Business Training for Nurse Managers – Part One

Read the second installment of this series here.

How prepared are new nurse managers?

When asked, many will admit they felt inadequately prepared for their role.

And this is no surprise.

In a 2011 article in Healthcare Financial Management, KD Sanford wrote that many nurse managers admit their first leadership positions were not planned. They were excellent clinical nurses therefore it was assumed they would make excellent managers.

New nurse managers typically have a number of years experience on the unit and within the organization. They know the ins and outs and are respected by their peers.

What the newly promoted manager is typically lacking is business training, even if they have completed a BSN and/or MSN degree program.

These programs generally do not offer any or enough curriculum focused on teaching new nursing leaders how to most effectively and efficiently run their business, i.e., their unit. This accountability has traditionally fallen to the organization.

Sadly, we hear from many organizations and frustrated nurse managers that the on-the-job training is neither effective nor geared to their learning styles and background.

The Knowledge Gap

Financial acumen, an understanding of analytics, and knowledge of staffing strategies are typically the most significant gaps in a nurse manager’s knowledge. Familiarity with these connected areas can catapult a nurse manager into an all-star with unlimited upward potential.

The ability to analyze metrics and begin to make the connections to implement improvements is not a terribly difficult skill to learn. Likewise, some of the more basic best practice staffing strategies are relatively easy to digest.

The most difficult part of learning anything new is letting go of what you think you know and being able to take a step away from the “this is the way we’ve always done it” mentality.

Depending on the aptitude of the individual, a new nurse manager could become competent in just a few hours of training.

More training will be needed for the higher level concepts and strategies, but with a foundational understanding he or she will be able to build on their knowledge by managing through real-life, everyday scenarios.

However, unless given the opportunity of a good mentor (or mentors) to provide the insight and hands-on training to assist them through the process initially, most new managers are not prepared to add insight or positively disrupt and improve the unit’s established processes.

At the very least they will pick up the habits of their predecessors (both good and bad), or they will possibly have to start from scratch, piecing together what they can along the way.

Having a mentor can greatly reduce the anxiety and intimidation many new nurse managers experience.

The role of the nurse manager is critical in the ability of an organization to meet financial and quality targets, to foster high morale, to control turnover, and, of course, to meet quality goals. Organizations that invest in the skill building of these leaders will experience better results and outcomes.

Closing the Gap

The waste that occurs with regard to healthcare labor management comes about one decision at a time. These seemingly insignificant decisions happen every day and everywhere within a hospital, health system, or clinic setting.

Examples of instances that add up quickly include incidental worked time (time on the clock before or after a scheduled shift) and FTE leakage (staff hours worked below their FTE). And there are soft-cost decisions that can become long-term drags on morale and retention such as allowing certain staff members to either pick up extra hours, receive a low census, or float/not float out of order.

A lot of these types of decisions (that should be based on business rules but are not) are the result of managerial naivety – focusing on making decisions that will make people happy instead of following processes that result in fairness.

Often, a lot of new nurse managers’ struggles have to do with the fact that they are caregivers, i.e., they are compassion-centric. They care deeply about others’ happiness and wellbeing, otherwise they wouldn’t be nurses! Managerial training helps new nurse managers separate some of the emotion-based elements from the business operations. This results in more rules-based and data-driven decisions.

The first step to establishing an effective nursing leadership business training program is to embed and facilitate a culture of collaboration and mentorship, both internal to nursing and between nursing and other departments, particularly finance.

Depending upon the current state of the organization, this can be initiated with a shared team-building session which could include HR, nursing and finance in which executive leadership, or whomever appropriate, sets the stage and reminds the team of the company mission/vision. All groups within the organization are working toward the same goal: to provide efficient, top-quality patient care.

Jenny Korth is a senior consultant at Avantas.

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