Nurses’ Experiences Transitioning from Staff Nurse to Management in a Community

Section 1: The Problem
Introduction
Management in healthcare is a career option for many registered nurses (RNs),
and an important role in nursing leadership is that of the nurse manager. Nurse managers
contribute to accomplishing daily goals for their respective units (Kath, Stichler, &
Ehrhart, 2012). The Institute of Medicine ([IOM], 2011) noted the importance for all
professional nurses to be leaders within their environment, focusing on change that will
enhance patient outcomes. However, many nurses are leaving their manager role to
resume a staff nurse position or to withdraw from the nursing profession completely,
which has a critical impact on patient outcomes (Sankelo & Åkerblad, 2008). With the
nursing shortage predicted to continue, the number of nurses choosing to enter
management may decline (Wong et al., 2013).
The Problem
Remaining in the management role is a challenge for nurses due to the ambiguity
of the position’s functions and high stress levels associated with unrealistic expectations
related to meeting goals and ensuring outcomes. In spite of the IOM call for nurses to
assume leadership positions, the Robert Wood Johnson Foundation ([RWJF], 2010)
identified that average patients and healthcare professionals do not expect nurses to
function as agents of change or to enter management roles. Perceptions that management
roles are not influential in creating change and a lack of preparation for manager roles
both hinder the transition of nurses to managerial roles (RWJF, 2010; Wong et al., 2013).

The absence of nurse managers results in unsupported nursing staff and lack of valuable
nursing staff input at administrative meetings focused on improving patient care.
To address the problem of inadequate numbers of experienced nurse managers, it
is crucial to gain insight into the experiences of present and former nurse managers who
have exchanged or attempted to exchange staff nursing positions for management
positions. Previously untapped information could prove valuable in changing the negative
perception among nursing staff of the nurse manager role, thus possibly increasing the
numbers of nurses who become career nurse managers.
This section of the project study provides definitions of key terms and the
rationale behind and evidence to support a project study for nurses who choose a career
in management. The significance of the problem of nurse managers exiting their position
is discussed in terms of its importance to the local and national situation of high turnover
of nurse managers. Research questions are used to explain the focus for the study,
identifying and addressing the gap in practice created by the failure to retain nurse
managers. The literature review includes conceptual frameworks for the study and recent
research articles to support and address the need to explore the problem. The implications
section explores potential projects, as identified by the data analysis, that would address
the problem of high turnover among nurse managers.
Definition of the Problem
During the period from 2009 to 2014, there was large turnover in nurse managers
within one local community hospital, with some of the remaining managerno open nurse manager positions. However, there are two other hospitals within a 25-
mile radius of this hospital, and one of them appears to have been experiencing the same
problem of turnover in nurse managers; within the last two years they have had up to 23
open positions for nurse managers at various times. Constant turnover of nurse managers
has a direct impact on staff performance and on the operations of nursing departments
(Watrous, Huffman, & Pritchard, 2006). Nurse managers provide essential services by
keeping the units operational by supporting nurses through appropriate resources,
managing payroll, assisting with patient transition from admission to discharge,
monitoring staffing, and participating at various meetings (Surakka, 2008).
There are just over 3.25 million active female nurses versus, approximately
306,000 active male nurses employed in the United States (Kaiser Family Foundation,
2016). In 2020, almost 30% of the U.S. population will be 55 or older, and it is projected
that there will be more women than men are in this age group (Toossi, 2012). The large
population of female nurses and the larger population of women retiring, may contribute
to the projected shortage of over 300,000 nurses by 2020 (Juraschek, Zhang,
Ranganathan, & Lin, 2012), and ultimately the pool of potential nurse managers.
Warshawsky and Havens (2014) conducted a study on nurse managers’ satisfaction with
their position and their intention to leave. The researchers discovered that almost 75%
(181) of the 243 nurse managers surveyed planned to leave within the coming five years.
With the large number of potential nurse managers planning to retire within the next
decade, there is an emphasis on focusing on organizational support for nurse managers
(Zastocki & Holly, 2010). Zastocki and Holly (2010) identified that the increasings stating that
they were considering leaving management in the near future. At present, the hospital has