Nurses are always looking for new and innovative ways to improve their practice. And nurse leaders constantly seek additional perspectives on ongoing nursing issues like leadership development, staff retention, and improved nursing education. Wherever nurses gather, a lively discussion is sure to ensue.

“Nurses have passion about what they do,” says Major General Barbara C. Brannon, RN, MSN, CNAA, Assistant Air Force Surgeon General, Medical Force Development and Assistant Air Force Surgeon General, Nursing Services, at Bolling Air Force Base in Washington, DC.

Brannon and other military nurse leaders play an active role in professional specialty organizations. “We share strategies for overcoming current issues like the nursing shortage,” Brannon says, “and we often use civilian benchmarks in developing new programs.” For example, learning more about Magnet hospital development, says Brannon, has helped in refining military nursing services.

Nurse leaders practice in different environments, with different resources and support systems, but they face the same concerns in ensuring quality health care within their organizations. Long known for their tradition of nursing leadership, in war and peace, military nurses have developed specific strategies for some of today’s nursing leadership concerns.

It’s All About Retention

Like her civilian counterparts, Brannon sees recruitment as an ongoing challenge. “Our retention is good; however, and I see some unique things that we provide that aid retention,” she says. One of these proven tools Brannon refers to is “deliberate staff development. We encourage nurses to become proficient in more than one area of nursing,” she says, “and we don’t wait for a nurse to burn out.”

Nurses are asked frequently whether they want or feel they need a change. “When I visit work centers, I ask nurses what they want to do next,” says Brannon. “This encourages them to think ahead, and helps with motivation. She offers an example: “If a nurse has been at the bedside, working shifts for a few years, she or he might be ready to go to a clinic to develop additional skills and take advantage of educational opportunities.”

Taking a proactive approach, rather than waiting for nurses to choose other avenues, often outside of nursing, could help in civilian nurse retention. “Civilian nursing could consider developing systems to offer opportunities for nurses to move,” says Brannon.

There is a definite hierarchy in the military, which, of course, cannot be translated to the civilian leadership arena. One of the pluses of this hierarchy, however, is that the nurse’s role within the organizational framework is well defined and clearly understood. “During orientation, we identify our mission, describe why the work is important, where they fit, and what their work is worth,” says Brannon. A large portion of the orientation is also spent in explaining how the service is organized — not just the hierarchy — but the customs, courtesies, and cultures, as well. “This helps build a good relationship with the whole team,” she says.

Jumpstarting Leadership Development

The average age of nurse managers — 46 to 50, according to American Hospital Association statistics — causes many nurse leaders to question where future nurse leaders will be found. More organizations are offering training, encouraging continued education, and developing more support for their nurse leaders to alleviate this concern.

The military model of leadership development can lend some helpful insight for civilian organizations in addressing this shortage. In the military arena, leadership expectation permeates the military nurse experience. The Army’s recruitment web page, for example, includes the leadership qualities that nurses, as junior officers, need to join the Army, and the job description begins with, “as an Officer in the Army Nurse Corps, you will lead a nursing team 85.” Nurses enter as junior officers, and their job description states that they will be leading teams of nurses.

“From my perspective, I believe we do have an advantage with the BSN as a baseline for entry,” says Major General Gale S. Pollock, RN, CRNA, MBA, MHA, FACHE, MHCA, chief of the Army Nurse Corps, commander of the Tripler Army Medical Center, and the command surgeon of the U.S. Army Pacific, in Hawaii. This, she believes, is an indicator that the nurse is ready for continued leadership development.

New Army nurses begin their service, as do all new recruits, by attending the Army Medical Department Officer Basic Course, Pollock says. This initial orientation includes leadership training, as well as officer’s values and standards.

Even without a BSN requirement, emphasizing leadership expectations and providing leadership training for all nurses at all levels of practice, could help develop more civilian nurse leaders.

The yearly evaluation, called the Officer Evaluation Report, assesses leadership growth. “We are always looking for officers with leadership potential,” says Pollock, “and the chief nurses in each facility invest considerable time in mentoring and demonstrating leadership for our junior officers.” Pollock believes there is great value in grooming nurses for leadership development early. “It helps them grow professionally and personally,” she says.

Every year, each chief nurse identifies four junior officers who demonstrate remarkable leadership aptitude. These nurses attend a weeklong course devoted to the opportunities within Army nursing. “We want them to learn what’s inside the Army leadership, and this workshop helps open their eyes to know what is possible,” says Pollock.

Communicating and Career Planning

Communication can often be the greatest challenge for any nurse leader. “We need many avenues to communication,” says Rear Admiral Nancy J. Lescavage, RN, MSN, director of the Navy Nurse Corps and commander of the Naval Medical Education and Training Command in Bethesda, Md. “We have 5,000 nurses, including active duty and reserves,” Lescavage says. “My e-mail address is available to all, and I also list my phone number on our website.”

Part of successful communication, she believes, is offering nurses a clear, well-defined career planning model. The Navy Nurse Career Planning Chart outlines five distinct career pathways, and the specific education, skill sets, competencies, and experience needed to advance within each.

The clinical pathway, for example, begins with the staff nurse entry level, and then progresses through a trajectory that includes clinical nurse specialist, advanced practice nurse, and/or CRNA. The education and the administrative pathways also illustrate each step and its requirements for those nurses more interested in this type of nursing practice. “Nurses can look at the road map and see what they need to do to progress from the basic level, through the intermediate, and all the way to the executive level,” says Lescavage.

While many civilian health care organizations have career ladders that outline avenues of advancement, there may be value in formalizing some form of career counseling. This system can be extremely motivating. This can add to nurses’ sense of value and support within their health care environment. And although civilian health care facilities may not have the resources to prepare nurses educationally in a similar career roadmap, assisting nurses with career planning could aid staff retention and encourage nurses to continue their education.

Mentoring plays a big role in the Navy Nurse Corps. One of their People Goals in their Strategic Plan is “All Navy Nurses will be involved in mentoring.” Some of their mentoring initiatives include —

• A Mentoring Corner (short article and highlighted website) in their quarterly newsletter
• A mentoring champion at each facility. Each champion participates in an electronic communication forum that allows for sharing of ideas and programs
• A list of “organizational mentors” on the website, e.g. specialty leaders, patient safety experts
• Formal mentoring at least twice a year that is tied to a performance evaluation

When Lescavage speaks of every Navy nurse’s involvement in mentoring their novice nurses, she is talking about more than those in current and active service. “Additionally, we involve nurse retirees,” she says. “They stay very linked to us.”

Whenever nurse leaders get together, they will continue to share new, innovative solutions to ongoing concerns. Someone once said, “There’s nothing new, just new ways of looking at the same things.” Environments and resources may vary greatly, but ideas can grow and be transplanted to fit. “We view ourselves as hand in hand with our civilian colleagues,” says Lescavage. “We teach them, and they teach us.”

Margaret Hawke, RN, MA, is a contributing writer for Nursing Spectrum.