In this incredibly tight labor market, employee retention has become a profound concern for nearly every organization. This rings particularly true for hospitals who are frantically struggling to maintain staffing levels and hold on to nurses who are looking to leave. However, pay hikes and signing bonuses alone aren’t really the cure, and they aren’t doing enough to improve the situation. Many nurses have cited poor working conditions and incompatible environments as primary catalysts for considering their resignations. So, it may be an issue of culture. This presents nurses with a unique opportunity to really explore how beneficial their relationships with recruiters can be. Savvy recruiters know their clients and their management styles. By learning what supervisory qualities nurses best align with or prefer, recruiters can match them to clients with those leaders. 

The Labor Market Isn’t Just Tight, It’s Constricting

"Nurse shortages are a long-standing issue, but because of COVID, it is anticipated to grow even more by next year," Dr. Ernest Grant, president of the American Nurses Association, told ABC News. "Nurses and other health workers are overworked and they are exhausted from the pandemic."

As Rebecca Love And Daniel Pianko wrote in Fortune, “After a year defined by the global public health crisis of COVID-19, America’s nursing workforce is in dire straits. Some experts estimate that last year marked the largest retirement of nurses ever recorded in the U.S., and forecasts predict an additional 500,000 nursing retirements by 2022, which will leave the country with a nursing shortage totaling an estimated 1.1 million.”

It’s no secret that we are now confronting the worst nursing staffing shortage in decades, with 60% of nurses and 20% of physicians preparing to exit their professions. Yet, it’s also not a new event. The mass exodus of nurses, Love and Pianko noted, has been gaining steam for years: “Of the approximately 155,000 registered nurses who join the profession each year, as many as half leave the bedside within two years. And it exacerbates one of the most pernicious gaps in the country’s labor force.”

The burnout, fatigue, and mental health strains wrought by the outbreak of COVID-19 only worsened an already fraught situation. But the workforce in general has reached a similar crossroads. 

“Companies are going to have to work harder to attract and retain talent,” said Randstad’s Karen Fichuk in an interview with the New York Times. “We think it’s a bit of a historic moment for the American labor force.” Desperate employers are lowering the barriers for entry, raising wages, and offering bonuses. But that’s still not having much of an impact. The reality, when polled, is that workers want a company culture in which they can thrive, whether that involves teleworking, better leadership, more diversity, opportunity to grow, skills development, superior benefits, or a host of other incentives. 

Nursing Leadership and Culture

Aspen University posted an interesting article in January about seven leadership styles in nursing and their impacts: “Leadership and management styles notably affect nurse performance and job satisfaction. Effective nurse leaders directly impact quality of care and patient experience. Some of the best leaders ensure efficiency and proficiency while delivering mentorship.”

Given the different types of nurse managers, the big question is which kind brings out the best in you? And how do you seek out those managers who are suited to your working preferences? This is where you can leverage your recruiter as a trusted advisor and guide, which is precisely the role he or she should occupy in support of your career progress. 

Recruiters solicit constant feedback from their nurses and their clients. They gain an intimate understanding of the leadership styles that exist within their client organizations. Have an open discussion with your recruiter and describe your ideal supervisor—his or her approach, demeanor, and methods. This dialog will go a long way in landing you a position under the direction of a manager who helps you shine, while promoting a culture that fulfills you. So let’s examine the common leadership styles illustrated by Aspen University.

Laissez-faire 

As the name implies, these managers are often hands-off and allow for a great deal of autonomy. They could be new or inexperienced nurse leaders, or they may just not offer a lot of guidance on their own. As with all the styles discussed, there are pros and cons, depending on your preference as a practicing nurse. 

• Pro: There’s no micromanagement here. For very seasoned, disciplined, and self-motivated nurses, this could be ideal.  Laissez-faire leaders work well in home healthcare and hospice environments, where nurses are highly confident in their skills and can work independently. 
• Con: You’ll likely have to set your own goals and solve problems independently. If you’re a new nurse or someone who desires a lot of mentoring or coaching, this type of manager might not represent a good fit.

Democratic

Democratic leaders focus on team building, collaboration, and professional development. They routinely encourage feedback, engagement, communication, and involvement from their team members, 

• Pro: “Nurses who enjoy getting in-depth feedback, want to grow professionally, and actively participate in decision-making and changes work well with democratic leaders,” explained Aspen University.  
• Con: Democratic nurse managers don’t always respond rapidly to a crisis. Because of their approach, they may rely more on “decision by committee,” spending too much time researching the situation, or adhering to bureaucratic processes. 

