1. Strickler, Jeffery DHA, BSN, RN, NE-BC
  2. Bohling, Stephanie BSN, RN
  3. Kneis, Clare BSN, RN
  4. O'Connor, Megan DNP, MSN, NE-BC
  5. Yee, Patricia L. MSN, CPN

Article Content

Leadership development and succession planning is a challenging task for any organization. The challenge involves translating clinical skill sets so nurses can be as effective in the boardroom as they are at the bedside.1 This article discusses how one large healthcare organization designed and implemented a program to help clinical nurses make the transition into management and other leadership roles.


Building "bench strength" for the future

The University of North Carolina Medical Center (UNCMC) is a large MagnetTM academic medical center. It boasts both a stable long-term core nursing workforce and a young, engaged staff who are early in their careers. UNCMC chose to invest in a Nursing Leadership Academy to facilitate leadership development. The CNO sets the tone and direction of this investment through the organization's mission of developing leaders from within. The goal of the Academy is to build UNCMC "bench strength" so that each department has a succession plan for when current leaders are promoted within the organization and vacancies for new leaders open up, putting younger nurses into the leadership "game."


The Division of Nursing utilizes a four-tiered performance-based "clinical ladder" framework for professional advancement. The clinical ladder levels are based on Patricia Benner's novice-to-expert model.2 Nurses who have been promoted to Clinical Nurse III (CNIII) or Clinical Nurse IV (CNIV) enhance their leadership abilities via the Nursing Leadership Academy, which consists of four courses that focus on topics pertinent to emerging nurse leaders:


* a foundational Nurse Leader Course


* an innovative systems simulation known as "Friday Night in the ER"


* an introductory class on nursing finance


* a Nurse Leadership Fellowship Program (NLFP).



Educational surveys and needs identified by nursing directors and the CNO guide Academy content and objectives. Instructors for each course are selected based on subject expertise, leadership level, and teaching experience.


Assisting nurses on the rise

The Nurse Leader Course is designed to assist rising nurse leaders as they transition into their new roles. New managers and recently promoted nurses are encouraged to attend this 1-day educational program. During the course, participants share experiences and network with other new leaders. This networking opportunity helps build collaborative, supportive relationships.


The program content includes an overview of the Division of Nursing's mission, core values, and philosophy, and provides information about nursing education, professional development, research, evidence-based practice, and accreditation and regulatory compliance. Attendees explore different leadership styles as well as the expectations and challenges of role transition.


Nursing directors and nursing executives from different service lines throughout UNCMC teach the course. This teaching structure gives attendees the opportunity to interact with members of the senior nursing leadership team and learn from their knowledge and expertise.


Learning to play the game

Nurse leaders benefit from a systemwide understanding of patient movement and the consequences of strategic decision-making. UNCMC teaches this concept through "Friday Night in the ER," an innovative board game. The game is an experiential learning session intended to explore systems issues such as communication and strategic planning.


Each game board represents a fictional hospital where each player is responsible for one unit within the hospital. Two game facilitators use flipcharts and game cards to offer instructions on patient movement. Players are given basic instructions and then spend 2 hours playing the game, which represents 24 hours within the hospital. At the end of each hour, players record information about patients who are waiting to get into their unit and staff who have been called in to work. This information is then used to calculate finance and quality scores for each group of players. At the end of game play, participants share and compare their scores.


Facilitators use this opportunity to share more information on how a player's decisions impacted finance and quality scores, examine the effectiveness of communication and teamwork, and discuss with teams how the game relates to real decisions made at UNCMC every day. Players leave the game with a better understanding of how individual actions affect patients and the organization.


Minding the budget

In the modern healthcare environment, nurse leaders are assuming ever-greater responsibilities for unit budget and financial operations. The Academy Finance Course helps new nurse leaders move toward this financial stewardship. Nursing directors or the senior business analyst within the Division of Nursing teach the course, which gives new nurse leaders the chance to meet key staff involved in financial operations.


The course begins with the foundations of finance and provides a rationale for why nurse leaders need this information. Instructors review financial terms used within the healthcare organization, as well as some of the calculations that are used to determine key statistics such as patient days, productivity, and monthly budget variances. Nurses bring a copy of their unit's monthly budget variance report so they can review their own data and gain a better understanding of these tools.


The class spends time discussing labor expenses and the importance of appropriately staffing a unit because labor costs account for most of a unit's spending. The class focuses on budgeting, pitching new projects, and finding ways to make a financial case for a proposed initiative. The course finishes with a discussion on the future of healthcare and the impact of trends on reimbursement.


Fellowship opportunities

The NLFP is a 6-month program created to support the growth of emerging nurse leaders new to the CNIII and CNIV role. Each cohort includes CNIIIs and CNIVs from across the institution who have been in their role for less than 1 year. The diverse background of the group enriches the group dialogue and helps create relationships between nurses across service lines.


The NLFP comprises five didactic classroom sessions covering leadership, communication, professional development, crisis management, and education. Each topic is presented by a nursing leader familiar with the content who shares real-world experiences and tactical strategies to help the Fellows achieve their personal goals. Fellows highly rate this feature of the program because it gives them opportunities to interact with top nursing leaders.


In a sixth session, the Fellows take a "behind the scenes" hospital tour guided by leaders from key hospital departments such as Food and Nutrition, Maintenance, Hospital Security, and Pharmacy. These department leaders help the Fellows understand how departments work together to enhance patient care. In turn, these ancillary departments benefit from introducing nurses to their processes, building collaborative relationships.


Fellows are also assigned a mentor who has committed to meeting with them between sessions. Mentors are chosen by nursing directors because of their proven leadership ability, experience in their roles, and mentoring experience. Most mentors are experienced nurse managers and CNIVs from throughout the hospital. Mentor and Fellow pairings are made across service lines to promote the sharing of ideas and practices with the expectation that the relationship will continue beyond the Fellowship Program. The mentors are given discussion prompts related to each class session to stimulate collaborative sharing. At the end of each Fellowship Program, Fellows rate their experience with their mentors, which guides future pairings.


Tracking outcomes

Continuing-education hours are provided for most classes in the Nursing Leadership Academy, which requires an evaluation at the end. Evaluations are used to improve future classes. Evaluations are consistently positive and written comments indicate that the programs make emerging leaders more comfortable in their roles and more dedicated to growth in a leadership capacity at UNCMC. Annual National Database of Nursing Quality Indicators Surveys and Workforce Engagement Surveys further support the effectiveness of the Nursing Leadership Academy in increasing staff satisfaction, retention, and commitment to the hospital.


Paving the way to promotion

UNCMC has successfully created a leadership program tailored to the culture of the institution and in alignment with the CNO's goals to promote from within. The future is bright for nurses who complete the Nursing Leadership Academy. Current leaders enlist graduates in performance improvement projects, stewardship task forces, and hospital-wide nursing initiatives because of their new skill sets. The Nursing Leadership Academy has paved the way for numerous internal promotions, resulting in substantial recruitment cost savings for the organization while building the tradition of great nursing "bench strength."




1. Pate MF. Nursing leadership from the bedside to the boardroom. AACN Adv Crit Care. 2013;24(2):186-193. [Context Link]


2. Benner PE. From Novice to Expert: Excellence and Power in Clinical Nursing Practice. Menlo Park, CA: Addison-Wesley; 1984. [Context Link]