Newborn & Infant Nursing Reviews 16 (2016) 161–163

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Newborn & Infant Nursing Reviews

journal homepage: www.nainr.com

A Call to Action: Succession Planning Needed

Cynthia Acree-Hamann, DNP, APRN, NNP-BC
Cincinnati Children's Hospital Medical Center, Neonatal Intensive Care Unit, ML 1013, 3333 Burnett Avenue, Cincinnati, OH, 45229, United States

a r t i c l e i n f o a b s t r a c t

Keywords: The statistics regarding the aging American workforce, including the nursing workforce, are quite daunting. The
Succession planning aging workforce coupled with nursing's inability to recruit nurses to replace those leaving the field, creates a
Succession management sense of urgency to develop strategies to retain the nurses actively engaged in the profession. There is also a
Multigenerational nursing workforce sense of urgency to work to develop a subset of nurses to successfully assume leadership positions that will be
Complexity leadership vacated in the next five to ten years. Succession planning, management, and implementation are activities that
are urgently needed in the nursing workforce today.

Give light and the people will find their way Ella Baker
© 2016 Elsevier Inc. All rights reserved.

The U.S. Department of Labor, Bureau of Labor Statistics in 2013, up-
dated their statistics for projecting employment for 2012–2022 indicat-
ed that healthcare and social assistance roles were growing very
rapidly. 1 The increased demand on the workforce is a result of the
2010 Accountable Care Act (ACA) enabling millions of citizens to gain
access to care. An additional burden on the healthcare system is the
large, aging population of individuals born between the years 1943
and 1960, commonly referred to as the Baby Boomers, needing more
care as they age. The Bureau of Labor is projecting an annual growth
rate of 2.6 percent adding 5 million jobs. Employment totals will in-
crease by 574,400 jobs for RNs and advanced practice registered nurses
APRNs by 2022. 2 When retirements are included in the job numbers,
the U.S. will need to produce 1.13 million new RNs by 2022 to fill the po-
sitions available in the healthcare system. 2 All nursing leaders need to
strategize and collaborate to continue to build the nursing workforce
in order to avoid another nursing shortage in 2022.
Increasing Complexity of the Work Environment
The healthcare environment is growing increasingly more complex
as health care systems are called upon to meet quality metrics outcomes
with fewer resources to complete the work. Some authors postulate
that health care is suffering from outdated leadership practices, such
as poor readiness for change, linear thinking, and leader-
centricity. 3This type of leadership has resulted in a high cost, low qual-
ity, unsustainable system based on volume and not value, and is cur-
rently being called upon to radically change and transform. There is a
need to move beyond transactional and transformational leadership
E-mail address: Cindi.Acree@cchmc.org.
into a complexity leadership model to help transform healthcare. Com-
plexity leadership uses innovation, continual collaboration, and com-
plex systems thinking. 3 We need strong nursing leaders to practice
and role-model the new complexity leadership style to make the trans-
formation process as safe and patient-centered as possible.
Tulgan4 best describes the dynamic work environment using four: Is
Institutions being in a state of constant change, Individuals being in a
state of constant motion, Information growing exponentially every
day, and Immediacy accelerating with no end in sight. 4 These four Is
combine to contribute to an ever changing and evolving work environ-
ment which decreases overall organizational effectiveness.5
To add to the complexity, there is an unprecedented four genera-
tions of nurses in the workforce during these tumultuous times. Succes-
sion planning can be very difficult in this type of environment with
workers with differing values, behaviors, work ethics, and styles associ-
ated to the different generations. The generations are described as Vet-
erans born 1922–1943, Boomers born 1943–1960, Generation X born
1960–1980, and Generation Y born 1980 to present.Levin6 postulated
that the differences amongst the generations is not one of values, it is
one of currencies or those things that are most important to individuals.
For Baby Boomers the currency is money, for the Gen Xers the currency
is the access to information, and the currency for Gen Yers is time.6
The currency and importance of time is reflected in the Gen Yers as
how time is to be spent inside and outside of work. Stephen R Covey
once stated: When one is on their death bed, they are not going to
wish they had worked more. 7 The Gen Xers and Yers have seen how
hard their parents and nursing colleagues from the Veteran and Baby
Boomer generations have worked, and they are choosing a different
approach to their lifestyle. When the younger generations observe man-
agers and advanced practice nurses consistently working their long
hard hours, it does not seem appealing to pursue them to that type of

