Karlene Kerfoot

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Nurse managers play an essential role in uniting exceptional patient care with a healthcare organization’s mission and operational goals. They serve in key administrative roles overseeing daily operations, hiring and retaining staff, conducting ongoing training, assuring quality outcomes are achieved, creating and maintaining departmental budgets, and promoting financial stewardship. In addition to these ongoing responsibilities, nurse managers create healthy work environments, provide emotional support for teams, and are a major component in addressing fatigue and burnout throughout the industry.

 are considering leaving the profession, and amid unprecedented burnout and turnover among nurses at all levels, there’s increased urgency for healthcare organizations to develop a formal nurse manager succession plan. Today, 

of healthcare organizations have a formal leadership succession plan in place for nurse manager positions. 

When vacancies arise at the nurse leadership level and a succession plan isn’t in place, there can be immediate and detrimental effects on the broader workforce, as well as the quality and safety of patient care. The most successful healthcare organizations will be those that integrate nurse manager succession planning into their workforce management strategy.


Without effective nurse leaders, organizations may have trouble finding and keeping enough nurses, and without enough nurses on staff, it’s virtually impossible for a hospital to provide high-quality patient care and meet their operational goals. Organizations need nurse managers tomake tough, compassionate, data-driven staffing decisionsand stay on top of workforce developments to always ensure adequate staffing.

Nurse manager succession planning is not the same as replacement hiring – rather, it’s a proactive and deliberate process in which an organization forecasts staffing needs before a vacancy causes a leadership crisis. Succession planning involves developing a talent pipeline, identifying potential future nurse leaders, and equipping those nurses with the leadership competencies to transition into nurse manager roles when a vacancy occurs.

When healthcare organizations have a nurse manager succession plan in place, they can better weather operational changes and prevent disruption. Strategic planning also supports leadership and cultural continuity by demonstrating a strong organizational commitment to internal human resources.

Here are sixsteps healthcare organizations can take to develop an effective nurse manager succession plan:

1. Document current nurse manager competencies and responsibilities.


Beyond basic leadership skills, identifying a nurse manager’s primary responsibilities is a foundational step in creating an effective succession plan. This ensures that hospitals will seek the right person whose skillset best aligns with the job description and organizational culture.

Recruiting and retaining nursing staff is an essential part of nurse managers’ responsibilities, but there are several other areas where nurse managers provide equal value. For example, establishing goals for their unit and ensuring these goals are met, implementing evidence-based practices, creating healthy work environments, and overseeing unit-based finances are just a few examples of the multi-faceted roles nurse managers play. As such, ideal nurse manager competencies should include areas such as financial management, human resources management, performance improvement, strategic planning, and clinical practice knowledge, among others.

When thinking about nurse manager succession planning, it is essential to identify future leaders who have the potential to deliver on these diverse responsibilities based on how your specific organization prioritizes them.

2. Assess current talent to identify potential future leaders.


Effective nurse manager succession planning depends on leveraging your organization’s talent pool. This requires the use of objective, performance-based measures to help capture and identify high-performing, high-potential nurse manager talent. Organizations must assess an individual’s current performance and their level of potential as a future leader. 

Considering the difficulty of the position, the talent pool of nurses who want to be nurse managers is not large. Watching your manager work long hours with minimal recognition is a deterrent to many people considering the position. Succession planning also involves spotting nurses with potential and engaging in dialogue to explain how they can be extremely influential and impactful in the nurse manager position. 

3. Develop infrastructure for internal training and mentorship opportunities

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Once a potential nurse manager is identified, curriculum content for leadership development should be centered around concepts of strategic planning, business and finance management, human resources, informatics, quality improvement, team building, communication, and conflict resolution skills. However, we have learned with the pandemic that formal mentoring has become difficult and informal mentoring serves as an effective alternative. Training infrastructure must include the leading practices of informal mentoring as a centerpiece of the project. 

4. Implement individual development plans

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These plans should be prepared for each identified successor based on their unique current capabilities and expected competencies for the targeted role. The specific characteristics and skills sought likely will need to be tailored to the organization and its culture. 


Examples of data-driven outcomes for your nurse manager succession plan might include retention and time taken to fill vacancies, as well as nurse manager empowerment, engagement, and achievement of role competencies within four months post-intervention. Note that an organization’s 

 is dependent on having a formal nurse manager succession program with empirical outcomes.

While succession planning is strategically important, retention of workforce talent is equally critical. Succession plans that don’t address root causes of turnover are not effective and are merely reacting to the revolving door. Organizations can strengthen retention by integrating appropriate technology that identifies high turnover risk employees and creating effective interventions to reduce turnover.

Equipping nurses with the leadership competencies to transition into nurse manager roles is essential as the industry faces lingering challenges from the pandemic, as well as a host of other staffing and workforce challenges. When nurse manager vacancies arise, a formal succession plan ensures that there are internal procedures in place to accommodate changes in employment. This not only benefits patient care but can also reduce recruitment and replacement costs. Ultimately, nurse manager succession planning is a part of a successful workforce management strategy that prepares healthcare organizations for critical and time-sensitive transitions with as little interruption as possible.

