The Case for Supporting Nursing Directors

Providing the correct ratio of directors to managers is a good start toward positioning nurse managers to develop their leadership skills.

Nurse managers, 300,000 strong, represent the largest segment of the healthcare management workforce. Yet their potential to influence clinical outcomes and strategic goals has been overlooked by healthcare organizations for decades.

But that is changing, says Cheryl Hoying, RN, PhD, NEA-BC, FACHE, FAAN, senior vice president of patient services, at Cincinnati Children's Hospital Medical Center.

Now, she says, CNOs should be asking themselves this question: "What are the supports that nurse managers need to be resilient in that role?"

Make Management Manageable

Hoying says one area that leaders should evaluate is the expectations placed on nurse managers.

About seven years ago, she noticed a troubling trend among the nursing directors at her organization.  "What I was seeing was all the directors getting out of here at seven or eight o'clock at night and not being able to get home in a timely manner," she says.

Hoying approached the CEO at the time and successfully made the case to add nurse managers in order to support the directors. The organization also implemented a one-manager-to-25-FTE ratio.

"Depending on how many employees were on their unit, that's how many managers they got. If they had a staff of 50, there was a nurse director and then they got a nurse manager. If it was 75, they got two nurse managers and a director," she explains.

"By that [ratio] you're able to work with the staff and do all of the education with the staff that's needed and vice versa. It allows the manager to be successful and be the nurse leader that that individual could be."

Having a large amount of direct reports is not uncommon for nurse managers, but leadership needs to consider whether the practice is in the best interest of nurse managers.

"I've heard some stories where managers have had 100 people that they're responsible for. How do you begin to do 100 evaluations?" she says.

"I think for the manager to be successful, even before you do the education, you have to have realistic foundations for these folks."

Leadership Skill Development

Another benefit of the ratio is that it gives both directors and managers time for education to develop their leadership skills.

"That was really the foundational piece," she says, "making sure that we built in the opportunity for that director to go to different things and to attend sessions and help mentor and grow that nursing group that's coming up in the ranks."

This also helps to address another age-old issue in nursing management—promoting a strong clinician-to-management position without prior training.

"This way they're learning budgets, they're learning HR issues, they're learning how to mentor others," she says of the manager/director structure. "They're learning as they go and they have 25 employees that they're helping along."

Providing this type of support benefits not just the nurse manager but staff nurses, patients, and the organization.

"It's our job as leadership to make sure we've got the right resources so that they are successful and they are going to enjoy their role," Hoying says. "Because when that role turns over, that affects everybody on the unit."