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Nurs Admin Q Vol. 39, No. 1, pp. 58–68 c 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins Copyright
Planning for a Smooth Transition Evaluation of a Succession Planning Program for Prospective Nurse Unit Managers Vicki Manning, RN, BAdmin (Nursing), MPH; Alan Jones, RN, MOrgPsych; Pamela Jones, RN, MHlthLeadMgmt; Ritin S. Fernandez, RN, MN, PhD The current and projected nurse workforce shortage has created significant pressure on health care organizations to examine their approach to managing talent. This includes the need for strategic development of new formal leaders. This article reports on a succession planning program for prospective nursing unit managers. Eight prospective management candidates participated in a Future Nursing Unit Managers program. The effectiveness of the program was measured through a comparison of pre- and postprogram surveys relating to participants’ perception of personal managerial and leadership skills. Significant differences in scores from baseline to 6-month followup surveys were observed in the participants’ confidence in undertaking the nursing unit manager role and in their management skills. Investment in structured programs to prepare nurses for leadership roles is strongly recommended as a management workforce strategy. Key words: leadership development, nurse managers, succession planning
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HORTAGES in the nursing labor market,1 coupled with the imminent retirement of the current cohort of experienced aging nursing workforce,2 has created a significant pressure on health care organizations to examine their approach for managing talent. Initially pioneered in the business sector,3,4 succession planning has become a strategic initiative
Author Affiliations: Nursing & Midwifery Services (Ms Manning ND Mr Jones) and Nursing Strategy and Allocation (Ms Jones), St George Hospital, Kogarah, Australia; School of Nursing and Midwifery and Indigenous Health, University of Wollongong, Australia (Dr Fernandez). The authors declare no conflict of interest. Correspondence: Ritin S. Fernandez, PhD, RN, MN, School of Nursing and Midwifery, University of Wollongong, Wollongong, NSW 2522, Australia (ritin@uow .edu.au). DOI: 10.1097/NAQ.0000000000000072
for managing talent and is increasingly being adopted by health care organizations.5-8 In nursing, succession planning involves identifying suitable nurses and developing them through mentoring, training, and job rotation so that they are competent to assume new roles following the retirement of senior nurses or when these roles become available.5 Various advantages to succession planning programs have been reported. These include the recruitment and retention of talented people, improvement of employee commitment, added value to the organization’s strategic plan, and reduction of the difficulty and costs inherent with recruitment of external applicants.9,10 Past succession planning programs have focused largely on the development of nursing executives.11,12 More recently, there has been an emphasis on succession planning for
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Planning for a Smooth Transition clinical leadership roles such as clinical nurse consultants and nurse practitioners.13 However, there is a dearth of literature on succession planning programs for middle nursing management, including nursing unit managers (NUMs) or ward managers. This is concerning, because it has been well established that NUMs have a direct influence on the quality of care provided to patients.14,15 THE CONTEMPORARY NUM Over the last 30 years, the role of the ward manager has changed significantly.16 It has evolved from the matronly charge ward nurse to that of a dynamic, broad focused, allencompassing NUM.14 It can be claimed that the role of the contemporary NUM is akin to that of an air traffic controller. The NUM is the central communication officer directing the traffic, ensuring that admissions (the arrivals) and discharges (the departures) are timely while maintaining accountability for patient and staff safety. He or she must also be responsive to any changes in condition that might occur at a moment’s notice. To perform the role, the NUM must master a range of leadership and people management skills.15,17,18 However, in practice, many nurses assume the NUM roles without the skills needed to effectively lead and manage teams.17,19 In addition, they may not have had any formal orientation to the NUM role or knowledge of key organizational imperatives.20 Additional barriers, including unrelenting pressures around meeting key performance indicators at all costs, staff demands, and patient safety, coupled with the Australian Public Health System’s (NSW) Nurses and Midwives Award around payment for higher duties,21 deter nurses from assuming the role of a NUM. It is therefore vital that a succession planning program is in place to develop nurses to undertake the role of a NUM. Numerous succession planning models have been described in the literature.10,22,23 The common principles underpinning these models include organizational support, identification of skills and competencies required
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for the position; identification of talent, skills, and competencies gaps; developmental opportunities for the identified skills and competencies including mentoring and coaching; and reassessment and tracking of progress.10,22,23 What is lacking in the literature are strategies for implementation of these models, particularly strategies for developmental opportunities for the identified skills and competencies. The goal of this article was to evaluate the impact of the Future NUMs program, which is a succession planning program on the managerial and leadership skills of prospective NUMs. THE FUTURE NUMS PROGRAM The Future NUMs program was designed to equip prospective NUMs with knowledge, attitudes, behaviors, and skills they require to provide highly coordinated care at the ward/unit level and thereby improve the patient journey and the patient and carer experiences as identified in the NSW Health Take the Lead initiative.24 (A carer is anyone who cares, unpaid, for a friend or family member due to illness or injury.) The Future NUMs program was structured around the premise that there has to be a balance between clinical leadership and management. The program was modeled around the core principles of succession planning10,22,23 and is described as follows: 1. Organizational support: The project was initiated and led by the Director of Nursing and Midwifery Services at the hospital. A memorandum of understanding was completed between the participants and the hospital. Participants were provided with supernumerary time during the program, as well as an agreement to provide acting relief opportunity as an NUM in a ward or unit within the hospital. Funding for the project was received from the Local Health District Nurse Strategy Initiatives program. 2. Identification of skills and competencies required for the position: The position description was used to develop
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NURSING ADMINISTRATION QUARTERLY/JANUARY–MARCH 2015 the skills and competencies required for the NUM. A local working group of experienced NUMs at the hospital mapped the expected tasks and key responsibilities against each of the general overarching position description criteria. These were then aligned with the skills and competencies required to undertake the tasks and responsibilities. 3. Identification of talent: The topdown/bottom-up succession planning approach25 was used for the identification of participants for the program, as it serves to empower nurses with responsibility for their own career development. 4. Skills and competencies gap analysis: Managerial skills workbooks were issued to participants. The workbooks consisted of information and subject tasks relating to purchase requisitioning, reviewing and analyzing of financial data, actioning incident reports, rostering, and completing a new manager’s checklist. 5. Developmental opportunities: A combination of developmental opportunities was implemented. These included 2 full days of face-to-face education sessions, 2 weeks in an observer capacity (observing the work of senior managers), and 2 weeks with a mentor NUM.