http://dx.doi.org/10.1053/j.nainr.2016.07.001
1527-3369/© 2016 Elsevier Inc. All rights reserved.
162 C. Acree-Hamann / Newborn & Infant Nursing Reviews 16 (2016) 161–163
role secondary to the level of workload. Sverlik 8 reported this type of
phenomenon in a large tertiary care facility that had 62 assistant
nurse managers, who had expressed interest in leadership, yet no one
expressed an interest in a vacant nurse manager role.
A Call to Action for a Succession Planning and Implementation
Process
Succession planning and succession management need to be added
to the strategic planning of all healthcare facilities and given a high pri-
ority designation. Without good succession planning and implementa-
tion, the potential for a future strong nursing workforce and strong
nursing leadership looks dismal. Even more sobering are the thoughts
of poor patient care and experiences, and poor healthcare outcomes.
Who will be there to provide care for the patients or teach and mentor
students when all the chronologically-gifted nurses and educators re-
tire? Who will be there to take care of all of the chronologically-gifted
nurses when they need a nurse? How will nursing be able to respond
to the Institute of Medicine's 9 recommendation for nursing to be full
partners, with physicians and other health care professionals to rede-
sign health care in the United States, if we have no adequately-prepared
nursing leaders to do this work?
Strategic planning for succession planning and succession manage-
ment is a project that any leader could develop and implement in
most healthcare institutions. The project may only be a personal project
or a leader could be an impetus for an organization to start a succession
plan for more than the most senior of leaders.Collins 10 reported that
only 21–55% organizations have a succession-planning process in
place. Many of those programs are geared toward senior leadership po-
sitions, and less than 50% of organizations see the need for succession
planning for other positions. A recent national study revealed that less
than 50% of hospitals have leadership development programs.11
Carriere et al12 in their integrative review and Titzer et al13 in their
concept analysis use simple definitions to describe the two concepts of
succession planning and succession management. Succession planning
is the process of identifying and developing individuals who have dem-
onstrated potential to assume new roles in an organization.
• Succession planning is defined by Titzer et al 13 in their concept
analysis of nurse manager succession planning as a strategic pro-
cess where intellectual capital is identified, developed, and evalu-
ated to promote leadership continuity in an organization.
• Succession management is a more formal process of identifying
and developing leaders to maintain a leadership talent pool that
may be tapped to fill any leadership position in an organization.
Titzer et al13 refer to succession management as a “closely related
term” in concept analysis parlance, and is included with other con-
cepts such as talent management, leadership development, and
leadership continuity planning.13
These two terms will be combined and referred to as succession
planning for the remainder of this article.
Creating a Plan
The right business strategy combined with the evidence of succes-
sion planning, and Lewin's Three Step Change Theory could be used
for a project to start with simplistic microsystem planning or complex
macro system planning. A succession planning project could be struc-
tured using a four phase process 14 with eight common strategies 12
using Lewin's change theory involving a three-step process.15
Hastings et al 14 has established a four-phase process for a generic
human resources management approach to succession planning in
any industry. Phase I: Establish the Scope involves (a) reviewing the
organization's strategic plan in order to link training and development
with organizational goals, (b) assessing retirement projections and at-
trition rate by all causes, (c) determining the impact of any potential
external factors impacting certain positions or the organization, and
(d) defining the scope for succession planning initiatives.Phase II:
Create a Succession Plan involves (a) analyzing job functions,
(b) determining staffing levels that will be needed and the associated
and necessary knowledge, skills, and abilities, (c) determining staff
availability, (d) determining the gap analysis and generate priorities
for closing the gap, and (e) establishing a workforce development
plan of strategies with evaluation and outcome measures. Phase III: Im-
plement the Plan involves (a) communicating the process of succession
planning to the organization, and (b) implementing the strategies ac-
cording to priorities. Phase IV: Monitor, Evaluate, and Revise involves
(a) monitoring the progression of the plan and intervening when neces-
sary and (b) evaluating the implementation process and revising it as
necessary as new challenges surface.14
Carriere et al 12 in their comprehensive integrative review process
found eight common strategies that can be used in health care succession
planning. These strategies are (a) strategic planning, (b) identifying de-
sired needs and skills, (c) identifying the most valuable key positions,
(d) identifying possible succession candidates, (e) coaching and
mentoring, (f) providing additional career and personal developmental
processes, (g) securing an allocation of resources, and (h) evaluating
of the process.12
Evidence of Success With Succession Planning and Implementation
Goudreau et al 16 report encouraging outcomes from the develop-
ment of a successful succession planning program with an individual
development program at their institution using these aforementioned
phases and strategies at a hospital on the west coast. They developed
a high performance development model (HPDM), which was intended
to provide a development structure for all nurses which has led to
higher job satisfaction and higher performance. The HPDM is designed
to provide training and coaching to achieve competence in
(a) personal mastery, (b) interpersonal effectiveness, (c) customer ser-
