An Updated Model for Frontline Nursing Leadership

Female nurse wearing blue scrubs next to the title "An Updated Model for Frontline Nursing Leadership

This blog article is a summary of a session at AONL 2023 entitled “You may be on to something:” An Updated Model for Frontline Nursing Leadership. This was given by nurse leaders at Inova Health System.

At AONL 2023, several visitors to the Catalyst Learning booth talked to us about this session and noted its relevance to our advocacy charge nurse development. This is a different topic for Catalyst Learning, but we felt like it was an interesting professional practice idea to share with our readers. Thank you to Inova Health for providing this. The full presentation is available on AONL’s website.

Inova Health System is expanding its span of control for Nurse Director and Clinical Directors by adding a co-lead operational leader to help these directors to focus more on care, safety, and nurse development. Inova’s goal is to gain better outcomes through collaboration between clinical and non-clinical leaders, and positively impact the care environment. Inova’s reasoning is that collaboration between clinical and non-clinical staff impacts quality outcomes, just like the care environment does.

When Inova issues hosts focus groups and asks what stumbling blocks are for nurse leadership, feedback is that it is mundane issues that became large annoyances. On-job issues like poorly functioning IT equipment, EVS, JCAHO prep, or not enough supplies.

Within the clinical director focus groups, some of these “pebbles in the shoe” issues could become more like boulders in the shoe. Sometimes nursing directors responded that they spend more time on administrative tasks than clinical. With expanding scopes, evolving workforce and 24/7operations, anything to relieve stress was welcomed. 

Generally, at U.S. health systems if a director needs to spend more time developing nurses and help with patient care, a health system would insert more nurse managers across larger and growing departments. But this often creates inconsistency in reporting and role confusion. Because Inova had tried that many times, the organization wanted to update the model.

Now, Inova is expanding control of director’s roles, giving them roughly double the span of control. One director for example, the labor and delivery director is now responsible for both L&D and family centered care units. But Inova is also building a Unit Operations Supervisor role across its health system to pair with nurse directors, so directors spend more time on big picture issues. 

The new Unit Operations Supervisor role reports to clinical directors, but also works with a team of operations peers across departments all over the hospital. The catch is that the Unit Operations Supervisor role is not an RN. 

Inova initially thought there would be pushback. After all, a nurse had always performed these efficient and operational tasks before. Many nurse execs thought “is this where we want to go as a profession?” 

But the early results were positive! Over 1 year in the L&D and family centered care unit at the Fair Oaks Hospital, it saw a nearly 18% improvement in nurse engagement and a 20% improvement in nurse well-being scores. And the most startling outcome was that nurse turnover went from 23.5% in 2021 to 13.2% in 2022. The vacancy rate was almost cut in half, going from 16% to 9.6%. The clinical director was more able to focus on nurse development and leading. And the new model helped to share accountability across the unit.

As this new model is rolled out to more departments, Inova runs focus groups to gauge success. Clinical directors are saying they now get to focus on what is most meaningful for them. And the same thing applies to operations supervisors, many with MBA backgrounds, that get to apply their organizational skills. Inova is hearing feedback like “we get to share the burden,” “our work is enhanced,” and “diversified leadership skill sets is a WIN.”

Hospital C-suite sometimes expect to hear grumblings like “the person in this operations role should be a nurse, so we can use them in staffing in an emergency.” But what Inova is finding is just the opposite. Focus groups are saying it is actually a good thing that operations staff cannot be pulled into staffing. 

Some clinical directors, even though they didn’t enjoy the operational and admin part of their roles, still occasionally find it hard to “let go” of some functions. Safety was one of those, but directors also note that operations managers were able to prioritize safety. Operations managers are willing to consult with the right teams, like engineering or biomed for example.

With a larger span of control, these two roles have to coordinate and be flexible. 2 leaders across two departments will take time to get hard-wired into the system. But freeing up directors to solely focus on outcomes, nurse development, and leadership is a win.

Maureen E. Sintich, DNP, MBA, RN, WHNP-BC, NEA-BC, EVP, Chief Nurse Executive at Inova Health System
Jane J. Yang, MHA, Business Operations Manager, Surgery Service Line at Inova Health System