More Work To Be Done in Overcoming Nurse Leadership Transitions


Change can be frightening, and the temptation is often to resist it. But change almost always provides
opportunities – to learn new things, to rethink tired processes, and to improve the way we work. 

Klaus Schwab


HTS3 Executive and Interim Recruiting is a recognized consultancy, skilled at aligning the best qualified leaders within your organization in times of transition. Healthcare is what we do, so we do it exceptionally well.
Contact Hudson Shelton on to recruit your next quality Interim Leader and Peter Goodspeed on for your Permanent Executive Leader.

Introduction to Diane Bradley – PhD, RN, NEA-BC, CPHQ, FACHE, FACHCA
Diane has held the position as Regional Chief Clinical Officer with HealthTechS3 for the last eight years, having worked in a variety of staff, administrative and consulting roles. She is currently working in an Interim CEO position at a Critical Access Hospital in middle Georgia. Diane begun her healthcare career as a staff nurse in the Emergency Department of a major medical center and has over 30 years of accumulated clinical management experience; having worked in numerous leadership positions across Critical Access Hospitals, Acute Care Hospitals, Long-Term Care and Behavioural Healthcare Facilities. Equipped with rich expertise, she provides guidance and assistance to senior leaders and middle management in a variety of areas, especially as it relates to quality and patient safety.

In this article, Diane shares her wisdom to ensuring a smooth nurse leadership transition in times of change.

In today’s tumultuous health care environment, changes in leadership can quickly cause destabilization among nurses if not handled properly. Diane Bradley, Regional Chief Clinical Officer with HealthTechS3 for the last eight years and now currently working in an Interim CEO position at a Critical Access Hospital in middle Georgia, shares her wisdom to ensuring a smooth nurse leadership transition in times of change.

  1. Leaders – Made, Not Born
    While some researchers may expound that leaders achieve greatness through their genetic makeup, it is much more often through hard work, persistence, and good mentoring. It is anticipated that 30% of leadership comes through genetics while the remainder comes through experience. By this token, the loss of exceptional leaders can be profoundly impactful to an organization and to the employees. There are many phrases that have been used over the decades to describe great leaders such as high integrity, servant mentality, positive attitude, compassionate, participative — and more recently — transformative. To be an effective leader, you must have the desire to lead.A skilled clinical nurse may be asked to assume a leadership role because he/she is an excellent nurse. However, the job responsibilities of a nurse vs. nursing manager or executive are dichotomously different, which can lead to a steep learning curve and potential failure if not coached and mentored. Understanding the basic expectations of leadership is important, including but not limited to identifying skills gaps in yourself and others, creating a team with a diverse skill set, and continuous communication.Developing into a great leader is a marathon, not a race.
  2. Succession Planning
    The goal of succession planning is two-fold: (1) identify individuals who may have the genetic traits inherit in great leaders, and (2) develop leadership talents through readiness assessments, education and skills training, mentorship and motivation.Succession plans are most often created because: there is a grouping of suspected retirements or leadership moves/losses, insufficient talent to fill key positions, and/or the business is growing or changing. Once the rationale is established for the succession plan then it is easier to stay focused on the type of talent most likely needed.As we’ve mentioned previously, the rationale for a nursing leadership succession plan is to mitigate as much as possible the impact to patient care as well as to cultivate new leaders within a segment of the healthcare talent pool that continues to anticipate growth well into the next 5-10 years.Transparency in communicating the succession plan to leaders helps to reduce confusion and surprises when the plan has to be activated. The succession plan should be evaluated annually to assure accuracy and assess leadership development.
  3. Gaining Momentum
    Clearly succession planning is tantamount to minimizing uncertainty within the staff when losing a leader. An internal promotion of a strong leader who can bring the team back together and build a stronger, more productive team is ideal, however, that strategy may not present itself at the right time.Senior leaders should always assess the job description and evaluate the characteristics they and the employees define as important for the prospective candidate. No one is perfect, but there are “must haves” for maintaining the organizational culture and assisting employees in moving from one leader to the next.Begin recruitment as soon as a nursing leader has informed their respective supervisor and human resources of their departure. Recruitment can include networking with the State’s Hospital Association and the State’s Organization of Nurse Executives and Leaders. Additionally, involving staff in the interviewing process, regardless of an internal or external candidate, can lessen the gap of not having a leader since they are part of the process of replacing the leader whom they can support.Uncertainty and change within an organization have the tendency to create rumors, political jockeying for power, and “water cooler” or breakroom conversations leading to embellished and incorrect information which erodes trust in senior leadership and diminishes high performance. Remedy: communicate, communicate, communicate, in fact, over communicate to reduce rumors.
  4. Managing Staff and Expectations
    Another essential element of a leader change includes the identification of informal leaders, those people who can bring logic and rationale thought to helping their colleagues through the loss. These are the high performers whom the majority follows. Perhaps some of you who are reading this blog remember the Nursing Clinical Ladder that was developed in the late ‘80s and early ‘90s to recognize clinical excellence but also leadership talents. Utilizing the wisdom of these informal leaders can assist in keeping the remaining staff on the right track, and can help integrate a new leader into the group dynamic.Organizations big and small have employee assistance counselors who can be helpful when a tenured leader leaves. This type of change can be particularly difficult for staff who have developed a trusting relationship with the former leader. Occasionally, staff may go through the grieving process due to the departure. Oftentimes, nurses especially, tend to maintain a strong exterior and hold in their feelings simply because of the work we do. Again, this is a process that may not work for all, but EAP counselors can facilitate expression of feelings in order for staff to move forward.Be prepared to cite staff behavioral expectations prior to interviewing. No one is irreplaceable, however sometimes there is a sense that an exceptional leader is irreplaceable. Caution must be exercised when selecting staff to interview candidates to prevent comments that may deter the best candidate from continuing. For example, you do not want someone to say, “Are you sure you want this job” or “The manager job is horrible; it’s a no-win situation”. Providing guidance to interviewers is critical since they are an essential component of making the leader successful. Finally, listen to the staff and their impression of candidates. If senior leaders overrule the staff recommendation, there must be an absolutely solid reason, and it must be communicated to the staff or distrust will build.

    The departure of a strong leader is truly a loss to any organization. The difficulty that people experience is embracing change, however change continues to happen at an amazing rate today, so the strategies to help staff work through change by becoming part of the change is a must.