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Capacity Building for Frontline
Nurse Managers: Executive
Summary
Current Frontline Nurse Manger Succession
Practices
Frontline nurse managers are critical in establishing a high performing
nursing culture through effective task delegation, the development of
staff, and mentoring. In addition to clinical expertise, this demanding
position requires confidence and experience in creating structure and
facilitating positive outcomes while effectively managing resources.
Presently, many Canadian nurses are promoted to frontline leadership
mainly because of their clinical proficiency and/or seniority level and may
lack the confidence and skills required to succeed in the position,
especially if no additional training is provided. Consequently, frontline
nursing managers are subject to high stress and burnout, which increases
their potential to leave the position.
Job Satisfaction for Frontline Nurse Mangers
Lack of job satisfaction contributes to high burnout and turnover rates in
nurse managers. To increase job satisfaction, it is necessary to focus the
scope of responsibilities (reasonable number of direct reports) and
provide adequate social and organizational support. Organizational
support creates psychological and structural empowerment and allows
managers to use their power to positively influence the unit and staff.
Leadership Style and Patient Outcomes
Two main leadership styles have been identified and examined in the
literature:
 Task-oriented approach, focusing on structures and tasks; and
 Relational approach, focusing on people and relationships to
achieve common goals.
Transformational leadership belongs to the relational style of leadership
and is most effective in nursing. Tranformational leaders focus on teamand relationship–building among various cohorts, staff nurses, and other
health care providers. They encourage employees to envision and
achieve change by building relationships that lead to empowerment,
enhanced nurse satisfaction, recruitment, retention, healthy work
environment, and improved patient outcomes.
Transformational leaders use emotional skills to build trust through
listening, empathy and responding to staff concerns. These leaders are
able to retain higher numbers of competent and proficient staff, and
reduce absenteeism and overtime. Resulting staff stability leads to
decreased patient mortality, and fewer hospital acquired infections,
medication errors, readmissions, and patient falls.
About the Literature Review
This expedited narrative review
provides an overview of frontline
nurse manager capacity building
with the focus on:
 Current state and practices of
succession planning in the
field;
 Job satisfaction, leadership
styles, and patient outcomes;
 Required competencies for
frontline nurse management
position; and
 Best practices for succession
planning.
Methods Used to Obtain
Journal Articles
The review consists of recent
systematic reviews obtained in
collaboration with field expert, Dr.
Sonia Udod, assistant professor in
the College of Nursing, University of
Saskatchewan, who specializes in
the quality of nurses’ work life,
especially as it relates to nursing
leadership, nurse and nurse
manager roles, and nurses’ work
environment.
In total, there were 10 systematic
reviews and syntheses of evidence
Contact
used to compile this review.
To obtain more information about
the Office of the Associate VicePresident Research – Health (UofS)/
Vice President Research and
Innovation (SHR), please click here.
What Makes a Competent Frontline Nurse Manager?
In addition to clinical knowledge and expertise, there are a number of emerging characteristics, which are
essential in developing a successful frontline nurse leader. Different nursing and leadership organizations,
including the Center for Creative Leadership Research, the American Organization of Nurse Executives (AONE),
the American Association for Critical-Care Nurses (AACN), and the Association of Perioperative Registered
Nurses (AORN) compiled the Nurse Manager Leadership Collaborative (NMLC) model, which incorporates three
domains:
 The science of managing the business;
 The art of leading people; and
 Creating the leader in oneself.
Nursing and contemporary business literature also outlines the following necessary competencies:
Nurse Manager and Leadership Competencies
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Personal mastery
Financial management
Human resource management
Caring
Systems thinking
Staffing and scheduling
Risk management
Interpersonal skills
Setting the vision
Conflict resolution
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Leading employees
Strategic planning
Inspiring commitment
Managing change
Resourcefulness
Being a quick learner
Doing whatever it takes
Building effective teams
Translating vision and strategy
Maintaining focus on patient and customer
Table adapted from Fennimore and Wolf (2011)
Effective Succession Planning
Only 21% of hospitals report having succession planning process in place and overall, there is little deliberate and
systematic effort made by healthcare organizations to ensure leadership continuity in key positions, such as
frontline nurse management. Due to the ageing nursing population it is imperative that best practices in
succession planning are consciously and strategically integrated in the organizational vision and plan.
Many succession planning programs are not implemented to their full potential. Often, programs exist only on
paper. There are several frontline nurse manager succession planning programs presented in the literature.
However, evaluation of programs is limited and most programs fail to address all the components necessary for
effective succession planning. Also, reports fail to thoroughly report the full scale of benefits, such as cost
reductions and improved patient outcomes.
The organization should ensure that the barriers to successful succession planning and implementation are
overcome, as effective planning leads to increased organizational performance and lower staff turnover. Also,
succession planning initiatives should engage all leadership levels, including the CEO (and senior leadership) and
be thoroughly embedded in the organization’s vision.
Strategic succession planning should incorporate the identification, recruitment, retention, development, coaching
and mentoring of potential nurse leaders. Once implemented, the plan should be regularly evaluated and
supported to ensure it remains viable and current. A successful frontline manager succession program should be
considered as an interrelated process which incorporates a close working relationship between service delivery
and academia.