Selected Podcast
Hold On to Your Nurse Managers Through a Comprehensive Retention Program
Retaining effective nurse managers is critical to any organization as they impact financial and quality outcomes as well as nurse satisfaction and retention. The daily stressors for nurse managers are real. Implementing strategies and processes to hold on to your managers is needed now more than ever. This presentation will provide you with strategies you can use in building a comprehensive nurse manager retention program at your organization.
Featuring:
Patricia Duclos-Miller, MS, RN, NE-BC
Patricia Duclos-Miller, MS, RN, NE-BC graduated from Saint Anselm College and Boston University. Her professional experience includes nurse leadership positions in acute, home health and long-term care, and in academia as nursing faculty. Her role at Bristol Hospital is in the development of leadership programs, coaching and mentoring leaders. She is a recognized speaker both locally and nationally on contemporary topics: new graduate transition, team building and documentation. She is the author of numerous books on these topics. Transcription:
Bill Klaproth (Host): This is a special AONL podcast as we speak with session presenters from the AONL 2022 Conference. And with me is Patricia Duclos-Miller. She is a Nursing Professional Development Specialist at Bristol Hospital and Healthcare.
This is Today in Nursing Leadership, a podcast from the American Organization for Nursing Leadership. I'm Bill Klaproth. Patricia thank you for being here.
Patricia Duclos-Miller, MS, RN, NE-BC (Guest): Thank you for having me. is a timely topic.
Host: It is. We're talking a lot about nurse retention and this is a very timely topic. How to hold on to your nurse managers through a comprehensive retention program. How did we get here? Why were we losing so many nurses? What was the problem?
Patricia: The problem is universal. It wasn't just in our organization, but obviously my concern was holding on to the managers that we had, and we had a large turnover in 2019 for us.
Host: Before the pandemic?
Patricia: Before the pandemic. And so what I did was do a literature search on what were the driving forces that our nurses, our nurse managers are leaving for. We all know the stressors that nurses have, but a lot of people do not understand the stressors that nurse managers have. I equate it to the Oreo cookie syndrome. There's administration on the top, the nurse manager is the filling and the bottom are the staff and other challenges. So that's the way I explain nursing management when I was a manager to my staff.
Host: That's a good analogy. The Oreo cookie analogy. So the nurse managers are in the middle. Okay. So there's a lot of pressure on them from the top and the bottom, basically.
Patricia: Correct. But to be specific, if you're a nurse manager in today's world, pre pandemic even, was organizational stress, span of control that was enlarged, let's say, personnel issues, finding staff. Finding the right staff is always been a challenge. And then of course we had the pandemic that exacerbated that. We also had sometimes a lack of work-life balance. And lastly, a lot of nurse managers will leave if they feel they do not have the organization's support.
Host: So if they don't feel supported, they're like, why am I here? I'm going to search out a place that where I do feel supported and acknowledged and heard.
Patricia: That's correct. As anyone would.
Host: As anyone in any business? That's right. How did you uncover all of this? How did you learn all of this? Was it just through perception? Did you do surveys? Did you talk to a lot of people? How did you come to these conclusions that we've got a problem here?
Patricia: I have been a nurse manager and a nurse director and a nurse executive. So I know the problem is real. And then when I saw our dip in our nurse managers, I put together a proposal and presented it to the chief nurse officer who said, oh, sure, go ahead. So what we did is we built a program on how to retain good nurse managers because the nurse manager is pivotal in whether or not your organization will be successful. And at the unit base. So I think for me doing a literature search only solidified what I had already knew was going on. And in our case, those nurses, that nurse managers that left us felt that for whatever reason, the system and processes were broken and they felt that they weren't being fixed fast enough.
Host: So you said you put a program together on how to retain nurse managers. So tell us about that program. What did you do?
Patricia: What we started was an onboarding process specifically for our nurse managers that would introduce them to some key people within the organization. And that was first and foremost. They attend a nurse leadership, or I call it leadership orientation program. We started out with just nurse managers. We've now expanded it to the whole organization because we felt that onboarding and leadership orientation and education is pivotal in ensuring that you keep your leaders. In addition to that, meet with the nurse managers on a monthly basis and lunch is provided. I had approached the ACNO and said, could you give them lunch? And they said, sure. So they have a lunch voucher, and we meet in a group so that we're building cohesion, collegiality. It's a safe place to vent. I am a facilitator. I am not there to do anything than facilitate the conversation. And probably my goal is to help them do some problem solving and mentor them in how to be even a better leader. Anything we say during these sessions is not open to anyone unless they give me permission to share it with the organization's leadership.
