Why It Matters
Whether we realize it or not, nurses know quality improvement. Every day, with every patient, nurses use small tests of change to treat our patients. Based on what we learn from a clinical assessment, we try one course of treatment. We see what happens. Based on that, we stick to the treatment, or try something else. We are essentially running Plan-Do-Study-Act (PDSA) cycles. We look at data over time. We do quality improvement at a single-person level.
But what happens when patient-facing nurses get promoted? Through a combination of hard work, ability, experience, and maybe additional education or certification, a nurse is moved up to a nurse manager role to use their skills for unit, service line, or health system improvement. Many nurse managers, unfortunately, find they have not been equipped or supported with the right skills, resources, or guidance to live up to their full leadership potential.
Typical training for managers may focus on payroll, scheduling, and hospital procedures. Nurse managers rarely receive training that emphasizes the leadership skills, adaptable and technical quality, safety, and improvement knowledge required to make a good nurse leader into a great nurse leader.
Without the right support, burnout and high turnover can result. Amazing staff nurses become managers and get into the grind of management work without any sense of where their old role ends and their new one begins. We chip in and do everything because nurses are typically team-oriented people. We put out fires with no understanding of how the fire started and how it could have been prevented. We end up overworked, exhausted, and thinking there has to be a better way.
Tips for Managing Improvement
Fortunately, there are ways to build and refine skills that increase the likelihood of success when leading or being a contributing partner to unit, service line, or system-level quality improvement efforts:
- Learn the basics of quality improvement. It is so important to understand the difference between normal variation and special cause variation. Without a good handle on what data means, you might react and respond to insignificant data points, e.g., a 10-point shift in heart rate in a healthy person, a 5- or 10-minute change in your commute time or weighing a few pounds more or less after the holiday season. Learning how to understand variation so we do not overreact every time the data goes up or down is important for leaders at all levels of an organization.
- Understand there are many ways to lead. Most of us have a mental model of what a leader looks like. It might be a style or a way of speaking. If we do not match that mental model, we may doubt our ability to lead. But there are many different leadership styles. Understanding our own style and the leadership styles of others helps us work together effectively and get things done.
- Find out what matters to each team member. Put in the time to understand what drives each person. What brings them to work each day? What are their strengths? Where do they have opportunities for improvement? How can we help them shine?
- Accept that managing former peers can be challenging. In addition to getting to know what motivates everyone to do their best work, open communication and mutual respect are essential for all teams, but particularly for those in which we are leading former peers. Learning people’s answers to “What makes a good day for you?” (as described in the IHI Framework for Improving Joy in Work) and doing all we can to make that happen, demonstrates care for each person as an individual and that we take seriously the responsibilities of our managerial role.
Managers play a crucial role in meeting the improvement goals of their organization. It is their job to communicate high-level objectives to the people providing direct patient care. With the right training and support, nurse managers and others given these responsibilities can effectively lead quality improvement efforts.
Jennifer Lenoci-Edwards, RN, MPH, CPPS, is an Institute for Healthcare Improvement Vice President.
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