Take stock and prepare for success.
- Leadership in today’s healthcare environment is challenging.
- This 10-question decision-making framework can help clinical nurses who are considering a transition to leadership.
I FREQUENTLY ASK clinical nurses if they’re interested in leadership positions. They usually say no, but when I press them, many reveal that they’d like to take on a leadership role but they don’t feel qualified. How about you? Have you been eyeing an open leadership position in your organization? To help boost your confidence and prepare you for what to expect in your pursuit of this next step in your career, ask yourself these 10 questions (and consider the accompanying advice). They may help clarify your decision-making.
1 Do you understand the job?
The position description will delineate most expectations but it probably won’t capture everything. Fully understanding a specific job comes with doing it for a period of time. If you’re called for an interview, learn what you can about the organization beforehand and take questions with you. This effort will help you better understand the roles and responsibilities, and it will signal that you’re serious about the position. Some questions you might want to ask during the interview include: What’s the turnover rate? Do you have unfilled vacancies? What quality data related to patient outcomes can you share? Will I be expected to maintain clinical currency and fill in as needed? Is the service line profitable? Will new service lines be added? Will my scope of responsibility change? Will I be on-call? Whether you’re selected or not, the process of learning about the job will help you get a better understanding of the organization’s expectations of nurse leaders.
Advice: Try to be objective as you weigh the pros and cons of a position. For example, if you learn that many of the staff have less than 1 year of experience, view the opportunity to mentor new nurses as positive. Conversely, suppose you believe you could do well in this position but are concerned about being on-call because of obligations at home. Ultimately, only you can decide if you can, or even want to, take on this responsibility.
2 Are you qualified?
Compare your credentials and experience with the minimum requirements for the new position. If you’re qualified, great. If not, you still may be considered if you’re qualified in other ways. Ultimately, if no wiggle room on specified credentials and experience exists, you’ll be screened out. Whether you’re selected or not, the process of applying is valuable; you’ll learn what to do to become more competitive next time.
Advice: In your résumé or cover letter, highlight how you’re working on obtaining required credentials or education. This also is an opportunity to describe ways you exceed requirements if you already have certifications and specialty continuing education.
3 Have you told your current employer about the potential career change?
If you’re considering an internal move, you may need to get an endorsement from your current supervisor. If you’re seeking an external move, decision-making can be a bit more complicated. The lag time between submitting an application to being screened and ultimately selected can be weeks to months. On one hand, you want to be honest and transparent with your current employer, but signaling your intent to leave an organization can create tension.
Advice: This is where career planning can be pivotal. Ideally, long before you consider a move, communicate your long-term plans to your employer. For example, let’s say I’m your supervisor and for the last 2 years you’ve been one of my valued clinicians. During our annual evaluations you’ve told me that you’re interested in a leadership position. One of my roles as your supervisor is to help you meet your career goals, preferably enabling you to advance within our organization. If you decide to pursue an opportunity that is external, I would be disappointed but would support your decision, assuming you provided sufficient notice.
4 Are you comfortable with change?
This is a tumultuous time for healthcare. Leaders have to view change as a never-ending journey. Learn as much about the organization as you can through online research and conversations with others who work (or have worked) there. The information you gather may provide some degree of insight into changes that could be on the horizon. As a leader, you’ll be expected to facilitate change by working with your team and interprofessional colleagues.
Advice: If you’re change averse, challenge that thinking. Change is normal. You may encounter problems with planning and implementation, but change is inevitable.
5 Are you comfortable with conflict?
I know leaders who address conflict immediately and always arrive at a solution that’s agreeable to everyone. I also know leaders who avoid important issues because they aren’t comfortable with conflict. Like change, conflict is to be expected in healthcare. Whether the issue is a chronically late employee, a dissatisfied patient, an angry physician, or a disagreement with another department, leaders must work to resolve conflict in a way that’s best for the organization. I’ve noticed that effective leaders don’t get pulled into the emotions that accompany conflict. As they work to understand the situation, they first focus on facts. For example, the fact that one of the nurses on your team consistently arrives 5 to 10 minutes late is undisputable. Understanding why and determining what to do can be harder, but agreement on facts is a place to start.
Advice: Consider how you typically manage conflict. If avoidance is your primary strategy, realize that won’t work. Though managing conflict may never be your strength, you can learn to be more effective. However, if you believe that managing conflict will be a struggle, perhaps you should defer seeking a leadership position until you’ve invested some time in developing this skill. (See Conflict management resources.)
