Memphis-based Methodist Le Bonheur already had a strong, broad-based generic leadership development program in place. Yet, nurse executives recognized their nurse managers needed a tailored program aimed at their unique needs and responsibilities. Ultimately, such a program could help nurse leaders contribute to quality and financial goals of the seven-hospital system.
“Our nurse leaders are typically running $1.2 million to $4.5 million businesses,” says Paula Spears, DNSc, RN, NEA-BC, corporate director, professional practice and advancement. “Our main concern is knowing how to help these nurse leaders build their business and management skills. How do we make good leaders become great leaders?”
The Nurse Leader Institute was created, thanks to a five-year $1.2 million grant from the Health Resources and Services Administration of the U.S. Department of Health and Human Services.
All clinical and administrative directors are being trained through a year-long program through the Institute, says Spears. The one-year program has three main features:
- Individual initial assessments that identify each nurse leader’s strengths and weaknesses—and that help Institute staff identify topics to cover for the entire training group.
- Regular classroom seminars on a variety of leadership and business topics.
- Extensive individual and on-site, on-the-unit coaching by an executive leader coach and a nurse leader coach.
“Many have called our program a best practice example,” says Spears. “A lot of programs assess managers’ skills and have classroom training. But few add the coaching resource, especially the onsite coach.”
The executive leader coach helps the managers with general leadership skills, such as personnel management, interpersonal skills, and time management.
The other coach—a nurse with past experience as a nurse director—provides guidance on how to run a unit/department. “This coach collaborates with the managers on their units and shadows them, observing and giving advice,” says Spears. “The coach also helps them with budgets and creating business presentations and plans, such as a business case for a new service line initiative.”
Before graduating from the year-long program, all nurse leaders attend a finance workshop, which uses real-life scenarios to drive home important lessons. For example, attendees are asked to develop a budget for a new hospital unit based on projected volumes. Attendees also discuss various cost control illustrations.
An incremental overtime example always turns into an “ah hah” moment for many attendees, says Spears. Instructors use the example of one nurse on a unit who always has 15 minutes of overtime. To illustrate how this impacts the organization’s bottom line, the instructors show how much 15 minutes of overtime on every unit in the facility and in the system would cost on an annual basis.
“We then focus on how we would use the $1.7 million saved in incremental overtime costs to improve patient care,” says Spears.
The finance workshop ends with a panel discussion that includes three CNOs and three CFOs from system hospitals. “We ask the participants to give us their thoughts on how they’ve developed good CNO-CFO relationships and how they do their budgeting,” says Spears.
The Nurse Leader Institute is meeting its goals of improved patient safety and nurse retention. Turnover and vacancies are down. So are rates for decubitus ulcers (adult care hospital units) and catheter-associated blood-born infections (pediatric units).
Plus, error reporting has gone up significantly. “As nurse managers develop their leadership skills, they are developing more rapport with their staff and encouraging an open culture, which includes error reporting,” says Spears.
Putting a program like the Nurse Leader Institute together costs about $13,000 per participant, estimates Spears. The main costs have included start-up costs (e.g., supplies and equipment), salaries and benefits for three personnel (i.e., two coaches and one coordinator), and a formal evaluation to ensure the quality of the program.
However, the costs of a program like the Nurse Leader Institute are recouped many times over by reductions in nurse vacancies, says Spears. “One recent participant told us, ‘This job is so tough, I know I could not continue without this coaching and support.’”
Interviewed for this article: Paula Spears, DNSc, RN, NEA-BC, is corporate director, professional practice and advancement at Methodist Le Bonheur (spearsp@methodisthealth.org).