Education sessions At the commencement of the program, the participants were issued with a documents folder that included (1) key business rules, (2) information relating to the NSW Nurses and Midwives Award, the Code of Conduct, Grievance Policy, Rostering Manual (3) flowcharts that related to each of the sessions, and (4) a skills workbook. Experienced nurse managers from the hospital presented interactive sessions on key subject areas relevant to the role of the NUMs, which included staffing, budget, evaluations, payroll, compliance with health policies, and human resource management. The presenta-
tions focused on practical issues that an NUM would face when managing a unit. Observer role The participants spent 1 day each observing “a working day in the life of” the Director of Nursing and Midwifery, Deputy Director of Nursing, Nursing codirectors, and other senior managers whose roles impact directly on the daily activities of NUMs. It was anticipated that the observer role would expose the participants to an explicit or implicit learning experience from the senior managers. Structured mentoring The Mastermind mentoring and business coaching model was implemented, in which the experts coached the participants.26 Each participant was allocated a mentor NUM who worked outside the participant’s area of practice. Participants were required to spend 2 weeks (4 months apart) with their mentors to consolidate the learning provided in the education sessions. In the first week of placements, participants were required to work with the mentor NUM in an observer capacity. In the second week, they assumed the primary NUM role and worked under the supervision and direction of the mentor NUM. During this week, they completed purchase requisitioning, reviewed and analyzed the financial data for reporting, managed incidents at the unit level, and completed rostering and staffing allocation tasks. METHODS The study was conducted at St George Hospital, a 650-bed tertiary referral institution in Sydney, Australia. The hospital has a full-time equivalent of approximately 1500 nurses, with a less than a 2% vacancy rate. Consultation regarding the project was undertaken with members of the nursing executive team. Registered nurses working at the St George Hospital were eligible to apply for the Future NUMs Succession Planning program. Data were collected using a
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Planning for a Smooth Transition self-administered survey. Items for the survey were generated on the basis of consultation with nurse managers as well as a literature review. Data were collected relating to sociodemographics, ability to undertake the role of the nursing/midwifery unit manager (N/MUM), ability to undertake key managerial tasks, perception of their leadership characteristics, and satisfaction with the program. Items for the role of the N/MUM were informed by the NSW health document “A Conceptual Framework the Nursing/Midwifery Unit Manager Role.”27 The aim of this conceptual framework is to illustrate the purpose and broad functions of the N/MUM role, as is defined by the award. The roles of the N/MUM were classified into 3 main categories: patient care coordination and the practice of nursing/ midwifery (8 items), nursing/midwifery staff management and leadership (5 items), and ward/unit management (6 items). Each category contained subcategories. The subcategories included examples of activities that related to the N/MUM role (Table 1). Participants had to rate each activity on a scale of 0 to 5, with “0” indicating “no confidence in undertaking the activity” and “5” describing “total confidence in undertaking the activity.” Ability to undertake key managerial skills was assessed using the items identified in the document “Review of the Nurse Unit Manager Role” (Table 2).15 Participants had to rate each item on a scale of 0 to 5, with “0” indicating “not skilled in undertaking the activity” and “5” describing “highly skilled in undertaking the activity.” The Leadership Practice Inventory was used to assess participant’s self-rated leadership characteristics (Table 3). It is a behavior measurement instrument that measures leadership practices and is consistent with a transformational leadership style.28 The Leadership Practice Inventory instrument consists of 30 statements that measure 5 key practices of exemplary leaders. The 5 key practices include (a) Modeling the way, (b) Inspire a shared vision, (c) Challenge the process, (d) Enables others to act, and (e) Encourage the heart.
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Each statement is rated on a 10-point Likert scale ranging from (a) almost never, (b) rarely, (c) seldom, (d) once in a while, (e) occasionally, (f) sometimes, (g) fairly often, (h) usually, (i) frequently and (j) very frequently. The Cronbach α for the LIP has been reported to be between 0.70 and 0.84, and a testretest reliability of 0.94, which demonstrates sound psychometric properties.29 Table 4 includes items that assisted participants in rating their own leadership characteristics. Satisfaction with the program was assessed using an investigator-developed questionnaire. Cost benefit of the program was assessed by the number of NUM vacancies that were filled internally and how quickly these positions were filled. Evaluation of the program Evaluation was undertaken by asking participants to rate their perception of the presentations and teaching styles of the senior managers as well as the content of the program on a 4-point Likert scale ranging from 1 (strongly agree) to 4 strongly disagree. The questionnaire was administered before commencing the succession planning program and at 6 months after completion of the program. The survey took approximately 10 to 20 minutes to complete. Participants received an information sheet stating the purpose of the survey and the contact details of the researchers. Completion of the questionnaire was considered implied consent. Approval to conduct the study was obtained from the St George Hospital Human Research Ethics Committee. Data analysis All analyses were completed using SPSS version 17. Descriptive analyses (frequencies and percentages, means, and standard deviations as appropriate) were undertaken to assess the characteristics of the participants and responses to managerial and leadership skills. Differences between baseline and follow-up were analyzed using Student t tests.
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Table 1. Confidence in Undertaking Nursing/Midwifery Unit Manager Role
Patient care coordination and the practice of N/M Lead direct and coordinate care in the ward/unit Facilitate collaborative teams in the delivery of patient care Use patient and carer feedback to inform patient care service delivery Enable a culture of enquiry and questioning about the practice of N/M Establish and maintain the use of EBP Maintain knowledge of contemporaneous N/M practice Up hold the principles of practice as defined by Nurses and Midwives Act of 1991, ANMC Codes of Conduct, Codes of Ethics and Professional Conduct Establish and maintain a standard of practice that meets ANMC competency standards, NSW DoH AHS and organizational policy and procedures N/M staff management Ensure and being an exemplary role model Establish and maintain relationships and trust Creating an empowering environment that enables the transfer of knowledge into practice Inspire and support others to achieve their potential Enable others to achieve a shared vision Ward unit management Ensure the human physical and financial resources of the ward/unit are managed, in collaboration with relevant subject matter experts, to deliver safe and efficient health care within available resources Participate in problem solving in matters related to the functioning of the unit/ward Establish and maintain processes to facilitated performance improvement Manage ward units’ staff to facilitate growth and development Monitor and maintain a safe environment for patients, staff, and visitors in collaboration with the relevant subject matter experts Ensure and maintain knowledge and participation in business management activities within NSW DoH, AHS, organizational policy and procedures
Baseline, Mean (SD)
Follow-up, Mean (SD)
P
95.6 (16.4)
112.7 (10.4)
.02
14.3 (2.8) 13.8 (1.1)
17.3 (1.84) 13.6 (1.0)
.02 .65
17.0 (3.3)
21.3 (2.1)
.00
11.3 (2.1)
13.2 (1.3)
.06
10.7 (1.10) 11.1 (2.2)
12.7 (1.5) 13.1 (1.4)
.04 .05
9.3 (4.0)
12.8 (2.0)
.04
7.7 (1.7)
8.3 (0.74)
.369
53.3 (8.7) 12.2 (1.8) 11.3 (1.4) 16.7 (3.6)
65.5 (7.3) 13.3 (1.4) 13.5 (1.4) 21.6 (2.6)
.01 .190 .009 .009
9.6 (2.1)
12.7 (1.6)
.006
3.3 (0.51) 62.7 (15.7) 14.0 (7.1)
4.2 (0.70) 82.6 (10.7) 23.5 (5.1)
.014 .01 .008
19.2 (2.4)
21.6 (2.8)
.110
10.3 (2.8)
12.5 (1.0)
.060
7.3 (1.7)
8.7 (1.0)
.070
6.2 (1.6)
8.6 (1.0)
.004
4.6 (2.1)
7.6 (1.5)
.009
Abbreviations: AHS, Area Health Service; ANMC, Australian Nursing & Midwifery Council; DoH, Department of Health; EBP, evidence-based practice; EMR, electronic medical record; IT, information technology; N/M, nursing/midwifery; NSW, New South Wales.