6 What help is available, especially during the first 90 days on the job?
If you’re transitioning into a position currently filled by a leader who’s retiring or making an internal move, you’ll probably have an opportunity to learn from someone with expertise about the organization, the work setting, and the role. If you’re moving into a position currently filled by an interim leader, he or she may have similar insight, but at a more superficial level. Depending on the organizational structure, your supervisor may or may not be directly involved in your orientation, but you’ll need his or her input. Be clear about all aspects of the job description, performance expectations, and priorities. Both during your transition and going forward, always keep your supervisor informed of any major personnel or patient issues.
Advice: Achieving results within the first 90 days sets the tone for long-term success. Along with support from your supervisor, consider seeking a peer responsible for a similar work setting who’s willing to help you.
7 Do you speak and write with credibility?
Some degree of oral and written communication is needed in any leadership role. At a minimum, you’ll be representing your unit in key meetings and emails.You’ll need to understand the scope of service, budget, and other key issues well enough to advocate for unit needs. Your writing should be clear, concise, and technically accurate. Use the situation-background-assessment-recommendation (SBAR) technique for conversations about patients. SBAR also is a good framework for simple, direct writing. If oral presentations are required in your new position, you will find that many resources are available to help you create and deliver effective content. (See Presentation resources.)
Advice: To check your written communication, try reading it aloud; and, if possible, read emails twice before hitting send. For official correspondence, find someone who’s a good editor to review your work. Similarly, for oral presentations, ask someone to review your slides. Run through your presentation at least once before giving it, ideally with a colleague who can provide constructive feedback.
8 Do you want to do this?
This may seem like an odd question, but we make career changes for different reasons. Sometimes we knock on doors and sometimes doors just open. I’ve been asked to apply for jobs that I wouldn’t have previously considered. Ask yourself whether you really want this leadership position.
Advice: If you really want the job, great. If you’re hesitant, ask yourself why. If this role is something you believe you can do, and perhaps even be good at, don’t let fear hold you back. You were a novice clinician once, and every leader begins somewhere.
9 Do you want to do this for a long time?
Transitioning into a leadership role will be stressful for you and the staff. If you intend to move on in 1 to 2 years, be honest. You might be screened out, but it might not be a deal breaker. Having a strong leader in place, even in the short term, can bring needed stability. However, if you’re primarily looking for experience for your next job, you may not bring the commitment and passion that the staff deserve.
Advice: Think about the commitment you’re willing to make, and recognize that if you’re selected, it’s not just about you anymore.
10 Are you prepared to succeed and are you prepared to fail?
Everyone should add value to an organization. As a novice, you’ll need to invest time to improve your readiness to lead. TheAmerican Organization of Nurse Executives (AONE) Nurse Man ager Competencies document is a great place to start (aone.org/resources/nurse-manager-competencies.pdf). It identifies a range of competencies that are clustered into three domains: the science (managing the business), the art (leading the people), and the leader within (creating the leader in yourself). To build these competencies, seek out books and seminars on nursing leadership. For example, both AONE and the American Nurses Association offer printed resources, live workshops, and online programs on a range of leadership topics. Another helpful resource is the Institute for Healthcare Improvement’s Open School (bit.ly/2DzUKzx), which provides free online courses on quality improvement, patient safety, and leadership. In the long term, you might even consider a graduate program in nursing leadership. Work to excel every day, but consider what might happen if you try your best and ultimately the position isn’t a good fit. Would you be provided an opportunity to transition to something else? As a worst-case scenario, if you were fired, could you handle being without a paycheck for a period of time?
Advice: Learn from your mistakes. Seek and provide feedback often. If your supervisor has expectations that you’re not meeting, you need to know right away and do your best to address concerns. Always be respectful. If you’re fired, remember you were selected because you have skills. Another door will open, either in your current organization or in another.
Taking the first step toward leadership can be scary, but with awareness of your strengths, weaknesses, and expectations, you can prepare yourself for success. Use these questions to help you determine whether you really want to take that first leadership career opportunity.
Patricia E. Alvoet is a faculty member and program coordinator for the department of baccalaureate and graduate nursing at Baptist Health System School of Health Professions in San Antonio, Texas.
American Nurses Association. Leadership and excellence. nursingworld.org/continuing-education/ce-subcategories/leadership/
American Organization of Nurse Executives. AONE education programs. aone.org/education/overview.shtml
American Organization of Nurse Executives. Nurse Manager Competencies. 2015. aone.org/resources/nurse-manager-competencies.pdf
Institute for Healthcare Improvement. Open school. ihi.org/education/ihiopenschool/Pages/default.aspx
Institute for Healthcare Improvement. SBAR tool: Situation-background-assessment-recommendation. ihi.org/resources/Pages/Tools/SBARToolkit.aspx
Shirey MR. Leadership transitions and the first 90 days. J Nurs Admin. 2016;46(4):169-72.ant1-Leadership role-103