From Nurse to Nurse Manager

Schlaak, Mary Ellen, MSN, RN.AAACN Viewpoint; Pitman Vol. 41, Iss. 2, (Mar/Apr 2019): 1,13-14.

Abstract
In today's complex, rapidly changing, and unpredictable health care environment, the nurse manager must also
possess business acumen, emotional intelligence, an ability to communicate effectively across disciplines, and a
drive to fully participate in the process to improve efficiency and outcomes - thereby increasing the value of health
care. In some cases, nurse managers in ambulatory care settings have the added responsibility of developing new
staffing models to accommodate the influx of patients with increasingly complex health care needs. Nurse manager
competencies identified by the American Organization of Nurse Executives (AONE) include, but are not limited to,
financial and human resource management, performance improvement, foundational thinking, technology, strategic
thinking, clinical knowledge, personal/professional accountability, career planning, relationship management,
influencing behavior, and shared decision making (AONE, 2015).

Historically, staff nurses have been promoted to nurse manager positions based on excellent clinical skills and
knowledge, but have needed to rely on 'on the job training' in order to develop the competencies necessary for
effective management. In today's complex, rapidly changing, and unpredictable health care environment, the nurse
manager must also possess business acumen, emotional intelligence, an ability to communicate effectively across
disciplines, and a drive to fully participate in the process to improve efficiency and outcomes - thereby increasing
the value of health care. Vitale (2018) acknowledges "there is evidence that nurse leaders are ill equipped in terms of
knowledge and may lack support and guidance to manage the challenges inherent in the role, such as productivity,
job satisfaction, and retention concerns" (p. 8). This lack of preparedness, coupled with a lack of organizational
support, leads to decreased job satisfaction, increased job stress, and an increased nurse manager turn-over rate
which can lead to unit/department and organizational instability. The nurse manager who is ill-prepared and
overwhelmed by the scope of responsibility inherent in the role also presents a less than favorable image of the role
which could, in turn, discourage staff nurses to pursue opportunities in nursing leadership (Warshawsky & Havens,
2014). With a surge of nurses, including nurse managers reaching retirement age, our profession must rethink the
way in which we prepare the next generation of nurse managers and leaders.

Nurse managers, in both acute and outpatient settings, are responsible for communicating and implementing
organizational mission, vision, and values, to nursing non-licensed and ancillary personnel at the point of care. In
some cases, nurse managers in ambulatory care settings have the added responsibility of developing new staffing
models to accommodate the influx of patients with increasingly complex health care needs. As more organizations
move to a value-based reimbursement system, it is imperative that the nurse manager has the skill set to lead high
performing, interprofessional teams to achieve expected clinical outcomes and organizational goals. Nurse manager
competencies identified by the American Organization of Nurse Executives (AONE) include, but are not limited to,
financial and human resource management, performance improvement, foundational thinking, technology, strategic
thinking, clinical knowledge, personal/professional accountability, career planning, relationship management,
influencing behavior, and shared decision making (AONE, 2015).

It is no longer feasible to promote nurses to management positions based on clinical skills alone.
Advanced nursing education - beyond the baccalaureate level - is the first step in preparing the next generation of
nurse managers and leaders. While many undergraduate nursing programs include course work
in nursing leadership, the focus of undergraduate nursing education, by necessity, must emphasize basic clinical
competency. The depth and breadth of undergraduate leadership course work is not adequate to prepare the next
generation of nurse managers. It is interesting to note that while graduate nursing education is a prerequisite for both
the Certified Registered Nurse Practitioner (CRNP) and the Clinical Nurse Specialist (CNS), it is not a prerequisite
for the nurse manager. A review conducted by Thompson and Fairchild (2013) reported a positive correlation
between advanced nursing education and nursing professionalism, which was found to have a direct impact on staff
satisfaction and retention.

