Inspired leadership: Nursing retention toolkit
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- Goal statement
- Initiative – Cultural change: Create a culture that can inspire leadership at all levels
- Initiative – Leadership competencies: Enhance or develop leadership training programs and tools nurses focused on developing key leadership competencies
- Initiative – Emerging nursing leaders: Identify and support emerging leaders
Goal statement
Empower nurses of all levels, roles, and settings to experience fulfilment in their work and become leaders within their organizations.
Initiative – Cultural change: Create a culture that can inspire leadership at all levels.
Intended outcome
- Reduced turnover in leadership roles.
- Improved retention.
- Increased accountability across the organization.
- Healthier work environments in which nurses feel a sense of belonging and that they can advance within the organization to become leaders.
Description
Role modeling: This initiative is focused on creating an organizational culture that supports the cultivation of inspired leadership. All organizations have a unique culture, whether it is defined or not. Creative ideas, innovation and a cadre of motivated staff can be stymied if the existing organizational culture does not foster inspired leaders. Key principles for a culture that promotes inspired leaders include:
- Starting at the top: Leadership needs to commit to culture change that is aligned with the organization's values and should model the desired behaviours of inspired leadership in their interactions with staff, patients, and colleagues.
- Nurse-centric leadership roles and structures: Chief Nursing Officer/Executive (CNO/CNE) roles at organizations should be protected in a way that enables the CNO/CNE to drive a strategic vision that meets the needs of nurses. These roles, where possible, should not be combined with other operational roles and responsibilities. See "Structured Participatory Governance" for more.
- Moving away from "crisis mode": Leaders are encouraged to evaluate how to shift away from more autocratic leadership styles driven by a sense of crisis, and move towards inclusive, collaborative leadership styles that truly listen to and consider the insights from the point-of-care.
- Backed by resources: Resources, time, and budgets need to be allocated to drive culture change. For example, a tool to build inclusive culture is hosting Nursing Councils, where nurses can meet, share challenges, and problem-solve together. However, without support (e.g., paid time, support on their shift to participate in Nursing Councils), attendance is inaccessible.
- Channels for collaboration with accountability: Channels that encourage nurses to raise concerns without fear of sanctions for criticism can create real opportunities for collaboration, dialogue, and understanding between different roles and levels of the organization. An anonymous culture survey is one example of a mechanism for collecting honest feedback and can inform the prioritization of initiatives. Importantly, channels designed to gather insights and feedback need accompanying accountability systems that track and measure how feedback is used and have impact.
- Creating brave spaces and addressing bullying: Leadership should actively create environments free from harm and discrimination, in which nurses feel safe and encouraged to share their perspectives even in the face of discomfort. See "Zero-Tolerance for Violence, Bullying and Racism" initiatives for more.
- Training for nurse leaders: Culture is largely influenced by the style and role modeling of managers and nurse leaders at all levels of the organization. Provide support so that nurses can lead with authenticity and best support their teams (e.g., open-door policy, validating experiences, administrative support, etc.)
- Strategic plans: Culture change requires a strategic plan with short-, mid-, and long-term goals and clearly articulated core values aligned with the principles of inspired leadership. A change management plan to guide the organization through a cultural shift with key performance indicators (KPIs) for employee satisfaction and retention to measure and evaluate progress are important considerations. Furthermore, to create sustained change, strategic plans should not be viewed as a one-time, short-term initiative. Ongoing monitoring and tracking of stated goals and core values are critical for lasting impact.
Target nursing population
All (Student, New Grad, Mid-Career, Late-Career, Managers and Faculty, etc.)
Stakeholder involvement and role of nurses
- Responsible and Accountable: Executive Leaders, Point-of-Care Nurses
- Consulted and Informed: Nurses
Reference resources and examples (See appendix for links)
- Nursing Councils in Quebec: Such councils are strictly dedicated to the quality of care and are independent from management. The Nursing Councils are elected bodies that have direct access to the Board of Directors of an organization, so issues can be escalated when needed. In Quebec, Nursing Councils are enshrined in health care law. All health care institutions must have a Nursing Council. Other regions may want to consider the introduction of Nursing Councils to benefit from this important accountability mechanism.