Host: So when you say it's a safe space, that's what you mean.
Patricia: They trust me immensely.
Host: And this is your opportunity to just sit back and listen, right? You said you're not there to promote anything. You just want to listen and hear from them and then see how you can help. So that's really good. So you talked about an onboarding process, a leadership orientation program meeting on a monthly basis. You're having a lunch with them. Any other tactics or strategies or initiatives you can share with us?
Patricia: Yes, I developed a survey. It has, four questions, very, very brief survey. And they get sent to the survey at 30 days, if you're a new manager for and one year, and it starts to uncover whether or not this person is feeling comfortable in their role and within the organization. If I get nos, in other words, we're not being, they don't feel that it's meaningful work or they're not. They don't have the accountability they thought they were going to get, that I will bring to nursing leadership, but again, it's completely confidential. So that nursing leadership is aware there are things that we might have to change a little bit.
Host: That's really interesting. So it's a four question survey that goes out at 30 days, four months and one year. So you really can see maybe what somebody expected at the beginning, and maybe it wasn't meeting their expectations at four months or one year. So you really kind of get a real look over time at what their perception or how they're feeling about their job, basically.
Patricia: Correct.
Host: And then you can put the steps in place in coaching them or talking to them or listening to them. Why do you not feel this? I saw this in the survey and of course you're providing a safe space for them where they can talk to you and say, well, listen, here's what's happening. Here's what I'm feeling.
Patricia: Yeah. The other thing is I'm always available for coaching and mentoring. So if and I've done that with some of our new leaders, where I will meet with them at their convenience, not a long meeting and let them share with me some of the challenges that they're facing. And then I can give them some ideas on how they could approach it. Doesn't mean they always take by advice, but I'm there available for coaching and mentoring.
Host: So Patricia, for someone listening to this, that's like, wow, I love this, what can they do? Or what are some first steps someone can do at their own hospital or healthcare organization to implement some of the things you just talked about? Give us some first steps for someone listening.
Patricia: Well, first steps would be take a look at your onboarding process. Is it a one day orientation, then you send them off onto the units or the departments? Be sure that you're onboarding is engaging, that they meet with their director. One of the parts that I want them to meet with their director weekly for the first month, and then monthly thereafter, if they're not already doing that. As well as meeting with the CNO within the first month of their employment, if they haven't already met with that person.
So that's an example of some of the tweaking that I did with the onboarding, And, they must attend the leadership orientation. And it's broken up into two parts. The first part is held every month. And that goes over the logistics, the day to day tools that they need. For example, how to do payroll, what's our scheduling system look like, what is the quality department, what are they doing for us and how do I access that? Those kinds of logistics. Finance comes in and does a presentation on budgeting. So that's part one of the orientation. Part two is more of the theoretical new knowledge or existing knowledge that we talk about and that might be things like, I have them do a self assessment on where they are in emotional intelligence.
I talk about generational differences. Obviously the challenging situations and personalities, they might face. Up to the last module in which we go over leadership. I use John Maxwell's five levels of leaders. So I'm not reinventing the wheel here. I'm using existing presenters within the organization or myself and leaders. So in the last class, the CEO comes in and talks for about an hour on challenges in healthcare.
And then at the end of that session, and again, a participant had given me this great suggestion bring in the other executive leaders because we'd like an open forum with them. So at the end of the last module, the VP of HR, the VP of finance, the VP of nursing, or our Chief Nursing Officer, they come and it's an open forum that our new leaders can have with them.
Host: Wow. It sounds like you really put a lot of emphasis on this onboarding process. This initial month as leadership orientation, you said, Ffor someone listening, look at the onboarding process. You said you have them meet weekly with the director in the, in the first month, meeting with the CNO. And you just talked about all the other people that are coming in and talking. So it sounds like getting off to a great start is really important.
Patricia: Absolutely. And I think engagement is the key word that I keep using. How are we engaging our new leaders? What are you doing to keep them engaged? It's not just onboarding, it's also making those relationships.