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Planning for a Smooth Transition Table 2. Ability to Undertake Key Managerial Skills
Business management Manage conflict resolution Political astuteness IT training/data management excel, word, etc IT training, EMR Risk analysis ERMS Incident management as an NUM People management Counseling/active listening Networking Research training Timesheet management Inventory management Budget and finance management—power budget
Baseline, Mean (SD)
Follow-up, Mean (SD)
P
2.5 (1.0) 3.5 (0.75) 2.63 (0.91) 3.3 (0.91)
3.8 (0.83) 4.3 (0.51) 3.8 (0.64) 4.1 (0.35)
.012 .017 .007 .049
3.7 (0.70) 1.3 (1.1) 2.0 (1.6)
3.8 (1.6) 3.6 (0.91) 4.5 (0.53)
.846 .001 .001
3.7 (0.88) 4.0 (0.92) 3.1 (1.3) 1.8 (1.1) 1.1 (1.5) 0.88 (1.3) 0.75 (1.1)
4.3 (0.51) 4.3 (0.51) 4.2 (0.46) 3.7 (0.70) 3.5 (0.92) 3.3 (1.1) 3.2 (1.1)
.107 .334 .043 .001 .002 .002 .001
Abbreviations: EMR, electronic medical record; ERMS, Enterprise Risk Management System; IT, information technology; NUM, nurse unit manager.
RESULTS Eight staff (5 females and 3 males) participated in the Future NUMs program. The mean age of the participants was 29.9 years (range, 26-38 years). Four participants were clinical nurse specialists and 4 were registered nurses. The number of years of experience of the participants ranged from 4 to 6 years.
Confidence in undertaking the N/MUM role Overall significant differences from baseline to follow-up were observed in the participants’ confidence in undertaking the N/MUM role in all 3 main categories. In the category “Patient care coordination and the practice of nursing/midwifery,” significant differences in
Table 3. Participant’s Self-rated Leadership Characteristics
Challenge the process Inspire a shared vision Modeling the way Enables others to act Encourage the heart
Baseline, Mean (SD)
Follow-up, Mean (SD)
P
41.3 (4.6) 41.5 (4.3) 50.9 (3.6) 49.8 (2.8) 47.8 (2.8)
48.6 (6.6) 46.5 (5.0) 54.9 (4.3) 53.1 (4.2) 53.5 (4.6)
.02 .05 .07 .09 .04
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Table 4. Items in the Subscales of the Leadership Practice Inventory Challenge the process I seek out challenging opportunities that test my own skills and abilities I challenge people to try out new and innovative approaches to their work I reach outside the formal boundaries of my organization for innovative ways to improve what we do I make sure that people are creatively rewarded for their contributions to the success of our projects I experience and take risks even when there is a chance of failure I take the initiative to overcome obstacles even when outcomes are uncertain Inspire a shared vision I talk about trends that will influence how my work gets done I describe a compelling image of what our future could be like I appeal to others to share an exciting dream of the future I follow through on promises and commitments that I make I am contagiously enthusiastic and positive about future possibilities I speak with true conviction about the higher meaning and purpose of our work Modeling the way I set a personal example of what I expect from others I spend time and energy on making certain that the people I work with adhere to the principles and standards that have been agreed upon I am clear about my philosophy of leadership I make certain that we set achievable goals, make concrete plans, and establish measurable milestones for the projects and programs that we work on I make progress toward goals one step at a time Enables others to act I develop cooperative relationships among the people I work with I actively listen to diverse points of view I treat others with dignity and respect I support the decision that people make on their own I give people a great deal of freedom and choice in deciding how to work I ensure that people grow in their roles by learning new skills and developing themselves Encourage the heart I praise people for a job well done I make it a point to let people know about my confidence in their abilities I ask what we can learn when things don’t go as expected I publicly recognize people who exemplify a commitment to shared values I find ways to celebrate accomplishments I give my coworkers lots of appreciation and support for their contributions
scores from baseline to follow-up were observed in items relating to “Lead, direct, and coordinate care in the ward/unit” (P = .02), “Use patient and carer feedback to inform patient care service delivery” (P = .00), “Establish and maintain the use of EBP (evidencebased practices)” (P = .04), and “Uphold the principles of practice as defined by Nurses and Midwives Act of 1991, Australian Nursing & Midwifery council (ANMC) Codes of Con-
duct, Codes of Ethics and Professional Conduct” (P = .04). Similarly, in the category “Nursing/ midwifery staff management and leadership,” significant differences in scores from baseline to follow-up were observed in items relating to “Establish and maintain relationships and trust” (P = .009), “Creating an empowering environment that enables the transfer of knowledge into practice” (P = .009), “Inspire
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Planning for a Smooth Transition and support others to achieve their potential” (P = .006), and “Enable others to achieve a shared vision” (P = .014). In the category “Ward unit management,” significant differences in scores from baseline to follow-up were observed in items relating to “Ensure the human physical and financial resources of the ward/unit are managed, in collaboration with relevant subject matter experts, to deliver safe and efficient health care within available resources” (P = .008), “Monitor and maintain a safe environment for patients, staff and visitors, in collaboration with the relevant subject matter experts” (P = .004), and “Ensure and maintain knowledge and participation in business management activities within NSW DoH (Department of Health), AHS (Area Health Service), organizational policy and procedures” (P = .009). Ability to undertake key managerial skills Significant differences from baseline to follow-up (P < .05) were observed in participants ability to undertake 11 of the 14 managerial skills. In the remaining 3 managerial skills that included “IT training and electronic medical records (EMRs)” and “People management and counseling/active listening,” there were increases in scores from baseline to follow-up; however, these results were not statistically significant. Leadership characteristics Of the 5 key practices of exemplary leaders, significant differences in scores from baseline to follow-up were observed in practices relating to “Challenging the process” (P = .02) and “Encouraging the heart” (P = .04). The mean baseline score for “Inspiring a shared vision” was 41.2 (SD = 4.3) and at follow-up was 46.5 (SD = 5.0). However, this increase in leadership practice was not statistically significant (P = .05). Similarly, although scores increased from baseline to follow-up in practices relating to “Modeling the way” (mean difference = 4.0) and “Enabling others to act”
