In my discussions and research with nurse managers, I have found that one of their most significant challenges in today’s environment is building close collaborative, working relationships with the nurses that they lead. Nurse managers today supervise an average of 65 nursing FTE, but spans of control up to 100 are not unusual. With 12 hour tours, some of these staff interact infrequently with their manager. Communication with staff and the development of personal relationships takes very intentional work on the part of the manager.
The American Organization of Nurse Executives (AONE) and the American Nurses Association (ANA) recently issued some guiding principles to assist nurse managers in building more collaborative relationships with clinical nurses. To develop the guidelines, the organizations selected three nurse managers and three clinical nurses to ensure a balanced perspective from each side. The group worked together to determine the principles and guidelines to effective working relationships. The Principles are divided into three main themes—effective communication, authentic relationships, and learning environment and culture. The recommendations for clinical staff and nurse managers to build more collaborative relationships include the following:
- Maintain Effective Communication through active listening to fully understand what is being said. Remember that context is important in communication as is tone, emotions and the accuracy of the information that is being discussed. Both managers and staff should be more intentional in their communication, and understand the purpose and expectations of messages that are conveyed. To be effective, communication must be open, accurate and the right people need to be involved in the discussion.
- Build Authentic Relationships through the type of caring for each other that nurses are so easily able to cultivate when caring for patients. Being authentic means that you are true to yourself, and present your true self in interactions with others. It means being honest but respecting the personalities, needs and wants of others. It also means believing the best of others, and assuming good intent from their words and actions. In authentic relationships, both staff and leaders are empowered to do their best work.
- Establish Learning Environments and Cultures through the recognition that a learning environment supports great nursing care while giving nurses the satisfaction of knowing that their work is valuable and meaningful. A learning environment allows nurses and leaders to thrive because they are not afraid to fail. In order to establish this type of environment, innovative and creative thinking must be valued. Successes should be celebrated and mistakes should be recognized as an opportunity to learn and grow. Asking “what if” should be the cultural norm versus “no way” in response to suggestions for change.
You may view the above recommendations and wonder why it took a panel to develop principles that seem to be such obvious building blocks of a healthy work environment. If strong collaborative relationships existed in all our work environments between nurse managers and their clinical staff, there might not have been the need to develop these guiding principles. But the sad reality today is that many of our nursing environments are not healthy, and change is needed. This change is a joint responsibility between managers and their clinical staff. What is also true is that changes in attitude, behavior and work environment can be simple, sustained and virtually costless when there is a commitment to have more collaborative relationships.