1. Section Editor(s): Thompson, Elizabeth M. MSN, RN, CNOR

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"Too many leaders and not enough followers," is an idiom I've often heard. But does this idiom still hold true today? With consolidation of healthcare institutions and reorganization, managers are asked to take on more staff and responsibilities. Recently, this exact situation happened to an acquaintance of mine. She resigned because she felt the demands of the position were more than what one person could perform effectively. Sadly, this is happening more often.

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The nursing shortage hasn't gone away. More than 50% of nurses are retiring soon.1 From this statistic, we can infer that the number of managers will also drop to a critical level. In considering the role of the perioperative manager, one survey reported, "... the typical profile of a surgical services manager is that he or she is 52 years old and plans to retire in 2017. The bulk of these managers work in community nonteaching hospitals with an average of 13 staffed ORs, manage 5.7 departments, oversee 96 clinical and 26.5 non-clinical FTEs [full-time equivalent employees], and are responsible for an operating budget of $14.7 million."2


This shortage in nursing leaders becomes a patient safety issue. The Joint Commission (TJC) identified leadership failure as a contributing factor in 50% of sentinel events in 2006. TJC went on to report that "research shows that leadership makes a major difference in the quality and safety of patient care."3


So how do we prepare our future leaders? In the past, those who were proficient in their position were earmarked as having the qualities of a good manager. However, these qualities didn't necessarily translate into being an effective manager. In addition, new managers didn't receive adequate orientation or mentoring. The leadership style was more autocratic: leaders gave orders and expected them to be followed.


Now, increased patient acuity, increasing budgets, healthcare reform, and the expectation of the nurse leaders to have equal partnerships with physicians has challenged and is changing the nurse manager role. Nurse leaders are expected to have a basic understanding of managing a budget. The Institute of Medicine advocates, "a style of leadership that involves working with others as full partners in a context of mutual respect and collaboration," citing studies showing that this style of leadership is associated with better patient outcomes, fewer medical errors, and greater staff satisfaction.4


Nurse leaders have an important role in recruitment and retention. Our future leaders will need more education and better preparation. Already, many institutions are requiring nurse leaders to have more education and are creating internal leadership programs for developing future nurse leaders.


So to answer the question "Are there too many leaders and not enough followers?" No, but succession planning and recruiting are key to preparing the leaders and managers of tomorrow. Coaching them to better education and preparing them for the role is the charge of today's nurse managers.


Elizabeth M. Thompson, MSN, RN, CNOR

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Editor-in-Chief Nursing Education Specialist Mayo Clinic, Rochester, Minn. ORNURSE@WOLTERSKLUWER.COM




1. American Nurses Association. Nursing World. Nursing shortage. [Context Link]


2. Bisol S. Succession planning for surgical services leaders: how and with whom will you fill those shoes? Blue Jay Consulting. [Context Link]


3. The Joint Commission. Sentinel Event. Issue 43: Leadership committed to safety. [Context Link]


4. Garner C. IOM sees a future where all nurses are leaders. American Sentinel University healthcare blog. [Context Link]