All too often, nurse leaders are thrown into a new role and are expected to “figure it out” as they go. There is no orientation period, no mentorships, and no guidance through the learning process. In the ambulatory care setting, it can be hard simply to define what a nurse manager means.

In a vast ambulatory care service line within a large healthcare enterprise (over 80 clinics throughout the state), nurse leaders are imperative to a successful clinical environment. Recently, nursing leadership positions in this enterprise grew from 5 to 11 nurse clinical manager seniors within ambulatory care services. It was important during this influx to create a more standardized orientation approach to this essential role. Major job responsibilities for the nurse clinical manager senior include quality patient care and outcomes management, personnel and resource management, professional development, and service. Using these job responsibilities, along with orientation elements that were already in place for clinical staff, a standardized process was created.

An orientation program should socialize the new manager; they should learn about their coworkers and the organization’s culture, values, and goals. Didactic content should be supplemented with programming designed to help new managers step into their leadership role, learn necessary management skills, and cultivate an overall understanding of the institution (Conley, Branowicki, & Hanley, 2007). New nurse managers were invited to attend leadership training offered by the organization, as well as a clinical orientation day that introduced them to ambulatory care and nursing services. They participated in a preceptorship, both with other nurse clinical manager seniors and their non-clinical practice manager counterparts within the clinic. They shadowed individuals in various clinical roles to learn day-by-day processes and identify existing workflows and areas for change and improvement.

Competencies are an important aspect of orientation because they assess the critical thinking, technical, and interpersonal skills of the new team member. Initial competencies are based on core job functions, frequently used functions, high-risk functions, and the intended essence of the job (Wright, 2005). In the absence of an existing nurse clinical manager senior competency, one was created from portions of the current nursing competencies with the addition of essential functions from the role’s major job responsibilities. The various preceptors working with the new nurse manager help to complete competencies during the orientation period.

In addition to preceptorships and competencies, the new nurse managers receive a detailed checklist of requirements (both classroom and online education), a calendar of their orientation schedule, including scheduled classes and time with various preceptors, and progress meetings with a senior nurse leader and staff development specialist. In a survey of the new managers, 75% described these elements as “very helpful.”

References
1. Conley, S.B., Branowicki, P. & Hanley, D. (2007). Nursing leadership orientation: A competency and preceptor model to facilitate new leader success. The Journal of Nursing Administration, 37(11), pp 491-498
2. Wright, D. (2005). The ultimate guide to competency assessment (3rd ed.). Minneapolis, MN: Creative Health Care Management, Inc.

Karolyn Roberts MSN, RN, CPN

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