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Abstract
Aim The identification and development of managerial talents for nursing manager succession in the future should be a concern for organisations, as the concept of succession planning has not been seriously addressed in nursing. This study aimed to explore managers’ perceptions of the concept of succession planning in nursing management.
Design This qualitative study used a conventional content analysis approach.
Methods Participants included 15 nursing managers, who were purposively selected based on predetermined inclusion and exclusion criteria. After obtaining ethical approval, data were collected through semistructured interviews. MAXQDA software was used for data management, and data analysis was performed using the seven-stage method by Graneheim and Lundman. The credibility and dependability of the data were assessed using Guba and Lincoln’s criteria.
Results The main categories identified in this study were barriers to succession planning, facilitators, succession planning requirements, contextualisation, succession planning cycle, the dynamism of the successor organisation and consequences of lack of succession planning. Based on the findings of this study, it is recommended that organisations plan and adopt policies to develop qualified personnel management in nursing organisations and appoint these individuals to critical managerial positions.
- management
- total quality management
- healthcare planning
- succession planning
Data availability statement
No data are available.
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
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WHAT IS ALREADY KNOWN ON THIS TOPIC
Based on the nature of nursing management, it should be important for managers and organisations to identify, select and appoint competent nurses in managerial positions.
WHAT THIS STUDY ADDS
The results of this research showed that succession planning is important for choosing competent people and managers in the future and in a fair and correct way.
HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY
It is recommended to carry out in-depth and applied research, also, to make a tool to examine the concept of succession in nursing management.
Introduction
Nursing managers may leave their positions due to various reasons, such as retirement, illness, relocation or migration.1 2 Therefore, finding suitable replacements for competent managers is a challenging and crucial task.3 Organisations need to anticipate the departure of managers and select appropriate successors.4 Nursing management plays a significant role in organisational success, and vacancies or incompetency in management positions can have a detrimental effect on organisational management and leadership.5 Therefore, identifying capable individuals, training them and replacing them in management positions is crucial. Succession planning is an effective approach to identifying, training and developing eligible, and capable individuals to replace managers at various levels of management.6 It enables managers to avoid worrying about vacant management positions.7 Identifying and training nursing management talents should begin from the early stages of nursing staff entering the hospital, as it can help develop the management process and promote leadership in the organisation.8 9 However, succession planning in healthcare management, particularly in nursing, is not yet given due attention.10 It is not a priority in many organisations, and some are apprehensive about implementing it, fearing that competent successors may replace them.11 12 In some cases, external and environmental factors, lack of resources, and time constraints may hinder the implementation of succession planning.13 The nursing profession has historically taken a simplistic approach to succession planning, but it requires further development and strengthening.14 The challenges and issues related to succession planning in clinical nursing management have not been thoroughly examined.15 Given the lack of sufficient studies on the attitudes of nursing managers toward succession planning, and considering its importance and the significant impact it can have on improving nursing care services, as well as the need for transparency and examination of individuals’ perceptions in implementing a structure-oriented process, this research aimed to clarify nursing managers’ perceptions of succession planning in clinical nursing management.
Methods
Aim
This study aimed to explore managers’ perceptions of the concept of succession planning in nursing management.
Design
The current study employed a qualitative approach and a content analysis method based on the steps proposed by Graneheim and Lundman. This paper adheres to the guidelines for reporting mixed-methods research.16 After conducting the interview and transcribing the text, all the text was considered as the unit of analysis, the written text was read several times, the important phrases were identified as the semantic unit and they were tagged with new phrases, then the primary codes based on the similarity between them, they were placed in subcategories, obtained by comparing the subcategories, and based on their similarities and differences, they were placed in the main categories.
Sampling strategy
15 nursing managers who possessed the necessary experience in nursing care were purposively sampled to participate in the study. Inclusion criteria consisted of having over 2 years of management experience, holding a bachelor’s degree or higher, and having the required experience in the field of nursing care. Participants who were unwilling to participate in the study or showed limited cooperation were excluded.
Setting
This study was conducted in Tehran. The place of implementation of the research was the Ministry of Health of Iran and some areas of hospital management in Tehran. The interviews were conducted based on the convenience and wishes of the participants so that it does not interfere with the complexities of people’s jobs. In some cases, it was necessary to conduct interviews virtually.
