Is healthcare paying enough attention to nurse leaders?

Over the past few years, much of the discourse on supporting the well-being of healthcare workers has focused on nurses and front-line teams — and rightfully so, as many nurses continue to report burnout stemming from their work environment. But to ensure efforts meant to support bedside nurses live up to their full potential, hospitals and health systems should be placing an equal focus on nurse managers, leaders say. 

"Managers and nurse leaders have always been forgotten from the conversation," Jennifer Mensik Kennedy, PhD, RN, president of the American Nurses Association, told Becker's

Early this year, the American Organization for Nursing Leadership Foundation released findings from more than 2,400 nurse leaders who were surveyed in November. Thirty-five percent of respondents indicated they were considering an exit from their roles: 12% said they intend to leave and 23% said they may leave within the next six months. When asked what the top reasons were for thinking about an exit, nurse leaders pointed to work having a negative affect on their health and well-being and not having the resources to do their job — a parallel to what bedside nurses consistently point to as drivers of burnout or reasons they've stepped away from the job. 

Meanwhile, when nurse leaders were asked what boosted their work satisfaction, being able to take time off when needed, work-life balance support, professional development and transparent communications were among the top selected responses. 

"Oftentimes when we talk about the [work] environment and what direct care nurses need, it's the same exact thing that the nurse managers and leaders need," Dr. Mensik Kennedy said. 

Optimizing managers' workload and scheduling flexibility are two key areas of focus chief nursing officers have mentioned when it comes to supporting leaders on their teams. On this front, health systems have taken a close look at what nurse managers are responsible for on a given day to identify what tasks could be delegated through technology or other roles. 

Coaching, time card edits and developing schedules for their departments were some of the key tasks that surfaced when Keck Hospital of USC in Los Angeles conducted an audit of nurse managers' workload last year. 

"None of our nurse leaders are doing that," anymore, Ceonne Houston-Raasikh, DNP, RN, the hospital's CNO, told Becker's last fall. "All of that work is consistently delegated to assistant nurse managers." 

In addition to relieving administrative burdens, health systems are considering how to offer nurse managers more scheduling flexibility. At The Ohio State University Wexner Medical Center in Columbus, some nurse managers have started working four, 10-hour shifts per week. 

"That has definitely made the job much more attractive and we've been able to recruit because of that," the hospital's CNO, Deana Sievert, DNP, RN, told Becker's. "We have to relieve them of their 24/7 responsibility. … They can't be everything to everybody 24/7." 

New Orleans-based Ochsner Health is among the systems considering four-day workweek options for nurse leaders, as well as how artificial intelligence and predictive modeling can make staff scheduling easier for them. 

"We are just looking at leadership differently [this year], knowing that they are the ones that really sit in the middle of patients, our front-line staff, and really are the key to our strategy for the system," said Tiffany Murdock, PhD, Ochsner's senior vice president and CNO. 

In addition to embracing new models of clinical care — a core part of many health systems' long-term strategies to improve nurse staffing — organizations need to consider new models of management, said Maryann Alexander, PhD, RN, chief officer of nursing regulation at the National Council of State Boards of Nursing.

"Having at least one other person that covers a different shift or different days seems like a simplistic solution, yet for the nurse leader, it may provide them the work-life balance all of us need," Dr. Alexander said, adding that virtual co-managers are another way to bolster support for front-line nurse managers.

It's not uncommon for nurse managers — who help oversee finances and manage patient care quality and staff interactions — to have hundreds of direct reports, which should be reflected in their pay, similar to other industries, Dr. Mensik Kennedy said, recalling the recent story about Walmart raising average pay for store managers to $128,000 with a bonus potential of up 200% of their annual base salary. A recent review of salary data found a median average salary of $94,401 for nurse managers, though that may vary greatly based on location and experience. 

"Our nurse managers are running multimillion-dollar businesses," she said. "We've continued to add on and add on to nurse managers, just expecting that they will take that as part of the job. We really need to look at other industries and pull things back." 

Ultimately, overlooking nurse managers' needs and concerns can have consequences for nursing staff and patient care. 

"What we know for sure is that direct care nurse satisfaction and patient outcomes [are] really linked to nurse manager satisfaction, so when we have good nurse managers and direct care nurses feel supported, you have better patient outcomes, you have less turnover rates," Dr. Mensik Kennedy said.

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