For Nurse Managers, It’s Time to Embrace Succession Planning

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Nurse Manager Succession PlanningIt’s probable that one-third of today’s nurses will be leaving the profession in the next 10 years and probable that a much higher percentage of nurse managers will be vacating their jobs.

With more than 500,000 additional nursing jobs in the forecast and 1.5 million or more vacancies expected to be filled, a staggering number of personnel decisions will be made, and the onus will be on nurse managers to make them wisely.

Considering the large size of the nurse workforce, currently about 2.8 million in the United States, the scope of this personnel shuffle is historic. But the methodology in place for making these decisions is prehistoric.

Succession planning in health care

There’s an ever-more-popular saying in business management that a truly effective executive grooms and hires his or her own successor. Nurse managers have been late adapters, but in the past five to 10 years there has been increasing noise in nursing about the need for succession planning.

“Succession planning is about creating a road map for the future talent of your organization, as well as how you will go about developing that talent,” said Kathy Noland, Ph.D., B.E. Smith’s senior vice president in charge of executive search. “But ‘planning’ is the key word here. Succession planning requires determining actions to address a future need before that need is realized, and oftentimes it’s just not on the radar — yet it’s critical to every health care organization’s future success and continued momentum.”

That means it’s wiser to groom leaders from within than to hire piecemeal from outside as the need arises.

The financial implications alone are crucial. It costs at least $50,000 to replace a leader from outside, and into the millions to replace a chief operating officer, according to Hospitals & Health Networks.

The business world is increasingly embracing succession planning to fill most jobs, not just executive positions.

Considering the large size of the nurse workforce, currently about 2.8 million in the United States, the scope of this personnel shuffle is historic. But the methodology in place for making these decisions is prehistoric.

Succession planning in nursing

Efforts to bring succession planning into nurse-management methodology, however, aren’t progressing fast enough, says one expert on the methodologies of nurse management.

“There is a greater awareness of the need for nurse manager succession planning, but we are not yet where we need to be,” said Maria R. Shirey, Ph.D., an assistant dean at the University of Alabama at Birmingham School of Nursing. “Research suggests that even for CEOs, succession planning isn’t embedded in the institution like it should be,” Shirey told Tracey Boyd on

It behooves nurse managers to change that.

“Historically, the role of the nurse manager has changed,” Shirey said. “Since the period of re-engineering in the 1990s, nurse managers have effectively become the chief executive officer of the patient care unit, and, in many institutions, the leaders of more than one.”

In this role, nurse managers have the following responsibilities:

  • Human resources: hiring, counseling, developing and mentoring staff
  • Finance: creating and monitoring budgets
  • Patient care: ensuring quality and safety of care delivery

Some of those responsibilities will have to be carried out in a vacuum.

It isn’t clear whether there will be a nurse deficit or a nurse surplus by 2025. The longstanding assumption of a deficit in the neighborhood of 260,000 was offset in 2015 by a government report projecting a 340,000-nurse surplus.

That uncertainty will affect the near-term plans of the 1 million nurses reaching age 60 in the next 10 years as the aging of baby boomers continues its statistical domination of demographics. Will they or won’t they be needed? Contingency plans must be made, often while persuading retirement-age nurses to stay on the job.

Succession planning best practices

Those contingencies might be part of a broader strategy, and examples are being set in the health care industry. The National Center for Healthcare Leadership (NCHL) published a broad overview of the topic in 2010 that cited best practices in general, as well as three specific examples of successful implementation.

NCHL-recommended best practices emphasized:

  • Clear communication that stresses the importance of succession planning to the organization.
  • Tight linkage of succession planning as an organizational priority.
  • Involvement and ownership of the program by most or all levels of senior management.
  • Use of a leadership competency model.
  • Recruitment of newcomers who share the organization’s core values.
  • Rigorous assessment of those with strong leadership potential and striving to retain those people.
  • Forcing those people to stretch their skills and perspectives.
  • Professional development plans emphasizing on-the-job experiences.
  • Ongoing measurement and evaluation of outcomes leading to modifications.

The NCHL report presented three case studies, including the New York City area’s North Shore-Long Island Jewish Health System (North Shore LIJ), the second-largest nonprofit secular health care provider in the nation. North Shore LIJ entered into succession planning by:

  • emphasizing  heavy involvement by its board of directors and senior leadership;
  • making talent management every leader’s No. 1 priority;
  • fostering transparency regarding which employees would be considered high potential;
  • continuous evaluation of future talent requirements and gaps to fill;
  • emphasizing on-the-job learning;  and
  • alignment with the organization’s mission and business objectives.

With those rallying points, North Shore LIJ implemented annual procedures that began with identifying high-potential candidates each December at each of its facilities and selecting those candidates in January.

That led to assembling mixed-level teams among the program participants and staging an annual leadership retreat; comprehensive assessments of the highest-potential participants; and, beginning each March, offering those participants a wide array of resources, such as peer coaching, for overcoming challenges. By April, the participants would be implementing individual development plans linked to performance reviews. During the rest of the year, participants would receive ongoing support and feedback from coaches and peers. They also would submit target development plans each quarter.

The level of emphasis might seem excessive, but Shirey and her research colleague, Jennifer L. Titzer, say that’s what it takes.

“A lot of institutions say that they have a succession plan in place, but what they’re talking about is putting the nurse manager through a leadership program after they have already assumed the role,” Titzer said. “For it to be true succession planning, the plan needs to have a few antecedents. It needs to be very strategic and there should be a very targeted set of competencies for which these leaders are being developed.”

It paid off for North Shore LIJ. The impact included employee satisfaction levels as high as 85 percent, compared to an industry norm of 59 percent; a decrease in turnover that saved roughly $7.7 million and resulted in a reduction in the turnover rate for new nurses from 65 percent to 13 percent; and $25 million improvement in overall operating margin.

It’s all part of being more businesslike, said Titzer. She noted that Fortune 500 companies identified high-potential individuals as long as 10 years out to prepare for leadership roles.

“A key is to have a very deep nursing management leadership bench,” Titzer said. “Once these key individuals are identified, they are groomed and developed so that when they assume the role, the stress of transition to the role is decreased.”

During the next 10 years, there will be plenty of stress amid massive transition as it is. Now seems the time to minimize it.

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