Shortage Busters

Build a culture of retention by understanding, supporting your middle managers

The nursing shortage has increased the pressure on an already strained healthcare system. One group feeling this staffing crunch most acutely and increasingly being held accountable for staff retention is middle management.

In some cases, this pressure has worked to help increase retention levels. Yet, putting all the weight on middle managers is not a universal remedy. Tasked with this load could potentially lead to serious burnout. Administrators also need to understand how managers can help increase retention levels.

Much has been written about creating a culture of retention — one in which nurses feel needed and valued and are less inclined to leave. Numerous articles and studies illustrate the value of incorporating methods such as mentoring programs, in-service training or utilizing a healthcare staffing service in order to ease the pressure on existing employees.

Yet, for most organizations, it’s usually not enough to blindly implement these or other measures. What administrators need is a solid point person, somebody who has a big-picture view of the organization’s overall strategic plan, yet also is aware of the daily issues that plague nurses and other healthcare staffers — which, more than anything else, can cause them to leave.

Middle managers constantly straddle two worlds, implementing strategies devised by the higher levels of healthcare administration, while serving as the link between these higher levels and the general hospital workforce.

In order to support middle managers in this crucial role and increase their chances of improving retention, it helps to know what they actually do.

Successful middle managers must balance many tasks and fulfill many roles on a daily basis, including:

• Monitor
  Effective managers know what’s going on in their environments. Managers should monitor their environments, quell rumors and solve issues before they have a chance to ripen into problems.
• Communicator
  Managers also must develop an environment where people feel comfortable talking about their issues. By being active, supportive listeners, managers can help to address a staff member’s concern before it becomes a serious problem.
• Delegator
  Good managers don’t try to do everything themselves. By delegating tasks to their staffs, managers remain fresh and help to increase the output and streamline the efforts of the organization.
• Motivator
  Delegating tasks is only half the battle. You also need staff members that will complete these assignments because they want to, not because they are asked to. Motivated staff members, who believe in what they are doing, will put in the extra effort to ensure that the job is done right.
• Team Builder
  An effective manager knows how to challenge employees without breaking them, and can determine whether staff members would benefit from additional training so that they can handle a greater level of responsibility. Effective managers build teams that serve the organization better, while nurturing the careers of team members and making them feel needed.
• Problem Solver
  Not every issue can be resolved before it reaches a crisis point. A good manager knows how to remain levelheaded under fire, address the problem, allocate the appropriate resources and re-establish equilibrium as soon as possible. Maintaining this balanced environment helps to relieve some of the pressure from nurses and other healthcare workers who may feel besieged if problems are allowed to develop and become pervasive.
• Liaison
  The size of today’s healthcare systems can be daunting to nurses and other frontline staffers, who may feel they don’t have a voice. Good managers run interference for their staff members, helping to shield them from politics and inefficient processes so the nurses can focus on patient care. At the same time, when lack of resources or a conflicting strategy keeps staff members from getting what they want, a good middle manager can explain why.
• Strategist
  While mid-level managers keep things running smoothly, they also should be involved in the organization’s overall strategic plans. These managers have their fingers on the pulse of the organization and can offer insights into the effect that new initiatives will have on nurses and other staffers.
• Leader
  Healthcare workers need to believe in their superiors. When nurses feel their efforts are wasted, and that their leaders are not capable, it makes the leap to another organization — or even another field that much easier.

The effects of being constantly pulled in different directions and forced to change roles and adapt to new initiatives, can result in high burnout for middle management. And this can be dangerous for a healthcare organization. The stakes in healthcare are higher than other industries, so effective managers, who help reduce risk and save the organization’s reputation, should be rewarded for their efforts.

You can reward your managers in many different ways. Again, just as the success of individual retention-building initiatives will depend upon your particular environment, you also should choose your rewards based on what fits your managers the best.

For many organizations, effective middle managers are the glue that help to keep the foundation workforce — the nursing staff and other healthcare workers that interact directly with your patients — fulfilled and can be the key to building the coveted culture of retention. In an industry that is in constant flux, having this stability can help give you an edge on your competition.

For a list of works cited, visit www.endonurse.com

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