Transformational

Yes, these are the breakout “visionaries” who are devoted to fueling enhancements for patient care and improving processes using creative or modern advances. For instance, as Aspen University cited, “a 2019 study of 17 hospitals in Pakistan showed gains in employee satisfaction may reduce rates of patient care errors. A recent Belgian study also demonstrated improvements in the safety performance of nurses due to transformational leadership.” 

Transformational leadership is one component of the American Nurses Credentialing Center’s (ANCC) Magnet Model. According to the American Nurses Association (ANA) transformational leaders “must lead people to where they need to be to meet the demands of the future.”

• Pro: Transformational nurse leaders are excellent mentors for new nurses, instilling trust and confidence to help nurses work more independently—and become leaders themselves in the future. Like Democratic leaders, they regularly encourage feedback and communication. They also hold a lot of sway with organizational executives as influencers. You often find these managers in clinics and hospitals that are undergoing improvement or are reputed for their commitment to constant innovation. 
• Con: Because these leaders are visionary, they don’t often shine as brightly for day-to-day activities and direct management for traditional tasks. They are big picture thinkers, more interested in the conceptual than the transactional. Yes, they get high marks for employee satisfaction, but may not mesh well with nurses who need direct input for less glamorous duties. 

Servant

The term was coined in 1970, but the philosophy reaches back to Florence Nightingale. Servant leaders are relationship-oriented and focus on the needs of their individual nurses. They commit themselves to providing teams with the skills, tools, and resources needed to achieve the best possible outcomes. 

• Pro: These leaders dedicate their efforts to employee development. They are patient, empathetic, drive diversity and inclusion, and foster goal-oriented environments. They are ideal managers in teaching hospitals, and stand out as nurse educators and clinical leaders. 
• Con: Servant leaders may come across as more academic than tactical. By placing the needs of nurses at the top of their priority list, they can be susceptible to losing sight of the organization’s strategic objectives. For results-driven, experienced, and autonomous nurses, Servant leadership isn’t always productive. 

Situational

This leadership approach emphasizes agility, flexibility, and change. Situational leaders can modify their tactics based on shifting needs, whether within the organization or the ranks of their nurses. They tend to be analytical in their decision making.

• Pro: They are excellent supervisors for nursing students in clinical settings. 
• Con: Like Democratic leaders, they can be slow to react, even though they excel in dynamic circumstances. They also have a reputation for diverting from an organization’s long-term strategies. This may turn off established nurses who champion the facility’s stated mission and function better with a clearly defined trajectory.

Transactional

“Efficiency is prioritized over building morale,” wrote Aspen University. “Highly bureaucratic healthcare organizations have traditionally utilized transactional leadership strategies to meet short-term goals.” Put another way, these leaders may appear “old school,” and they frequently rely on a rewards and punishment system. Transactional managers are existential—they focus on the moment, not the future. The relationship between these managers and their nurses is predicated on outcomes. Employees must be motivated by rewards and discipline to succeed under this style of leadership.

• Pro: They’re great problem solvers. They reduce errors, enforce efficiencies, and practice an empirical approach to care, relying on evidence. They are task-oriented, so they lead well in emergency situations and deadlines. 
• Con: Punishment, for the most part. You may encounter more than a few Transactional leaders who seem more preoccupied with your past mistakes than in cultivating a learning or inspirational environment. 

Autocratic

Although the name would suggest something despotic, Autocratic leaders are not hostile rulers. They do, however, make decisions independently, with little input or consultation from their nurses. 

• Pro: They think on their feet quickly, give solid direction, and delegate tasks effectively. They concern themselves with protecting patient health and safety, sometimes at a legal or policy level. They perform best in emergency situations. 
• Con: Similar to Transactional leaders, Autocratic managers aren’t focused on team building, the professional development of their nurses, or eliciting opinions. They can also react with negative reinforcement over encouragement and inspiration. 

Choose Your Own Adventure

There’s seldom a one-size-fits-all management style that every nurse will relish. There are nurses who prefer Transactional or Autocratic leaders because they appreciate a high degree of discipline. It’s no different than gym goers who hire intense personal trainers. For new nurses seeking growth and advice, other leadership styles serve those aspirations better. The trick is to understand how you perform at your best and which managers can draw those attributes out. And by conferring with your recruiter, you can eliminate the mystery of management styles from your job search.

Photo by National Cancer Institute on Unsplash