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Do You Need a Nurse Manager?
Ann Geier
Publish Date: October 10, 2007   |  Tags:   Staffing

Ann Geier, RN, MSN, CNOR At some point in your career, you'll probably have to decide whether to hire a nurse manager. Perhaps one has left, or your facility hadn't needed one before, but now the volume is enough to justify adding the position. Take these steps to secure the best person for the job.

Ann Geier, RN, MSN, CNOR\ 1. Determine your center's needs
There's no prototypical nurse manager. The right candidate for one facility may be all wrong for another. It all depends on the strengths and weaknesses of the facility - and the staff.

Do you need an organized, detail-oriented leader? If so, you may want to focus on someone who may not have front-line patient care experience but who's experienced writing policies and enforcing quality assurance.

Do you need a strong clinical practitioner? In many care settings, the nurse manager wears scrubs and participates in patient care. In others, you may want someone with experience honing a cross-training program. The nurse's certification (CNOR or CAPA) and education (BSN or MSN) may come into play.

Do you need someone who can bring new ideas into the facility? You may want someone who's active in professional organizations and keeps a mental Rolodex of innovative strategies that work at colleagues' facilities.

2. Post the job internally
Like it or not, facility politics play a role in hiring - and acceptance of - a nurse manager. Some facilities, especially hospitals, prefer to promote from within. Others look for an outside candidate.

No matter what you do, don't let your staff think that you pre-selected the person you hired. Even a highly capable nurse manager will have to overcome significant staff mistrust - perhaps even outright hostility - if there's a feeling that management rigged the hiring process. How do you avoid this scenario?

First, post the opening for the staff to see and let your internal RNs apply for the job. Nothing fosters suspicion and resentment like a job search that the staff knows nothing about. On the other hand, avoid inbreeding. Hiring on the basis that the job is a reward for seniority or a favor to a friend are recipes for staff resentment and an ineffective hire. Secondly, make it a fair competition. Post the opening early enough to allow reasonable time for staffers to submit a written application. Once you have a candidate pool, give every applicant equal consideration.

Ask candidates for their goals and objectives in applying, a self- assessment of their strengths and weaknesses and their short- and long-term visions for the facility. These criteria are especially important when you consider the credentials of existing staff members. You may think you already have a good feel for their capabilities, but you need to consider them objectively from a different perspective.

If you hire from outside the organization, keep your staff informed about the opening and seriously consider all candidates.

Staffing Benchmarks

  • 9.50-12
    The range of man-hours spent per case in an efficient ASC, depending on case mix and volume
  • 10-10.5
    The ideal average number of man-hours spent per case in a center performing 250 cases per month
  • 3
    Number of ways to measure salaries and benefits: as a percent of net revenue; as total FTEs worked per month; and as man hours per patient
  • 25%-28%
    A favorable percentage of net revenue to spend on salaries and benefits

Source: FASA

3. Consider people skills
Interpersonal skills aren't apparent on a nurse-manager candidate's resume. The applicant can have top-notch clinical skills and be a well-organized administrator, but still lack the ability to manage personnel. While interviews help give you an indication of how their people skills mesh with management, look long and hard at how the candidates relate to staff, too.

When you review internal candidates, consider how the nurse interacts with the rest of the staff and project how this may or may not change if the RN becomes the nurse manager. You want team players that you can trust with sensitive employee information. Beware of candidates who take part in the gossip grapevine, form cliques or who are unable to both give and receive constructive criticism from the staff.

If it's an outside candidate, you can still compile the people skill information you need, even if references are hard to come by. I'm a big believer in letting the staff talk to candidates without the manager present. This lets the candidate and the staff ask and answer questions openly, it gives the staff a feel for how they might work with this candidate and lets staff convey their honest feelings about the working environment. It also provides the candidate a slice of real life at the facility, including the personalities of those whom they may manage. While it's impossible to please everyone, involving the staff helps ensure buy-in for your hiring decision.

First impressions are lasting
No matter which candidate you select, staff will be watching closely. There won't be much of a honeymoon period before your staff form their opinions of the new nurse manager. It's crucial that management supports the nurse manager and help smooth out the rough edges as she searches for ways to inspire the staff to give their all to your facility and your patients.