- Sinai Health's Magnet® designation from the American Nurses Credentialing Center's Magnet Recognition Program®: This designation is a testament to nursing excellence and requires meeting exemplary standards in clinical outcomes, patient satisfaction and staff satisfaction. The program engages nurses and provides a roadmap to nursing excellence, including excellence in nursing leader roles.
Initiative – Leadership competencies: Enhance or develop leadership training programs and tools nurses focused on developing key leadership competencies.
Intended outcome
- Nursing leaders feel equipped to lead, regardless of their formal level, role or setting.
- An amplification of the voice of nursing at all levels of the organization.
- Increased mentorship and training opportunities accessible to developing leaders at an early stage.
Description
This initiative is focused on enhancing or creating leadership training programs and tools for nurses that are focused on developing key leadership competencies. Programs and tools should prepare nurse leaders for both formal leadership roles (which include technical knowledge), and informal leadership. Examples of training programs and tools include:
- Leadership competencies that are required for nurse leaders and help guide nurse leaders' development. These competencies should be aligned with the values of the organization. They should also include the development of financial and data-driven skills as they are critical for nurses to engage with leaders and nurses in the organization to improve quality of care.
- Communities of practice to foster mentorship and connections that support leadership development.
- Situational leadership training to prepare nurses at all levels, roles, and settings to be leaders in situations they find themselves in most often.
- Training on "self" and emotional intelligence, including developing emotional regulation, self-awareness, and self-care to foster empathy, understanding and care through leadership.
Planning considerations:
- Accessibility of the tools and programs need to be considered in their development. Programs, tools, and nurses' time in participating must be supported by the organization, accommodating nurses with different levels of experience and who work various shift schedules. Furthermore, accessibility of programs for nurses from diverse backgrounds is critical to create role models and empower nurses to step into leadership positions. It is not only important to recruit with an anti-racist and equity, diversity and inclusion (EDI) lens with attention to anti-indigenous racism but also to provide the right supports and environment for individuals to thrive.
- Communities of practice, which can facilitate the sharing of success stories, may provide support in identifying the right tools and programs for each organization.
- Clear objectives and purpose for tools and programs to guide content development and activities for the identified target audience and the appropriate types of leaders (e.g., management leaders, bedside leaders).
- Involve skilled facilitators who have strong leadership and communication skills to drive engagement and discussion for Communities of Practice and situational leadership training.
- Engage nurses through needs assessments, focus groups, or other means to inform the development (or ideally co-development) of tool and program content.
Target nursing population
All (Student, New Grad, Mid-Career, Late-Career, Managers and Faculty, etc.)
Stakeholder involvement and role of nurses
- Responsible: Regulatory bodies should consider building leadership development of nurses into their quality assurance and continuing competence tools. Managers and other leaders must also provide opportunities to all nurses to exhibit competencies.
- Accountable: Finance department and organization executive team
- Consulted and informed: Nurses, Nurse Educators
Reference resources and examples (See appendix for links)
References on leadership competencies and programs
- Inspire Nursing: A LEADS-based Nursing Leadership Program from the Canadian College of Health Leaders (CCHL)/Canadian Nurses Association (CNA) developed by nurses, for nurses, looking to explore and develop nursing leadership capabilities and influence change in the Canadian health system.
- Bringing Leadership to Life in Health: LEADS in A Caring Environment: This reading is part of the CNA/CCHL Inspired Nursing Program.
- Canadian Association of Schools of Nursing (CASN) National Nursing Education Framework: national framework (which includes leadership) outlining core expectations for baccalaureate, master's, and doctoral programs in nursing education.
- Sigma Global Nursing Leadership Competency Framework: A framework with 10 key competencies identified through collaboration with global nurses, which can be used as tool to develop leadership programs.
- Standards de pratique et compétences: Guide à l'intention des infirmières oeuvrant en gestion des soins infirmiers au Québec – Book on leadership competencies by Sylvain Brousseau.
- American Organization of Nurse Leaders (AONL) competency resources: Resources outlining Nurse Manager Competencies and Nurse Executive Competencies are available for organizations to draw inspiration from.
References on representation
- Ted Rogers School of Management's Diversity Institute at the Toronto Metropolitan University (TMU): The TMU Diversity Institute provides resources on representation in leadership, including best practices to advance racialized people to senior leadership positions.
