Supporting the nurse manager to improve staff nurse retention

SueEllen Pinkerton. Nursing Economics. Pitman: Jan/Feb 2003. Vol. 21, Iss. 1; pg. 45, 2
pgs

Abstract (Summary)
The importance of the role of the nurse manager in nurse retention is well acknowledged.
A project initiated to determine what support a nurse manager needed to improve
retention is described along with interventions to make it happen.

Full Text (1122 words)

Copyright Anthony J. Jannetti, Inc. Jan/Feb 2003

[Headnote]
Executive Summary

[Headnote]
> The importance of the role of the nurse manager in nurse retention is well
acknowledged.
> A project initiated to determine what support a nurse manager needed to improve
retention is described along with interventions to make it happen.

Over 2 years ago Northside Hospital in Atlanta, GA, undertook a project to assess the
needs of nurse managers. The intent was to provide the support they needed to improve
nurse retention.

There is an abundance of literature focusing on the critical role of the nurse manager in
retaining staff nurses. Their role is described as one of the most difficult positions in a
health care organization since they have such a broad range of responsibilities, a large
number of direct reports, and are central to the coordination and organization of patient
care.

The project initiated at Northside Hospital had three learning objectives: (a) describe a
process for identifying and meeting nurse manager needs affecting nurse retention, (b)
identify critical elements of the nurse manager role influencing nurse retention, and (c)
identify work activities affecting nurse manager job satisfaction (Northside Hospital,
2002). The hospital used a national survey to determine what changes would improve the
job satisfaction of the nurse managers. Three areas were identified: time allocation,
increased need for training and education, and access to administrative support.

To address these issues, three teams were formed and the outcomes follow:
1. Administrative team. It was determined that providing a unit assistant (operations
assistant) would help reduce the burden of paperwork and some administrative tasks. In
turn, more time would be available for nurse managers to spend coaching and mentoring
staff.

2. Education team. This team developed technical and educational training programs.

3. Operations team. Coordinating a consistent process for strengthening new hire

orientation, unit preceptor selection, and competence were the focus of this team.

Administrative Team

To determine the opportunities for supporting the nurse manager in the most productive
way, a survey was completed asking the nurse managers to identify the time they were
spending performing administrative tasks. The number of hours spent on administrative
tasks that were subsequently assigned to the operations assistant varied from 27 to 79
hours a week (with an average of 41 hours) which converted to an average of 0.9 FTE
and a range of 0.4 to 1.8. Nurse managers were responsible for an average of 83
employees with the range being 23 to 215 employees.

These data were used not only to determine a job description for an operations assistant,
but also to determine the number of nurse managers an operations assistant could support,
given the range of time being spent by the nurse managers on administrative tasks. Some
of the tasks listed in the survey which the operations assistant (named secretary II in the
job description) can now perform as needed are payroll/attendance reports; monthly time
schedules; ordering supplies; scheduling and preparing for meetings; equipment, and
furniture maintenance; maintaining employee files on the unit; processing documentation
for staff evaluations; reading, sorting, and routing mail; and processing paperwork for
operational and capital budgets. The applicants must have a high school diploma or
equivalent plus 2 years of clerical/secretarial experience. Specific typing skills, software
knowledge, and medical terminology requirements vary by unit.

An extensive orientation was developed based on the administrative tasks assigned to the
operations assistant along with an orientation checklist and resource guide. The
evaluations of the orientation rated the content from 4.2 to 4.7 on a scale of 1 to 5, with 5
being the highest ranking. Once orientation was completed, a quarterly check-in for the
operations assistants was established.

Education Team

A second nurse manager survey was designed based on core management competencies
and was completed to assess the educational needs. The areas surveyed were: PC and
applications, decision support and finance, management engineering, business office
activities, internal audit, accounting, risk management, ANSOS software, patient care
support services, payroll, purchased labor (contract labor), human resources, and quality
improvement. The top five areas of training the nurse managers ranked, starting with the
most needed, were finance (operations budget and reporting, capital budgeting, and
investment analysis), PC and applications, management engineering (productivity and
labor standards), business office activities (charge master, activity analysis, and
documentation), and accounting (general ledger process and cost accounting overview).

The nurse managers were given a choice as to when the classes would be held, and the
majority (76%) said immediately following a standing meeting as opposed to planning a
separate meeting (24%).

Operations Team

The operations team focused on developing a consistent process to strengthen new hire
orientation, unit preceptor selection, and competency. Interviews of clinicians and
clinical nurse specialists were completed to identify best practices. Competencies of the
preceptor identified by newly hired personnel were clinical role model, socializes,
assesses, plans, implements, and evaluates. Preceptors received a letter from the nurse
manager and clinical nurse specialist requesting participation, received a gift basket
recognizing their participation, and participated in debriefing meetings led by clinical
nurse specialists where successful teaching and coaching practices are shared.

