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Mentoring Frontline Leaders
Andy has been the chief nursing officer (CNO) of Whitefish Community Hospital for the past 5 years. He has done an excellent job of advancing the knowledge, skills, and self-confidence of his directors, and the hospital was recently awarded Magnet designation with special commendation for research and innovation. Andy considers this to be a major accomplishment because when he first came to Whitefish Community the nursing department was led by a very authoritative leader in a hierarchical organizational structure. Andy has made many changes to the nursing organization and has won the respect of the executive team for all that has been accomplished. Physicians in the hospital have also commented on how nursing has improved dramatically over the past 5 years. Although Andy has every right to feel proud of nursing leadership and the clinical staff, he feels uneasy about the level of preparedness of the frontline leaders at the point-of-service.
The nursing organizational structure consists of directors who report to Andy, managers who report to the directors, and assistant managers who are shift leaders with responsibility for the day-to-day direction of staffing and the interface with the clinical nurses for their schedules and performance appraisals. In addition to the assistant managers, the more advanced clinical nurses are also designated as charge nurses, who are responsible for leading the clinical activities of the unit, including the patient assignments for each shift.
What concerns Andy is that the least experienced manager has the greatest interface with the clinical nurses, other professional partners, and the patients and families. He recognizes a need to improve the knowledge and competencies of the frontline leaders to improve patient outcomes, increase nurse and physician satisfaction levels, and ensure that there are adequate numbers of prepared individuals for a viable succession plan should the need occur. Andy realizes that the frontline leaders who are unprepared for their roles could significantly affect the hospitals reputation for excellence.
Andy often states, A good reputation is hard won, easily lost, and sometimes never regained. He encourages his direct reports to focus on the issues that define quality from the perspective of the patient, physician, and employees. It matters significantly that our nursing-sensitive indicators and all other quality metrics meet and exceed our targeted goals, but its also critical that we address issues that are perceived by our customers as quality indicators. A clean environment, meal trays delivered on time, medications given when requested, and a comfortable space for the families are all issues of quality for the patients. Having information and resources available, the presence of the nurse during rounds, and an efficient hospital visit are all issues of quality for physicians. Having needed resources, adequate staffing, and a healthy work environment are all issues of quality for the nursing staff. We as leaders need to ensure that our nurses have the resources that they need to do what they do best, and then we need to get out of their way and let them do it! We need to assure our physicians that we have the best, the brightest, and the most competent nurses in the world who can provide excellent care for their patients and their families. We need to provide a calm, pleasant, healing environment for patients and their families. The only way that we can accomplish these goals is to be authentic leaders who are physically and emotionally present in our support for our nursing staff and particularly for the frontline leaders who are the least prepared for their critically important role.
Andy shares his concerns with his directors and the other executives on the healthcare team. He gathers their ideas, and they develop a mind map of all possible ways that the frontline leaders can be developed in the most cost-efficient way. They decide to develop a Leadership Institute with an array of courses and classes offered online and in quarterly presentations. They design a leadership development program that includes lectures online and in class, reading materials, video presentations, and group discussions of actual case presentations. It is decided that after the participants earn 25 units of education, they will be given a leadership certificate and pin presented at a graduation ceremony. The graduation will include a national speaker and recognition of the new graduate in the Whitefish Community Hospital publication that is distributed to all employees, physicians, patients, friends of the hospital (financial donors), and the board of directors.
Andy is pleased that this plan provides an educational foundation for the frontline leaders who may not have had the opportunity for leadership education beyond their basic nursing education; however, he still feels that something is missing in advancing the leadership skills and competencies of the frontline leaders. During the budget season, Andy had the opportunity to review all of the programs and services offered by the nursing division and other hospital divisions to ensure their worthiness of being financially supported in the upcoming year. During this analysis of all programs, Andy reviewed the annual report for the New Graduate Residency Program, and the data clearly indicated the positive outcomes and cost-efficiency of the program. Nested in the program was a strong and viable mentor program for the new graduate residents. Feedback from the new graduates indicated that the mentor program provided the social support that they needed to be acculturated on their units and provided a safe resource for them when they had questions, concerns, or frustrations they did not feel comfortable sharing with their direct supervisors. When Andy read the annual report and the anecdotal comments, he had an aha! moment. Of course! This is the support that is missing for frontline leaders. We need to pair them with more prepared and experienced managers or directors who have clearly demonstrated success in their roles and who are willing and able to mentor the frontline leaders beyond the planned educational courses and sessions. Andy is excited about developing a leadership mentoring program not only for new leaders in the organization but also for the existing less-experienced frontline leaders. He strongly believes that a mentor from another department would provide the social and experiential support that is often missing in formal education.
When Andy shared his vision with the directors and executive colleagues, they are also interested, particularly when he shares the positive outcomes of the mentor program for the new graduate residents. He mentions that he would be using that program as a pattern for the development of the leadership mentor program. He also shares how he would be evaluating the programs effectiveness with outcome metrics that he would report back to the executive team. He indicates that the program would be provided within existing budgeted educational funds, and the return on the investment would not only be measured in financial terms but also in terms of patient, physician, and provider outcomes because the frontline leaders strongly influence these outcomes. Andys next steps are to engage some of the directors, managers, selected frontline leaders, and the research nurses in the design, development, and measures of the leadership mentor program.
Questions
1. What is your opinion of Andys plan to advance the knowledge and competencies of the frontline leaders?
2. What additional benefits, if any, do you see resulting from the development of a leadership mentor program?
3. What attributes of a transformational leader and coach does Andy demonstrate in his role with his direct reports, executive colleagues, and the nursing division as a whole?
4. Compare and contrast the similarities and differences between an authentic leader and a transformational leader.
5. In reviewing the attributes of quantum leaders, how do these attributes intersect with the attributes of authentic and transformational leaders?
6. If you were in Andys role, what would you do to advance the knowledge, skills, and competencies of frontline leaders, and how would you measure whether you were successful in this endeavor?
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