Data collection
Data were collected using a semistructured interview method, with interview durations ranging from 30 to 90 min. An example of the interview question was ”Please describe how you perceive the status of nursing care management in terms of succession planning?”. Interview location and method were based on the participants’ preferences, and interviews were conducted in person, virtually and over the phone. Some interviews were conducted by calling people, in some situations through WhatsApp and Skype software, and some other interviews were conducted. In this regard, we asked the participants to let us know the most suitable time to make a call. Follow-up interviews were also conducted if necessary. The interviewer was experienced in qualitative research interviews. All interviews were recorded with the permission of the participants by Teflon with the researcher, the participants were assured that the audio file would be kept confidential and deleted after the transcription of the files. After the researcher listened to the recorded files, they were transcribed word by word in Microsoft Office Word 2019 series. MAXQDA 10 software was used to store and analyse the interview data while maintaining the confidentiality of information.
Data analysis
Data analysis was performed simultaneously with data collection through the Graneheim and Lundman steps.17 Data analysis was done at the same time as the interviews began. This process continued until reaching data saturation. Data saturation was when no new information was obtained during the interviews and as the study progressed; in fact, the participants’ words were repetitive. The five stages of this approach included the word-for-word transcription of all interview texts, reading the interview text to understand the main concept of the text, identifying important statements of individuals and coding semantic units, classifying primary codes and identifying hidden content within the data. The interviews were immediately transcribed and converted to unit text. The interview texts were read several times by the researcher. In the coding stage, phrases, sentences and paragraphs that were relevant to the study goal in each interview were considered semantic units and identified. The semantic units were coded using participants’ words and appropriate labels. The created codes were constantly reviewed and compared. Similar cases were placed in the primary categories and then subcategories and main categories were created.
Rigour
Data validity and reliability were examined in this study based on the stages proposed by Lincoln and Guba.18 For data triangulation, the researcher was involved with the research data for a long time and was present in the field. Furthermore, long-term involvement with the data added to the credibility of the data. The member-checking method was used to ensure the credibility of the data, in which participants were asked to confirm the consistency between the generated codes and their experiences. Peer review by two experts in qualitative studies was also used to verify the accuracy of coding and data classification. Preserving documents related to various stages of the research added to the study’s credibility. To ensure transferability, the researcher provided detailed descriptions such as a precise description of participants’ involvement, sampling method, time and place of data collection, so that the reader could comment on the transferability of the findings.
Results
The demographic information of the participants is presented in table 1. Data analysis led to the identification of the primary, sub and main categories in the field of succession patterns in clinical nursing management. Out of 1860 primary codes, this study identified 7 main categories and 25 subcategories. Based on the results of this study, the main categories include barriers to succession planning, facilitators, succession planning requirements, contextualisation, succession planning cycle and the dynamism of the successor organisation, Also, the subcategories and the primary category are mentioned in table 2.
Demographic characteristics of nursing managers participating in the study
Primary category, subcategory and main categories resulting from perceptions of nursing managers in the field of surrogate parenting in clinical nursing management
Barriers to succession planning
Barriers to succession planning were found to have the highest number of codes and extracted concepts from the participants’ statements in this study. Based on the analysis of participants’ statements, the most important barriers to succession planning included succession evasion, non-acceptance of nursing management, inhibitory organisation, complexity of succession planning and wrong criteria.
Succession evasion
Succession evasion is one of the major barriers to succession planning, which was identified as a fundamental finding in this study as a new concept. Fear of succession planning, suppression of talents, belief in the permanence of position and the manager’s reluctance to promote others as primary reasons for the occurrence of succession evasion, which prevent the implementation of succession planning.
Participant No. 3: In our organization, there was a manager who was afraid to take her place when we introduced a capable person for management positions, that’s why she ran away from competent people.
Not accepting nursing management
Another barrier to succession planning, namely the non-acceptance of nursing management by primary care staff, was identified based on the analysis of participants’ statements. Issues with nursing management, weakness in nursing management positions and a tendency towards experience-oriented/knowledge-oriented thinking were the reasons for non-acceptance.
Participant No. 7: In nursing, there are situations that no matter how competent a person is, they cannot become a manager immediately, and the challenges of the field, such as the lack of nursing, prevent succession planning.
Inhibitory organisation
The primary categories associated with the inhibitory organisation are another obstacle to successful succession planning, including incorrect perceptions by managers, arbitrary behaviour by managers within the organisation, executive challenges within the organisation, ethical challenges in selecting successors, insufficient successor development criteria, unscientific succession planning, limited suitable options, nepotism in the appointment/selection of managers, neglect of succession planning, the absence of succession planning laws and organisational injustice.
Participant No. 9: In the hospital where I was working, there were no necessary criteria and conditions for the selection of a competent manager.
Complexity of succession planning
As another serious obstacle to the implementation of succession planning, the complexity of succession planning, consisting of primary categories such as time-consuming succession planning, difficulty in implementing succession planning and problems related to talent identification, have been identified.