Nurse managers are tasked with the responsibility of creating and maintaining Microsystems of care that promote
patient and family engagement which in turn will lead to improved patient outcomes and population health (Deyo,
Swartwout, & Drenkard, 2016). Nurse managers are expected to lead interprofessional teams and participate in
quality improvement initiatives. They are also the frontline leaders who regularly identify, plan, and implement
quality improvement programs. This work involves using evidence-based practice and data to continuously monitor
care processes and outcomes to improve the quality and safety of health care delivery at the microsystem level
(Djukic, Kovner, Brewer, Fatehi, & Jun, 2015). The Counsel on Graduate Education for Administration
in Nursing advocates for Master of Science in Nursing preparation and board certification for NMs (Pawlak, Scott,
& Murphy, 2013). Advanced nursing education - beyond the Baccalaureate level - coupled with
continuing nursing education, which focuses on leadership competencies, will provide the nurse manager with the
knowledge and skills that are necessary to successfully navigate and improve health care systems.

Nurse managers are the face of nursing leadership at the point of care in all health care organizations. In addition to
educational preparedness, the novice nurse manager requires ongoing support from executive nursing leadership and
health care organizations. Developing and implementing strategies to support, recruit, and retain nurse managers can
lead to organizational success and stability. Successful strategies include identifying nurses who demonstrate a
willingness to learn and perform under challenging conditions (Glassman & Whithall, 2018), implementing a nurse
manager residency program where prospective nurse managers participate in a year-long structured training
(Watkins et al., 2014), and nurse leader mentorship. Mentorship is a proven strategy that has been utilized to provide
support and guidance to new-to practice registered nurses. Mentorship can also be utilized to
promote leadership development in nurse managers. Leadership succession planning through mentorship has been
identified as an evidence-based strategy in the identification and promotion of nurse managers (Vitale, 2018).
Nursing leadership is an evolving discipline which requires an advanced skill set. This skill set includes advanced
planning and education among nursing professionals who aspire to nurse management positions. Effective nurse
managers develop their skills through a combination of experience and formal education. Current research suggests
graduate-level preparation is an essential foundation for nursing leadership positions, with specific training and
certification in health care leadership preferred (Pawlak, Scott, & Murphy, 2013). As the largest segment of health
care professionals, nurses are poised to lead the way in transforming health care in the United States, and this
transformation begins with the nurse manager. ?

Mary Ellen Schlaak, MSN, RN, is Director of Ambulatory Nursing, Department of Obstetrics and Gynecology,
Thomas Jefferson University Hospital, Philadelphia, PA. She may be contacted at [email protected]

Sidebar
As the largest segment of health care professionals, nurses are poised to lead the way in transforming health care in
the United States, and this transformation begins with the nurse manager.

References
References

American Organization of Nurse Executives (AONE). (2015). Nurse manager competencies. Retrieved from
http://www.aone.org/resources/nurse-manager-competencies.pdf

Deyo, P, Swartwout, E., & Drenkard, K. (2016). Nurse manager competencies supporting patient engagement
[Special section]. The Journal of Nursing Administration, 46(3S), S19S26. doi:10.1097/NNA.0000000000000318

Djukic, M., Kovner, C.T., Brewer, C.S., Fatehi, F, & Jun, J. (2015). Educational gaps and solutions for early-career
nurse managers' education and participation in quality improvement. The Journal of Nursing Administration, 45(4),
206-211. doi:10.1097/NNA.0000000000000186

Glassman, K.S., & Whithall, J. (2018). Nurse manager learning agility and observed leadership ability: A case
study. Nursing Economics, 36(2), 74-82.

Pawlak, R.P., Scott, E.S., & Murphy, L.S. (2013). Crossing our quality chasm: Continuing the case for graduate
preparation for nurse managers and leaders. The Journal of Nursing Administration, 43(12), 627-629.
doi:10.1097/NNA.0000000000000003

Thompson, J.A., & Fairchild, R. (2013). Does nurse manager education really matter? Nursing Management, 44(9),
10-14. doi.org/10.1097/01.NUMA.0000433382.65013.ba

Vitale, T.R. (2018). Nurse leader mentorship. Nursing Management, 49(2) 8-10.
doi:10.1097/01.NUMA.0000529932.89246.ab
Warshawsky, N.E., & Havens, D.S. (2014). Nurse manager job satisfaction and intent to leave. Nursing Economics,
32(1), 32-39. Retrieved from https://www.ncbi.nlm.nih.gov/ pubmed/24689156

