Managers go through predictable stages as they assume leadership. Each stage has its challenges, growth, and development implications. If you're a manager, where do you fall? We'll review the four stages in the July through October issues of Nursing2006 SDU so you can learn what to watch for at each stage and what to do.

This stage happens to new managers as well as to experienced managers moving to a new position within their organization.

1. Paralysis or indecision
   • being reluctant to start doing managerial work
   • letting information-gathering and indecision consume you
2. Failure to trust staff
   • assuming trust comes with the managerial assignment
   • assuming that trust is easily maintained and hard to lose
3. Reluctance to find a confidante or sounding board
   • assuming that since you were given the job you're expected to have all of the answers
   • assuming that having someone to discuss issues with is a sign of weakness
4. Being too judgmental and critical; setting impossible standards
   • failing to understand that your success is now measured by the work that others do
   • punishing mistakes so harshly that they're not reported or are swept under the carpet
5. "Doing the work"
   • spending too much time at the bedside avoiding making tough managerial decisions
   • not finding satisfaction in the delayed success that comes from long-term initiatives

1. Observe successful managers. Shadow one successful manager in your organization: See how he behaves in meetings, with staff, and customers. What's his strategy?
2. Score early successes, get some wins, and "harvest low-hanging fruit." Make changes the staff has asked for repeatedly. Think like a patient: What's irritating, what's right?
3. Be analytical--start to build a mental model of the organization. Ask "why" questions. Use the basic nursing process to assess and implement new ideas/programs or services. Look for the causes of systems failures rather than simply solving problems.
4. Begin to delegate. Assign a report, a simple procedure, or attendance at a meeting so staff begins to adapt a style of shared responsibility. Model the behaviors you want to see in your staff.
5. Learn to consider your motivation and monitor your emotional reactions. Identify, accept, and remember your emotions.
6. Practice thinking about the future. Build a model of how you want the department to look in 3 to 5 years.

Key to career growth:
Gain a good insight and understanding of your organization's climate and your staff's trust through observations, discussions, and conversations.

The enthusiastic manager's story: "I have to improve things--and I have to pace myself. My biggest problem is others can't keep up."

1. Early-stage burnout
   • fatigue from constant problem-solving
   • failure to monitor stress and fatigue
2. "Too much, too soon" leadership
   • overconfidence
   • assuming you have all the right answers
3. Lack of focus
   • trying to do too much
   • not focusing on the significant projects
4. Seduction by power
   • misinterpreting the power that comes with authority
   • examining relationships to determine if it's you or the position
5. Reliance on only a few staff members
   • relying too heavily on certain members of your staff
   • missing the potential of others to demonstrate their ability
6. Letting skills get in the way of good management

• failure to distinguish between patients and staff
• failure to provide good, timely feedback and performance targets

Things to do:

1. Use your time wisely. Set meaningful priorities. Balance short- and long-term goals. Take a vacation, exercise, enjoy your hobbies, and spend time with your family.
2. Invest in staff development. Coach and encourage the people who work with you. Let the dedicated, motivated, capable members of your staff perform.
3. Set high standards and enforce them. Set reasonable and challenging goals for staff. Maintain compassion and empathy for patients and staff.
4. Gain visibility. Try subtle self-effacing approaches, such as, "Here's something we're trying that I thought you might be interested in…," or, "How have you handled a situation like this?" Begin to practice self-promotion because effectiveness depends on peers and seniors knowing about your successes.

Key to career growth:

Develop a smooth operation that's ready for change and responds to challenges with ease. The skills and interests that brought you into nursing and that you've expanded and enriched through your training and experience can be extremely helpful in your role as a manager.

A mature (meaning experienced tempered with reason) manager might say, "I'm getting clear about where I want us to be in the next 3 to 5 years. Members of my team are emerging as strong contributors to the achievement of our vision. I need to work on my personal development and continue to build relationships."

1. Losing touch with day-to-day staff functions
2. Focusing on the big picture to such an extent that you neglect daily functions; not developing and implementing effective systems of monitoring; setting benchmarks, baselines, and limits; establishing quality reporting procedures; and monitoring results as early indicators of deviations from the plans.
3. Poor attention to detail--letting routine matters get out of hand
4. An "edifice complex"
   • becoming so obsessed with the need to build something, reorganize, or add a new piece of equipment that you move everything else to a lower priority
5. Reliance on the hierarchy
   • using the "class distinction" between staff and managers to keep you from having open communication
   • not getting the information you need to identify potential high performers

1. Look for ways to extend your influence. Where can you become more visible within the organization?
2. Work on improving your ability to listen. Revitalize your nursing communication skills and apply them to your managerial duties.
3. Learn more about the way your organization works. Talk with people who've had successful projects, participate in team projects, attend meetings that include large cross sections, and hold conversations with the sages.
4. Think politically. Politics becomes more important as you move up in the organization. Learn to apply your political skills in dealings with the rest of the organization.
5. Remember what led to your success. Tap into elements from your nursing background that are highly valuable and applicable to your managerial success.

Key to career growth:
Excite staff members about your vision, and coach and empower them to get the work done.

Those who attain this stage might say, "I've seen almost everything, and I'm still amazed and delighted to witness young people maturing. Maybe old ideas that didn't work need to be tried again. I have to continue to work on redefining my role and my contribution for the good of the organization and the profession."

1. Cynicism, indifference, lassitude, boredom
   • not keeping up with the latest trends in the profession
   • living in the past
2. Setting yourself "above the fray"
   • wanting to set yourself apart from the daily grind, the minor frictions, and disagreements
   • focusing too much on the future and strategic thinking
3. A legacy fixation
   • polishing your image and erasing all of your mistakes
   • creating a persona that's very different from reality
4. Failure to recognize the value of this stage
   • not working to bring about the major changes in the industry that can result from your actions
   • not being available as a mentor or consultant

1. Look for excitement in your job. One of the problems that accompanies this stage is a difficulty in staying connected. Aging is seen as something to be avoided; taking on the mantel of age is very counterintuitive. Get excited about the successes of your protoge and your staff; remember your numerous accomplishments.
2. Look for ways to make your knowledge and expertise more widely available. Use the best practices you've amassed to help get important things done.
3. Accept the role of arbitrator, resource, and historian. It takes some special skills, but the payoff can be enormous.
4. Nurture and counsel your staff. Get your rewards through the successes of others. Learn to delay gratification, to take a long look, and to see that success in major change efforts takes time, patience, and nurturing.
5. Help others begin to see the big picture. Cultivate the ability to move with ease from micro to macro, from tactical to strategic, and from short term to long range.

Source: Master the four stages of management by RB Pickett, LK Shoemaker, and MM Kennedy, Men in Nursing, 1(3):12-14, June 2006