Participant No. 13: I believe that succession planning is a time-consuming issue and due to the difficulty in implementation, it cannot be easily applied to nursing managers.
False criteria
One of the findings of this study that was considered an obstacle to succession planning was false criteria arising from culture, consisting of primary categories such as the negative role of nativism, fraud and flattery, external coercion, unreasonable demands and political short-sightedness.
Participant No. 2: I believe that succession planning is a time-consuming issue and due to the difficulty in implementation, it cannot be easily applied to nursing managers.
Facilitators
Another major category derived from data analysis was succession planning facilitators, which were formed from subcategories of individual motivators, supportive factors and nursing management capacities.
Individual stimuli
Based on the analysis of study data, individual stimuli were identified as a subcategory of facilitators of succession planning, consisting of two primary categories, self-confidence and motivation in susceptible individuals.
Participant No. 8: One of the suitable solutions for people to accept succession planning is to increase the self-confidence of nurses. When people have enough confidence to enter the management hub post, it is easier to enter the succession planning path.
Supporting factors
The findings showed that managers’ enthusiasm and positive attitudes towards effective communication with employees, as well as a conducive organisational environment for implementing succession planning, were facilitators and supporters.
Participant No. 10: If we want to implement an embodied succession planning in the organization, we must prepare to provide the organization’s structure and environment based on this.
Nursing management capacities
Among the existing capacities in nursing management that facilitate the implementation of succession planning, one can refer to the use of external managers, traditional succession planning in nursing, succession planning in nursing institutions, unconscious succession planning in nursing, nursing management as an art, stepwise promotion in nursing management and gradual management in nursing.
Participant No. 5: There are fields in nursing, such as the laddering of promotion of managers, which can be helpful for the implementation of succession planning in the hospital.
Succession planning requirements
The important requirements for the implementation of succession planning, according to the participants’ analysis, include the need for succession planning, the requirements for implementing succession planning and a justice-centred approach.
Need for succession planning
The findings indicated that participants believed that attention to succession planning by leaders, attention to succession planning at management levels, care in implementing succession planning and the decline of nursing managers are among the issues that increase the need for succession planning in clinical nursing management.
Participant No. 1: The head of nursing in my hospital believed in identifying the worthy nurses and after education and training, they would enter the leadership path step by step.
Requirements for implementing succession planning
According to participants, there are several requirements for implementing succession planning. These include the need for an appropriate succession planning model, the development of validation indicators, the availability of qualified successors, a clear succession planning process, attention to succession planning, scientific updates, coordination of implementation and provision of regulations.
Participant No. 14: It should be clear and transparent the way of implementing the succession planning in the hospital and its stages and they should be clear based on the needs of each management position.
Justice-centred approach
One of the requirements of succession planning is a justice-centred approach. This includes selecting successors through fair and transparent processes, ensuring employee equality in implementation, avoiding prejudice in the selection of suitable individuals and treating individuals fairly.
Participant No. 6: The nursing manager must see different talents in nurses and treat them fairly to become a manager.
Contextualisation
Contextualising is another important aspect of succession planning. It consists of prerequisites, culture-building and organisational authority. The participants highlighted the importance of creating a suitable environment for implementing succession planning, soliciting and disseminating ideas, ensuring harmony between the selected individuals and current managers, replacing ineffective managers, promoting satisfaction, eliminating non-expert opinions, considering multiple successors, emphasising youthfulness and belief in existing talents.
Prerequisites
The most important prerequisites for implementing succession planning, as identified by the participants, including having a succession planning team, bridging scientific gaps, stakeholder participation, promoting a suitable environment, soliciting and disseminating ideas, ensuring harmony between selected individuals and current managers, replacing ineffective managers, promoting satisfaction, eliminating non-expert opinions, considering multiple successors, emphasising youthfulness and belief in existing talents.
Participant No. 12: When I wanted to choose a manager, I didn’t attention to opinions that were not specialized and non-professionals could not comment on this matter.
Culturalisation
According to the participants’ perspective, the groundwork for succession nursing is related to culturalisation. This includes defining nursing succession, cultural requirements in the field of succession nursing, justifying succession nursing, raising awareness, training managers in the implementation of succession nursing, introducing and explaining the subject of succession nursing, the necessity of insight into succession nursing in managers, and managers’ support and empathy.
Participant No. 10: One of the ways to develop succession planning is to spread this concept among employees in the organization. People get to know this word and it gradually becomes a culture.
Successor organisation (organisational authority)
To establish a successor organisation, ethical dimensions in succession nursing, turning succession nursing into a culture, understanding professional differences, accepting succession nursing in the organisation, using local talents, creating an effective organisational environment for succession nursing and preparing for the implementation of succession nursing must be provided.
