Jim Collins, author of the best-selling book, Good to Great, called it the “single most important decision facing any executive.”¹

Succession planning — deciding how leadership roles will be fulfilled in the future — is a part of the business strategy in 73% of 240 major U.S. companies, according to a 2002 study by the HR consulting firm, Hewitt Associates.² Although a handful of articles in the nursing literature address aspects of the topic, many nurses in leadership positions have probably not given the idea of choosing a successor the attention it deserves.

The continuing nursing shortage adds additional dimensions to any thoughtful plan for ongoing leadership in nursing. For example, will the talent pool of potential nurse leaders be deep enough to fill leadership positions in the future in both clinical and academic settings? Are aspiring nursing leaders being given the opportunities they need to develop leadership skills for the future? Are their managers encouraging these opportunities and mentoring less experienced colleagues through increasingly complex leadership challenges? Indeed, nurse leaders today need to consider succession planning at two levels. They need to ask not only, “Who will succeed me in my current role and carry on the initiatives I have led?” but also, “What can nurse leaders do to encourage leadership development in the profession at large?”

We spoke to a number of nurse leaders across the nation about these issues and found that there is a great deal of exciting work occurring to groom talented nurse leaders for the future. However, our experts agreed that these efforts and those like them need to be more broadly known and practiced if the legacy of nursing leadership is to be continuously felt into the future.

Create Opportunities

Pamela Thompson, RN, MS, FAAN, chief executive officer at the American Organization of Nursing Executives, says that a long-term leadership development plan is crucial in any organization. “One of the things I was taught as a young manager,” says Thompson, “is that my job was to replace myself.
If we are constantly saying, ‘I am trying to identify who is going to take my job,’ that is a good thing.”

Thompson says that a key strategy in this ongoing search for leaders is to create opportunities for individuals to demonstrate their talents. She says that mechanisms such as shared governance or other forms of shared decision making help build “leadership capacity.” They give people a chance to achieve success at incrementally more difficult leadership challenges well before they will move into a formal leadership role. “By the time they are ready to move into management,” says Thompson, “they have built that reservoir of talent for themselves.”

Judy Reitz, RN, ScD, executive vice president and COO of the Johns Hopkins Hospital, in Baltimore, discusses the importance of an individualized educational and professional development plan for every staff member as a way to ensure a viable succession plan.

“To have a good succession plan, you have to have a solid educational career ladder and job mobility strategy,” says Reitz. “You can be very deliberate and purposeful on the exposures you offer your professional staff.” She notes that involving nurses in broad-based leadership opportunities in the organization will enable talented people to rise to the surface and be recognized.

Rhonda Anderson, RN, MPA, CNAA, FAAN, CHE, COO at Banner Desert Medical Center in Mesa, Ariz., says that as she engages her leadership team in building and sustaining professional nursing practice at the medical center, signs of talent emerge. She notes, “You know who has the capacity to think differently, who is not afraid of change.” She also talks about “planting the seeds” of leadership by using mechanisms such as annual retreats as well as informal dialogue and goal-sharing.

Nancy Fugate Woods, RN, PhD, FAAN, dean at the University of Washington School of Nursing, speaks in similar terms regarding leadership opportunities for nurse faculty. “From the time someone is hired,” says Woods, “we make an effort to help [them] move into … leadership positions.” Woods also discusses the importance of focusing on the “good of the whole” as she plans leadership for the future, rather than being narrowly focused on a personal agenda.

“I view my position as not being about me,” she says. “It is unusual for me to get a chance to work on something that is just … ‘my stuff.’ It’s our stuff.

It’s all about promoting the organization and the effectiveness of the people in it.”

Jim Collins and his research group on the Good to Great project call this focus on the good of the organization as a whole a characteristic of “Level 5 Leadership.” According to their research, this is one of the traits that distinguish “great” companies from those that have fared less well in the long term. Level 5 leaders, they note, maintain an unswerving focus on the company rather than on personal renown. In doing so, they tend to cultivate a culture of leadership around them and “set up their successors for even greater success in the next generation.”¹ In contrast, so-called Level 4 leaders tend not to build superb management teams, preferring to hold all management decisions tightly to their vests and using subordinates more as “helpers” than as developing leaders in their own right. When the leader then leaves the company, the results can be disastrous. Any succession plan that may have been in place fails because the company has not learned to survive in the absence of the leader.

Notice Talent and Name It

A number of nurse leaders talked about an important corollary to developing leadership that is perhaps less often discussed — that of naming leadership talent when it is evident. Thompson recalls a turning point in her own career, when a colleague didn’t stop at merely complementing or praising Thompson on a job well done, but rather was more explicit about the potential she thought the success represented, saying “I think you are going to want to move into a management position some day.” Thompson recalls, “She saw something I didn’t see. The important gift she gave me was she named it, and she brought it to my awareness. I’m not sure we always do that. We may say, ‘You did a really good job,’ but we may not say, ‘You did a good job organizing that and structuring it, and those are important leadership skills.”

