Frontline Nurse Leader Development Sigma Theta Tau 41st Biennial Convention November 1st, 2011

One of Four Key IOM Messages Foster leadership skills and competencies Nurses must see policy as something they shape #3) Nurses should be full partners with physicians and others in redesigning U.S. health care IOM (December 2010) The Future of Nursing

The Evidence on Nursing Leadership Many current nurse leaders “fell into their positions” and often did not received orientation, coaching or mentoring. Nurse leaders play a critical role in the recruitment and retention of staff. Nurse leaders play a key role in the establishment of healthy work environments. Recruitment of nurses into leadership roles can be very challenging. The expectations of nurse managers have significantly increased over the past decade and there is greater reliance on charge nurses to manage clinical leadership issues. By the end of the decade, succession planning will be a critical issue for nurse leaders.

The Study Exploratory Descriptive design with a goal to learn about the perspectives of current charge nurses on frontline leadership development. Conducted in the Spring of 2010 during 10 charge nurse workshops in South Florida with 354 study participants. Survey included open and closed ended questions designed to determine the following: Leadership qualities needed by Frontline Leaders Role challenges Role satisfiers Interest in applying for formal leadership roles

The Sample N Completing Survey = 354/400 All Currently in Charge Nurse Roles Age (Mean) 46.4 Years of Age SD = 5.7 Gender 91% Female 9% Male Highest Level of Nursing Education 44% Associate Degree 38% BSN 11% Diploma 7% Masters Degree 0% Doctorate Years of Nursing Experience (Mean) 19.5 Years SD = 6.4 Practice Setting 26% Critical Care 22% Telemetry 16% Medical-Surgical Unit 11% ER 7% OB/GYN 5% OR 2% Oncology 2% Pediatrics 11% Other

Leadership Qualities Theme Qualities Frequency Mentioned Manages Communication Listening Skills Keeping Everyone Updated Sensitivity to Communication Styles Confronts Conflict Directly 293 Acts as the Team Coach Clinical Competence Seen as a Go-To Person Expert Educator Cheer Leader for the Team Team Player Collaborative Knows how to Delegate 243 Seen as Approachable Non-judgmental Caring Demonstrates Empathy Positive Corrective Feedback Transparent Available 183 Works like an Air Traffic Controller Organizes the Work of the Team Ability to Prioritize Reduces Unit Chaos Multi-tasks Manages Stress 168 Viewed as a Professional Confident Assumes Accountability for Actions Diplomacy with Interdisciplinary Team Role Model Leadership respected by all Professional Advocate for Nursing 123

Most Challenging Role Responsibilities Frequency Checked Managing Conflict on the Team 313 Keeping Patients and Families Satisfied 225 Staying Current with Changes in Policies and Procedures 203 Delegating Care to Others 119 Ensuring Good Communication with Team Members 115 Meeting Regulatory Requirements 112 Maintaining a Safe Patient Care Environment 105 Making Staffing Decisions 95 Supervising the Work of Others 92 Coaching and Giving Feedback Facilitating Education and Orientation 86 Communicating with Physicians and Consulting Physicians 76 Making Patient Care Assignments 58 Acting as Preceptor for New Staff 54 Arranging Patient Transfers 39 Other 26

Most Satisfying Aspect of the Role Theme Satisfying Aspects Frequency Mentioned Developing Staff Coaching Staff Watching New Graduate Grow Teaching Others Serving as a Mentor 90 Keeping Patients Happy Satisfied Patients/Families Good Patient Outcomes 87 Leading the Team When Team Functions Well When Staff are Happy Positive Feedback on Leadership Skills 79 Making a Difference Solving Problems Keeping things from Falling through the Cracks Avoiding Near Misses 62 Managing Unit Flow Trouble Shooting Problems Avoiding Chaos Organizing Care and Staffing Resolving Conflict 40 Becoming a Leader My Personal Growth Serving as a Role Model Having Autonomy Being a Good Communicator 29 Maintaining Quality Keeping Patients Safe Meeting all the Measures Caring about Quality 10

Would You Consider a Nurse Manager Role? 36% Would Definitely Consider 46% Would Possibly Consider 21% Would Definitely Not Consider

What would stop you? Theme Factor Subthemes Frequency Mentioned Role Compensation Loss of Salary Lack of Job Security Loss of the 12 Hour Shift Unpaid Hours Expected Loss of Overtime/Shift Differentials 50 Role Stress Role expectations from staff, management, patients and families Role responsibilities Organizational Politics Regulatory/Compliance Accountability Paperwork and Budget Leaving the Bedside Loss of clinical skills Loss of direct patient care contact Loss of satisfaction from patient care 41 Role Qualifications Lack of Academic Education Lack of advanced leadership skills Lack of Self Confidence to Lead at that Level 39 Role Support Anticipated lack of Support from Leaders Sandwiched between Leadership & Staff No Organizational Mentors 35 Outside Support Significant Home and Personal Obligations Childrearing Lack of Support from Spouse 22

Implications The Charge Nurse role is very challenging in today’s environment. Charge Nurses need ongoing competency development to keep pace with changes in the system. Strong Interdisciplinary Teamwork is needed to promote change but managing team conflict is challenging. Developing and coaching staff is a key role satisfier and should be used to encouragement nurses to assume charge. Charge Nurses are considered to be a key group to recruit from for formal leadership positions but many are ambivalent about moving into these roles.

Upcoming Publications Sherman, R.O., Schwarzkopf, R. & Kiger, A. (in press). Charge nurse perspectives on frontline leadership in acute care environments. International Scholarly Research Network: Nursing.   Schwarzkopf, R., Sherman, R.O. & Kiger, A. (in press). Taking charge: Frontline nurse leader development. Journal of the Continuing Education in Nursing.

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Contact Information Christine E. Lynn College of Nursing Florida Atlantic University Rose O. Sherman, EdD, RN, NEA-BC, FAAN Emerging Leader Project Director Associate Professor/Director, Nursing Leadership Institute (561) 297-0055 E-Mail rsherman@fau.edu