Host: So it's not just that first month. It's obvious it's ongoing with all the other strategies.
Patricia: Correct. It's staying engaged, building relationships and supporting them.
Host: So engagement, building relationships, support. So talk about your success with that. People are going to say that all sounds great, but what happened? I know you said before the 2019, you lost a lot of your workforce. So you've implemented a lot of these strategies. Where are you at now? What has happened since then?
Patricia: We have held onto all of our nurse managers.
Host: Wow. How that?
Patricia: During the pandemic.
Host: Wow, that is amazing. So that speaks to the efficacy of this program. You said you lost a lot of nursing nurses in 2019, and you've managed to hold on to your nurse leaders, managers throughout the pandemic.
Patricia: I also think that we have to also speak about the leadership that we have in the organization. That's also very important. I can do all these education classes, but if leadership doesn't support or also engage with our leaders it's not going to be a success. So from the C-suite so to speak, the CEO right down to the director level, anybody who's reporting to you, you need to look at what are your relationships with them. What are you doing for engagement? Because the younger generation, who's going to be taking our places. It's all about relationships.
Host: So getting that buy-in from top leadership is ultimately important as well. And when everyone does that, when everyone buys in is on, the same page as far as this onboarding process and engagement in support is you talked about, you can understand why you're having such success in retention right now.
Patricia: That's right. It's our leadership who has embraced this program, endorsed this program. It has an expectation that everybody attend. So that's tremendous support for an educator to have that support.
Host: Patricia, thank you so much for your time. So when we talk about holding onto your nurse managers, through our comprehensive retention program, give us your final thoughts. What else would you like to add?
Patricia: Being a former leader myself, is that the way in which we manage will dictate your success and it's all about relationships. I know that sounds so simple, but in a busy day when I talk to the managers, I said, you all look like hamsters on wheels. What are you doing for yourself? What are you doing? Cause if you don't take care of yourself, you're not gonna be able to take care of your staff. And so what relationships do you have with your colleagues? What relationships do you have with your staff? And it takes a lot, it's a lot of energy, but it's well worth it.
Host: Absolutely. I love that line the way in which we manage will dictate our success. That kind of sums it up. That's fantastic. All right, everybody listening, tweet that out right now and say you got that from Patricia Duclos-Miller. Patricia, thank you so much. This has really been enjoyable. I've loved talking with you. Thank you for your time.
Patricia: Thank you.
Host: And once again, Patricia Duclos-Miller and for more information, please visit aonl.org. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is Today in Nursing Leadership. Thanks for listening.
Bill Klaproth (Host): This is a special AONL podcast as we speak with session presenters from the AONL 2022 Conference. And with me is Patricia Duclos-Miller. She is a Nursing Professional Development Specialist at Bristol Hospital and Healthcare.
This is Today in Nursing Leadership, a podcast from the American Organization for Nursing Leadership. I'm Bill Klaproth. Patricia thank you for being here.
Patricia Duclos-Miller, MS, RN, NE-BC (Guest): Thank you for having me. is a timely topic.
Host: It is. We're talking a lot about nurse retention and this is a very timely topic. How to hold on to your nurse managers through a comprehensive retention program. How did we get here? Why were we losing so many nurses? What was the problem?
Patricia: The problem is universal. It wasn't just in our organization, but obviously my concern was holding on to the managers that we had, and we had a large turnover in 2019 for us.
Host: Before the pandemic?
Patricia: Before the pandemic. And so what I did was do a literature search on what were the driving forces that our nurses, our nurse managers are leaving for. We all know the stressors that nurses have, but a lot of people do not understand the stressors that nurse managers have. I equate it to the Oreo cookie syndrome. There's administration on the top, the nurse manager is the filling and the bottom are the staff and other challenges. So that's the way I explain nursing management when I was a manager to my staff.
Host: That's a good analogy. The Oreo cookie analogy. So the nurse managers are in the middle. Okay. So there's a lot of pressure on them from the top and the bottom, basically.
Patricia: Correct. But to be specific, if you're a nurse manager in today's world, pre pandemic even, was organizational stress, span of control that was enlarged, let's say, personnel issues, finding staff. Finding the right staff is always been a challenge. And then of course we had the pandemic that exacerbated that. We also had sometimes a lack of work-life balance. And lastly, a lot of nurse managers will leave if they feel they do not have the organization's support.
