- Why is Nursing Culture Important - February 10, 2020
- Do you Know Your Nursing Hours Per Patient Day? - May 18, 2016
- Are There Any Nurse Manager Competencies Like We Use For Clinical Tasks? - May 28, 2015
You might be surprised to learn that the answer to that question is yes. And it is the greatest antedote to the battle of internal dialogue that new managers put themselves through. One of the greatest toxicities to new nurse leaders is “The Cloud of Self-Doubt”. I watch countless new managers crumbled under the pressure. They are convinced at any minute they’ll be exposed for the fraud they believe they are. They believe that they are expected to know it all Day One: to hit the ground running. Every meeting they attend, every email they send, every non-stock requisition they sign off. They perceive they are running blind.
Any Learned Skill Takes Time: Leadership Is No Different Nursing was no different either.
When we came to this gig as young and naive nurses – ready to save lives, make a difference – but we couldn’t tell the difference between a cannula and a catheter. Everything was confusing. Managing a patient load of four patients was enough to have us quivering in our tea by 10am when we had royally failed to get all our showers done by that important, yet largely nebulous, timeframe.
The difference between then and now is that we didn’t apply the same pressure on ourselves to be Wonder Nurse on Day One as we do when turning up to be a nurse leader. Just as senior nurses on our first ward gently scoped our building competency, we follow a similar path as nurse leaders. We weren’t ready to access a Port-A-Cath until we had been signed off on that competency. Same for managing a ventilated patient. Same for running a dialysis machine. Same for taking on a building case load in the community.
Competency had to be grown.
Nurse Manager Competencies Are The Same
Let’s take intravenous cannulation as our analogy.
To learn that skill, we read the Self-Directed Learning Package. Perhaps it’s a one-hour lecture by the nurse educator. Perhaps a online e-learning course. Often a quiz testing our uptake of the fundamental anatomy, physiology, techniques, contraindications and adverse events. We practice on a fake arm for a while. But we then move into a series of supervised practices. Perhaps 2, maybe 5 supervised cannulations.
The first one is horrible. A needle wildly waving toward an innocent patient’s cubital fossa. A hovering experienced nurse as tetchy as you are. A patient who picks up that all is not well and that vein shrinks to oblivion before your very eyes. Needle goes in. It’s no surprise to all 3 of you that nothing happens. A gentle bit of probing yields no yearned-for flashback, but it prompts the competent nurse to step in and sort it. Awful.
But you back up for another go at the next opportunity. This time you get it. The next time you don’t: but this time you know what you did wrong. A few more times and you’re signed off.
A clusters of skills, behavioural attributes and personal attitudes
Competency is more than just successful execution of a given task. It depends greatly on behaviour and personal attitudes as well. The cannulation analogy demonstrates that beautifully: you get baulked by a failed cannulation, and you’re sure to have a run of failures. It’s all in the mind.
A recent study showed that successful attainment of a common set of nurse manager competencies were more important to the successful execution of this role than formal qualifications and/or number of years experience.
In short, they predict job performance.
These Are The True Predictors Of Job Performance
The ability to absorb, interpret and execute the nurse manager competencies as well as adopt the behaviours and attitudes is what makes all the difference. Build self-confidence. Kill that Cloud. Like cannulation – if you don’t believe you can do it, then you leave a lot of blown veins in your wake.
Let’s take a look at John. He’s now a Nursing Director and he’s been doing it for a while. But when he started, things were pretty shaky.
John: As Team Leader….
His clinical background is in oncology. When he started as a Clinical Nurse, the role came with being shift leader. Not something that he had ever done before. He was eager, but after a few shifts, he became intimidated by the role. His lack of confidence bred a lack of enthusiasm for the role. He certainly had trouble seeing the big picture and “The Vision” that the top brass talked a lot about. When problems emerged, he showed no confidence in his ability to deal with that problem. As a result, others perceived him to shirk a great many of his responsibilities. One evening, the night duty nurse calls in sick. John has no idea how to sort it. He ignores the problem for a while. Eventually, he calls the hospital coordinator, but her expectation is that ward team leaders exhausted all options before calling. He hasn’t done that. John is stressed and he is anxious.
