1. McCarthy, Jonathan E. RN, MSN, CNAA, BC


These guidelines can help new nurse managers adjust to their roles and create climates of growth and change.


Article Content

In our ever-evolving world of healthcare, the only certainty is change. Encouraged by some, resisted by others, today's nurse manager must execute change in a constantly evolving environment. For new managers, this becomes even more of a challenge.


One: Promise small, deliver large

As anyone who's ever begun a new position can attest, the first thing most of us want is to be "liked" by the staff. This often starts in the interview process, as you obviously want staff to accept you from the beginning. Much like politicians, new managers sometimes try to make promises they're unable to keep. "Promise small, deliver big" is a philosophy that serves new managers well, as a way to build rapport with the staff and prove you can deliver what you promise. In contrast, failing to deliver on promises allows naysayers to tout the "I told you so" argument to change.


Two: Create a 90-day plan

Strategic planning is the basis for all business ventures. As the manager of a nursing unit, you're the CEO of your own small business, with responsibility for millions of dollars in revenue and expenses. As such, plan accordingly.


Identify three or four goals, and deliver or at least make progress on each one. Share the successes with your staff and be sure to give credit where it's due. When the staff achieves a goal, celebrate it publicly in meetings and other communication mediums. As you meet goals, revise the original plan and continue to set higher standards with each revision. All goals don't need to be profound-they may be as simple as increasing your per-diem pool to help provide better coverage for time off. The important factor is to ensure goal achievability.


Three: Keep "resisters" close

Nursing units often have obstructionists-those who use the shield of tradition to fend off the winds of change. It's important to identify likely allies in affecting change. In every interview, people stand out as either likely supporters or likely resisters. Embrace the supporters upon your arrival, and encourage their input on a path to change. Lean on your allies as much as possible in the beginning, as they can tell you about past attempts and why they were unsuccessful.


During the planning phase for your changes, identify "fence-sitters" and resisters, then include them in the process. There's probably no bigger victory than having one of your most resistant staff members come on board and champion a cause. Be sure to encourage and reward innovation and creativity.


Four: Pick popular battles

One of the pitfalls new managers face is setting unrealistic goals and then failing to achieve them, which leads to discouragement and decreased risk taking. If you choose winnable battles, you can easily demonstrate success and build rapport with your staff. Common obstacles on nursing units include attendance and special deals.


Attendance is always an issue with staff. Use your company's policies to your advantage. By simply enforcing the absenteeism policy, you can improve morale and increase productivity. As some problematic employees work through the disciplinary process, they often recognize that the unit isn't a good fit. Conversely, others may realize that they'll be held accountable and change their behavior.


Special deals can also impact staff cohesion. In situations where the same manager has worked on a unit for a long time, some employees may have a schedule or other arrangements that aren't in line with the general staff. Although it may be painful, it's important to set a time frame and eliminate as many "deals" as possible. Staff members appreciate equity and feel more valued when everyone's held to the same standards.


Five: Find the right people

Turnover is often inevitable, but your response to it will ensure future success. Many managers recruit staff when they have an opening or when a new class graduates from nursing school. Recruitment needs to begin when nursing students arrive on your floor to learn. If their learning experience is positive, they may decide to work with you. But if they don't have a fulfilling tour of duty, they'll likely never work in your unit or at your institution.


Encourage staff members to be preceptors and identify the strongest students as potential nurses for your floor. They can also help identify potentially poor fits before they join your unit.


When you interview potential candidates, avoid hiring someone with a marginal track record. Your current staff members would probably rather work harder for a bit longer to ensure the right person is in the position.


Being a new manager is difficult at best. The key to success is to believe in your staff members, draw on their strengths, and most importantly, believe in yourself. The people who chose you for the position obviously saw the leadership skills necessary to promote change and be successful. Be an innovator, be a change agent, and take risks.