Leadership Ladders: A Practical Guide to Building the Next Generation of Nurse Managers – MedCity News

While programs for clinical advancement, such as clinical ladders, exist in some form today in many health systems, there’s a gap in the standard professional development structure within healthcare organizations when it comes to developing the next generation of nurse managers. 

Health systems can fill the gap with “leadership ladders,” which are similar in spirit to clinical ladders, but emphasize the development of team members of all roles with multiple options for various leadership interests.

How are my current professional development programs performing?

Two questions serve as litmus tests for whether an organization is running professional development programs to turn frontline team members into nurse leaders. 

1. Is the organization consistently filling open leadership roles in nursing by drawing on a pool of internal candidates who have progressed through established professional development programs? 
2. Is there enough transparency and communication within the organization so individuals interested in any form of leadership can articulate a clear, objective process for advancement?

Common challenges health systems are encountering with current programs 

One challenge today is that existing professional development programs lack meaningful variations. Some employees want to be people leaders; some want to become experts in particular aspects of their roles; others want to learn to train their colleagues. Another issue is that, with typical professional development programs, nurses often don’t gain practical competencies that prepare them to lead effectively. These programs often focus on progressive involvement in hospital affairs and advancement of degrees or qualifications. While these activities are valuable to the individuals and organizations, they tend to overshadow the development of practical skills, such as how to best conduct daily employee and patient rounds, or how to have an accountability conversation. In clinical departments, many new nurse managers share that they feel unprepared for their roles as leaders, despite having advanced degrees, certifications, and prior involvement in development ladders.

A further challenge is that participation in professional development programs is often too tedious. Though some formal professional development programs offer financial incentives and the reward of gaining expertise, the burden of figuring out the ladder or the toll of the requirements to complete it often outweighs the reward. 

Finally, it is difficult for nurses to determine if and how the professional development programs will support them and their goals. Meaningful self-assessments of learning goals and needs are rarely built into existing programs. Self-assessing their goals and visualizing how the program will further them on their leadership journey helps nurses understand why they should participate.

Introducing … Leadership Ladders

Leadership ladders are a development tool that organizes and extends the leadership capability of any frontline manager’s team. Building on each individual employee’s goals and strengths, coupled with defined department standard work, leadership ladders can play a central role in transforming culture, improving staff morale, building local leadership teams, creating platforms for delegating and sharing leadership work, and advancing the professional growth of team members to the benefit of the entire organization.  

Leadership ladders are a path to increasing what managers can effectively delegate to their team members, which both builds mutual trust and reduces the work burden on managers. Organizations can create them at the organization or department level to build the skills most needed in the next generation of leaders. Employees can learn to manage teams, track and analyze data, create and manage new initiatives, and much more.

Three examples of leadership ladders are management, education, and interdepartmental representation; many others are possible. Even within these three, team members can see a breadth of opportunities. Example approaches for these three are:

• Management ladder: shadow assistant managers, take on staffing responsibilities, and lead daily huddles and leader rounds. 
• Education ladder: review and share best practices, track quality and safety data, support educational initiatives within the department, and develop improvement plans. 
• Interdepartmental representation ladder: participate in hospital-wide committees and lead initiatives to solve interdisciplinary challenges.

Building a meaningful leadership ladder program

The following steps provide a guide to building a meaningful leadership ladder program. 

First, to develop leadership ladders that support the types of leaders the organization needs to meet its future objectives, define the program objectives for each service area/role. 

Next, build a program with a focus on developing practical competencies. For each specialty track and participant in a leadership ladder program, it is essential to offer routine feedback and coaching if the intent is true competency development versus just higher pay. This should include feedback conversations with a leader or coach skilled in this type of dialogue to ensure that the participant is defining specific goals and receiving specific feedback about their desired practical competencies.

Structure the program with clear and simple steps. Though ladder programs often include nonproductive time spent in committee meetings or education sessions, consider including achievable milestones that create impact and can occur during routine work, such as providing peer feedback, initiating a departmental task or project during downtime, or creatively solving a scheduling issue. Consider integrating the ladder program with job descriptions to reduce the burden of managing it as a separate program. Ensure that movement up the ladder represents meaningful growth in skills and competencies and not just completion of tasks, attainment of degrees or certifications, or attendance at events. And potentially add more “rungs” to allow less experienced team members to realize a sense of tangible upward movement early in their careers. For example, consider adding preliminary steps to enter the ladder for new graduates.

Ensure that a meaningful self-assessment of learning goals and needs (as well as reflection and personal awareness) are integral parts of any ladder. Managers should prioritize self-assessment activities to ensure that an individual’s objectives for a ladder program align with their aptitude, professional goals, and organizational needs. Utilize consistent approaches with skilled mentors, leaders, and ladder facilitators to enable applicants to self-assess where they are, what they hope to learn, how they hope to grow, and how others perceive their growth.

Finally, act to support and train team members as they climb to higher rungs. Leverage understood methods of learning that support lasting behavior and culture change, such as William Halstad’s “see one, do one, teach one” method, widely applied in healthcare settings.

• “See”/first rungs: Engage team members in discussions about leadership potential and provide exposure to the Leadership Ladder in general as well as the specific types of ladders that exist.
• “Do”/middle rungs: Begin more formal orientation; add progressive responsibility through training. Participants start to take on delegated tasks, especially simple repetitive ones, from a peer or the department manager. 
• “Do”/middle rungs: Have developing leaders assume accountability for projects, processes, and outcomes metrics.
• “Teach”/higher rungs: As they reach the top, give ladder members responsibility for training new candidates entering the leadership track and encourage them to suggest ladder updates based on their own experience to improve the path for the next round of leaders.

The benefits of leadership ladders

Developing nurses into leaders saves healthcare organizations time and money, enabling them to leverage their existing pool of team members while enhancing their overall culture, employee experience, and ability to attract talent. The investment an organization makes in bringing on junior nurses means it’s worthwhile to provide them with a pathway to growth that benefits everyone.

Photo: Liana Nagieva, Getty Images

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