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(mean difference = 3.4), these results were not statistically significant (P > .05). Cost–benefit of the program Of the 8 participants who completed the program, 1 has been appointed to a permanent NUM position within the employing facility; 1 is currently in a long-term relief position; and 2 have accepted the position of an NUM in other organizations. Evaluation of the Future NUMs program Overall evaluation indicates that participants gained significant benefits from participating in the Future NUMs program. All participants either agreed or strongly agreed that the information provided was relevant to their learning needs and that the presentations and teaching styles were effective. Participants also indicated that spending a day with the various senior managers enhanced their understanding of the role of the manager or the department in patient care. For example a comment about the Director of Nursing (DON) included: “Great leader, inspirational, good to see what the DON does.” Another participant commented on the bed management center: “Busy job, great handson experience.” Mentors indicated that they felt humbled and honored to have been chosen to mentor prospective NUMs. DISCUSSION The declining number of nurses undertaking an NUM role will create a significant impact in the clinical setting, as the older NUMs begin to retire. To maintain a pool of potential NUMs, senior nursing leaders need to focus on appropriate succession planning to develop the leadership and management skills of the next generation of nurse managers. This study was undertaken to assess the impact of a structured succession development and mentoring initiative called “the Future NUMs program” on the leadership and management skills of prospective NUMs. The program was designed for nurses keen to pursue a career in
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nursing management who find that they lack the confidence to take that step because they are unsure of the everyday requirements of the position. The mean age of the participants in this study was 29 years. This is in contrast to the literature where the mean age of NUMs is generally 45 years.30 (There is a belief that to obtain a leadership position nurses should have extensive experience in the clinical setting.)31,32 Overall significant differences from baseline to follow-up were observed in the participants’ confidence in undertaking the N/MUM role. In the category relating to “Patient care coordination and the practice of nursing/ midwifery,” there were no significant differences in the subcategories relating to facilitating collaborative teams in the delivery of patient care, enabling a culture of enquiry and questioning about the practice of nursing/midwifery, maintaining knowledge of contemporaneous nursing/midwifery practice, and establishing and maintaining a standard of practice that meets ANMC competency standards. This could be due the fact that the participants were nursing clinicians and that working collaboratively with multidisciplinary teams as part of contemporary nursing practice. Current nursing education programs create a culture of enquiry and questioning in student nurses about the practice of nursing/midwifery, which they then bring into their clinical practice. In the category relating to “Nursing/ midwifery staff management,” significant differences were observed in all subcategories except for the subcategory relating to “Being an exemplary role model.” It could be postulated that the participants were all clinical nurses and had limited opportunities in the clinical setting during the study period to be a managerial role model. However, the scores at follow-up for this subcategory were higher than the baseline scores, which demonstrate that the participants gained some confidence in being an exemplary role model. The Future NUMs program is focused on the managers’ need to do on a day-to-day basis. Therefore, in the category relating to “Ward
unit management,” there were significant differences in scores from baseline to follow-up in all 3 subcategories that related to everyday work. The remaining 3 subcategories related to long-term goals and require experience working as an N/MUM. Improvements from baseline to follow-up were observed in participants’ ability to undertake all the key managerial skills. However, in 3 skills, including “electronic medical records,” “people management,” and “counseling/active listening,” the results were not statistically significant. Various reasons could be postulated for these results. The baseline scores for “electronic medical records,” “people management,” and “counseling/active listening” were already high, which could be due to the fact that these are part of the everyday role of the registered nurse. The Future NUMs program did not focus on these skills, as these were considered to be assumed knowledge. Although the Future NUMs toolkit included activities and literature to improve leadership characteristics, significant changes were found only in items relating to “Challenging the process” and “Encouraging the heart.” These results could be due to the fact that these skills can be easily obtained in a short period of time, because they are an extension of the skills of a nurse. In contrast, skills relating to “Inspiring a shared vision,” “Modeling the way,” and “Enabling others to act” require experience and should be assessed as long-term goals. Participants reported that they benefitted from participating in the Future NUMs program. The personal engagement of the DON and other senior managers created a climate where the prospective NUMs were supported and empowered. This aspect remains a key feature of the program. The principles implemented in the Future NUMs program in this study can be easily transferable to succession planning programs for all levels of nurses. Any succession planning program has inherent cost implication. Therefore, organizational support remains the cornerstone for
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Planning for a Smooth Transition the success of any such programs.33 In this study, the cost included a time commitment from senior nursing managers and administrators and the backfilling of positions so that participants could complete the program. Despite the costs, the Local Health District has agreed to provide additional funding for 4 more candidates for the following year. It is important that succession planning programs are integrated into the nursing business plan, rather than pursued during NUM shortages. Despite the positive results obtained, some of the limitations inherent in undertaking such a study need to be acknowledged. The sample size for this study was small, so generalization of the results may not possible. The small sample was due to the fact that there were limited resources to undertake this project. In addition, the number of NUM vacancies that would be available in the interim was few. Another limitation of the study was that we did not assess the educational level of the participants. However, previous research
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has shown that, irrespective of their educational qualifications, nurses can be in leadership positions.34 Further research into progression of the participants’ advancement in leadership roles is warranted. Implications for management This study has provided some implications for nursing management. Although the Future NUMs program provided participants with a leadership development opportunity, maintaining these leadership skills will remain a challenge if a NUM position is not readily available. An extension of the current role could be an alternate solution to maintain the managerial skills developed during the program. CONCLUSIONS The Future NUMs program was positively evaluated by participants. The organisation is now equipped with a pool of emerging Nursing Unit Managers who have been educated and mentored to successfully undertake the role of the NUMs across the organization.
