1. Cox, Sharon MSN, BSN

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Q Having been elected chairperson of our nurse manager council for next year, I want to improve our meetings. We operate in a silo mentality, follow-through is lacking, and we often end in a gripe session. Attendance is uneven, and we're a poor role model for other councils. Where do I start?

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You're rightly concerned about the need to be more productive and cohesive because your peer group is your "first team."1 The nurse manager council meeting is crucial for resolving system issues, ensuring consistent policies and change processes across units, and building horizontal relationships beyond nursing. Clinical nurses compare notes in the parking lot, so it's essential that managers speak with one voice.


This is the perfect time of year for a fall retreat, facilitated by a colleague skilled in group dynamics, to determine if you have a critical mass (one third) of managers who are willing to take ownership for the turnaround you need. Ask everyone to read The Five Dysfunctions of a Team: A Leadership Fable by Patrick Lencioni so that you'll have a common frame of reference.1 Address the issue of ownership by having the group make a list of ways in which they've contributed to ineffective meetings. This list will guide much of your discussion, so be honest. Useful meetings are a shared responsibility for preparation, participation, and follow-through-be careful not to over own this turnaround. Ask your facilitator to attend meetings periodically and offer feedback.


In addition to the typical structure for effective meetings, such as agendas distributed in advance, beginning and ending on time, and minutes with follow-up outlined, develop ground rules so that everyone knows what's expected. Listing three to four behaviors at the bottom of the agenda increases the chances of sustaining needed changes. Address the issues you've identified; for example, assume positive intent; focus on facts, not personalities; and fix the system, not the blame. Update this list quarterly, deleting behaviors that have improved.2 Establish routine agenda items and apply an agreed-upon timed agenda as the meeting begins. Use meeting time for reporting the work being done by various subgroups to ensure that the tone is proactive rather than reactive.


Have the group appoint a process person to notice needed changes in group dynamics, allowing 10 minutes at the end of each meeting for a process check. This helps end side conversations, redirect tangential conversations, and manage disruptive behavior. Routinely make time to celebrate successes. Use a consensus process for decisions-defined as 70% agreement and 100% supportive-rather than voting, which splits groups. As chairperson, ask for a routine monthly meeting with the CNO to improve linkage, negotiate time frames, clear roadblocks, and maintain alignment with organizational initiatives.


To get commitment for consensus decisions, you can use a "thumbs up" approach after completing discussion on an issue. Each person indicates "fully supportive" (thumb up), "can live with it" (thumb to the side), or "I have work to do before I can do this" (thumb down). This visually depicts when you've reached consensus and decreases waffling on decisions. To identify system issues, a hassle audit is helpful. Put a flip chart on each unit and ask staff members to list the hassles they have in getting their work done over a two-day period. Pool this information as a group and pinpoint system issues, breakdowns in ancillary services, and quick fixes.


Utilizing department liaisons can help build horizontal relationships. Managers volunteer to become the contact for key departments, such as human resources, materials management, information technology, and pharmacy, acting as the conduit for communication regarding departmental concerns. Another best practice involves developing an orientation process for new managers and assigning them a buddy as part of the onboarding process. Making a group directory that includes each manager's background and areas of expertise, such as scheduling, physician issues, and staff development, also increases group cohesion.


Make this fall retreat an annual time for reflection, planning, and celebration of your turnaround!




1. Lencioni P. The Five Dysfunctions of a Team: A Leadership Fable. San Francisco, CA: Jossey-Bass; 2002. [Context Link]


2. Cohen S, Cox S. Essential Skills for Nurse Managers. Danvers, MA: HCPro; 2015. [Context Link]