Developing Future Nurse Leaders Through Shared Governance

Background: With the rapid transformation of the healthcare delivery system and the uncertainty of the number of nursing workforce, the country may be faced with nurses unprepared to assume key leadership positions. Approximately 67,000 nurse managers are expected to retire in five years (1). The difficulty in filling the nurse manager position may adversely impact the nursing work environment and the quality of patient care. Assessment of current state in an academic medical center showed that the time to fill the Assistant Patient Care Manager (APCM) position is approximately 215 days in 2014. The estimated cost of the turnover of nurse managers is approximately 75–125% of their annual salaries. Action Taken: Succession planning (SP) is an essential organization strategy that has emerged as a result of the impending nursing leadership shortage. A comprehensive literature review was conducted using the evidence-based succession planning framework by Titzer and Shirey. In 2014, the Shared Leadership Councils (SLC) implemented structure and processes based on the evidence-based SP framework, which consisted of four phases: assessment, planning, implementation, and outcomes monitoring. The strategic interventions were leadership development sessions, experiential learning, coaching/mentoring. The monthly 8-hour council days provided the council members experiential learning, leadership development, and coaching. Individualized leadership competencies were identified and a structured monthly leadership development program was implemented. Outcomes: The four components of a balanced scorecard used to evaluate the program were decrease number of days to fill vacant positions due to internal promotion, internal processes such as leadership bench strength, leadership competency progression, and participant perception based on Kanter’s structural empowerment components. After 18 months of implementation, 32 SLC members were promoted to Assistant Patient Care Managers (APCM) (16) and other leadership positions (16). Internal promotion of SLC members to APCM positions resulted to a decrease in the number of days to fill vacant APCM position from 215 days to 23 days. Council members on the professional nurse development program increased from 22 to 45, indicating increased in leadership bench strength. Based on the pre and post assessment survey results, there is a statistical difference in the participant perception as a leader (p 0.0001), indicating an increase in perception as a leader overtime. A statistical difference was also noted on the participant project (p = 0.04) and committee participation (p= 0.03), indicating increase involvement in continuous process improvement. The post survey on Kanter’s structural empowerment components indicated statistically significant difference on the top box score (p < 0.05) as compared to the pre-survey, signifying higher perception on access to support, resources, information, and opportunities to learn and grow. The evidence-based SP framework is applicable in any settings as the organization aim to develop succession planning at all levels of care.