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16. Krugman M, Smith V. Charge nurse leadership development and evaluation. J Nurs Adm. 2003;33(5):284. 17. Chase LK. Nurse manager competencies [PhD thesis]. Iowa City, IA: University of Iowa; 2010. 18. Oroviogoicoechea C. The clinical nurse manager: a literature review. J Adv Nurs. 2006;24(6):1273-1280. 19. Kleinman CS. Leadership roles, competencies, and education: how prepared are our nurse managers? J Nurs Adm. 2003;33(9):451-455. 20. Contino DS. Leadership competencies: knowledge, skills, and aptitudes nurses need to lead organizations effectively. Crit Care Nurse. 2004;24(3):52-64. 21. NSW Health. Public Health System Nurses’ & Midwives’ (State) Award. http://www.health.nsw.gov .au/resources/jobs/conditions/awards/nurses_pdf .asp. Published 2012. Accessed September 16, 2012. 22. Collins SK, Collins KS. Changing workforce demographics necessitates succession planning in health care. Health Care Manage. 2007;26(4):318-325. 23. Groves KS. Integrating leadership development and succession planning best practices. J Manage Dev. 2007;26(3):239-260. 24. NSW Health. “Take the Lead”: The Nursing/ Midwifery Unit Manager Project. Sydney, NSW, Australia: NSW Health; 2008. 25. Doherty C, Hope W. Shared governance—nurses making a difference. J Nurs Manage. 2000;8(2): 77-81. 26. Rolf A. (2007). Mentoring Demystified. Terrigal NSW, Australia: Mentoring Works. http://www.usgs
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.gov/humancapital/ecd/mentoringreadinglist/ MentoringDemystified.pdf. Accessed February 2, 2012. NSW Health. A Conceptual Framework for Nursing/ Midwifery Unit Manager Role. Sydney, NSW, Australia: NSW Health; 2010. Posner BZ, Kouzes JM, Dixit V. The Leadership Challenge. J Educ Voc Res. 2011;1(1):1-3. Tourangeau AE, McGilton K. Measuring leadership practices of nurses using the leadership practices inventory. Nurs Res. 2004;53(3): 182. Acorn S, Ratner PA, Crawford M. Decentralization as a determinant of autonomy, job satisfaction, and organizational commitment among nurse managers. Nurs Res. 1997;46(1):52-58. Scoble KB, Russell G. Vision 2020, part I: profile of the future nurse leader. J Nurs Adm. 2003;33(6): 324-330. Smith SL, Manfredi T, Hagos O, Drummond-Huth B, Moore PD. Application of the clinical nurse leader role in an acute care delivery model. J Nurs Adm. 2006;36(1):29-33. Currie K, Grundy M. Building foundations for the future: the NHS Scotland advanced practice succession planning development pathway. J Nurs Manage. 2011;19(7):933-942. Wicker TL. Self-report of Nursing Leadership Practice After Completion of Training. Charleston, SC: BiblioBazaar; 2011.
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Planning for a Smooth Transition Evaluation of a Succession Planning Program for Prospective Nurse Unit Managers Vicki Manning, RN, BAdmin (Nursing), MPH; Alan Jones, RN, MOrgPsych; Pamela Jones, RN, MHlthLeadMgmt; Ritin S. Fernandez, RN, MN, PhD The current and projected nurse workforce shortage has created significant pressure on health care organizations to examine their approach to managing talent. This includes the need for strategic development of new formal leaders. This article reports on a succession planning program for prospective nursing unit managers. Eight prospective management candidates participated in a Future Nursing Unit Managers program. The effectiveness of the program was measured through a comparison of pre- and postprogram surveys relating to participants’ perception of personal managerial and leadership skills. Significant differences in scores from baseline to 6-month followup surveys were observed in the participants’ confidence in undertaking the nursing unit manager role and in their management skills. Investment in structured programs to prepare nurses for leadership roles is strongly recommended as a management workforce strategy. Key words: leadership development, nurse managers, succession planning
S
HORTAGES in the nursing labor market,1 coupled with the imminent retirement of the current cohort of experienced aging nursing workforce,2 has created a significant pressure on health care organizations to examine their approach for managing talent. Initially pioneered in the business sector,3,4 succession planning has become a strategic initiative
Author Affiliations: Nursing & Midwifery Services (Ms Manning ND Mr Jones) and Nursing Strategy and Allocation (Ms Jones), St George Hospital, Kogarah, Australia; School of Nursing and Midwifery and Indigenous Health, University of Wollongong, Australia (Dr Fernandez). The authors declare no conflict of interest. Correspondence: Ritin S. Fernandez, PhD, RN, MN, School of Nursing and Midwifery, University of Wollongong, Wollongong, NSW 2522, Australia (ritin@uow .edu.au). DOI: 10.1097/NAQ.0000000000000072
for managing talent and is increasingly being adopted by health care organizations.5-8 In nursing, succession planning involves identifying suitable nurses and developing them through mentoring, training, and job rotation so that they are competent to assume new roles following the retirement of senior nurses or when these roles become available.5 Various advantages to succession planning programs have been reported. These include the recruitment and retention of talented people, improvement of employee commitment, added value to the organization’s strategic plan, and reduction of the difficulty and costs inherent with recruitment of external applicants.9,10 Past succession planning programs have focused largely on the development of nursing executives.11,12 More recently, there has been an emphasis on succession planning for
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Planning for a Smooth Transition clinical leadership roles such as clinical nurse consultants and nurse practitioners.13 However, there is a dearth of literature on succession planning programs for middle nursing management, including nursing unit managers (NUMs) or ward managers. This is concerning, because it has been well established that NUMs have a direct influence on the quality of care provided to patients.14,15 THE CONTEMPORARY NUM Over the last 30 years, the role of the ward manager has changed significantly.16 It has evolved from the matronly charge ward nurse to that of a dynamic, broad focused, allencompassing NUM.14 It can be claimed that the role of the contemporary NUM is akin to that of an air traffic controller. The NUM is the central communication officer directing the traffic, ensuring that admissions (the arrivals) and discharges (the departures) are timely while maintaining accountability for patient and staff safety. He or she must also be responsive to any changes in condition that might occur at a moment’s notice. To perform the role, the NUM must master a range of leadership and people management skills.15,17,18 However, in practice, many nurses assume the NUM roles without the skills needed to effectively lead and manage teams.17,19 In addition, they may not have had any formal orientation to the NUM role or knowledge of key organizational imperatives.20 Additional barriers, including unrelenting pressures around meeting key performance indicators at all costs, staff demands, and patient safety, coupled with the Australian Public Health System’s (NSW) Nurses and Midwives Award around payment for higher duties,21 deter nurses from assuming the role of a NUM. It is therefore vital that a succession planning program is in place to develop nurses to undertake the role of a NUM. Numerous succession planning models have been described in the literature.10,22,23 The common principles underpinning these models include organizational support, identification of skills and competencies required
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for the position; identification of talent, skills, and competencies gaps; developmental opportunities for the identified skills and competencies including mentoring and coaching; and reassessment and tracking of progress.10,22,23 What is lacking in the literature are strategies for implementation of these models, particularly strategies for developmental opportunities for the identified skills and competencies. The goal of this article was to evaluate the impact of the Future NUMs program, which is a succession planning program on the managerial and leadership skills of prospective NUMs. THE FUTURE NUMS PROGRAM The Future NUMs program was designed to equip prospective NUMs with knowledge, attitudes, behaviors, and skills they require to provide highly coordinated care at the ward/unit level and thereby improve the patient journey and the patient and carer experiences as identified in the NSW Health Take the Lead initiative.24 (A carer is anyone who cares, unpaid, for a friend or family member due to illness or injury.) The Future NUMs program was structured around the premise that there has to be a balance between clinical leadership and management. The program was modeled around the core principles of succession planning10,22,23 and is described as follows: 1. Organizational support: The project was initiated and led by the Director of Nursing and Midwifery Services at the hospital. A memorandum of understanding was completed between the participants and the hospital. Participants were provided with supernumerary time during the program, as well as an agreement to provide acting relief opportunity as an NUM in a ward or unit within the hospital. Funding for the project was received from the Local Health District Nurse Strategy Initiatives program. 2. Identification of skills and competencies required for the position: The position description was used to develop
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NURSING ADMINISTRATION QUARTERLY/JANUARY–MARCH 2015 the skills and competencies required for the NUM. A local working group of experienced NUMs at the hospital mapped the expected tasks and key responsibilities against each of the general overarching position description criteria. These were then aligned with the skills and competencies required to undertake the tasks and responsibilities. 3. Identification of talent: The topdown/bottom-up succession planning approach25 was used for the identification of participants for the program, as it serves to empower nurses with responsibility for their own career development. 4. Skills and competencies gap analysis: Managerial skills workbooks were issued to participants. The workbooks consisted of information and subject tasks relating to purchase requisitioning, reviewing and analyzing of financial data, actioning incident reports, rostering, and completing a new manager’s checklist. 5. Developmental opportunities: A combination of developmental opportunities was implemented. These included 2 full days of face-to-face education sessions, 2 weeks in an observer capacity (observing the work of senior managers), and 2 weeks with a mentor NUM.
