By Monica Puga, MSN, RN, Shelly Delfin, DNP, RN, and Jessica Jimenez, MSN, RN
According to a recent survey by the American Organization for Nursing Leadership, 45% of nurse managers intend to leave their current role, a potentially critical situation for healthcare providers and nursing management given how much these leaders impact safety, quality, engagement, and fulfill one of the industry’s most challenging roles.
While nurse manager dissatisfaction within Memorial Healthcare System never reached the level cited in the AONL study, we did, in the worst days of COVID-19, understand we had a looming crisis on our hands. The pandemic exacerbated our nurses’ concerns about their own safety while the unprecedented circumstances in which they worked maximized stress on every shift. It was a difficult time for everyone, especially those on the front lines who were counted on to provide leadership and guidance to an increasingly inexperienced workforce while working a job that too often left them exhausted, burnt out, and lamenting their poor work/life balance.
Introduction of Shared Governance and Participatory Leadership
Out of that, however, came a strategic initiative whose positive impact continues to resonate to this day. What began as a peer group to provide support to each other and help govern practices evolved into a systemwide Nurse Manager Council that is directly impacting retention, quality, safety, and finance. Part of Memorial’s strategic plan for nursing, the council empowers nurse leaders with a collective voice that gives them more control over their lives and careers and has become a model for shared governance and participatory leadership.
There are 12 nurse managers on the council, representing the six hospitals in the Memorial system and more than 50 leaders with that title, whether they work with inpatients, in the operating or emergency rooms. The council’s first order of business was establishing a set of core values important to them, which were, in essence, lead with heart, do what’s right, show up and make a difference, and trust your voice will be heard. They then defined areas of great concern, which included poor work/life balance, disorganized onboarding, and lack of professional development opportunities.
While they established priorities, nurse managers also bonded with each other. Professional friendships developed that might not have otherwise, given the size of our organization, and the leaders provided support for each other, regardless of where they worked. Additionally, seasoned nurse managers began mentoring newer counterparts and shared best practices that can be utilized across Memorial Healthcare System.
Improving Outcomes
For the past two years, the Nurse Manager Council has been empowered to meet and make decisions about anything related to workflow and nurse practice, with a number of policies and procedures since implemented that increased employee retention, job satisfaction, and engagement:
- Adoption of flexible, 40-hour work schedules
- Development of nurse manager core competencies
- Standardization of the onboarding process
Memorial Healthcare System leadership, at both the system and hospital level, is seeing the quantifiable fruits of the council’s labor. Given the estimated $80,000 cost to replace a nurse manager, our turnover/vacancy rate dropping from nearly 17% to 6% is significant and demonstrates the importance of the nurse manager’s role in staff retention. Memorial retains nurse residents from year one to year two of their careers at an impressive 94% (the national average is 67%), which can also be attributed to strong leadership. We’ve also reduced pandemic-era staffing costs for travel nurses by $130 million and now have a waiting list of nurses hoping to join our organization. The bottom line is the improved work environment for nursing staff not only increased retention, but also positive patient outcomes and satisfaction.
What’s Next?
Moving forward, our Nurse Manager Council will be evaluating their scope of responsibilities and will use evidence-based research in search of healthier professional environments that foster and encourage innovation in practice. While we don’t yet know what recommendations may come from this aspect of the council’s agenda, we do know executive nurse leadership and hospital CNOs are interested to hear the recommendations.
Since its inception, the Nurse Manager Council has had our collective buy-in and support, which aligns with the Memorial culture that values the voices of all our caregivers and prioritizes a healthy environment for nurses to practice and grow.
Monica Puga is the chief nursing executive at Memorial Healthcare System.
Shelly Delfin is the chief nursing officer at Memorial Regional Hospital South and Memorial Rehabilitation Institute.
Jessica Jimenez is a nurse manager at Memorial Hospital Miramar and co-chairs the Nurse Manager Council.
To learn more about nursing opportunities at Memorial Healthcare System, visit www.mhs.net.