Being a Nursing Leader in Post-Acute Care

Often, leadership training in nursing is generic and is generally based on the assumption that the nurse is working in the setting of an acute care hospital. However, those of us in post-acute care know that these settings are very different, and so are the challenges their leaders face.

In the acute care setting, nurses may have a patient for three to five days, but in post-acute care, patients could be with us anywhere from two weeks to two months. It's much easier to keep a patient satisfied for a few days than over an extended period of time. One might argue, though, that in post-acute care, we have the time to build relationships prior to discharge; we should take advantage of that.

Being a nursing leader in post-acute care can be challenging, but it can also be rewarding. The following are some tips—some new, some old— that I've learned in my nearly 30-year post-acute care nursing career.

Managers vs. Leaders

The terms managers and leaders are often used interchangeably, but in fact, they couldn't be more different. Leaders are aspirational, proactive, and look to find new ways to work more efficiently and effectively. Managers look at existing goals and work to achieve them. They ensure tasks are completed, but they are not presenting new ideas in the way that leaders do.

So can one go from being a manager to a leader? Absolutely. You don't have to be a "born leader." It can be accomplished with work. If you are a staff nurse, be the best staff nurse. Instead of complaining to your supervisor, work with them to develop solutions. Take every opportunity to learn, whether it's taking on a new project or obtaining a new degree or certification.

• What tasks must be completed today? Make a list and mark them off as you go.
• What are your known stressors for the day/week? Knowing these beforehand can help you better prepare and manage them.
• How are you doing on your goals? Set aside a few minutes each day to determine how you are progressing toward your goals.
• Evaluate negative thought patterns throughout the day and adjust them accordingly.

Maybe some people are born leaders, but for most of us, it takes work. Become a lifetime learner, and you're taking the first step in building a foundation to becoming not just a manager, but a leader.

Leading People 

The nurse leader in post-acute care must maintain five caring essentials to lead the staff they serve. Nurse leaders cannot just be visionaries for nursing practice. The core business in post-acute care is caring for people in all phases of ability and debility. Those five caring essentials are:

1. Maintain a clinical presence. You must be present for your staff in their environment. That means at the unit level. Staff must know that the leader knows what and how they do what they do—that is gained over time through a physical presence, connecting with them and showing respect for the practice of nursing at the unit level.
2. Listening, respecting and facilitating dialogue. As I move through a hospital or other post-acute care setting, I can easily get an impression of the nurse leader by seeing the reaction of the staff to their presence on the unit. It should not really be a reaction at all. It should be normal, as the nurse leader is there frequently listening to staff, hearing what they say to each other, to patients, to other leaders. A nursing leader can help them learn to respect each other's differences and varied opinions.
3. Establish affirming relationships. We need to set ourselves up for success by establishing positive affirming relationships—have some positive go-to people who build you and the profession of nursing up rather than tear them down.
4. Build the strength to persist. These positive relationships will infuse the leader with the strength to remain positive with staff during times when only their survival skills help move them along. We all experienced this at points during the pandemic.
5. Balancing limited resources. I always recommend to new nurse managers that they create a "Don't Do" List of tasks that are not absolutely necessary for shifts when there is a staffing crisis. A staffing shortage is the one crisis that we know is going to come. The thought is to plan ahead, in a positive way, to help staff survive and, to feel like survivors, by giving them a list of tasks they can skip for that shift.

The Importance of Engagement 

Three buzz words in healthcare—despite the setting—are patient satisfaction, patient experience, and patient engagement. So what do we really mean when we're talking about these?

• Patient satisfaction is the perceived value the patient and their family received while in your care. Did they like your services, the food? Were their expectations fulfilled?
• Patient experience tells us about how they experienced quality care and safety while in your care. How timely was the call light response? Did staff coordinate care? Was the patient fully informed of their healthcare decisions?
• Patient engagement is not about the care the patient received, but what they gave back. Did they see themselves as part of your healthcare team? Did they fully understand their medication instructions? Are they owning their healthcare outcomes?

Mary Ellen Hatch, MSN RN CRRN, is the vice president of nursing operations at Encompass Health. She recently presented a four-part series on Nursing Leadership in Post-Acute Care to the Association of Rehabilitation Nurses. She is also an ARN Board Member.

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