Watkins, A., Wagner, J., Martin, C., Grant, B., Maule, K., Resh, K., ... Thompson, E.J. (2014). Nurse manager
residency program: An innovative leadership succession plan. Dimensions of Critical Care Nursing, 33(3), 121-128.
doi:10.1097/ DCC.0000000000000036

Word count: 1216

Copyright American Academy of Ambulatory Care Nursing Mar/Apr 2019
Title: From Nurse to Nurse Manager

Reference: Schlaak, Mary Ellen,M.S.N., R.N. (2019). From nurse to nurse

manager. American Academy of Ambulatory Care Nursing.

Summary:

Historically, staff nurses have been promoted to nurse manager positions based on
excellent clinical skills and knowledge, but have needed to rely on 'on the job training' in
order to develop the competencies necessary for effective management. In today's
complex, rapidly changing, and unpredictable health care environment, the nurse
manager must also possess business acumen, emotional intelligence, an ability to
communicate effectively across disciplines, and a drive to fully participate in the process
to improve efficiency and outcomes - thereby increasing the value of health care.

It is no longer feasible to promote nurses to management positions based on clinical

skills alone. Advanced nursing education - beyond the baccalaureate level - is the first
step in preparing the next generation of nurse managers and leaders. While many
undergraduate nursing programs include course work in nursing leadership, the focus of
undergraduate nursing education, by necessity, must emphasize basic clinical
competency. The depth and breadth of undergraduate leadership course work is not
adequate to prepare the next generation of nurse managers.

Nurse managers are expected to lead interprofessional teams and participate in quality
improvement initiatives. They are also the frontline leaders who regularly identify, plan,
and implement quality improvement programs. Advanced nursing education - beyond
the Baccalaureate level - coupled with continuing nursing education, which focuses
on leadership competencies, will provide the nurse manager with the knowledge and
skills that are necessary to successfully navigate and improve health care systems.

Nurse managers are the face of nursing leadership at the point of care in all health care
organizations. In addition to educational preparedness, the novice nurse manager
requires ongoing support from executive nursing leadership and health care
organizations. Developing and implementing strategies to support, recruit, and retain
nurse managers can lead to organizational success and stability. Mentorship is a
proven strategy that has been utilized to provide support and guidance to new-to
practice registered nurses. Mentorship can also be utilized to
promote leadership development in nurse managers.

Nursing leadership is an evolving discipline which requires an advanced skill set. This
skill set includes advanced planning and education among nursing professionals who
aspire to nurse management positions. Effective nurse managers develop their skills
through a combination of experience and formal education.
Reflection:

I’ve been a nurse for a while now, and I love my job. There’s nothing that thrills me more
than knowing I'm making a difference and helping those in need.

But I'm starting to think that I want to increase my impact even more. In the nursing
field, you can’t really climb the corporate ladder by schmoozing your boss or putting in
extra hours. But there are ways you can increase your responsibilities. If you’re a
natural leader and you enjoy helping others succeed, you may have what it takes to
become a nurse manager. I've already mastered the skills needed to be a great nurse.
But those will only get you halfway to a management role. Just because you have
impeccable bedside manner does not mean that you will be able to lead others to do the
same. Managers must be able to lead, inspire and motivate others to provide the best
care possible.

It takes a special person to become a nurse manager who is talented in what they do.
Not only do you need to be a talented communicator and possess business know-how,
you also need to be a skilled nurse who has a way with patients and their families. If you
believe that you have the leadership skills, professional values and the qualities that you
need to take on a managerial role, it is time that you learn what steps you will need to
take to hold a nurse management title.

You will need nursing skills and managerial skills to work alongside other talented
nursing managers. To attain the skills you need, you will need to complete an
undergraduate program and then an advanced graduate program. Be sure to learn what
it takes to get certified as a nurse manager and then you can earn a higher salary range
while you open up new paths.

I love the feeling I have when I leave work each day knowing that I made a difference in
my patients’ lives. If you’re ready to use a different skill set to help impact nursing at a
higher-level, becoming a nurse manager may be the perfect change of pace for you.