- An Introduction to Anti-Racism for the Nursing Professional by Nadia Prendergast: An open education resource on anti-Black racism in the Canadian context specific to the nursing profession.
- Action Plan by the Diversity, Equity, Inclusion, and Belonging Council (DEIB) at Horizon Health Services: An action plan with commitments has been developed, and resources, best practices, approaches, and training are under development.
- Canadian Nurses Association: Provides resources on racism in healthcare focused on anti-black racism and anti-indigenous racism.
Initiative – Emerging nursing leaders: Identify and support emerging leaders.
Intended outcome
- More nursing leaders who demonstrate leadership skills.
- More nursing leaders who demonstrate the ability to create and support emerging leaders.
- Understanding of competencies that must be exhibited for developing nursing leaders.
- Democratize pathways to leadership with intentional talent spotting.
Description
This initiative is focused on identifying and supporting emerging nursing leaders in all levels, roles and settings. This can be accomplished through various mechanisms that can be implemented simultaneously. Several are described below:
- Formal programs: Formal emerging leader programs, where nurses who have shown interest and initiative in leadership activities are selected and provided formal opportunities to develop their leadership skills. It is critical that any selection process is inclusive, done with an anti-racist and EDI lens and is unbiased. Prerequisite requirements may or may not be required for the program to be successful. Training may include information on leadership competencies and professional development skills, such as resume building, to support movement into progressive and formal leadership roles.
- Talent spotting: Informal process where emerging leaders are identified by existing leaders or peers, ideally at an early stage in a nurse's career, to recognize individuals with exceptional talent and develop a pipeline of capable leaders. Engage existing leaders in the talent spotting process, as their experience and insights may help identify individuals who exhibit qualities necessary for effective leadership. Identify potential leaders from diverse backgrounds and experiences and incorporate findings into succession planning processes as well as learning and development programs. Diversity in leadership brings a range of perspectives and ideas that can benefit the organization.
- Performance management: Annual performance management processes are an existing opportunity to identify and support emerging nursing leaders, since managers in nursing environments often have visibility over many nurse direct reports and emerging leaders. Consider ongoing feedback throughout the year to provide continuous guidance and input to help nurses excel in their roles.
Planning considerations:
- Voice of nurses: Seek to understand what inspires today's nurses to become nursing leaders in the development process. Newer generations of nurses have unique motivations and values.
- Inspirational programming: Formal opportunities to develop leadership skills should strive to inspire emerging nursing leaders to drive organizational cultural change and engagement.
- Mentorship: Development of emerging nursing leaders requires dedicated mentorship. See "Mentorship Programs" for additional considerations related to components of a mentorship program.
- Insights and mentorship from late-career nurses: Consider how late-career nurses in your organization can utilize their skills and experience to support the development of emerging nursing leaders. See "Mentorship Programs" for considerations related to incentives and voluntary participation.
Target nursing population
Student, New Grad, Mid-Career, New Managers, Late-Career Nurses (for program support and mentorship)
Stakeholder involvement and role of nurses
- Responsible: Human Resources, EDI teams, Chief Experience Officers, and Nurses.
- Accountable, consulted, and informed: All groups identifying and supporting emerging nursing leaders, and nurses who are receiving training and opportunities.
Reference resources and examples (See appendix for links)
- Inspire Nursing: A LEADS-based Nursing Leadership Program from the Canadian College of Health Leaders (CCHL)/Canadian Nurses Association (CNA) developed by nurses, for nurses, looking to explore and develop their leadership capabilities and influence change in the Canadian health system.
- Michael Garron Hospital's (MGH) Emerging Leaders Program (ELP): A year-long hospital-wide leadership development program that provides staff and credentialed clinicians with opportunities to develop their leadership skills through hands-on experiences customized to their interests and developmental goals.
- University of New Brunswick's Certificate in Nursing Leadership and Management: A certificate program, including courses on communication, change leadership, human resources, quality management, and financial stewardship specifically for nurses. Horizon Health Network sponsors an intake of employed nurses to take this formal leadership program.
- McGill Leadership Program for Nurse Managers: A three-module online course that aims to help organizations make leadership more concrete for nurse managers.
- Canadian Nurses Association (CNA) Certification Program: A nationally recognized nursing specialty credential for nurses consisting of 22 nursing practice specialties.
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