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Managing the Transition from RN to Nurse Management

Healthcare management is an industry where skill sets are incremental. Nurses must gain their clinical skills before they develop their management skills. In nursing, being able to walk the walk is most important. Healthcare management is an industry where skill sets are incremental. Nurses must gain their clinical skills before they develop their management skills. In nursing, being able to walk the walk is most important.

In contrast, the food service industry may have a manager introduced to a restaurant environment straight out of school. He/she may have graduated with their business management degree from a four-year college and their transcript reflects strong academic efforts. This candidate is skeptically accepted by the staff in the restaurant. The bartenders or waiters typically know more about the daily operations, however, when challenged with the accounting or marketing perspectives of the position, the new managers’ skills are critical. In healthcare, the clinical skill training comes first, typically followed by on-the-job training or formal academic training for the management skills. This path lends the clinical integrity to the management position that seems to be required in a field of licensed professionals.

Nurses graduate from nursing school and spend time perfecting their clinical skills within a nursing specialty. Then, the typical career path for someone interested in advancing their career proceeds through a Bachelor program of some sort and potentially on to a masters program. This may be a degree of nursing, business management or a few other key fields. Next, this candidate gains charge experience and possibly quality improve or utilization management along the way.

Unit management may be the next choice as one pursues their career path. Nurses who desire careers in education may choose to pursue an academic path aligned with nursing degrees. This typically advances their career quickly along that path. Alternatively, nurses with administrative pursuits may have a more varied academic background. The key for these candidates is demonstrated operational management strength.

As a nurse transitions from their clinical role as a registered nurse to a nurse manager, the growth experience is multifaceted. If a candidate is promoted from within, there are multiple social aspects that must be negotiated. The staff need to adjust to the new job requirements of one team member who was previously a peer. Their reaction to management decisions will be strongly dependant on how seriously the new manager takes these added responsibilities. Staff who used to be peers may not understand the accountability that must be required and maintained in order to manage daily operations.

Additionally, the staff may press limits. It is critical for the new manager to identify themselves as a new leader, clearly establish professional boundaries and prioritize their career in the professional environment. These decisions and choices are not easy and can often be clouded by personal relationships.

Individuals who have strong personality traits and may require acceptance by friends, may have difficulty with the transition from RN to nurse management. Candidates may desire more responsibilities, want to have opportunity to try new things, or have professional drive to advance their careers, but without the ability to clearly identify the boundaries between personal relationships and professional needs, this will be a difficult transition. One nurse in Virginia found herself in a position where management was requesting that she step up and assume additional unit leadership responsibilities. She resisted, feeling she did not have the necessary skill set.

However, having a natural leadership ability made her the ideal candidate for succession. This nurse was able to step out of the clinical ranks that she had been in for over 20 years. She had the respect of all her peers. Her ability to listen and make objective decisions would prove to withstand any controversy that may arise. She was able to manage a staff that even included a sibling. This was done with objective, empathetic and rational decision making. She is extremely successful in her role.

Transition from an RN at one healthcare center to a leadership role in a new facility may produce additional challenges. When an RN is promoted from within, she already has a knowledge base for the environment, supplies, available resources and support structures of the institution. When a candidate enters a promotional role from outside the facility, this can add stressors and integrity or trust challenges as the candidate is an unknown entity.

Being confident in your skills and knowing that you need to live by your belief structure will help guide you though this period of transition. Jack Welch, former CEO of General Electric believed nothing happed because of “I”. “We” is the most important phrase in a department or a facility. The team is what makes it happen. When new managers govern with these thoughts in mind, their team will often follow.

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