Karlene Kerfoot, PhD, RN, FAAN, is Chief Nursing Officer at symplr. As CNO, Karlene is responsible for integrating the science of patient care, staffing, and clinical informatics into symplr solutions. Prior to joining symplr in 2011, she was the Corporate Chief Nursing and Patient Care Officer at three of the largest US healthcare systems

Articles

Twenty percent of nurse managers are considering leaving the profession, and amid unprecedented burnout and turnover among nurses at all levels, there’s increased urgency for healthcare organizations to develop a formal nurse manager succession plan

The Importance of Nurse Manager Succession Planning 

Burnout is a long-standing issue among staff in healthcare and a key contributor to America’s on-going nurse shortage. Registered nurse (RN) turnover costs a hospital between $3.6m – $6.5m annually, according to the 2021 NSI National Health Care Retention and RN Staffing Report.

Prior to the pandemic, 1.2 million registered nurse vacancies were predicted by 2022 as aging baby boomers retire and health care needs grow. This number will likely increase because of the COVID pandemic which added unprecedented levels of duress to already-overstretched nurses. Burnout is causing early retirement and prompting others to leave the hospital grind for less demanding environments. Fewer than 50% of nurses today work in a hospital. Half opt for less stressful settings with more predictable hours like ambulatory surgery centers (ASCs) and stand-alone specialty clinics.

Hospitals are in an arduous position. The American Association of Colleges of Nursing (AACN) reports nursing schools across the country are struggling to expand capacity to meet the rising demand for care. Hospitals also compete with ASCs, specialty clinics, entrepreneurial start-ups and established healthcare-related businesses for talent. Savvy hospital leaders recognize that to successfully attract—and retain—talent they must reassess how they view nurses. Otherwise, patient health–and a hospital’s bottom line–are at risk.

Nurses are typically viewed through two vastly different lenses. To some healthcare leaders, nurses are seen as an expense. And to minimize expenses, nurse headcount is reduced. When stretched thin stress levels are higher, retention is low and patient satisfaction and outcomes frequently suffer.

In comparison, nurses working in a hospital where they are viewed as an investment—not an expense—tend to be happier, patient satisfaction is higher, and outcomes are typically better. Nurses in these environments are nurtured and trained to ensure they have the skillsets needed to do their jobs to the best of their ability. Magnet hospitals are a great example of the successes associated with investing in nursing staff.

Magnet designation by the American Nurses Credentialing Center (ANCC) is considered the “gold standard” for nursing excellence. To attain Magnet status, a hospital must meet a lengthy series of credentialing requirements through the AANC’s Magnet Recognition Program. Achieving Magnet status is a multi-year, costly process. Supporters believe overwhelming that the benefits of the program far outweigh the costs. Evidence shows that turnover is much lower in Magnet hospitals, as nurses are more satisfied. In fact, Magnet hospital are often sought out by nurses. Quality outcomes and patient satisfaction are also markedly better at Magnet hospitals.

Since demand exceeds supply, the competition for nursing talent is fierce. Hospitals can no longer turn a blind eye to workforce issues.They must do a better job of attracting—and retaining—quality nurses. Achieving Magnet status is not an immediate solution, but there is much to learn from this extraordinarily successful gold standard program. A great starting point is taking a hard look at how nurses are viewed by the leadership team and then, look at staffing.

Staffing levels and talent acquisition efforts can have a significant effect on nurse satisfaction and an organization’s bottom line. Headcount planning must be strategic. Healthcare-specific talent management software and advisory solutions make it easier to hire, keep and grow quality talent. Workforce management systems simplify managing labor costs including time, attendance and staff scheduling. An integrated, enterprise-wide system ensures consistency across health systems with multiple hospitals.

The adage, happy employees are loyal employees, certainly rings true in the healthcare industry. Employees who feel valued at work are more motivated to do their best work. With adequate staffing in place, meaningful recognition programs help maintain a culture and environment where people grow and feel appreciated. One of the most notable recognition programs for nurses is the DAISY (Diseases Attacking the Immune System) Award, an international recognition program that honors and celebrates the skillful, compassionate care nurses provide every day in bedside, leadership/manager and educator roles. 

 was established by the family of J. Patrick Barnes after he died from complications of the auto-immune disease ITP in 1999. During his hospitalization, they deeply appreciated the care and compassion shown to Patrick and his entire family. When he died, they felt compelled to say "thank you" to nurses in a very public way. More than 4,800 healthcare facilities and schools of nursing in all 

Technology should facilitate better care, not be a distraction. Learn how technology is impacting day-to-day work. Using multiple, disparate systems can be a real headache and another key contributor to nurse burnout. Integrated technology minimizes data entry requirements, and minimizes errors associated with redundant data entry. When processes are streamlined and simple, there is less chaos on the frontline.

Hospitals owe it to people on the frontline to make their lives easier and simpler. It is a moral imperative that nurses are recognized as an investment; and have the resources they need thrive and grow.

Karlene Kerfoot is the Chief Nursing Officer at 

, a global leader in enterprise healthcare operations including governance, risk management, and compliance (“GRC”) SaaS solutions.

Burnout is a long-standing issue among staff in healthcare and a key contributor to America’s on-going nurse shortage, says Karlene Kerfoot in this opinion piece.

Karlene Kerfoot

Articles

The Importance of Nurse Manager Succession Planning

Strategies to Combat Burnout in the Hospital Setting