Host: So if they don't feel supported, they're like, why am I here? I'm going to search out a place that where I do feel supported and acknowledged and heard.
Patricia: That's correct. As anyone would.
Host: As anyone in any business? That's right. How did you uncover all of this? How did you learn all of this? Was it just through perception? Did you do surveys? Did you talk to a lot of people? How did you come to these conclusions that we've got a problem here?
Patricia: I have been a nurse manager and a nurse director and a nurse executive. So I know the problem is real. And then when I saw our dip in our nurse managers, I put together a proposal and presented it to the chief nurse officer who said, oh, sure, go ahead. So what we did is we built a program on how to retain good nurse managers because the nurse manager is pivotal in whether or not your organization will be successful. And at the unit base. So I think for me doing a literature search only solidified what I had already knew was going on. And in our case, those nurses, that nurse managers that left us felt that for whatever reason, the system and processes were broken and they felt that they weren't being fixed fast enough.
Host: So you said you put a program together on how to retain nurse managers. So tell us about that program. What did you do?
Patricia: What we started was an onboarding process specifically for our nurse managers that would introduce them to some key people within the organization. And that was first and foremost. They attend a nurse leadership, or I call it leadership orientation program. We started out with just nurse managers. We've now expanded it to the whole organization because we felt that onboarding and leadership orientation and education is pivotal in ensuring that you keep your leaders. In addition to that, meet with the nurse managers on a monthly basis and lunch is provided. I had approached the ACNO and said, could you give them lunch? And they said, sure. So they have a lunch voucher, and we meet in a group so that we're building cohesion, collegiality. It's a safe place to vent. I am a facilitator. I am not there to do anything than facilitate the conversation. And probably my goal is to help them do some problem solving and mentor them in how to be even a better leader. Anything we say during these sessions is not open to anyone unless they give me permission to share it with the organization's leadership.
Host: So when you say it's a safe space, that's what you mean.
Patricia: They trust me immensely.
Host: And this is your opportunity to just sit back and listen, right? You said you're not there to promote anything. You just want to listen and hear from them and then see how you can help. So that's really good. So you talked about an onboarding process, a leadership orientation program meeting on a monthly basis. You're having a lunch with them. Any other tactics or strategies or initiatives you can share with us?
Patricia: Yes, I developed a survey. It has, four questions, very, very brief survey. And they get sent to the survey at 30 days, if you're a new manager for and one year, and it starts to uncover whether or not this person is feeling comfortable in their role and within the organization. If I get nos, in other words, we're not being, they don't feel that it's meaningful work or they're not. They don't have the accountability they thought they were going to get, that I will bring to nursing leadership, but again, it's completely confidential. So that nursing leadership is aware there are things that we might have to change a little bit.
Host: That's really interesting. So it's a four question survey that goes out at 30 days, four months and one year. So you really can see maybe what somebody expected at the beginning, and maybe it wasn't meeting their expectations at four months or one year. So you really kind of get a real look over time at what their perception or how they're feeling about their job, basically.
Patricia: Correct.
Host: And then you can put the steps in place in coaching them or talking to them or listening to them. Why do you not feel this? I saw this in the survey and of course you're providing a safe space for them where they can talk to you and say, well, listen, here's what's happening. Here's what I'm feeling.
Patricia: Yeah. The other thing is I'm always available for coaching and mentoring. So if and I've done that with some of our new leaders, where I will meet with them at their convenience, not a long meeting and let them share with me some of the challenges that they're facing. And then I can give them some ideas on how they could approach it. Doesn't mean they always take by advice, but I'm there available for coaching and mentoring.
Host: So Patricia, for someone listening to this, that's like, wow, I love this, what can they do? Or what are some first steps someone can do at their own hospital or healthcare organization to implement some of the things you just talked about? Give us some first steps for someone listening.
Patricia: Well, first steps would be take a look at your onboarding process. Is it a one day orientation, then you send them off onto the units or the departments? Be sure that you're onboarding is engaging, that they meet with their director. One of the parts that I want them to meet with their director weekly for the first month, and then monthly thereafter, if they're not already doing that. As well as meeting with the CNO within the first month of their employment, if they haven't already met with that person.
