The middle manager role proves integral to an acute care organizations success. Not only do middle managers oversee department budgets, address service utilization, influence clinical outcomes, and foster staff retention, they also translate organizational strategy into action.
Often overlooked by healthcare executives, multiple middle manager role functions directly impact financial performance.
Consider that the expense associated with a hospital acquired infection ranges from $1,000 to more than $36,000 for each occurrence. Reducing complications is increasingly important. Medicare no longer reimburses hospitals for eight conditions for which evidence-based prevention guidelines exist. While causes of hospital acquired complications are multi-factorial, nursing staff play a direct role in their prevention. Competent and perceptive nurse managers develop their staffs clinical practices to reduce the occurrences of hospital-acquired infections.
Ponder the expense associated with staff turnover. Experts estimate that the turnover of a registered nurse (RN) costs the hospital the equivalent of the RNs annual salary in recruitment and orientation expense. Managers who foster positive work environments demonstrate lower turnover among their direct reports, and thereby lower costs.

Given the middle manager role complexity and its impact on financial performance, health care leaders must invest resources in assuring middle manager competence. In doing so, these leaders will realize a positive return on their investment.

Using the nurse manager role as an example, Leverage Middle Manager Development into Improved Financial Performance will present the business case for investing in middle manager development. The analysis will extend beyond the role of an expert middle manager in overseeing department operating and capital budgets to quantifying the financial impact on clinical, safety, satisfaction and staff outcomes. Based on contemporary research, the session will describe the complex relationships among middle manager competence, the work environment, clinical outcomes, and staff retention. The congruence with Magnet Designated Hospital characteristics will be outlined.

With the business case as a foundation, the expert panel members will describe 11 middle manager competency domains and the scientific rigor upon which they are based [Developing a Curriculum (DACUM) methodology, behavioral event interview, and literature review] to document key nurse manager behaviors. A sample of 527 managers validated the tool (Chronbach Alpha = 0.96). Significant findings derived from implementation of this nurse manager competency assessment in a 625 bed acute care health system will be outlined. Finally, the panel will review development approaches identified through competency assessment implementation and its validation.