Residency Programs Support and Develop Assistant Nurse Managers

The assistant nurse manager (ANM) role is crucial to both inpatient and outpatient settings. With dual responsibilities for direct patient care and management, ANMs perform clinical and administrative duties that affect day-to-day operations and outcomes.

Becoming an ANM is a nurse’s introduction to formal leadership, and it can be a difficult position to step into.

Historically, ANM role training has been inconsistent and sometimes inadequate. Nurses who were identified as strong informal leaders were encouraged to consider ANM positions, but they often lacked needed knowledge and skills. The expectation was to learn through experience.

“New ANMs often assumed the role with little to no training or ongoing education to support their development,” said Mary Jo Krivanek, DNP, MPA, RN, NEA-BC, Education Manager, Cleveland Clinic Nursing Education and Professional Development. “There was a knowledge gap in the transition from staff nurse roles to leadership.”

For Cleveland Clinic, an ANM residency program was an ideal solution for bridging the gap.

Residency program benefits

Residency programs for new nurses help to better prepare them for their roles. Residencies have proven effective in reducing turnover, improving nurse and team satisfaction and decreasing anxiety and stress.

In 2019, Krivanek and her team began exploring the idea of a residency for ANMs. Following extensive research, a series of internal focus groups and collaboration with the health system’s nurse executives, several areas of need and opportunity were identified. The resulting vision supported new nurse leaders, encouraged program participation and contributed to caregiver satisfaction, retention and promotion to future nurse leader positions.

Introduced in 2020, Cleveland Clinic’s ANM residency provides foundational leadership skills and opens a robust pipeline for future nurse managers. All Cleveland Clinic ANMs, upon hire or promotion, are enrolled in the year-long program. Now in its 15^th cohort, several hundred have completed it. Program participation averages more than 90% and retention of ANMs at Cleveland Clinic hovers around 98%.

“The idea is to provide ANMs with the tools and resources needed to be successful,” says Krivanek.

Kendra Kulwicki, BSN, RN-BC, came to Cleveland Clinic a year ago. She was hired as an ANM at Marymount Hospital’s adult behavioral health unit and completed the ANM residency in February. Although Kulwicki’s background included several years of bedside nursing and supervisory experience, she was new to management in the inpatient setting.

“After a few months in the residency, I felt more confident,” Kulwicki said. “The program reaches you where you are and elevates your thinking. Coming from an outside organization, I was impressed that Cleveland Clinic cared that I was comfortable in my job and that I could do it well.”

Keys to program success

According to Krivanek, ANM residencies should encompass resources, education and mentoring.

Cleveland Clinic’s program was built on all three and includes five key areas of focus: standardized orientation, role clarity, annual education/pathway development, participation in enterprise standard ANM councils, and system access, including quality dashboards, data reports and workforce management aids.

Orientation and resources

Organizational policies and practices for onboarding are imperative for effective role transition.

“The first steps our department took focused on standardizing orientation and creating orientation guides,” Krivanek says.

Guides can include an organization's mission, vision, values and expectations. They can be used to share information that new ANMs may not be aware of, including computer program access, office details, leadership development plans, accountabilities and employee relations materials.

Equally important are professional development resources.

Within their first days on the job, new Cleveland Clinic ANMs receive a welcome email containing information on the residency, enrolling in courses and other professional development opportunities.

Resources are housed on Cleveland Clinic’s ANM Resource Center, which is an interactive online portal that assists ANMs through orientation, the residency and the mentorship process. The center includes a discussion thread, recorded presentations on leader strategies with associated tools, and more.

Residency courses

For a 1-year residency, Krivanek suggests four, 4-hour courses that are offered quarterly. Residents should enroll in the first course within 3 months of hire; although, flexibility around staffing challenges should be considered.

“Patients and staffing come first,” Krivanek says. “If needed, allow residents to make up courses in the following offering or take them out of order.”

An education manager and content experts are ideal course facilitators. One key theme per course is recommended, such as:

• Effective teams
• Effective communication
• Facilitating change
• Healthy work environments

“The classes teach you how to problem-solve and deal with different dilemmas,” Kulwicki says. “Learning active listening has helped me deal with difficult conversations and build trust with caregivers.”

Developing learning activities that are based on adult learning theory concepts is recommended.

“The learning environment was an interactive classroom setting,” Kulwicki says. “We would divide into groups to brainstorm, which allowed us to learn from each other. My cohort included a diverse group of individuals with different backgrounds and inputs and our interactions were very beneficial.”

Through in-person cohort-style courses, participants can meet other new ANMs and create peer connections for ongoing support.

“You can always lean on the people in your cohort — you are never alone,” Kulwicki says. “I recently shared my strategy for attendance with an ANM from my cohort and she implemented it. We all want to see each other succeed.”

Collecting participant evaluations at the conclusion of each course can provide enhancement opportunities, including program or course facilitation improvements and curriculum adjustment

Hosting a formal ceremony when all courses are completed offers acknowledgement and recognition. At Cleveland Clinic, certificates of participation are awarded by the executive chief nursing officer.

Mentorship

Partnering new ANMs with experienced ANMs provides valuable guidance and support.

Residency program leaders can work with their organization’s human resources department to obtain a list of qualified ANMs to recruit as mentors. Before contacting potential mentors, ask for nurse manager approval.

Mentorships can be conducted 1-on-1 or as a group, depending on cohort size.

“There is an incredibly high level of support associated with this program,” Kulwicki said. “Managers stand behind you and want you to be the best you can be. Having that makes individuals better and more loyal.”

At Cleveland Clinic, virtual ANM mentoring sessions are held eight times a year. Experienced ANMs share how they bring the ANM residency curriculum and concepts to life.

“Being in this program has been one of the most valuable experiences of my career,” Kulwicki says.