1. Tuazon, Nelson RN, CPHQ, NEA-BC, MAEd, MBA, MSN, FACHE

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Consider this scenario: One of your managers is retiring soon, another is getting married and plans to relocate, and you're concerned that the critical care unit manager isn't quite making it in spite of intensive coaching and mentoring. As managers move on or move out, it's crucial for the nurse executive to identify potential nurses who can fill management positions. Whether the candidate you have in mind is from an internal pool or someone from another facility, there are several things to keep in mind.

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Start with the basics

One of the traps of succession planning is that we promote the best clinicians, thinking they'll be great managers. But this isn't always the case. Managing people requires special qualifications and training, as does performing clinical bedside nursing.


Depending on your organization's standards and based on the job description, you need to establish the minimum professional experience, educational requirement, and personal and professional development expectations. There's growing recognition of the need for a bachelor's degree in nursing for managers, particularly if your facility is aspiring to achieve or maintain Magnet designation. Additionally, look for a candidate with a track record of commitment to professional development, including continuing education, national certification or specialty training, and membership in a professional organization.


What makes a good manager?

To determine whether the potential candidate will make a strong manager, consider these qualities.


[white diamond suit] Focus on quality and patient safety. Patient safety has increasingly become a top priority for nurse managers. Managers are expected to develop and execute a patient-focused clinical agenda. A strong level of engagement for evidence-based practice is key to ensuring the provision of quality care and keeping patients safe from harm.



[white diamond suit] Attention to patient satisfaction. The nursing management team has the major responsibility and accountability for positive patient care experiences. Mandatory public reporting of patient satisfaction scores has placed significant emphasis on improving the care experience of the patient. A manager with a good grasp of customer service and an excellent interpersonal skill set will be armed with the necessary tools to improve patient perception of the care experience.


[white diamond suit] Financial savvy. Typically, the nursing department is responsible for the majority of the institution's budget. Hospital leaders recognize the direct impact of managers on major business strategic initiatives. The budget needs to be managed effectively, with a focus on increased productivity and decreased premium labor, including agency staff and overtime. The manager's clinical knowledge is critical to identify and develop business plans for markets that need to be explored and expanded.


[white diamond suit] Strong physician relationships and collaboration. Relationships with physicians are one of the most challenging aspects of healthcare management. The nature of the hospital-physician relationship creates tension between managing resources and physician practices. Often this strained relationship leads to ineffective communication and tends to shift attention to complaints regarding poor nursing care or poor care coordination. It's critical for the manager to establish a robust collegial and collaborative relationship with physicians.



Putting the success back in succession planning

So what can you do to ensure you've identified the best candidate to fill an open management position? Here are some tips to follow.


[white diamond suit] Set the expectations from the outset. A dialogue on the expectations of the job is crucial. Burn out and disappointment can be avoided if the new manager is made aware of the management culture of the organization. The applicant needs to understand the line of sight of the nurse executive, the nursing management team, and colleagues. For example, clarify your expectations regarding visibility to all staff. If the unit is a 24/7 operation, discuss plans for rounding all shifts and accessibility to the staff. This will facilitate the transition and acculturation of the new manager and avoid the proverbial baptism by fire.


[white diamond suit] Provide a job preview. Often, the aspiring candidate hears about the promise, the excitement, and the allure of getting a promotion or being hired into a new management role. It's equally important for the hiring executive to provide a job preview to the applicant. Discuss the challenges, issues, and struggles inherent in any management position. Present the ups and downs of the new job. A realistic view of the scope and responsibilities of the job, explained in a manner that doesn't outwardly discourage the candidate, is beneficial for the new manager and the organization in the long run.


[white diamond suit] Pay attention to the other essentials. Although the candidate's resume or curriculum vitae provides objective and measurable qualities, qualifications, and accomplishments, there are other requisites for which you may want to look. Scout for a candidate who values teamwork and has skills in team building. Scrutinize behaviors that demonstrate collegiality and networking with other disciplines and outside of the organization. You need to assess the applicant's use of power and the ability to empower the staff. Appropriate use of power leads to effective decision making, influences staff performance, affords meaningful reward and recognition, and employs appropriate discipline. Empowering staff members is critical in promoting shared decision making. Ascertain the level of trust and trustworthiness of the candidate. Make sure the potential manager's work ethics and values are aligned with organizational values.



Finally, to move the unit and the organization to the next level, look for a candidate who's creative, innovative, and a risk taker. In addition, the ability to multitask, prioritize, and self-direct is vital.


Stamina wins the race

Aspiring managers need to recognize that a management job requires commitment, time, and effort. To sustain the momentum that your organization has achieved or to propel it to your desired state, pursue candidates who have stamina and energy. One of my mentors had sage advice: "Leadership is a marathon, not a sprint. You have to pace yourself and know that you're in it for the long haul."