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Nurse managers often list finance as the most challenging area of their roles, even after education and several years on the job (Baxter & Warshawsky, 2014; McFarlan, 2015). The Institute of Medicine (IOM) report, The Future of Nursing: Leading Change, Advancing Health, emphasized the need for nurses to practice to the fullest extent of their education and to work as full partners with physicians and other health care leaders to redesign the health care system (IOM, 2011; McFarlan, 2015; McKinney, Evans, & McKay, 2016). However, many nurse managers are promoted from bedside nursing roles based on their excellence as clinicians, and therefore many have not received structured orientations addressing the competencies needed to succeed in their management roles (Baxter & Warshawsky, 2014; Fennimore & Wolf, 2011; Guglielmi, 2014; Hadji, 2015; McFarlan, 2015). It is vital that nurse managers be well educated and receive ongoing support from their leaders to achieve the desired outcomes of their units. Nurse managers are vital to achieving financial goals, patient quality and safety metrics, and employee satisfaction and retention (Hadji, 2015; McFarlan, 2015; Muller, 2013; Warshawsky, Rayens, Stefaniak, & Rahman, 2013).
Background
The American Organization of Nurse Executives (AONE) collaborated with the American Association of Critical-Care Nurses (AACN) to identify competencies needed to be successful as a nurse manager. These competencies are comprehensive and evidence based. The Nurse Manager Leadership Partnership (NMLP) identified and categorized nurse manager competencies into the Learning Domain Framework (LDF) (AONE, 2015). The LDF best summarizes the competencies recommended by nursing experts into three learning domains: art, science, and leader within (Baxter & Warshawsky, 2014; Hampton, 2017; McFarlan, 2015; Titzer, Phillips, Tooley, Hall, & Shirey, 2013). The art domain encompasses the art of leading people and includes skillful communication and relationship building. The science domain includes competencies needed to manage the business and finances of health care, as well as having adequate clinical practice knowledge, and the leader within domain pertains to nurse managers' self-development both personally and professionally (Table 1).
Many nurse managers express confidence with competencies in the art domain, as these skills and knowledge often are inherent in clinical nursing and are addressed in undergraduate education. However, a significant number of nurse managers rate themselves as less than competent with...