Education sessions At the commencement of the program, the participants were issued with a documents folder that included (1) key business rules, (2) information relating to the NSW Nurses and Midwives Award, the Code of Conduct, Grievance Policy, Rostering Manual (3) flowcharts that related to each of the sessions, and (4) a skills workbook. Experienced nurse managers from the hospital presented interactive sessions on key subject areas relevant to the role of the NUMs, which included staffing, budget, evaluations, payroll, compliance with health policies, and human resource management. The presenta-
tions focused on practical issues that an NUM would face when managing a unit. Observer role The participants spent 1 day each observing “a working day in the life of” the Director of Nursing and Midwifery, Deputy Director of Nursing, Nursing codirectors, and other senior managers whose roles impact directly on the daily activities of NUMs. It was anticipated that the observer role would expose the participants to an explicit or implicit learning experience from the senior managers. Structured mentoring The Mastermind mentoring and business coaching model was implemented, in which the experts coached the participants.26 Each participant was allocated a mentor NUM who worked outside the participant’s area of practice. Participants were required to spend 2 weeks (4 months apart) with their mentors to consolidate the learning provided in the education sessions. In the first week of placements, participants were required to work with the mentor NUM in an observer capacity. In the second week, they assumed the primary NUM role and worked under the supervision and direction of the mentor NUM. During this week, they completed purchase requisitioning, reviewed and analyzed the financial data for reporting, managed incidents at the unit level, and completed rostering and staffing allocation tasks. METHODS The study was conducted at St George Hospital, a 650-bed tertiary referral institution in Sydney, Australia. The hospital has a full-time equivalent of approximately 1500 nurses, with a less than a 2% vacancy rate. Consultation regarding the project was undertaken with members of the nursing executive team. Registered nurses working at the St George Hospital were eligible to apply for the Future NUMs Succession Planning program. Data were collected using a
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Planning for a Smooth Transition self-administered survey. Items for the survey were generated on the basis of consultation with nurse managers as well as a literature review. Data were collected relating to sociodemographics, ability to undertake the role of the nursing/midwifery unit manager (N/MUM), ability to undertake key managerial tasks, perception of their leadership characteristics, and satisfaction with the program. Items for the role of the N/MUM were informed by the NSW health document “A Conceptual Framework the Nursing/Midwifery Unit Manager Role.”27 The aim of this conceptual framework is to illustrate the purpose and broad functions of the N/MUM role, as is defined by the award. The roles of the N/MUM were classified into 3 main categories: patient care coordination and the practice of nursing/ midwifery (8 items), nursing/midwifery staff management and leadership (5 items), and ward/unit management (6 items). Each category contained subcategories. The subcategories included examples of activities that related to the N/MUM role (Table 1). Participants had to rate each activity on a scale of 0 to 5, with “0” indicating “no confidence in undertaking the activity” and “5” describing “total confidence in undertaking the activity.” Ability to undertake key managerial skills was assessed using the items identified in the document “Review of the Nurse Unit Manager Role” (Table 2).15 Participants had to rate each item on a scale of 0 to 5, with “0” indicating “not skilled in undertaking the activity” and “5” describing “highly skilled in undertaking the activity.” The Leadership Practice Inventory was used to assess participant’s self-rated leadership characteristics (Table 3). It is a behavior measurement instrument that measures leadership practices and is consistent with a transformational leadership style.28 The Leadership Practice Inventory instrument consists of 30 statements that measure 5 key practices of exemplary leaders. The 5 key practices include (a) Modeling the way, (b) Inspire a shared vision, (c) Challenge the process, (d) Enables others to act, and (e) Encourage the heart.
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Each statement is rated on a 10-point Likert scale ranging from (a) almost never, (b) rarely, (c) seldom, (d) once in a while, (e) occasionally, (f) sometimes, (g) fairly often, (h) usually, (i) frequently and (j) very frequently. The Cronbach α for the LIP has been reported to be between 0.70 and 0.84, and a testretest reliability of 0.94, which demonstrates sound psychometric properties.29 Table 4 includes items that assisted participants in rating their own leadership characteristics. Satisfaction with the program was assessed using an investigator-developed questionnaire. Cost benefit of the program was assessed by the number of NUM vacancies that were filled internally and how quickly these positions were filled. Evaluation of the program Evaluation was undertaken by asking participants to rate their perception of the presentations and teaching styles of the senior managers as well as the content of the program on a 4-point Likert scale ranging from 1 (strongly agree) to 4 strongly disagree. The questionnaire was administered before commencing the succession planning program and at 6 months after completion of the program. The survey took approximately 10 to 20 minutes to complete. Participants received an information sheet stating the purpose of the survey and the contact details of the researchers. Completion of the questionnaire was considered implied consent. Approval to conduct the study was obtained from the St George Hospital Human Research Ethics Committee. Data analysis All analyses were completed using SPSS version 17. Descriptive analyses (frequencies and percentages, means, and standard deviations as appropriate) were undertaken to assess the characteristics of the participants and responses to managerial and leadership skills. Differences between baseline and follow-up were analyzed using Student t tests.
