Helping nurse managers succeed in hospitals

By any measure, frontline nurse managers face an incredibly challenging job.

Nurse managers play vital roles in hospitals, says Robyn Begley, CEO of the American Organization for Nursing Leadership.

Robyn Begley, CEO of the American Organization for Nursing Leadership and the chief nursing officer of the American Hospital Association, is aware of those difficulties.

She has led the American Organization for Nursing Leadership for seven years and has focused on helping nurse managers and executives become better leaders. She recently announced she plans to retire at the end of this year.

Over the past year, the organization has focused on the difficulties of nurse managers and the keys to helping them succeed in their roles. The organization teamed with Laudio Insights to produce a report looking at nurse managers.

In a recent discussion with Chief Healthcare Executive®, Begley talked about the importance of nurse managers to hospitals and health systems and some of the factors that make those jobs difficult. She also offers advice for nurse managers to succeed in their role.

Nurse managers must balance the responsibility of overseeing nurses and patient care. And as Begley says, “They have huge financial responsibilities. When you look at their patient care units, they really are small businesses.”

Nurse managers play a key role in retaining nurses and in overall patient care, so it’s critical to develop and keep strong nurse managers.

“If there's frequent turnover of the nurse manager … it leads to turnover of the staff nurses,” Begley says.

“It is so critically important that we get that nurse manager to stay, to be a stable force,” she says. “I mean, it really makes a difference from a patient satisfaction perspective, from a nurse engagement perspective.”

• Read more: Nurses love their work, but not their workplace

Managing dozens

The American Organization for Nursing Leadership report. indicates that nurse managers are often overseeing dozens of nurses.

The median headcount for nurse managers is 46, but that can vary by department. Nurse managers in emergency departments oversee a median of 83 nurses, while ICU nurse managers typically oversee 80 nurses.

When asked if there’s a limit on how many nurses a manager can oversee while still being effective, Begley says in her view, it’s not a clear-cut number. “There is no black and white, gold standard answer,” she says.

But hospitals and health systems can take steps to help nurse managers.

Begley points to the value of having assistant nurse managers who can help lighten the load. While more than half of all nurse managers (56%) have an assistant nurse manager, most managers have all team members as their direct reports, the report stated.

Hospitals can also offer administrative support to help nurse managers in areas such as scheduling, or other bureaucratic tasks to allow managers to spend more time working with their nurses, Begley says.

Meaningful interaction

To help nurses succeed and understand where problems arise, nurse managers must meet and talk with their nurses. But that’s not easy when a manager oversees dozens of nurses, some of whom are working different shifts.

Nurse managers should focus more on having quality time with their nurses, even if it isn’t necessarily frequent.

“It's not about the frequency or the number of times you talk to people,” Begley says. “It's about how meaningful it is. So, just saying, ‘I'm going to do weekly rounds and talk to everybody and spend five minutes with everybody,’ it's not necessarily the correct approach.

“It really is knowing the person, knowing what's important to them, having conversations that show that you care about them as a person and about what they're experiencing in their work,” she says.

Hospitals and health systems should work to ensure nurse managers have that time to talk with their nurses.

“If we can free up as much of their time to be able to have those meaningful conversations and take away some of that work that, quite frankly, just doesn't add joy to their job … those are the things that managers tell us is really important to them, so that they feel like they're effective in their communication and their interaction with their teammates.”

Managing the workload

Managers will routinely alter their schedules to work in the evening or on weekends to speak with nurses they don’t regularly see, Begley says.

At the same time, nurse managers should be careful about how many hours they are working, she adds. In the desire to meet with nurses and be there for their teams, managers can end up putting in long hours and long weeks and run the risk of wearing themselves down. Plus, managers often cover shifts when a nurse is absent.

• Read more: Nurses in hospitals: Burnout by the bedside

Nurse managers need to know when to take time off, Begley says.

“We have to role model healthy self-care behaviors,” she says. “We need to make sure that our nurse leaders, our managers or directors are taking the time that they require to be off, encouraging people, or kind of insisting that people take well deserved PTO or vacation time,” she says.

Managers also should not make it a “badge of honor” to work 80 hours in a week, she adds.

Nurse managers should need to set “rational boundaries,” Begley suggests.

Newer nurse managers sometimes tell staff that they should feel free to call at any time, but Begley says that’s not always the best idea. It can lead to a nurse working a night shift calling late in the evening simply to request a day off next month. Seasoned nurse managers will offer some guidance to nurses on matters that need immediate attention and those that don’t require an instant answer.

“Many of our new leaders want to be everything to their staff, but you have to take care of yourself, too,” Begley says.

Valuing nurse managers

Nurse managers play a vital role in patient safety and satisfaction, and Begley says she’s glad to see the recognition for those leaders.

“Our physician colleagues say having a stable nurse manager can really make or break the unit,” Begley says.

Savvy physician leaders also work with nurse managers to improve patient care, she adds.

“Our doctors who understand what it really takes to run great nursing units, they actively partner with the nurse manager, the nurse leader on the floor and on the unit,” Begley says. “It is a joy to behold when you have everybody, clinical leadership, sort of all in sync and moving in the right direction. It really improves the focus on the patient, which is really why we all come to work every day.”

Despite the heavy demands and responsibilities, being a nurse manager can be a fulfilling experience.

“It is wonderful to see a brand new nurse come to work and see the progress that he or she can make in say, six months, a year's time, two years’ time,” Begley says. “I mean, that is extremely, professionally rewarding when you are leading people and they're doing such really important work. I mean, taking care of our patients and their families, I can't think of a higher purpose.”