Nursing executives at Premier Health stepped in with what they believed would be an effective plan to help their nurse leaders, who were exhausted after working through the pandemic to deliver exceptional care to the patients of the southwest Ohio health system.

“We embarked on a journey to change the structure of nursing leadership across all our hospitals,” recalled Angela Wale, MSN, RN, CENP, system director for nursing professional practice and research at Premier. “We thought this was a great idea because we were going to help provide additional support to the nurse managers.”

But when nursing executives began to talk about their plans with Premier’s nurse directors and nurse managers, they received a cool reception.

“They didn’t think that our great idea was as great as we thought,” Wale said. “We thought we were doing a really good thing and it didn’t seem to be landing as well as we thought that it would. What were we missing?”

That’s when Wale and her colleagues decided to call for help.

Time for a Second Opinion

Wale turned to Mary DelGuidice, chief nursing officer (CNO) at Tipton Health. The system has been working with Tipton Health since 2015, when it began to pursue the ANCC Magnet Recognition Program® from the American Nurses Credentialing Center.

“Mary said, ‘You are a well-established Magnet organization and you’re making a change that is directly impacting your nurse managers. I’m surprised that I’m not hearing about how you’ve engaged your nurse managers in this work.’”

Wale realized that in their zeal to protect Premier’s nurse leaders and their time, the nursing executives had strayed from their practice of involving care team members in their discussions.

“We were trying to save nurse managers and they didn’t need us to save them,” said Wale. “They needed us to work with them.”

Involving Nurse Leaders

Wale and her colleagues decided to abandon their plan and start anew by inviting nurse leaders throughout the system to get involved.

“Instead of telling our nurse managers exactly what we had done for them, we invited them to come to the table,” she said. “I led a subgroup of those nurse managers that took a look at the job descriptions we were creating. We talked about roles and responsibilities and how these nurse managers were going to lead these new teams.”

Out of those discussions came a new realization, Wale said. “It’s really not just about structure change. It’s about the nurse leader work environment.”

Premier worked with Tipton to pull together nurse leaders and get their input on their work environment using Tipton’s Nursing Excellence Assessment tools.

Not surprisingly, the nurse managers said they were tired. But at the same time, the survey results showed that nurse managers were optimistic about efforts to improve the work environment.

“It was encouraging to see that overwhelmingly our teams were proud, and they were ready,” Wale said. “We knew that this was a good indication that we didn’t have to wait for the time to be right, because the time is now.”

The survey also identified six areas of opportunity for improvement Premier could pursue. They were:

  • Workload
  • Work-day wellness
  • Work-life balance and flexible work models
  • Nurse leader empowerment
  • Professional development
  • Meaningful recognition for nurse leaders

Wale said one comment made in the survey stuck out to her. “We had nurse managers who were leaving because they felt like they were inadequate because they felt like they couldn’t be who they wanted to be and do the job they wanted to do.”

The survey results and comments encouraged nurse executives to prioritize their efforts. “We’re going to elevate the role of nurse leaders by improving the nurse leader work environment,” said Wale.

A Steering Committee Sets Direction

Premier Health set up a steering committee that included the system CNO and two nurse managers to evaluate and prioritize the six areas of opportunity the survey had identified. After discussions, those six areas were narrowed to three:

  • Work-life balance and flexible work models
  • Professional development
  • Meaningful recognition

Premier set up subgroups to enable its nurse leaders to work together and talk through solutions. A few of those solutions included aligning the way nurse managers perform their jobs with the American Organization for Nurse Leaders (AONL) best practices, exploring how to use flextime, looking at professional development models and implementing a Nurse Leader Daisy Award for recognition.

The process showed that in many cases, nurse leaders were able to help themselves. One example, said Wale, was discussion around creating a “no-meeting Friday” policy, which would enable nurse managers to have more time to complete tasks from the week and plan for the week ahead. But they soon realized that a policy wasn’t needed, and nurse leaders were already “empowered to manage our own calendars and we don’t need people to stop scheduling meetings on Fridays. We need to take ownership of blocking that time on our calendars on Fridays or any other day during the week,” Wale explained.

Results Have Been Impressive

The results of the work have been impressive so far, said Wale. “We were able to significantly impact nurse manager turnover. Our results took us from a 15.2% turnover rate down to 2.2% turnover.”

In addition, “We were even more excited when we got to see the results of our second assessment,” she said. “From 2021 to 2022, our nurse leader work environment score improved by 15%. This is affirmation that the work that we’re doing is the right work—and certainly we’re not by any means done with this.”

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