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Table 1. Confidence in Undertaking Nursing/Midwifery Unit Manager Role
Patient care coordination and the practice of N/M Lead direct and coordinate care in the ward/unit Facilitate collaborative teams in the delivery of patient care Use patient and carer feedback to inform patient care service delivery Enable a culture of enquiry and questioning about the practice of N/M Establish and maintain the use of EBP Maintain knowledge of contemporaneous N/M practice Up hold the principles of practice as defined by Nurses and Midwives Act of 1991, ANMC Codes of Conduct, Codes of Ethics and Professional Conduct Establish and maintain a standard of practice that meets ANMC competency standards, NSW DoH AHS and organizational policy and procedures N/M staff management Ensure and being an exemplary role model Establish and maintain relationships and trust Creating an empowering environment that enables the transfer of knowledge into practice Inspire and support others to achieve their potential Enable others to achieve a shared vision Ward unit management Ensure the human physical and financial resources of the ward/unit are managed, in collaboration with relevant subject matter experts, to deliver safe and efficient health care within available resources Participate in problem solving in matters related to the functioning of the unit/ward Establish and maintain processes to facilitated performance improvement Manage ward units’ staff to facilitate growth and development Monitor and maintain a safe environment for patients, staff, and visitors in collaboration with the relevant subject matter experts Ensure and maintain knowledge and participation in business management activities within NSW DoH, AHS, organizational policy and procedures
Baseline, Mean (SD)
Follow-up, Mean (SD)
P
95.6 (16.4)
112.7 (10.4)
.02
14.3 (2.8) 13.8 (1.1)
17.3 (1.84) 13.6 (1.0)
.02 .65
17.0 (3.3)
21.3 (2.1)
.00
11.3 (2.1)
13.2 (1.3)
.06
10.7 (1.10) 11.1 (2.2)
12.7 (1.5) 13.1 (1.4)
.04 .05
9.3 (4.0)
12.8 (2.0)
.04
7.7 (1.7)
8.3 (0.74)
.369
53.3 (8.7) 12.2 (1.8) 11.3 (1.4) 16.7 (3.6)
65.5 (7.3) 13.3 (1.4) 13.5 (1.4) 21.6 (2.6)
.01 .190 .009 .009
9.6 (2.1)
12.7 (1.6)
.006
3.3 (0.51) 62.7 (15.7) 14.0 (7.1)
4.2 (0.70) 82.6 (10.7) 23.5 (5.1)
.014 .01 .008
19.2 (2.4)
21.6 (2.8)
.110
10.3 (2.8)
12.5 (1.0)
.060
7.3 (1.7)
8.7 (1.0)
.070
6.2 (1.6)
8.6 (1.0)
.004
4.6 (2.1)
7.6 (1.5)
.009
Abbreviations: AHS, Area Health Service; ANMC, Australian Nursing & Midwifery Council; DoH, Department of Health; EBP, evidence-based practice; EMR, electronic medical record; IT, information technology; N/M, nursing/midwifery; NSW, New South Wales.
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Planning for a Smooth Transition Table 2. Ability to Undertake Key Managerial Skills
Business management Manage conflict resolution Political astuteness IT training/data management excel, word, etc IT training, EMR Risk analysis ERMS Incident management as an NUM People management Counseling/active listening Networking Research training Timesheet management Inventory management Budget and finance management—power budget
Baseline, Mean (SD)
Follow-up, Mean (SD)
P
2.5 (1.0) 3.5 (0.75) 2.63 (0.91) 3.3 (0.91)
3.8 (0.83) 4.3 (0.51) 3.8 (0.64) 4.1 (0.35)
.012 .017 .007 .049
3.7 (0.70) 1.3 (1.1) 2.0 (1.6)
3.8 (1.6) 3.6 (0.91) 4.5 (0.53)
.846 .001 .001
3.7 (0.88) 4.0 (0.92) 3.1 (1.3) 1.8 (1.1) 1.1 (1.5) 0.88 (1.3) 0.75 (1.1)
4.3 (0.51) 4.3 (0.51) 4.2 (0.46) 3.7 (0.70) 3.5 (0.92) 3.3 (1.1) 3.2 (1.1)
.107 .334 .043 .001 .002 .002 .001
Abbreviations: EMR, electronic medical record; ERMS, Enterprise Risk Management System; IT, information technology; NUM, nurse unit manager.
RESULTS Eight staff (5 females and 3 males) participated in the Future NUMs program. The mean age of the participants was 29.9 years (range, 26-38 years). Four participants were clinical nurse specialists and 4 were registered nurses. The number of years of experience of the participants ranged from 4 to 6 years.
Confidence in undertaking the N/MUM role Overall significant differences from baseline to follow-up were observed in the participants’ confidence in undertaking the N/MUM role in all 3 main categories. In the category “Patient care coordination and the practice of nursing/midwifery,” significant differences in
Table 3. Participant’s Self-rated Leadership Characteristics
Challenge the process Inspire a shared vision Modeling the way Enables others to act Encourage the heart
Baseline, Mean (SD)
Follow-up, Mean (SD)
P
41.3 (4.6) 41.5 (4.3) 50.9 (3.6) 49.8 (2.8) 47.8 (2.8)
48.6 (6.6) 46.5 (5.0) 54.9 (4.3) 53.1 (4.2) 53.5 (4.6)
.02 .05 .07 .09 .04
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Table 4. Items in the Subscales of the Leadership Practice Inventory Challenge the process I seek out challenging opportunities that test my own skills and abilities I challenge people to try out new and innovative approaches to their work I reach outside the formal boundaries of my organization for innovative ways to improve what we do I make sure that people are creatively rewarded for their contributions to the success of our projects I experience and take risks even when there is a chance of failure I take the initiative to overcome obstacles even when outcomes are uncertain Inspire a shared vision I talk about trends that will influence how my work gets done I describe a compelling image of what our future could be like I appeal to others to share an exciting dream of the future I follow through on promises and commitments that I make I am contagiously enthusiastic and positive about future possibilities I speak with true conviction about the higher meaning and purpose of our work Modeling the way I set a personal example of what I expect from others I spend time and energy on making certain that the people I work with adhere to the principles and standards that have been agreed upon I am clear about my philosophy of leadership I make certain that we set achievable goals, make concrete plans, and establish measurable milestones for the projects and programs that we work on I make progress toward goals one step at a time Enables others to act I develop cooperative relationships among the people I work with I actively listen to diverse points of view I treat others with dignity and respect I support the decision that people make on their own I give people a great deal of freedom and choice in deciding how to work I ensure that people grow in their roles by learning new skills and developing themselves Encourage the heart I praise people for a job well done I make it a point to let people know about my confidence in their abilities I ask what we can learn when things don’t go as expected I publicly recognize people who exemplify a commitment to shared values I find ways to celebrate accomplishments I give my coworkers lots of appreciation and support for their contributions
scores from baseline to follow-up were observed in items relating to “Lead, direct, and coordinate care in the ward/unit” (P = .02), “Use patient and carer feedback to inform patient care service delivery” (P = .00), “Establish and maintain the use of EBP (evidencebased practices)” (P = .04), and “Uphold the principles of practice as defined by Nurses and Midwives Act of 1991, Australian Nursing & Midwifery council (ANMC) Codes of Con-
duct, Codes of Ethics and Professional Conduct” (P = .04). Similarly, in the category “Nursing/ midwifery staff management and leadership,” significant differences in scores from baseline to follow-up were observed in items relating to “Establish and maintain relationships and trust” (P = .009), “Creating an empowering environment that enables the transfer of knowledge into practice” (P = .009), “Inspire
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Planning for a Smooth Transition and support others to achieve their potential” (P = .006), and “Enable others to achieve a shared vision” (P = .014). In the category “Ward unit management,” significant differences in scores from baseline to follow-up were observed in items relating to “Ensure the human physical and financial resources of the ward/unit are managed, in collaboration with relevant subject matter experts, to deliver safe and efficient health care within available resources” (P = .008), “Monitor and maintain a safe environment for patients, staff and visitors, in collaboration with the relevant subject matter experts” (P = .004), and “Ensure and maintain knowledge and participation in business management activities within NSW DoH (Department of Health), AHS (Area Health Service), organizational policy and procedures” (P = .009). Ability to undertake key managerial skills Significant differences from baseline to follow-up (P < .05) were observed in participants ability to undertake 11 of the 14 managerial skills. In the remaining 3 managerial skills that included “IT training and electronic medical records (EMRs)” and “People management and counseling/active listening,” there were increases in scores from baseline to follow-up; however, these results were not statistically significant. Leadership characteristics Of the 5 key practices of exemplary leaders, significant differences in scores from baseline to follow-up were observed in practices relating to “Challenging the process” (P = .02) and “Encouraging the heart” (P = .04). The mean baseline score for “Inspiring a shared vision” was 41.2 (SD = 4.3) and at follow-up was 46.5 (SD = 5.0). However, this increase in leadership practice was not statistically significant (P = .05). Similarly, although scores increased from baseline to follow-up in practices relating to “Modeling the way” (mean difference = 4.0) and “Enabling others to act”