Woods agrees, talking about the potential that leaders in academia have for identifying leadership talent in students as well as faculty. She says, “As I encounter students whom I perceive have a good dose of aptitude, I try to contact them individually and say, ‘You know, you really have something very special to contribute …. I want to invite you to think about how, at another stage in your career, you could be influential in the organization you are going to practice in.”

National Programs

On a national scale, there are a number of programs and opportunities designed to nurture leadership skills in nursing — helping to create that pool of talent that is the linchpin of individual as well as professional succession planning. Thompson notes that several years ago, the AONE opened its membership to “aspiring nurse leaders” — those just beginning to explore more formal or sophisticated management positions. Just recently, says Thompson, the AONE took action to establish a membership category for students, which was launched in the fall of 2004. The organization sponsors “aspiring nurse leaders week,” encouraging members to concentrate on mentoring activities during a designated week in the year, and has established ties with the National Student Nurses’ Association as one of the repositories of what Thompson calls the “future leaders in nursing.”

Woods pointed out the value of programs such as the Robert Wood Johnson Executive Nurse Fellows Program. She calls the two-year fellowship “absolutely top notch,” but wants to see more such programs in place to prepare adequate numbers of nursing leaders for the next decade.

Some other programs are available. The American Association of Colleges of Nursing (AACN) holds an Executive Development meeting once a year, designed to help prepare faculty for leadership positions, and also invites leaders to participate in its year-long Leadership for Academic Nursing Program. The Honor Society of Nursing, Sigma Theta Tau International pairs aspiring leaders with mentors in its year-long Chiron Mentoring Program.

Anderson has high praise for the Nursing Leadership Academy, run by the best-practices research firm, The Advisory Board Company. Through the program, managers participate in a comprehensive assessment of their leadership skills and in intensive leadership training sessions. An additional Advisory Board program, the Center for Frontline Nursing Leadership, has leadership development programming for those in informal leadership roles and “rising stars” in nursing.

Protect and Defend Nursing’s Place
at the Leadership Table

With a multifaceted approach to leadership development in nursing, succession plans — at the institutional as well as at the professional level — seem more likely to succeed. This helps ensure that professional nurses continue to occupy key leadership positions in health care. Why is this important? Reitz, when asked about the value that her nursing background brings to her current position as COO of a major medical center, comments, “The nature of the business that we’re in is patient care …. When you have leaders who have knowledge — by their clinical professional preparation — in the very foundation of your mission (that is, delivering health care), you have an ability to translate more directly and completely the issues from a patient-centered perspective.”

In addition, effective nursing leadership is increasingly being tied to the national patient safety agenda. As hospitals strive to improve safety records, and as they struggle with the pressures inherent in the nursing shortage, improving the work environment for nurses has emerged as a top priority.³ For these improvement initiatives to succeed, an ongoing succession of talented nurse leaders is critical. In its 2003 monograph, Healthy Work Environments: Striving for Excellence, the AONE, in partnership with the management consulting firm McManis and Monsalve Associates, noted, “Hospitals increasingly recognize the importance of investing in nursing management leadership capacity …. Leadership development requires a sustained organizational commitment to management and leadership skills training, defined management career paths, and ongoing succession planning.”⁴

Celebrate the Leadership Role

In the end, the legacy of nursing leadership will depend in large part on how successful today’s leaders are in recruiting and developing their successors.

One worry within the industry has been that, as the nursing shortage continues, fewer nurses will find their way into leadership positions either because of insufficient opportunities or, perhaps more worrisome, because of negative impressions fueled by the perceived difficulties inherent in these increasingly complex roles.

Thompson says that today’s nurse executives have an obligation to publicize the joys as well as the challenges that these positions bring. “I strongly believe we need to find more joy in what we do, and we need to talk about that,” she says.

Anderson agrees, saying, “These are tough jobs. But if we keep saying that, we become our own worst enemy …. Our profession … is such an outstanding, wonderful profession with great opportunities for leadership …. It is an opportunity to really use your creativity. It is really different than it was 10 years ago, but that just gives you more opportunity to move your passion along.”

Jane Corrigan Wandel, RN, MS, is a writer and editor, and co-founder of Corrigan Kantz Consulting, Inc., a nurse-led firm specializing in health communications.

References

1. Collins J. Good to Great. New York, NY: HarperCollins Publishers, Inc.; 2001.

2. Succession planning made easy. Hewitt Magazine website. Available at: http://was4.hewitt.com/hewitt/resource. Accessed October 4, 2004.

3. Institute of Medicine. Keeping Patients Safe: Transforming the Work Environment of Nurses. Washington, DC: The National Academies Press; 2003.

4. Healthy Work Environments: Striving for Excellence, Volume II. Insights from a Key Informant Survey on Nursing Work Environment Improvement and Innovations. AONE website. Available at: www.aone.org/aone/docs/hwe_excellence_ intro.pdf. Accessed October 4, 2004.