Adapting a nurse leadership structure to align with a new strategic plan isn’t easy, but it’s essential to bring about meaningful change.
When Texas Children’s Hospital, Houston, recently adopted a fresh strategic plan that focused on exemplary practice, technology, patient and family centeredness, workforce planning, and quality outcomes—along with a vision for its nursing department to be recognized as a national leader in pediatric and obstetric nursing— the organization recognized it would need to reshape its nursing leadership network to support the new priorities.
The initiative was a joint effort between the nursing and human resources departments. Participants Emily Weber, MS, RN, CPN, NEA-BC, Jacqueline Ward, MSN, RN, NEA-BC, and organization development expert Terese Walsh shared their strategy in a recent issue of Nursing Management to provide guidance to other organizations faced with a similar challenge.
The change-makers began the process by brainstorming and developing guiding principles for the redesign of nursing leadership positions. A few examples: Evidence-based practice should direct nursing care. Defined structures and streamlined processes are necessary to produce positive outcomes. Nursing leaders should be supported clinically and administratively. And so on.
The exercise led to the identification of two new leadership roles that, when added to the existing structure, would support the guiding principles. The first new role was an assistant clinical director, a master’s-prepared nurse on each inpatient unit who would hold 24-hour responsibility for its operations. The second new role was a patient care manager, a frontline nurse leader focused on quality, staff effectiveness and family-centered care.
Next, nursing executives and human resource personnel identified specific job responsibilities for each role and created job descriptions. They then considered what qualities candidates should have to be considered for the roles.
“Human resources guided nursing leadership through a process to develop business-driven success profiles that aligned with Texas Children’s strategic priorities,” the authors recalled. “The activity yielded a set of competencies, personal attributes, knowledge, and experience areas for each role.”
Nursing and human resource leaders next created a set of behavioral-based interview questions that required applicants to give examples of their past performance that reflected the essential competencies. Some 14 nurse managers interviewed for eight assistant clinical director roles, and 32 clinical nurses for 16 patient care manager positions. Each applicant took part in interviews with individuals as well as with panels.
Later, interviewers met as a group to assign a joint rating for each competency for each applicant. They also discussed the applicant’s ability to fit in with the unit’s culture.
“The assessment of job fit was essential,” the authors noted, “to ensure job satisfaction and long-term retention.”
After the new set of nurse leaders were selected, each participated in a 4-hour simulation-based manager assessment. The new leaders answered calls and emails representing common challenges they could expect to face on the job. Trained assessors rated their performance on nine core leadership competencies, and then met with each new leader for a 1.5-hour debriefing.
“Reviewing the results first with the participant provided him or her with a safe environment to receive the feedback and allowed time to process the results,” the authors explained.
After the new leader’s supervisor was filled in on the results, the new leader, supervisor and a consultant met together to design an individual development plan.
New leaders also began a 2-year comprehensive training program that spans financial and business acumen, healthcare reform, patient- and family-centered care, human resource leadership, and other topics meaningful to nurse leaders. Each also received a playbook, which contained key information to help in the new role. Contents included job descriptions, orientation checklists, required competencies, individual development plans and leadership articles.
During annual appraisals, each leader’s ongoing performance in the leadership competencies was assessed. Success profiles were also discussed and compared with performance. For example, the assistant clinical director’s included building a successful team, coaching and developing others, and business acumen. The patient care manager’s included leadership disposition, delegating responsibility and facilitating change.
“Developing a pool of talent for today and into the future,” the authors noted, “requires a strong commitment from the nursing department, human resources, finance, and the executive team.”
Adapting nurse leadership to reflect changing priorities requires significant planning and sustained effort. But it can—and must—be done if an organization is serious about reaching its goals.
In the end, the payoff is worth the price.
“The most significant investment an organization can make in the delivery of quality patient care,” the authors wrote, “is the development of current and future nurse leaders.”