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Clinical Systems Leadership

How Different Management Styles Can Affect Nurse Retention

Nurses work in fast-paced, detail-focused environments that may require them to file paperwork one second and then assist with a trauma patient the next. Add to that the varied educational backgrounds, licensures and demographics (age, sex, race) present in nursing staff and devising a management style can seem like an overwhelming task. Leadership from the management level is crucial in nursing, not only to performance and care quality, but also morale and engagement with the job.

The solution is not as simple as instituting a blanket, one-size-fits-all strategy that treats every nurse the same as the other. As in any workplace, nurses are employees, but also individuals; they have diverse wants and needs from leadership, and may be incentivized and repelled by different quirks or demands of management. The structure of nursing leadership should be a dependable constant and needs to address personnel in ways that will motivate them; often, that means leadership needs to be flexible, agile and attentive to nurses’ needs as individuals.

This ideal takes on even greater importance in the modern nursing workplace. Not only because of the increasing diversity seen in today’s workforce, but because of what applied management styles can do for retention efforts. It’s a fact that there is a shortage of nurses in America, an issue which health systems have tried addressing on many fronts through recruiting. Tackling the problem from the retention end may help providers better save costs and preserve their talent pool.

Nursing team communicating.

 

The state of the shortage

Retention efforts, and the management styles that power them, are of central importance to health systems given the nursing shortage the industry at large faces. A number of factors have conflated over the years to create a shortage, and will continue to do so into the future, including the increasing average age of nurses, an influx of millions of new patients and providers’ own difficulties with hiring.

A recent study from NSI Nursing Solutions found “that the [registered nurse] labor shortage has returned and is intensifying.” The vacancy rate for RNs in 2016 was 7.2 percent, and increased to 8.5 percent a year later. The share of hospitals reporting a vacancy rate of 5 percent or less has declined from 58 percent in 2012 to 28 percent in 2016; conversely, those reporting a vacancy rate of 10 to 12.49 percent increased from 2 percent to 14 percent in that same time, and the number of those experiencing vacancy rates above 12.5 percent increased from 2 percent to 18 percent. Both latter categories saw 4 percent year-over-year jumps from 2015 to 2016.

Compounding these challenges are the obstacles providers face in recruiting qualified nurses. A 2015 study from the Healthcare Association of New York State found 47 percent of responding state systems had trouble recruiting experienced RNs, 52 percent said the same when seeking nursing managers: nearly 20 percent reported retention problems in both categories.

Why management styles can be effective retention tools

A primary driver of a nurse’s intent to stay on is their level of job satisfaction. There are a number of variables that contribute to shaping this sentiment (pay, hours, responsibilities), but an overarching theme to job satisfaction is interactions with management and how they help to ensure nurses have all the tools and support they need to get the job done.

In an article from the journal MEDSURG Nursing, an “unfriendly workplace” was the number 1 cited cause behind a nurse’s decision to leave. While situations involving harassment or abuse were included under this umbrella, the researchers reported an outsized impact on management styles and how failure to foster a learning and interdependent culture could lead to staff exits. For instance, leaving new RNs alone to “toughen up” only exacerbated their struggles in finding their footing.

Nursing managers have key technical roles in day-to-day operations, but really their effectiveness is decided by how well they can motivate, direct and support their charges on a personal level. Nurses who feel they can communicate with, and rely on, leaders generate greater performance, mentalities and, ultimately, job satisfaction.

Here’s a look at some innovative approaches to tailoring management styles:

Transformational leadership

One way to retain nurses is by making nurses feel as if they are personally invested in their job, and that they’re doing it for a reason beyond the material. The transformative leader is one who can use personal encouragement and big-picture thinking to instill confidence, motivation and trust in employees. This style relies less on daily minutiae and instead turns the focus to mission and shared values. When nurses are inspired to this degree and feel a connection between their job performance and the greater good, it may just positively influence their career decisions. However, there are drawbacks to this method: Those who crave the tiny details of tasks may feel unprepared, and even those who respond well may begin to grate at overgeneralized enthusiasm.

Authoritarian leadership

On the other end of the spectrum from transformative is authoritative leadership. Such a style’s traits are as self-evident as the name: In this construct, management dictates to employees, it exerts an authoritarian feel that may punish mistakes, has rigid team processes and prefers staff not weigh in on certain matters. While it can sound extreme in theory, in practice, efficiency and effectiveness can be benefits resulting from authoritarian leadership. This style is often employed in ERs or similar settings with little margin for error in chaotic situations. And while it may help to affect performance gains, it is just as likely to negatively impact retention. Providers may need to consider how and when to use this strategy to mitigate the negative effects.

Transactional leadership

An approach that is a little less severe than authoritarian, but which still carries over some characteristics, is transactional management. Namely, it emphasizes organizational structure, defined roles and directives, negative consequences of error and the present situation, not so much the future. Transactional motivation is based on rewarding successes and punishing those without the discipline. In many ways this environment works for nurses who thrive in project-oriented roles and push themselves to succeed in return for career and material gains; usually pay increases or advancement within the system. Those who seek greater personal mentoring or fewer restrictions and limitations may seek answers to their job satisfaction problems elsewhere.

Servant leadership

Nurses who want management to be more of a partner than an overseer usually find servant leaders to be the most compatible with their working type. Servant leaders are those who lead by example, who rally troops and build relationships that feature two-way communication, collaboration, guidance and commitment to personal growth. The positive reinforcement encourages nursing staff to hold themselves accountable and work together to achieve gains through unity. This style is different from transformational in that the servant leader may be more likely to engage with a charge on a particular patient and use the scenario to teach and show, as well as deliver quality care. Nurses who have an eye on the future and maybe even becoming a leader themselves are often drawn to servant leaders, who beget later generations of servant leaders. This can reduce turnover and position the system as a training ground for tomorrow’s influencers.

Nurse on tablet with team.

Nurse retention is, in many ways, dependent on leadership

In the end, hospitals and other care settings will decide which leadership style works best given their current resources, scale and staff. If retention efforts falter and vacancies rise, it may require a closer look at how management styles affect nurses to solve the challenge. In light of current difficulties in recruiting and retention, the fact that management styles empirically impact a nurse’s job satisfaction makes leadership tactics an important tool.

Nurses who enroll in the University of Arizona’s online RN-MSN program can improve their understanding of these leadership styles and examine situations in which each proves valuable. Leaders will always be needed, and those who see the effects of the shortage first-hand may want to pursue further education as a means to finding a solution.

Sources

http://www.nsinursingsolutions.com/Files/assets/library/retention-institute/NationalHealthcareRNRetentionReport2016.pdf

http://www.aacn.nche.edu/media-relations/nursing-shortage-resources/2015-NY-Workforce-Report.pdf

https://www.amsn.org/sites/default/files/documents/practice-resources/healthy-work-environment/resources/MSNJ_MacKusick_19_06.pdf

http://www.aanac.org/docs/white-papers/2013-nursing-leadership—management-leadership-styles.pdf?sfvrsn=2

https://www.aadns-ltc.org/Resources/Nurse-Leader-Blog/details/post/6-leadership-types-the-pros-and-cons-for-nurse-leaders/2014-03-11

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