In the early 1990s, Children's Mercy Hospitals and Clinics in Kansas City, Mo. began a dramatic cultural transformation that has included a fundamental shift in how employees function within the organization. As a result, employees are now recognized as essential to the institution's success, empowered to proactively recommend solutions to even the most complex organizational problems.
One such problem was a lack of nurses interested in advancing to unit manager positions—historically stressful posts in any health-care setting. The human resources, financial, and quality improvement responsibilities, coupled with the requirement that unit managers be on-call during the weekend and night shifts, turned off many qualified nurses, particularly those with young children, eager for better work/life balance.
Because part of the cultural transformation work at Children's Mercy included empowering staff to develop solutions to complex problems, the hospital was open to all suggestions, said Cheri Hunt, R.N., M.H.A., C.N.A.A., B.C., vice president-chief nursing officer. In response, a nurse who had been approached about becoming a manager offered an unconventional solution—she would accept the position if she could share its responsibilities with another manager.
That idea—which might not have even been suggested or considered if Children's Mercy had not undergone a cultural transformation—led to the development of the nurse co-manager program. Now, most medical-surgical units and the emergency department are managed by two individuals who share the responsibilities of the position.
According to Hunt, the co-managers are equal, full-time employees who mutually agree on the best ways to operate the nursing unit.
Since 1998, Janet Franzen, R.N., B.S.N., C.N.A. and Cheryl Powers, R.N., B.S.N., C.N.A. have been co-managers of a 24-bed medical/surgical unit specializing in cardiology, cardiac surgery and liver transplants. Franzen and Powers have been successful "work spouses," sharing responsibilities, growing professionally as nurses and maintaining a good work/life balance.
They share a shift on Tuesdays and Fridays, and split the remainder of their work week, providing a greater management presence on the unit, including night and weekend shifts. Each is responsible for day-to-day management of the unit, including staff supervision, when they are working.
They divide other responsibilities as well. Franzen manages quality improvement and the budget; Powers handles the unit's education and competency assessments and physician relations. They also share on-call duties after hours and on weekends.
The co-management model allows them to assume a more active role in providing care to patients. Franzen and Powers each serve as a charge nurse one day a week, giving them more time on the floor to interact with patients and mentor staff, as well as a greater understanding of the challenges facing frontline nurses as they care for patients.
Franzen and Powers also credit the co-manager program with providing them time to participate in hospital-wide committees. Powers created and now chairs the Nurse Resident Council, a committee of all levels of nurses and medical residents that meets monthly to discuss shared areas of concern.
There are many organizational benefits to the co-manager program. Hunt, the chief nursing officer, says that Children's Mercy has not only seen an increase in the number of nurses interested in advancing to a middle management role, but more managers are remaining in their positions. Better work-life balance is often cited as the reason.
The program has also resulted in higher satisfaction and reduced turnover among staff. On Franzen and Powers' unit, turnover has dropped from 19 percent in 1995, when the co-manager model was first implemented, to seven percent in 2005. The management satisfaction scores for their unit are generally several points higher than the average Children's Mercy scores.
Franzen and Powers agree that the nurse co-manager program has had a significant impact on their nursing careers. Franzen admits she had no interest in becoming a manager, and would have been happy to have remained a staff nurse for her entire career. Powers said that she would have sought a management opportunity even without having a partner, but questions whether she would have remained in her role as long as she has.
Franzen and Powers say that the co-management model is successful for them because of their strong communication skills. In addition, they respect each other's decision-making, are honest and open with one another, and recognize that their differences only make the partnership stronger.