Toxic Nursing, 2nd Ed. Cheryl Dellasega

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      introduction

      Today’s nurse managers face unprecedented demands in their role as leaders of the largest healthcare workforce in the industry: They must be clinically competent, relationally savvy, and administratively gifted. The lopsided aging of the population has had a double impact: More nurses are retiring from the profession at the same time as elderly baby boomers require increasingly complex and costly care.

      Implementation of the Affordable Care Act came with a renewed effort to contain healthcare costs and promote accessible, high-quality care, partially through the use of the electronic health record, which currently consumes half of the work nurses and physicians perform (Brown, 2020). An emphasis on value-based care rather than a fee-for-service model makes a reduction in hospital readmissions vital, even as length of stays dwindle. As healthcare legislation continues to change and evolve, new challenges are sure to be introduced.

      Nurse managers are tasked with a wide array of responsibilities, from staffing and budgeting to promoting safe and effective patient care. Ideally, they also work to create and sustain a healthy work environment:

      A healthy work environment is one that is safe, empowering, and satisfying, not merely the absence of real and perceived physical or emotional threats to health, but a place of physical, mental, and social well-being, supporting optimal health and safety. A culture of safety is paramount, in which all leaders, managers, healthcare workers, and ancillary staff have a responsibility as part of the interprofessional team to perform with a sense of professionalism, accountability, transparency, involvement, efficiency, and effectiveness. (American Nurses Association [ANA], 2015, p. 21)

      Due to a need for filling positions and a lack of succession planning, new nurse managers may not have the training or qualifications to manage effectively, nor the education and support needed to gain traction. Many nurse managers tend to fall into management positions because they have clinical experience or seniority, or perhaps because they are the ones willing to step into such a daunting role. If managers find it difficult to keep their unit staffed, remain within a budget, and maintain low rates of nosocomial infections, then providing support to staff and promoting a healthy work environment are going to feel mightily out of reach. The learning curve for a new nurse manager is steep, and the extended time it may take to train while on the job has the potential to impact negatively on a unit’s culture and morale (Roche, Duffield, Dimitrelis, & Frew, 2015). In a survey of 1,600 nurses, intent to leave their current workplace was closely related to the nurse manager’s leadership characteristics. The nurse manager’s people skills were identified as the most desired characteristic (Roche et al., 2015).

      transformational leadership

      Transformational leadership is based on five practices that promote “open communication, inspiration, enthusiasm, supporting positive change, and empowering others through shared decision-making” (Clavelle & Prado-Inzerillo, 2018, p. 39). These practices are defined in Table 0.1.

      table 0.1 transformational leadership practices

      But nurse managers need transformational leadership support too. In a systematic review of nurse leader retention, support from a transformational leadership team was identified as an important factor in a nurse leader’s decision to stay in the role (Vitale, 2018). The Organization of Nurse Leaders in New Jersey (ONL NJ) was created to address lack of succession planning within organizations by focusing on providing meaningful mentorship opportunities.

      The ONL NJ includes participation from more than 90% of New Jersey hospitals with a workforce of 116,000 nurses (clinical and academic; Vitale, 2018). The program has evolved over time СКАЧАТЬ