The preceptor course includes adult learning principles, evaluating progress, delivering
feedback, critical thinking skills, challenges faced by the new nurse, and how to be an
ongoing mentor to the new nurse. Evaluations of the preceptors have been positive. Areas
that have been difficult in the preceptor/orientee relationship have been attributed to
personalities, incorrect assumptions about the learner's knowledge base, inconsistent
practices among preceptors, and subjective assessments passed along to the orientee.

Although the retention efforts at Northside Hospital are new, there are some indications
of success. Departure rates have declined, thus realizing a gain in retained employees.

Retention rates are clearly a desired outcome of this program. However, note should be
taken of the results of the survey of nurse manager administrative tasks. To have such an
enormous responsibility for such tasks (full time for some of the nurse managers) barely
allows any time for staff development and creating an environment and infrastructure for
delivering patient care, let alone evaluating patient care. In addition, there are other areas
that must be attended to by nurse managers such as patient and family concerns,
physician concerns, relationships with other departments, hiring and firing, standing
meetings, and other tasks too numerous to mention. Supporting the nurse manager with
an operations assistant will efficiently free up time for the nurse manager to attend to
other responsibilities, many of them directly or indirectly affecting retention. This one
effort alone has already, and will continue to, produce retention results.
[Reference]
Northside Hospital. (2002). Meeting nurse manager needs to improve nurse retention. Atlanta, GA:
Northside Hospital.

[Author Affiliation]
SUEELLEN PINKERTON, PhD, RN, FAAN, is a Consultant, Creative Healthcare Management,
Minneapolis, MN. Comments and suggestions regarding this column can be sent to sepinkerton@msn.com.

Indexing (document details)

Subjects: Nurses, Managers, Retention
MeSH subjects: Georgia, Humans, Job Satisfaction, Nurse Administrators -- psychology
(major), Nurse's Role, Nursing Staff -- supply & distribution (major), Personnel
Turnover (major), Professional Competence, Staff Development -- methods
Author(s): SueEllen Pinkerton
Author SUEELLEN PINKERTON, PhD, RN, FAAN, is a Consultant, Creative Healthcare
Affiliation: Management, Minneapolis, MN. Comments and suggestions regarding this column
can be sent to sepinkerton@msn.com.
Document types: Journal Article
Publication title: Nursing Economics. Pitman: Jan/Feb 2003. Vol. 21, Iss. 1; pg. 45, 2 pgs
Source type: Periodical
ISSN: 07461739
ProQuest 291210011
document ID:
Text Word Count 1122
Document URL: http://proquest.umi.com/pqdweb?
did=291210011&sid=10&Fmt=4&clientId=26877&RQT=309&VName=PQD

Reaction:
 The Nurse Manager plays an essential role in healthcare. She sets the
tone of any healthcare system. The Manager is the backbone of the organization.
The quality of patient care, as well as staff recruitment and retention success,
rests with this key role. Over time it will be the strength of the nurse manager
group that determines the success or failure of nursing leadership.
Being a student nurse and having almost four years exposure to the
different series of rotations, I realized that there is also a delicate subtle art to
being a Nurse Manager-- from balancing the tensions between quality and cost
dealing with multiple stakeholders, presenting conflicting agendas ... to dealing
with stress and pressure every day ...to implementing processes needed to
ensure that individualized compassionate care is provided consistently in the
most efficient and effective manner possible…to guiding each staff in developing
and maximizing their clinical skills.
And yet it is rare that nurse managers are given the opportunity to acquire
enough assistance and resources essential to their success – and the success of
their organization.
As I read the article, it is nice to know that there are studies concerning
support for nurse managers being conducted; not just for the sake of the
manager herself but also in maintaining the number of nurses in the organization
for the continuous provision of superb health care.
The three support teams (administrative, education, and operation teams)
are essential to the development of the Nurse Manager, so that each patient care
area is managed to assure excellent quality of care and financial success.
And there is no better way for the Nurse Manager to achieve well deserved
recognition and career success.
Title: Supporting the Nurse Manager to Improve Staff Nurse Retention
Bibliography: Sue Ellen Pinkerton. Nursing Economics. Pitman: Jan/Feb 2003.
Vol. 21, Iss. 1; pg. 45.

SUMMARY:

The articele is about a project initiated to determine what support a nurse

manager needed to improve nurse retention. It was conducted at Northside
Hospital and has three learning objectives namely: to describe a process for
identifying and meeting nurse manager needs affecting nurse retention; identify
critical elements of the nurse manager role influencing nurse retention, and to
identify work activities affecting nurse manager job satisfaction.
Three teams were formed to address these issues, these are:
(1) administrative team, since it was determined that providing a unit assistant
(operations assistant) would help reduce the burden of paperwork and some
administrative tasks so that in turn, more time would be available for nurse
managers to spend coaching and mentoring staff; (2) education team to develop
technical and educational training programs; and (3) operations team which
focuses on coordinating a consistent process for strengthening new hire
orientation, unit preceptor selection, and competence.