vice, (d) creative thinking, (e) adaptability and flexibility, (f) systems
thinking, (g) organizational stewardship, and (h) technical skills.15
They have also developed a career help and advancement through
mentoring, personal improvement, and opportunities to nurture success
(CHAMPIONS) program. This curriculum includes (a) interpersonal com-
munication skills, (b) time management, (c) conflict management,
(d) writing skills, (e) presentation skills, and (F) development of a
short and long term individual developmental plan. They have data
with good results with these types of programs. They report the average
age of their participants as being in their 40s and 50s.15
Goudreau et al16 also have mentoring programs called Pathways and
STARs as well as leadership enhancement and development programs
(LEAD), executive career field (ECF) and executive leadership courses
(ELC). All of these programs serve the needs of the front-line staff at
the bedside to the leaders in the boardrooms. They have taken succes-
sion planning to heart and done a tremendous job of educating and de-
veloping leaders in their organization and across the country.
Capuano et al 17 report the success of a robust and well-supported
succession planning and implementation process in their network in
the northeastern portion of the United States. Their network recognized
that frequent transitions in leadership could cause lack of alignment
with organizational priority and strategy as well as inconsistencies
and inefficiencies.
They recognized succession planning as a priority for their large or-
ganization and created a multidisciplinary-comprehensive approach to
planning and implementation. They began by defining competencies
necessary for leadership effectiveness at all levels in their organization.
They created an interview and select process to include assessment of
the competencies and performed behavioral interviewing. They also de-
veloped a track performance of processes system where performances
were reviewed and leadership development occurred. They focused
on leadership development, performance management, and talent-
 C. Acree-Hamann / Newborn & Infant Nursing Reviews 16 (2016) 161–163
pool management. They engaged their whole organization in the pro-
cess. They developed succession education and mentoring programs
to help new leaders acclimate to their new role with their predecessor
before the predecessor left the position. Although they developed a
comprehensive and successful succession planning and implementation
process, it was actually three separate processes. They encourage suc-
cession planner to consider their approach as three separate bodies of
work which included leadership development as they worked toward
mutually agreed upon goals, succession planning with the individual
successor or successors identified, and the process of succession imple-
mentation. They reported successful outcomes to their program with a
48% decrease in leadership turnover in three years while maintaining
a 60–70% internal hiring level.17
Combining these strategies and experiences of two separate organi-
zations, a leader could craft a business/leadership action plan to develop
a succession planning program. The plan would require further research
and perhaps a fact-finding site visit to one of the aforementioned
organizations to explore their curriculum and their keys to success as
well as lessons learned. It is important to plan to evaluate for empirical
outcomes and do cost-benefit analyses to calculate a return on
investment for the program as part of the business plan.18
15
Lewin's Change Theory
Step One – Unfreeze
Any leader could develop a business/leadership action plan and se-
lect a team to begin to look at succession planning and individual devel-
opment strategies that can be piloted in any division to unfreeze the
culture so that senior leadership will want to move from the current sta-
tus quo of perhaps minimal attention being directed toward succession
planning and staff leadership development. Presentation of the demo-
graphic data and the pressing need for succession planning will hopeful-
ly create a desire and burning platform for change. The driving and
restraining forces supporting the status quo need to be identified and
addressed. The team and senior leadership will be helpful in identifying
challenges, brainstorming solutions, and allocating resources for
this work.
Step Two- Movement
This step will move the leader and senior leadership to the new
level of equilibrium with a vested interest and intent of developing
new leaders from current staff and developing the current practicing
leaders to higher levels of management. After key components of the
succession planning and individual development are identified and im-
plemented in the organization's culture, movement will hopefully natu-
rally occur and will be reflected as an improvement in the outcome data
on recruitment and retention, patient /parent/physician satisfaction,
and healthcare and patient outcomes. Productivity data metrics and
trends can also be used to evaluate the outcomes of the individual de-
velopment initiatives.
163
Step Three- Refreezing
The new culture and strategies will continue through sustainability
measures. Building organizational support with the assistance of the ed-
ucation and training, organizational effectiveness, and the human re-
source development departments will help embed and hardwire the
new strategies into the organization's culture with the opportunity to
spread the work to other divisions and other institutions.
Conclusion
This type of work is critical to the sustainability of a strong nursing
workforce as well as the maintenance of a strong nursing leadership
contingency despite the aging workforce and future retirements.
The present times and future times will never be any less challenging;
however, with adequate planning and due diligence to the succession
planning and individual development, nursing will be ready, willing,
and able to meet the healthcare needs of the American public and all
others that come into the health care arena seeking care.
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