So that's an example of some of the tweaking that I did with the onboarding, And, they must attend the leadership orientation. And it's broken up into two parts. The first part is held every month. And that goes over the logistics, the day to day tools that they need. For example, how to do payroll, what's our scheduling system look like, what is the quality department, what are they doing for us and how do I access that? Those kinds of logistics. Finance comes in and does a presentation on budgeting. So that's part one of the orientation. Part two is more of the theoretical new knowledge or existing knowledge that we talk about and that might be things like, I have them do a self assessment on where they are in emotional intelligence.
I talk about generational differences. Obviously the challenging situations and personalities, they might face. Up to the last module in which we go over leadership. I use John Maxwell's five levels of leaders. So I'm not reinventing the wheel here. I'm using existing presenters within the organization or myself and leaders. So in the last class, the CEO comes in and talks for about an hour on challenges in healthcare.
And then at the end of that session, and again, a participant had given me this great suggestion bring in the other executive leaders because we'd like an open forum with them. So at the end of the last module, the VP of HR, the VP of finance, the VP of nursing, or our Chief Nursing Officer, they come and it's an open forum that our new leaders can have with them.
Host: Wow. It sounds like you really put a lot of emphasis on this onboarding process. This initial month as leadership orientation, you said, Ffor someone listening, look at the onboarding process. You said you have them meet weekly with the director in the, in the first month, meeting with the CNO. And you just talked about all the other people that are coming in and talking. So it sounds like getting off to a great start is really important.
Patricia: Absolutely. And I think engagement is the key word that I keep using. How are we engaging our new leaders? What are you doing to keep them engaged? It's not just onboarding, it's also making those relationships.
Host: So it's not just that first month. It's obvious it's ongoing with all the other strategies.
Patricia: Correct. It's staying engaged, building relationships and supporting them.
Host: So engagement, building relationships, support. So talk about your success with that. People are going to say that all sounds great, but what happened? I know you said before the 2019, you lost a lot of your workforce. So you've implemented a lot of these strategies. Where are you at now? What has happened since then?
Patricia: We have held onto all of our nurse managers.
Host: Wow. How that?
Patricia: During the pandemic.
Host: Wow, that is amazing. So that speaks to the efficacy of this program. You said you lost a lot of nursing nurses in 2019, and you've managed to hold on to your nurse leaders, managers throughout the pandemic.
Patricia: I also think that we have to also speak about the leadership that we have in the organization. That's also very important. I can do all these education classes, but if leadership doesn't support or also engage with our leaders it's not going to be a success. So from the C-suite so to speak, the CEO right down to the director level, anybody who's reporting to you, you need to look at what are your relationships with them. What are you doing for engagement? Because the younger generation, who's going to be taking our places. It's all about relationships.
Host: So getting that buy-in from top leadership is ultimately important as well. And when everyone does that, when everyone buys in is on, the same page as far as this onboarding process and engagement in support is you talked about, you can understand why you're having such success in retention right now.
Patricia: That's right. It's our leadership who has embraced this program, endorsed this program. It has an expectation that everybody attend. So that's tremendous support for an educator to have that support.
Host: Patricia, thank you so much for your time. So when we talk about holding onto your nurse managers, through our comprehensive retention program, give us your final thoughts. What else would you like to add?
Patricia: Being a former leader myself, is that the way in which we manage will dictate your success and it's all about relationships. I know that sounds so simple, but in a busy day when I talk to the managers, I said, you all look like hamsters on wheels. What are you doing for yourself? What are you doing? Cause if you don't take care of yourself, you're not gonna be able to take care of your staff. And so what relationships do you have with your colleagues? What relationships do you have with your staff? And it takes a lot, it's a lot of energy, but it's well worth it.
Host: Absolutely. I love that line the way in which we manage will dictate our success. That kind of sums it up. That's fantastic. All right, everybody listening, tweet that out right now and say you got that from Patricia Duclos-Miller. Patricia, thank you so much. This has really been enjoyable. I've loved talking with you. Thank you for your time.
Patricia: Thank you.
Host: And once again, Patricia Duclos-Miller and for more information, please visit aonl.org. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is Today in Nursing Leadership. Thanks for listening.