Celebrating Front-Line Nurse Managers: “If Florence Could See Us NOW!”


Celebrating Front-Line Nurse Managers

As we celebrate Florence Nightingale’s birthday and Nurses Week, lots of thoughts go through my mind having been honored to work in this amazing profession for close to 45 years.  I think back about how much nursing has changed over the years. I remember when every patient received a back rub every night, we used glass thermometers and glass IV bottles, we poured our own meds using med cards and delivered them in little med cups on a metal tray, we hand wrote everything and relied heavily on the Kardex, and I remember when the hospital I worked for got its first cardiac monitors.

The other thing I think about is how little some things have changed, most notably how important the “Head Nurse”, now Nurse Manager, has always been to nursing staff.  That was really reinforced for me when I was a Chief Nurse and realized that my primary role was to take care of the staff so they could take good care of the patients. There is no way I could take care of all the staff singled handed – it required strong Nurse Manager’s and resilient Directors who supported their respective Nurse Managers.


I have long said that the Nurse Manager role is the most difficult and the most important role in any hospital.  They are closest to the patients and families, the staff and the physicians and they work with nearly every other hospital department. A strong nurse manager can make all the difference in how engaged the staff remain and how satisfied patients feel about their care and, these days with pay for performance, that makes a true contribution the bottom-line.
Five years ago, I wrote a column for Nursing Economic$ about what I think we need to do for front line Nurse Managers to ensure they are adequately prepared and supported in their critically important role.  I came up with 8 “E’s” to be considered.  I believe we must evaluate, educate, embrace, enable, empower, espouse, engage, and excite front line Nurse Managers.
The Eight “E’s”

  1. Evaluate them. Let’s face it; we all know some people are just not cut out for management.   Now, more than ever, we need to make sure we have the right people, on the right bus, in the right seats.  Many management skills can be learned, but the ability to work effectively with others and instill team work is paramount for the Nurse Manager role. For the sake of both the Nurse Manager and the staff, we need to make sure they are up for the role.
  2. Educate them.  If we expect Nurse Managers to manage some of the largest budgets and greatest number of staff we owe it to them and our patients to make sure they have the necessary education and tools.
  3. Embrace them. Formal education isn’t enough.  Equally, if not more, important is coaching and mentoring.  Our new, and some of the seasoned, Nurse Managers need to be embraced and supported in putting formal classroom education to use.
  4. Enable them. We must give our Nurse Managers the resources necessary to be successful.  They need both clinical and administrative support and we need to start looking critically at the return on investment that could be gained from properly resourcing these key leaders.
  5. Empower them. Many new Nurse Managers experience “the myth of empowerment,” which is the way to empower people is to leave them alone and let them manage themselves.  In this changing healthcare environment Nurse Managers don’t need myths, they need real empowerment.  They need to be supported in trying out new ways to deliver care efficiently and effectively.
  6. Espouse them.  We must do more to support and champion our front line managers. The fact is fewer and fewer nurses are seeking out management roles, and for good reason.  Front line Nurse Managers typically work far more hours, have far more “headaches,” and get less pay than their staff nurse counterparts.  If we don’t do something to get them the pay they deserve, reasonable work hours, and other resources they require we may be forced to look at other options for managing patient care, and that would be costly from both a financial and quality perspective.
  7. Engage them. If we are to get the full benefit of skilled front line Nurse Managers we must engage them in decision making and finding new ways to deliver care.  There are so many challenges that nurse leaders face in this age of healthcare reform, we need the best and brightest to help identify the best options for improving quality with fewer resources.
  8. Excite them.  And finally, to engage these nurse leaders, we are going to need to excite them about the prospects for change.  We need to get them to step outside the box and think about how teamwork can be enhanced, how to identify the 20% of the work that makes 80% of the difference in patient outcomes, and how to attract more of the best and brightest into this challenging but exciting profession.
The most significant investment that a nursing executive can make in an organization and to the delivery of quality patient care is the development of current and future front-line Nurse Managers.   We are in the midst of massive changes in access and the delivery of healthcare.  The front-line manager is in a critical position to make it all work and deliver what the public wants – better access, improved quality, and less cost.

Please join me in celebrating Nurse Managers and all Nurses this week!

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