Staffing
Optimal Staffing

New resource aims to help RNs implement evidence-based staffing plans When it comes to achieving quality care, better [Read More]