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(mean difference = 3.4), these results were not statistically significant (P > .05). Cost–benefit of the program Of the 8 participants who completed the program, 1 has been appointed to a permanent NUM position within the employing facility; 1 is currently in a long-term relief position; and 2 have accepted the position of an NUM in other organizations. Evaluation of the Future NUMs program Overall evaluation indicates that participants gained significant benefits from participating in the Future NUMs program. All participants either agreed or strongly agreed that the information provided was relevant to their learning needs and that the presentations and teaching styles were effective. Participants also indicated that spending a day with the various senior managers enhanced their understanding of the role of the manager or the department in patient care. For example a comment about the Director of Nursing (DON) included: “Great leader, inspirational, good to see what the DON does.” Another participant commented on the bed management center: “Busy job, great handson experience.” Mentors indicated that they felt humbled and honored to have been chosen to mentor prospective NUMs. DISCUSSION The declining number of nurses undertaking an NUM role will create a significant impact in the clinical setting, as the older NUMs begin to retire. To maintain a pool of potential NUMs, senior nursing leaders need to focus on appropriate succession planning to develop the leadership and management skills of the next generation of nurse managers. This study was undertaken to assess the impact of a structured succession development and mentoring initiative called “the Future NUMs program” on the leadership and management skills of prospective NUMs. The program was designed for nurses keen to pursue a career in
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nursing management who find that they lack the confidence to take that step because they are unsure of the everyday requirements of the position. The mean age of the participants in this study was 29 years. This is in contrast to the literature where the mean age of NUMs is generally 45 years.30 (There is a belief that to obtain a leadership position nurses should have extensive experience in the clinical setting.)31,32 Overall significant differences from baseline to follow-up were observed in the participants’ confidence in undertaking the N/MUM role. In the category relating to “Patient care coordination and the practice of nursing/ midwifery,” there were no significant differences in the subcategories relating to facilitating collaborative teams in the delivery of patient care, enabling a culture of enquiry and questioning about the practice of nursing/midwifery, maintaining knowledge of contemporaneous nursing/midwifery practice, and establishing and maintaining a standard of practice that meets ANMC competency standards. This could be due the fact that the participants were nursing clinicians and that working collaboratively with multidisciplinary teams as part of contemporary nursing practice. Current nursing education programs create a culture of enquiry and questioning in student nurses about the practice of nursing/midwifery, which they then bring into their clinical practice. In the category relating to “Nursing/ midwifery staff management,” significant differences were observed in all subcategories except for the subcategory relating to “Being an exemplary role model.” It could be postulated that the participants were all clinical nurses and had limited opportunities in the clinical setting during the study period to be a managerial role model. However, the scores at follow-up for this subcategory were higher than the baseline scores, which demonstrate that the participants gained some confidence in being an exemplary role model. The Future NUMs program is focused on the managers’ need to do on a day-to-day basis. Therefore, in the category relating to “Ward
unit management,” there were significant differences in scores from baseline to follow-up in all 3 subcategories that related to everyday work. The remaining 3 subcategories related to long-term goals and require experience working as an N/MUM. Improvements from baseline to follow-up were observed in participants’ ability to undertake all the key managerial skills. However, in 3 skills, including “electronic medical records,” “people management,” and “counseling/active listening,” the results were not statistically significant. Various reasons could be postulated for these results. The baseline scores for “electronic medical records,” “people management,” and “counseling/active listening” were already high, which could be due to the fact that these are part of the everyday role of the registered nurse. The Future NUMs program did not focus on these skills, as these were considered to be assumed knowledge. Although the Future NUMs toolkit included activities and literature to improve leadership characteristics, significant changes were found only in items relating to “Challenging the process” and “Encouraging the heart.” These results could be due to the fact that these skills can be easily obtained in a short period of time, because they are an extension of the skills of a nurse. In contrast, skills relating to “Inspiring a shared vision,” “Modeling the way,” and “Enabling others to act” require experience and should be assessed as long-term goals. Participants reported that they benefitted from participating in the Future NUMs program. The personal engagement of the DON and other senior managers created a climate where the prospective NUMs were supported and empowered. This aspect remains a key feature of the program. The principles implemented in the Future NUMs program in this study can be easily transferable to succession planning programs for all levels of nurses. Any succession planning program has inherent cost implication. Therefore, organizational support remains the cornerstone for
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Planning for a Smooth Transition the success of any such programs.33 In this study, the cost included a time commitment from senior nursing managers and administrators and the backfilling of positions so that participants could complete the program. Despite the costs, the Local Health District has agreed to provide additional funding for 4 more candidates for the following year. It is important that succession planning programs are integrated into the nursing business plan, rather than pursued during NUM shortages. Despite the positive results obtained, some of the limitations inherent in undertaking such a study need to be acknowledged. The sample size for this study was small, so generalization of the results may not possible. The small sample was due to the fact that there were limited resources to undertake this project. In addition, the number of NUM vacancies that would be available in the interim was few. Another limitation of the study was that we did not assess the educational level of the participants. However, previous research
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has shown that, irrespective of their educational qualifications, nurses can be in leadership positions.34 Further research into progression of the participants’ advancement in leadership roles is warranted. Implications for management This study has provided some implications for nursing management. Although the Future NUMs program provided participants with a leadership development opportunity, maintaining these leadership skills will remain a challenge if a NUM position is not readily available. An extension of the current role could be an alternate solution to maintain the managerial skills developed during the program. CONCLUSIONS The Future NUMs program was positively evaluated by participants. The organisation is now equipped with a pool of emerging Nursing Unit Managers who have been educated and mentored to successfully undertake the role of the NUMs across the organization.
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