Best Practices for Developing Nurse Leaders

Nurse Leadership Development

Nurse turnover is an epidemic, occurring most frequently during the first year of employment when expectations of the work environment are not aligned to the realities of the job. Within the nursing profession, turnover rates exceed the norms set for other professions due to clinician burnout resulting from the demands of extensive work shifts and high patient acuity. In fact, the American Organization of Nurse Executives (AONE) reported vacancy rates are as high as 8.3% nationwide among nurse managers. In a research study on organizational commitment and intent to stay, some of the strongest predictors of turnover were related to disempowerment, feelings of inadequacy, and feelings of being ignored. For nurse leaders who do choose to leave, the cost of finding and training a qualified replacement can be upwards of $42,000.

In addition to replacement costs, patient care dramatically suffers in hospitals that experience high rates of turnover. With nurse vacancies, the existing workforce is forced into overdrive to produce a consistent standard of care. In fact, organizations that struggle to retain their nurses experience higher incidents of patient falls and bed induced ulcers. Patients being discharged from hospitals where high amounts of turnover occur are more likely to be readmitted to a hospital within 30 days, compared to hospitals with average  turnover. To mitigate these risks, health systems are becoming more proactive in onboarding their nurse leaders and creating opportunities for leadership development to enable them to thrive on the job. 

Curing the Epidemic of Turnover

Above all, new nurse leaders need to be equipped by their organizations with the tools they need to succeed in their role and to properly acclimate to the social and political environment that comes with the nursing profession. Research shows that authentic leadership and shared decision-making to determine goals are two of the strongest factors that impact a nurse’s success on the job.Other strong predictors include educational options and frequent interactions with peers.  A comprehensive approach to assimilation and ongoing leadership development is an organization’s secret weapon to creating highly engaged nurse leaders.

Key Leadership Competencies for Nurse Leaders

The right competencies are as crucial to success in a nurse leader’s role as clinical competencies are for frontline nurses providing direct patient care. The Center for Nursing Leadership offers a holistic view of the competencies aligned to successful nurse leadership. They conclude that great nurse leaders are skilled in business management, leading others, and self-development. A skilled nurse leader has a thorough understanding of the job as well as the systems (financial, technical, and clinical) that are required to support the healthcare environment. These individuals have also mastered the art of leading their teams by clearly communicating their vision and motivating their teams to achieve their goals. Additionally, effective relationship building and influencing skills provide a strong base for effective strategic decision making. A highly skilled nurse leader has honed his or her skills by taking on challenging opportunities to develop the self-awareness they need to play to their strengths; they hold themselves accountable for their own growth; and, they have aligned their personal strengths with their professional goals.  Creating nurse leaders who can support the environment for success is a crucial investment that can be achieved through internally driven leadership programs. 

Nurse Leadership Development Considerations   

Extensive research has identified three factors that primarily influence effective onboarding and development of nurse leaders. These include use of assessment and coaching, targeted group development, and sustaining performance through peer mentoring.

Assessment and Coaching

Assessments are a common tool in leadership development programs.  These tools provide both personality and behavioral insights for leaders which allow them to target strengths and areas for improvement related to the job. Coaching focuses on providing a new leader with the knowledge, skills, and abilities that are required for a leader’s job and is used as a development opportunity especially at the executive level.  Leadership development which includes an assessment component, coupled with 1:1 individual coaching, results in improvements in nurse leadership competencies. Literature also suggests that programs that use assessments in tandem with coaching result in a greater return on investment, increased engagement, and higher retention. In addition, while assessment and coaching are effective means to develop leaders, coaching is also a great way to sustain performance over time.

A well-defined group leadership program built around the composite needs of a cohort of learners is associated with higher engagement. Results are most effective when content is curated towards overall group needs. Targeted group development can increase retention, improve patient and staff satisfaction, and enhance succession by retaining qualified staff. In addition, targeted group development has been identified as an effective way to build and maintain comradery among staff. Through group work, introspection, and interpersonal communication, group development can effectively remove barriers to understanding and support the development of skills necessary for high performance and organizational engagement.

Mentoring

 Mentoring differs from coaching in that it includes elements like ongoing social support, career development, and role modeling. Research is conclusive that mentorship programs are one of the most effective methods of sustaining the development of nurse leaders over time, as this form of development enables successful acquisition of knowledge, skills, and abilities from one role to another, while providing social support. Social interaction with colleagues and leaders are integral to maintaining expectations and gaining information about the norms of any organization. Not only does social interaction make for a richer and more meaningful mentorship experience, evidence demonstrates that peer support during onboarding has a down-stream financial effect on the bottom line of organizations as it streamlines the onboarding process. When transitioning to a new role, support groups that include other nurse leaders during the onboarding process result in reducing anxiety among new nurse leaders.

Taken together, assessment and coaching, group development, and mentoring can result in the productive integration of new nurse leaders into an organization. This approach exposes new nurse leaders to relationships that are required to be successful in addition to developing the skills, resources, and knowledge to support ongoing success. Moreover, multi-faceted development programs motivate employees, decrease turnover, increase productivity, enhance employee morale, and lower anxiety among new staff.

