Nurse Leaders: Is Promoting From Within a Disservice?

[Melissa Mills, BSN]

Susan had been a nurse for ten years. She worked on the same unit for nearly five years as a staff nurse and a floating charge nurse. She was recognized on and off for stellar patient care and leadership skills. When the unit manager position became vacant, Susan applied and was hired. She received on-the-job training and was quickly given the reins to work independently.

After a few months, Susan started feeling a bit overwhelmed. She noticed that nurses she was once friends with were no longer showing her the respect she had received from them in the past. Susan often felt ill-prepared to deal with budgetary and human resource issues, but she continued to try her very best. By the time she reached her first anniversary as the manager, Susan had wondered if management was for her. She considered asking for formal training or stepping down because she just wasn’t sure she wanted to continue.

A Common Story

Most nurses can think of someone who has been in Susan’s shoes. Alternatively, you might be living Susan’s life right now. Many nurses are quickly recognized not only for stellar clinical skills but leadership and administrative abilities that bode well for leaders. Possessing these skills can promptly lead to advancements into management positions. However, without training, could we be doing a disservice to future nurse leaders?

Nurses as Leaders

According to The Future of Nursing: Leading Change, Advancing Health, the public isn’t used to viewing nurses as leaders. Not all nurses start their careers with the intention of becoming a leader. However, nurses are leaders in every phase of their career in some capacity with patients and co-workers. As nurses transition into formal leadership roles, they must be ready to take on new responsibilities, learn policies, and work on committees.

We must remember that leadership isn’t innate. Some nurses can learn on the job and fulfill leadership positions at various levels well. Other nurses need help developing their leadership skills by attending formalized training or going back to school for administrative or business degrees.

Does Promoting From Within Work?

A 2014 Becker’s Hospital Review article lists the pros and cons of promoting leadership from within the organization. They report that one survey found that two-thirds of respondents felt that promoting from within was a bad idea. The other one-third thought that it was a good idea to promote from within as long as there is a mentorship program to help the candidate be successful. The survey of 400 hospital leaders found the below list of pros and cons:

Pros

1. Loyalty and retention grow when you promote from within

2. Morale among staff increases when they see opportunities for growth within the organization

3. A manager promoted from within has relationships with other staff, which can help in their success

Cons

1. Transitioning from being a peer to being a manager is difficult

2. An outside perspective may be better able to recognize issues and implement change

3. Possessing good clinical skills does not translate into being a good leader

4. A newly promoted leader might find it challenging to deliver criticism or negative evaluations to those they used to work beside

5. Peers might have a hard time recognizing the person and their new authority

6. Old peer networks can hold animosity toward new bosses

7. Newly promoted leaders may have difficulty remaining objective when dealing with staff whom they consider friends

From Great Nurse to Great Nurse Leader

No matter if you’ve had good or bad experiences with internal promotions, it happens and we need to understand how to support one another in our roles from the bedside and beyond. Here are a few easy ways organizations and co-workers can help support nurse leaders.

1. Recognize that being a great nurse leader is an entirely different set of skills than being a great nurse. Organizations and new leaders should seek training through an endorsed program such as the American Association of Critical Care Nurses or the American Organization of Nurse Executives.

2. Provide a mentor program where successful nurse leaders train and support other leaders in their new roles. Mentoring could be through formal meetings and workshops or informal support that provides opportunities to share stories and ask questions.

3. If you work with someone who has recently taken a leadership role in the same unit, offer support and understanding. Recognize that everyone will go through a learning curve as one of your own becomes part of the leadership team and learns to bridge the gap between an old peer group and a new one. Be open and honest with the new leader, while keeping in mind that they are now your boss.

Do you support promoting nurses into leadership roles within the same unit? Is their success solely based on their skills or the unit and organizational support? Have you made the transition into leadership only to discover it wasn’t for you?

[Emergent, RN]

Excellent article Melissa. I've seen the pluses and minuses of both scenarios. A lot of success depends on the culture of the unit, and personalities.

Some units are literally witches covens and need a strong outsider to shake things up. Others have a healthier culture and, after an adjustment period, one of their own can prosper.

[Melissa Mills, BSN]

4 hours ago, Emergent said:

Excellent article Melissa. I've seen the pluses and minuses of both scenarios. A lot of success depends on the culture of the unit, and personalities.

Some units are literally witches covens and need a strong outsider to shake things up. Others have a healthier culture and, after an adjustment period, one of their own can prosper.

Emergent - I agree. I think having support from upper management can make or break a nurse manager in just about any role.

Melissa

[llg, PhD, RN]

I think the article raises good points ... but the title is based on a false dichotomy -- as if the "evil" is in the hiring from within or from without.

The key element not represented in the title is mentioned later in the article. The real question is not "within or without," it is whether or not recently hired leaders are given the orientation and support that they need to thrive. Either way (from within or without), newly hired people in leadership positions need the right kind of education and support to succeed. They also need to be well-suited to the specific position in skills and temperament. Those factors are much more important to a leader's success than whether they were hired from within or without.

[NotReady4PrimeTime, RN]

Some of the worst managers I've ever had were those who had worked along side me. When the first flush of elation that the unit's finally going to be managed by someone who's been in the trenches fades and the new manager turns into an unrecognizable clone of all the rest, it's so disheartening. That shift from peer to superior can really go to some heads, and the fallout is that resentment builds quickly. There's a sense that these managers should remember what it's like to do the work and have some... umm... sympathy isn't the right word... let's go with cognizance - that certain situations lead to less desirable outcomes. For example, the new manager might have been the first to bemoan the fact that all the casuals had been cancelled and now the fertilizer was hitting the oscillating ventilator, with admissions and deteriorations the unit is ill-equipped to manage for lack of personnel. But now s/he's toeing the party line and cancelling the casuals AND the overtime, leaving the unit stretched to the breaking point. It's hard for some people to see these kinds of about-faces and they take it personally.

[klone, MSN, RN]

Interesting read, thank you! Just wanted to point out that in the first paragraph, you used the word "reigns" when you meant to use the word "reins."