Over time, though, he grew and learned lessons along the way. By the time he was ready to apply for a Nurse Manager’s role, his team leading skills were excellent. Now, he really did embrace the relevance of “The Vision” and could see its relevance and importance at the ward level. He talked to the staff about that vision when dealing with patients who were unhappy and potential complaints. He could give clear directions to the team and they responded well. He could coordinate a shift competely autonomously now – no need for constant checking with the following team leader about difficult decisions or phone calls to the Nurse Manager. He was good with what he’d decided. Tonight, like in the beginning, the team leader calls in sick for night duty. He’s been here before and has a number of options to try and knows who to escalate the problem to if he gets no joy from his Plans A, B & C. But it is Plan B that pans out, so job done. The rest of the team don’t even know there’s a problem until he lets them know that it’s now Joyce working the night now, not Angela. John is calm.
John: As Nurse Manager…
Now he’s taken up the role of Nurse Manager. He’s feeling out of kilter now that his core business is not patient care. That’s where his skill set lies – not in all this paperwork, policy writing and incident reporting. He attends the Heads of Department meeting for the first time. He remains silent and distant. He offers no insights or opinions: even on matters that directly impact oncology patients. John retreats from seeking the help from his peers for fear of being exposed. However, he does seek the counsel of a highly trusted few in his team about service issues, even though these trusted few are his subordinates now. John tends to overanalyse situations and often jumps to conclusions. His team find his “knee-jerk” responses to problems worrying: if the manager can’t handle it, how can they be expected to?! His manager finds his “knee-jerk” responses frustrating. John seeks refuge in escalating too many problems to his manager with the firm belief that it’s an issue that should be dealt with higher up. His manager disagrees.
As time goes on, John realises that involving those trusted few is counter-productive to building a collaborative and well-integrated team. He moves away from that approach and adopts a consultative approach, instead. He welcomes input from the team and is known by the staff for his “open door policy”. John attends those meetings know with confidence and offers his professional advice on matters where his skill set lies – the management of oncology patients. More broadly, he builds a network of colleagues who are his peers and is cognisant of their issues that parallel his. They work together and bring solutions to those meetings. John has started to master the ability to use analysis and logic to solve problems before they need to be escalated to his manager. He is much more restrained now about which issues are brought to executive and which ones are managed “in-house”. His team find his calm approach reassuring.
John: As Nursing Director…
The opportunity for Nursing Director came up and John felt ready to go for it. He won the job. When he started in the role, he felt like the issues that he had to deal with at that level were unsurmountable. His approach was highly reactive – just putting out fires in all the clinical areas he was responsible for. Day after day. He spent an inordinate amount of time with each manager grasping their challenges. Absorbing all the issues was overwhelming. Worst of all, the problems that he had encountered and mastered as Nurse Manager were tangible. Staffing shortages, roster problems, critical incidents to investigate, policies to write. They were tasks that one could feel they could put into a box and say “I’ve achieved this”. Now, however, the problems were grander, complicated and intertwined with other areas. They were much more intangible that what he’d dealt with before. He felt he lacked control.
John’s been in the Nursing Director for a while now and things have settled down. He’s able now to scan his areas and identify trends and anticipate problems before they crop up. He feels more proactive and less reactive than he did in the beginning. He’s worked out which problems are going to blow up and which ones will blow over. He can scan complex problems and see the issues. He can scan complex data and see the trends. He’s developed the ability to tell the difference between operational thinking and strategic thinking. He accepts that he cannot control this large, complex animal and goes about making it as great as it can be.
Nicole’s career coaching blog can be found at http://www.nursemanagerhq.com
McCarthy, G. & Fitzpatrick, J. J. (2009)”Development of a Competency Framework For Nurse Managers in Ireland” The Journal of Continuing Education in Nursing. 40(8): 346.
Cipriano, P. F (2011) “Move Up To The Role Of Nurse Manager” American Nurse Today