Ah[horizontal ellipsis]the good old days. We worked 8-hour shifts, usually rotating all 3 shifts within the pay period. There were a few nurses working a permanent shift and many waited years to get that precious day shift position. The team consisted of registered nurses, licensed nurses, nursing assistants, and unit secretaries-the glue that held us all together. The evening shift followed up with what the day shift was not able to get done, as did evenings and nights. People usually got to work early and just pitched in and helped with whatever needed to be done. Rarely did we actually have a full meal break. But almost every day we all brought in food and "grazed" through the shift. Many times we worked together to do pm care, complex patient care, etc. We knew all of the doctors, and they knew us and looked for us when they entered the unit to find the most current information and status of their patients.
Our vacancy and turnover rates were extremely low to nonexistent. There were no outside registries, but perhaps a small in-house float pool. We rarely called in sick because we did not want to leave our colleagues (many were even our real friends) short-staffed. When those disasters did occur, that is, codes, lots of admissions and transfers at the same time, etc, we just all pulled together, helped each other, and got through it all. Holidays and special requests for days off were just worked out among us all. Of course there were some personality differences, but it all just seemed to work out. Oh, and we usually knew our patients and families quite well too, especially those who were there for a long time or who returned on a frequent basis.
And then there was the management side. It was the organized staff nurse who was usually an excellent clinician who became charge nurse and used those organizational skills to run the shift. But she always had a patient assignment in addition to being the coordinator of the unit activities. This person then usually went into the supervisor role and on up into the head nurse position. Persons in each of these roles remained very clinically involved, knew all of the staff and physicians, and were highly visible and could jump right in at a moment's notice to assist with anything. Then the director of nursing was usually known to us, but a much more distant person, and none of us really knew what she did. Basically, she didn't bother us and we never really ever thought of her.
The other management role that was much more close to us was the shift supervisor who was responsible for coordinating and trouble shooting all units on the evening and night shifts, weekends, and holidays. This person could either be a life saver when the shift was falling apart or the person we all dreaded to see because she invariably came just as we had finally settled down and could take a breather. During this time, there was no talk of educational degrees or certifications. Orientations consisted of a few days with a seasoned charge nurse, shift supervisor, etc, but no formal classes. Once again when "tough" situations came along, somehow we just got through it, perhaps debriefing with a friend or colleague afterward.
Transition From the Past to Now
So, why take this walk down memory lane? In some sense, they were the good old days. Those experiences, relationships and learnings went a long way to make us what we are today. Such values and work ethic continue with us today: organization, ability to prioritize, working both independently and with others, valuing all team members, delegation, persistence, finding creative solutions to issues, patient centered care, and collaboration with physicians. Times were much different then for healthcare in general and for clinicians without so many external influences, regulations, and consumer expectations.
In time, it became evident that healthcare needed to look to the world of business for exemplars and practices that might positively impact the organization and functions of providing care and services. Business skills, strategy development, financial management, marketing concepts, forming alliances and partnerships, and quality monitoring became essential for all who managed in healthcare settings.
As this transition was occurring, the director of nursing was the "top" nursing role in the organization and usually reported to an executive who was part of a small group of top executives who made all the decision for the organization. The nursing director was not generally, at least formally, from an academic standpoint, prepared with any of these requisite skills, nor were there any attempts to facilitate and support the attainment of that knowledge. Even "back then," nursing had accountability for the largest part of the organization due to having the greatest number of employees and the majority of the real business of the organization.
Today's Executive Practice
Well, fast forward and here we are today with the chief nurse executive prepared with advanced academic degrees and certifications, part of the executive management team for the organization, and managing multimillion dollar budgets and large numbers of employees, often including other disciplines. The career trajectory for these persons has been as varied as the number of persons in the roles. Commonalities among them will most likely include those basic values discussed earlier, along with strong role models and mentors along the way, and some formal education or fellowship experiences that supplemented their basic education and personal drive and characteristics. We are indeed fortunate to have the great nurse executive leaders out there advocating for healthcare and healthy work environments today.
The emphasis on education and special management courses for the remainder of the nursing leadership team has become more evident lately, although it is still not common place in many settings. When there is turnover among the chief nurse position or any of the leadership team, the time to fill these essential positions is often long and momentum for key strategic initiatives is lost during the gap in time. The loss of continuity and disruption can have a great impact on the culture and those working in the affected area(s).
Looming Challenges
An additional challenge looming before us is the aging of our nursing workforce that affects every specialty, practice setting, and role. There will be a tremendous "brain drain" as the most seasoned persons exit organizations in the next few years leaving a gap that could have deleterious effects on not only our nursing profession but also on healthcare. To replenish roles and ensure organizational sustainability, we must tap into the potential of our top talent and cultivate existing and aspiring leaders to take us into the future. Although traditionally formalized in business and executive level position, succession planning is now needed in nursing. A succession plan prepares internal candidates to qualify for anticipated vacancies and promotes continued development of the leadership potential of persons. It is one way to secure the future.
In this issue are articles that address various perspectives on succession planning and grooming individuals for future roles. Redman provides an overview on leadership succession planning and delineates key elements in the process. His review includes existing evidence on both mentoring and succession planning programs. The importance of learning from each other cannot be overstressed. Beyers interviewed 5 nurse executives and gleaned multiple perspectives and approaches to succession planning, both formal and informal. The collective wisdom from this group of nurse leaders contributes to our knowledge from more personal, lived experiences. Similarly, Reid Ponte and colleagues interviewed 4 executive coaches. As healthcare becomes increasingly more complex and volatile, it is important that nurse executives are able to be agile and have new skills to appropriately respond. Executive coaches can be instrumental in facilitating the nurse executive's effectiveness. Development of staff is instrumental in succession planning as is seen in focused programs developed and reported by Cadmus, Wolf et al, and Goudreau and colleagues. Blouin et al share information on succession planning for both middle level and executive management. A very important component of executive practice is having the evidence that guides us to create the best practice and healthcare environment. In her contributed column, Lynn describes the importance of mentoring nursing systems researchers and ensuring that the next generation of researchers is there to support practice.
And So It Goes
Our world is changing quicker than we ever would have imagined just a few short years ago. As the result of the "whitewater change" that we have experienced in healthcare over the most recent years, we have had to become much more strategic in our actions. A strategic perspective draws upon the experience and strategic thinking and planning processes developed in the business sector. This approach will work well as we now have the opportunity to create the future in a more organized and well thought out manner. We can take the evidence that is out there, combine it with wisdom and lived experiences of our leaders, learn from what others have created, and invent our future legacy. We can combine strategic management with succession planning and stretch to strategic succession management. It's time to be strategic.