TLD Group’s Approach to Creating and Sustaining Nurse Leaders

New Nurse Leader Onboarding

Assessment and Data Gathering

• For all newly hired and or newly promoted nurse leaders, TLD Group reviews information on strengths and development needs gathered during the selection/appointment/promotion process (e.g., selection assessment reports from external consultants, internal selection evaluations, etc.).
• TLD Group conducts leadership assessments.
• TLD Group conducts interviews with key stakeholders to gain valuable insights. At a minimum, interviews are conducted with the nurse leaders’ direct supervisor, 2-3 peers, and 2-3 direct reports. Typical questions include: What are your expectations in working with the new leader?  What would be helpful for the new leader to know? What are the potential pitfalls to avoid? 

Feedback and Action Planning

• TLD Group presents results from the assessments, with a focus on stakeholder expectations, areas of opportunity, cultural issues, relationships to be developed and/or leveraged, watch-outs, etc.
• An action plan is developed, based upon the data gathered during the assessment process. The action plan is reviewed with key stakeholders and the nurse executive’s manager.

Team Assimilation Meeting

• TLD Group facilitates an Assimilation Team Meeting with the leader’s new team. The purpose of this meeting is to allow the team to pose questions of the new leader regarding their style, strategic direction and background; clarify objectives and direction; promote integration and communication; clarify expectations and requirements; openly exchange views; identify and provide recommendations; and, accelerate productivity of the entire group.

Individual Coaching

• TLD Group coaches the executive over the first 3 – 6 months for each new leader. During the coaching sessions the objective is to develop strategies for effective assimilation, practice new behaviors and work on action plans for successful integration. 

Measurement of Success & Planning for Sustained Success

• At the end of the assimilation coaching assignment, TLD Group administers an online 360° feedback survey that captures how key stakeholders have experienced the leader to date. TLD Group reviews these results with the nurse executive, and his/her manager.

Group Development

Small group Nurse Leadership Development is designed to supplement the onboarding program.  The basic tenets of this approach are to develop specific leadership skills that all participants will be required to demonstrate as a nurse leader; to create a synergistic experience for individual progress; and to instill a culture of trust, integrity, collaboration, and accountability in the nurse leader cohort.

• New leaders are brought together in small groups of 4-6. The new leaders meet regularly with a leadership development facilitator for a period of 6 months. These sessions include a learning module on one of several leadership topics (e.g., unconscious bias, leading through change, driving engagement, magnet journey (quality metrics), executive presence, managing competing priorities, stepping up, and showing up) followed by a group coaching discussion to instill the learnings and create a peer coach council.  
• Typically, in the first session, the program structure, process and learning elements are discussed - such as how to hold each other accountable, how to communicate during sessions, how to support each other’s growth and more.
• The group meets with an agenda each time. The session agenda is based on the group’s collective leadership development themes and typically includes one theme per session. The agenda is driven by the group, with guidance from the facilitator.
• The group learning includes activities prior to and after each session so the leaders can practice the new skills and concepts learned.  
• During the final session, the group reflects on how they have individually achieved their goals and collectively grown. They also discuss how to sustain their changes and continue their leadership growth.

Mentoring to Sustain Performance Overtime

• A culture of commitment can be generated through self-elected mentors across the organization with expertise in the areas of development that leaders require. Mentees select self-elected leaders of the program once potential mentors have been identified.
• TLD Group utilizes assessment feedback to continue leadership development through a mentor relationship. This method sustains the developmental process by moving growth opportunities into the organization to sustain the development that has occurred with the coach and group development facilitator.
• TLD Group hosts an orientation meeting between mentors and mentees to clarify roles and expectations. Once selected, attendees will learn about the concept of mentorship and the roles they will play in leaders’ development. The orientation meeting functions to facilitate discussion as well as clarify role expectations.
• Learning content is centered around developmental meetings that are identified during coaching engagement. If the coaching engagement has successfully developed the skillset required for the role, mentorship meetings may be based around growth opportunities that mentors and mentees co-identify.
• Meeting agendas are provided for facilitated discussions between mentors and mentees. The meeting agenda templates prompt discussion on areas for improvement and opportunities for development.  

Conclusion

Successful integration and development of nurse leaders is an integral component of any health system’s talent strategy. We recognize that engaging new nurse leaders in interactions that help them understand each other and how they interact with the organization is the core of any successful nurse leadership program. A three-pronged approach to assimilating and development nurse leaders has been determined as the best approach for prolonged success. Onboarding engagements enhance assimilation and focus on specific areas of development for new leaders as identified by a behavioral assessment and reinforced through an action plan.  Group leadership development creates a sense of camaraderie, reduces anxiety, and creates collaboration among nurse leaders. Finally, mentoring sustains learning by creating a local process that supports growth over time.  Taken together, this three-pronged approach tethers nurse leader success to organizational goals and improved job readiness.

ABOUT TLD GROUP

The Leadership Development Group (TLD Group) is a global health industry talent development consultancy. We develop leaders to take on the myriad challenges facing the industry to position their organizations and the industry as a whole for success. Our targeted solutions are designed to engage and empower leaders from within, between, and across the health ecosystem – and include coaching, consulting, leadership academies, and our speaker’s bureau. Our worldwide faculty of over 400 organizational development practitioners, academicians, coaches, and consultants with deep expertise across the health industry, enables us to offer targeted insights and deliver highly impactful results.

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