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April 25, 2022/Nursing/Clinical Nursing

Connecting As One Nursing Leadership Team

Uniting middle management leaders

Nursing middle managers

By Shannon Kunberger, MSN, RN, NEA-BC, Chief Nursing Officer, Cleveland Clinic Euclid Hospital


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Nurse leaders who hold middle management positions — directors, nurse managers, assistant nurse managers and nursing operations managers — have some of the most difficult and critical roles in nursing and in healthcare.

Every day, in a constantly changing environment, they are responsible and accountable for so much: patient care, quality and safety, implementing policies and procedures and managing patient and employee satisfaction and engagement, including cultural integration, staffing and retention. They are also the link between executives and frontline staff.

On an average day, the work is hard, and when the pandemic hit, it became harder. The duties of these leaders intensified greatly. Many middle management duties, such as daily communication or best practice sharing, took a back seat to the ongoing demands of patients and staff.

When I arrived at Cleveland Clinic Euclid Hospital last year, burnout from the pandemic was high among nurse leaders, and team unity needed strengthening. A reset was needed to help the team explore how they could better work together, and with greater efficiency.

With assistance from Cleveland Clinic’s Caregiver Office, specifically our nursing HR business partner, we planned a middle management nurse leader retreat. It was held at an off-site location to limit distractions, and attendance was mandatory. To further team collaboration, members of Cleveland Clinic’s quality and finance teams also attended. Leaders participated in several meaningful, engagement-based activities. Each created unique opportunities for team members to interact and reconnect with one another — and all would be helpful for middle management teams looking to build a stronger team connection.


Notes of pride

An important part of uniting teams is giving those on the team the opportunity to express pride and gratitude for themselves and their peers. One way to do this is to share pride-worthy moments.

At the retreat, we provided each attendee with a large, oversized sticky note. The note was divided into two equal sections. In one section, leaders wrote a message to their staff members explaining why they are proud of them. In the second section, the message was for themselves, and expressed what they were most proud of when reflecting on their leadership. Conducting self-realization exercises like this allows people to recognize their hard work. It also gives them the opportunity to share their successes. Additionally, it helps highlight the importance of every role on the team and the contributions each person makes.

Discovery sessions

Activities that prompt teams to reimagine how things are done or explore new possibilities in their jobs are effective ways to bring teams closer together.

For example, “start-stop-continue” exercises are designed to prompt people to think about things they’d like to start, stop or continue doing, and suggest ideas and recommendations for change. To enhance team building, this can be a great way for leaders to reflect on their roles and how they might improve or change their work in the future, as well as how they work together. For example, ask leaders:

  • What do you want to start doing in your role?
  • What do you want to stop doing in your role?
  • What do you want to continue in your role?

At our retreat, we labeled three large posters and hung them on the wall in the center of the room. Each attendee was provided a stack of small sticky papers. Writing one idea on one piece of paper, leaders filled the posters with all the things they wanted to start doing, stop doing or continue doing in their roles.

This activity was a favorite of the group and allowed each team member to identify what mattered most to them. It also gave leaders the opportunity to share recommendations for enhancing or improving roles.

From the activity, several themes emerged, such as professional development, nurse on-call services and team meetings. The themes were shared with Cleveland Clinic nurse executives, which prompted an evaluation of all health system middle management positions and launched new work to identify opportunities for position-related improvements.


Retreat participants also shared ideas about desired professional development and training. People spoke up about what they needed to do their jobs well. Ensuring effective leadership and training is one of the best ways to provide middle management leaders with added confidence and skills to perform their critical roles within an organization.

Personal connections

Members of any team should take time to get to know one another. Learning about colleagues’ likes, dislikes, passions and unique attributes helps build team relationships.

In the days leading up to our retreat, leaders were asked to submit two pictures — one of an activity they enjoy doing (they couldn’t be in the picture) and one baby picture. The retreat kicked off with a 30-minute coffee social and ice breaker where attendees attempted to match each person’s activity and baby pictures.

Another way to encourage personal relationships among team members is to put people in pairs and ask them to learn something unique or special about their partner, including what they enjoy about being a leader. All participants report their findings to the team. Sharing this personalized information offers added perspective about who people are and what’s important to them. It also offers insights into qualities that contribute to their leadership. Providing opportunities for personal and professional connections among middle management leaders enhances team collaboration, helps break down silos and communication barriers, and improves engagement and satisfaction. Doing so also reminds leaders they are valued and respected.


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