Tips for Senior Nurse Leaders: Improving Work-Life Balance for Nurse Managers

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In the latest AONL Foundation survey (November 2023), 23% of Nurse Leaders indicated they were considering leaving their roles within the next six months. The primary reason cited was “work is negatively affecting my health and well-being.”

I recently talked with a colleague about these results, the predicament many nurse leaders face with managing expectations from above and the needs within their own units. This conversation led me to recall a Nurse Manager (NM) from my previous role as Chief Nursing Officer (CNO). This individual, juggling a demanding family life and a rigorous DNP program, found herself in tears in my office due to the overwhelming pressures of her role and a life that was entirely out of balance.

Motivated by this experience, an evidence-based plan focused on improving work-life balance was created. This NM agreed to a two-month pilot program.

The Pilot Program

Step 1: Transition to a 4-day workweek

 The Nurse Manager transitioned to a 10-hour, 4-day work week. On her days off, her Assistant Nurse Manager (ANM) handled her duties, with support from other Nurse Managers (NMs) if needed.

Step 2: Reevaluating Span of Control An analysis revealed the opportunity to promote an Assistant Nurse Manager to an NM role, effectively redistributing workload without additional FTEs. Initially resistant, the Nurse Manager soon recognized the benefits of this essentially budget-neutral change.

Pilot Results

The NM described these adjustments as “life-changing.”

o   Decrease in overall workload

o   Decrease in time spent making decisions for the ANMs and Charge Nurses (CN)

o   Increase in perception of work-life balance

The ANMs described these adjustments as “significant rapid growth in leadership skills.”

o   Improved Big-picture capacity

o   Improved independent decision-making

o   Improved throughput related to quicker decision-making

Post-Pilot Enhancements

Recognizing the significant cost of leader turnover—ranging from $85,000 to $141,000 per leader lost—a compelling and urgent need arose to expand this support program. Pilot Steps 1 and 2, plus additional strategies, were incorporated for all nursing units:

Step 3: Expanding the Role of the House Shift Supervisor (HSS) HSS authority was increased, inclusion in all Nurse Leadership meetings was ensured, and their rounding expectations on all units were elevated.

Results: HSS became the first contact for ANMs and Charge Nurses (CN) when issues arose. HSS now handles initial issue resolution, allowing Nurse Managers to focus on strategic tasks.

Step 4: Increase NM collaboration and Cross-Coverage NMs were required to collaborate on days off and vacations to ensure continuous coverage. They were also available to support decision-making as needed.

Results: Improved NM relationships and understanding of the facility's big picture and the unique processes in other nursing units.

Step 5 Focus on dedicated NM Development Monthly nursing unit reviews and bi-annual Nurse Manager retreats were implemented.

Results: These sessions provided opportunities for leadership development, sharing best practices, and learning from Subject Matter Experts (SMEs) on topics including best practice hiring strategies, finance, communication, and change management.

Step 6: Succession Planning Succession planning was formalized by identifying and nurturing emerging nurse leaders for Charge Nurse (CN), ANM, and NM positions. 

Results: This approach facilitated improved emerging leader identification and decreased vacancy rates in filling leadership roles

Overall Results

Implementing these strategies led to a 20% decrease in NM turnover and increased job satisfaction. This pilot program demonstrated that thoughtful adjustments in work structure and support mechanisms can significantly improve the well-being and retention of our nurse leaders.

Call to Action

Senior Nursing Leaders are responsible for implementing innovative and contemporary practices that enhance practice environments and foster a healthy work-life balance for leaders and their teams.

References

American Organization for Nursing Leadership. (2023). AONL longitudinal nursing leadership insight study: Nurse leaders’ top challenges and areas for needed support, July 2020 to November 2023. American Organization for Nursing Leadership.

Carbajal, E. (2024, February 26). Is healthcare paying enough attention to nurse leaders? Becker’s Clinical Leadership. https://www.beckershospitalreview.com/nursing/is-healthcare-paying-enough-attention-to-nurse-leaders.html

Lyle-Edrosolo, G., Saria, M. G., & Bailey, K. D. (2023). Exploration of system chief nurse executive’s leadership practices to support, mentor, develop, and retain nurse leaders. Nursing Administration Quarterly, 47(3), 269–276. https://doi.org/10.1097/NAQ.0000000000000539

LeJeune, K. (2023). Enhancing nurse leadership engagement through formalized orientation programs: An integrative review. JONA: The Journal of Nursing Administration, 53(7/8), 415–419. https://doi.org/10.1097/NNA.0000000000001307

Li, Z., & Gephart, S. M. (2023). Prevalence and characteristics of hospital nurse leaders' turnover intention. JONA: The Journal of Nursing Administration, 53(9), 445–452. https://doi.org/10.1097/NNA.0000000000001314