Nurse managers are finally being recognized for their outsize impact on clinical outcomes and staff performance. But this recognition comes with a high cost; they are so critical to their unit’s performance that nurse managers find themselves overwhelmed by an unrelenting flood of new work.

This report outlines the main causes of nurse manager overload and equips executive leaders with five strategies for solving it.

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Nurse managers are overloaded—which hurts managers and their organization

Nurse manager overload is not only bad for nurse managers—it is even worse for their organization. Overloaded nurse managers aren’t able to lead as needed. They don’t have the time, energy, and resources to achieve key goals or hit important clinical targets.

An executive approach to put an end to nurse manager overload

When it comes to solving nurse manager overload, the Nursing Executive Center recommends three steps:

1. “Help managers help themselves” through training and development on topics such as prioritization, managing multiple changes at once, and reducing their own stress and burnout.
2. Alleviate “pinch points” that drag down nurse manager productivity.
3. Control the steady stream of new demands that add to the manager’s workload.

This report focuses on the final two interventions. Our reasons are: it is difficult to teach training through a publication—and while training can be very powerful, it can’t fix an unsustainable role.

11 best practices that help leaders put an end to nurse manager overload

Elevate the nurse managers’ role to “sign-off”

Make nurse managers the “approver” rather than “doer” by tapping into existing data and staffing experts. Read more (p.15).

• Practice 1: On-Demand Data Expert (p.17)
• Practice 2: Tiered Self-Scheduling (p.22)

Better leverage in-house roles to more effectively support managers’ needs

Allow nurse managers to focus on core responsibilities by establishing partnerships with highly qualified deputies. Read more (p.27).

• Practice 3: Back Office Backstop (p.29)
• • Supporting tool: Vanderbilt University Medical Center’s Business Coordinator Job Description
  • Supporting tool: Vanderbilt University Medical Center’s Clinical Staff Leader Job Description
• Practice 4: Lateral Nurse Consultants (p.35)

Filter strategic initiatives before they reach the nurse manager

Ease the burden of new projects by integrating and re-allocating strategic work before it reaches nurse managers. Read more (p.43).

• Practice 5: Integrated Executive Action Plans (p.45)
• Practice 6: Predetermined Project Routing (p.50)
• • Supporting tool: Intermountain Healthcare’s Practice Core Leader Job Description
  • Supporting tool: Intermountain Healthcare’s Leadership Core Leader Job Description
  • Supporting tool: Intermountain Healthcare’s Engagement Core Leader Job Description

Spotlight and control interdisciplinary demands consuming nurse managers’ time

Minimize the time nurse managers spend addressing interdisciplinary issues by identifying and eliminating insidious work that could be better handled by ancillary departments. Read more (p.55).

• Practice 7: External Demand Surfacing (p.57)
• Practice 8: Staff-Triggered Lateral Response (p.61)
•    ○ Introducing Code Orange (p.63)
• Practice 9: Cross-Discipline Shared Accountability (p.65)

Buffer against 24/7 unit demands

Help managers recharge and focus on the bigger picture by setting guardrails around work/life balance and creating space for important leadership activities. Read more (p.69).

• Practice 10: Decision Escalation Plan (p.71)
• Practice 11: Dedicated Reflection Block (p.75)