During the pandemic, Hollywood, Fla.-based Memorial Healthcare System realized it could face a potential crisis in terms of nurse manager retention.
A 2022 survey by the American Organization for Nursing Leadership found that 45% of nurse managers report they are considering leaving their roles, largely driven by burnout and lack of work-life balance. At Memorial Healthcare System, the turnover number wasn't as high, but it was higher than it had been previously, according to Shelly Delfin, DNP, RN, chief nursing officer for Memorial Regional Hospital South and Memorial Rehabilitation Institute.
"Not as much nurse managers leaving Memorial, but stepping into different roles," Dr. Delfin told Becker's. "Some of them stepped down from nurse managers into front-line nursing roles or different manager roles. That for us was a big red flag. We weren't seeing the turnover yet, but just paying attention to what was going on across the country, we knew we needed to do something to retain here."
This realization evolved into a systemwide nurse manager council, which has roots going back to a nursing strategic plan developed in 2017. Dr. Delfin said part of the goal with the original plan was to focus on retention of nurse leaders. The health system moved toward that goal with a peer group for nurse managers to connect with each other and share concerns. That peer group then became something different.
During COVID, "It was more the need to make sure we were standardized in the way we rolled things out to the front-line staff, the way that nurse managers led their teams," Dr. Delfin said. "That's how it evolved to more of an official [nurse manager] council."
The 12-member council first established the core values most important to them. Council members, which represent all six hospitals and 50 nurse managers throughout the health system, indicated they wanted an improved work environment, assessment of competencies of nurse leaders, and assessment of the onboarding of nurse managers.
"We had done some focus groups with nurse managers and the themes were feelings of exhaustion, not being valued, not having enough information or time to do the job, and it was moving from a nurse manager to a nurse leader/coach role to recruit and retain the nursing staff they had," said Dr. Delfin.
Over the last two years, the council has become an example of shared governance. Dr. Delfin said it also allows nurse managers to feel heard, and has resulted in the adoption of a flexible 40-hour work schedule, "so they have more control over balance in their life." Additionally, council members have developed core competencies and standardized an onboarding process.
"They know what they didn't get in their onboarding, and what we need to do to retain," said Dr. Delfin.
Memorial Healthcare System saw its nursing turnover/vacancy rate drop from nearly 17% to less than 6%, which she attributed to strong nursing leadership. The health system has also retained nurse residents, at a 94% rate.
"I am so impressed by the leadership courage of this [council]," Monica Puga, MSN, RN, chief nursing executive at Memorial Healthcare System, told Becker's. "They all get together. They're very transparent and open and honest about real issues. These are front-line leaders, and in this council, we have to reinforce the fact that no decisions about the front-line leaders or the front-line staff will be made without their voice.
"And this group has an incredibly strong voice. They're advocates for their leaders. They're advocates for their staff. It really doesn't matter what level of the organization [they're in]. It could be the chief human resources officer or the vice president of human resources. They have no issues with meeting with them, sharing real challenges in a professional, respectful way. I'm blown away by their courage and the level of commitment they have to serving their team and the organization."
Now, Memorial Healthcare System is working on a refresh of its nursing strategic plan, and, at the same time, the council is looking to recruit new members from various parts of the health system.
Dr. Delfin said the council is also focused on span of control and defining that for a high- performing and high-functioning nurse manager. Additionally, council members continue to use and build on standardized nurse leader competencies.
"We are transforming healthcare at the bedside. We are transforming healthcare on the business side," said Ms. Puga. "And when you have all these competing priorities and activities, it's important the nurse managers understand the 'why' behind these activities and initiatives, and can ensure the message is being carried forward and executed by the front-line staff. It has challenged a lot of us to be more balanced."