Finding our way
It started in February with an allnurses.com blog post titled “The Enemy...The Nurse Manager” in which an exhausted new nurse manager who couldn't engage her staff no matter how hard she tried wrote a despairing plea for advice. Then we had the Robert Wood Johnson (RWJ) Foundation report “10 Reasons Why Nurses Want to Leave Hospitals,” which lists managers in the top 10. When the American Association of Critical-Care Nurses posted the report on its Facebook page, several comments affirmed management as one of the reasons, with one remarking on “incompetent nursing leadership.”
The last dose of role assault occurred when I had dinner with a dear colleague who teaches leadership in an RN-to-BSN program. She told me how unhappy her students—all practicing nurses—are and that they're desperate for “compassionate direction.” At that point, it was hard to ignore the persistent, nagging signs of trouble.
Are we at a crossroads where if we aren't on the right road, we'll lose the passion and energy of our clinical staff? Is this a generational issue or a leader development issue? Or are these anecdotal commentaries not reflective of the real world? I'd like to magically think myself into believing the last question, at least for most of the time. We know that transformational leadership has a positive effect on nurse satisfaction, but we don't know how prevalent this style is. The write-in responses to the desperate manager on the allnurses.com blog were similarly about the characteristics of the best leaders—communication, transparency, honesty, and making connections—all transformational traits.
The RWJ report did mention the criticality of the frontline manager role, particularly for new graduates who need empathetic support. Many other sources in the management literature indicate the importance of the middle manager and, maybe more important for this discussion, how difficult it is to be “caught in the middle”—a leader of a frontline team and a direct report of more senior superiors at the same time. Our own Wellness Survey on work stress may give us some more clues and insight (see page 9).
Frontline managers create the unit culture and work environment, are pivotal to all of the outcomes that we care about, and role model the values that matter. We've seen floundering units turn around under new leadership, and thriving units whose leaders have wisely turned into facilitators so that unit staff members flourish on their own.
My takeaway is that we have to help each other and do a better job of preparing, supporting, and engaging frontline leaders. We all struggle at times—some times more than others—but it shouldn't be all of the time and certainly not at the risk of disengaging our staff. Maybe encouragement comes from the work in this journal and other reading, or the mentoring and coaching of others, or thoughtful educational experiences, or an inspired vision with clarity of expectations, or all of these and then some more actual workload relief. Let's make sure that the support is available.
We must find our way through leadership vacuums and to distressed colleagues so that we can shoulder the burden of hard times together and come out on the other side with our well-being intact. There's just too much at stake.