Participant No. 4: To implement succession planning, we must pay attention to the differences between the nursing profession and other health professions.
Succession planning cycle
The results of this study show that the succession planning cycle includes subcategories such as talent acquisition, talent identification, confirmation, selection/appointment, training/development of selected individuals, responsibility orientation, interpretation of experiences and evaluation.
Talent discovery
To implement talent discovery in the succession planning cycle, it is necessary to consider creating a database of managers’ identification information, identifying talents, suggesting and introducing capable individuals, the voluntary candidacy of individuals, creating healthy competition, determining the organisation’s management capacity, inviting individuals for talent identification and considering the needs of each position.
Participant No. 9: We called for the selection of the head nurse of the surgical ward and asked the employees to become candidates for entering the election cycle and announcing their volunteering.
Talent recognition
Participants believed that talent recognition in the succession planning process includes elements such as competency criteria, preparing and compiling an evaluation checklist for capable individuals, conducting interviews with selected successors, evaluating capable individuals for responsibility acquisition and assessing the ability of new employees.
Participant No. 15: Interviewing candidates for management positions helps to measure the abilities of different people in face-to-face encounters.
Validation (subscription)
The results indicate that to validate suitable individuals, factors such as possessing necessary qualifications, technical competence, skill proficiency, personal competence, ethical competence and psychological-emotional competence should be taken into account. Managers should pay attention to those who meet these criteria.
Participant No. 13: In my opinion, it is necessary for a person who wants to become a nursing manager to have the necessary skills in terms of technical and professional knowledge.
Selection/appointment
In the succession cycle, selecting qualified individuals for the position and appointing them to their positions is crucial after the confirmation step. This ensures that suitable individuals are chosen for the role.
Participant No. 2: After the initial interview and review process was over, we would finally approve the selection of people based on their desired characteristics.
Empowerment/development of selected candidates
Empowering selected individuals is crucial for their growth and development. This includes experience-based learning, creating opportunities for capable individuals to grow, preparing them for their roles, providing training, holding management courses for selected individuals and managing talent in the field of succession.
Participant No. 6: Both before getting the position and after being appointed, we made the selected managers enter the empowerment stage, such as participating in management workshops to develop their abilities.
Responsibility-oriented
Responsibility is a key element in the succession cycle, which includes factors such as delegating responsibility, delegating performance and delegating authority.
Participant No. 3: To check the real ability of people management, we evaluated the accountability and responsibility of people to be accountable for their tasks.
Experience translation
Experience translation is one of the subcategories in the succession cycle. It involves bringing together different experiences, using various experiences and setting a positive example for succession.
Participant No. 11: In my opinion, the exchange of experience by placing new nurses next to experienced nurses helps to implement mentoring as one of the elements of succession planning.
Evaluation
Based on the results of this study, evaluation is another subcategory of the succession cycle, which involves continuous monitoring of the performance of selected individuals, measuring their abilities and ensuring the proper implementation of succession.
Participant No. 8: After completing the succession process, we did not abandon people, we continuously evaluated them and, if necessary, strengthened their weak points.
Dynamism of the successor organisation
Implementing succession in the dynamic organisation of clinical nursing management has consequences, including the organisation’s dynamism, which is realised through future-oriented thinking.
Foresight
To ensure successful succession planning and maintain organisational dynamism, it is necessary to focus on purposeful succession planning and predict future conditions.
Participant No. 1: We continuously predicted that the effects of selecting managers in succession planning would lead to organizational development.
3.6.2 Organisational progress
The results of this study indicate that implementing succession planning leads to organisational advancement and progress, and helps to move the organisation forward.
Participant No. 10: Often, by examining the performance of selected managers based on succession planning and evaluating indicators such as client and personnel satisfaction, we observed that this program has led to the excellence of the organization.
Consequences of lack of succession planning
The participants noted that the lack of succession planning in nursing organisations has both organisational and individual consequences that can negatively impact the organisation’s effectiveness.
Organisational consequences
The consequences of the lack of succession planning for the organisation may include deviating from the organisation’s path, interference by non-specialists in selecting managers and the appointment of incompetent individuals.
Participant No. 6: A negative issue in our organisations is that non-experts intervened to select managers, and this is due to the lack of coherent succession planning.
Individual consequences
In the absence of succession planning, individuals may face consequences such as incorrect selection of successors and demotivation.
Participant No. 14: When a competent person realized that the managers were incompetent and did not have the necessary ability, so they lost the motivation to continue the work because the way of choosing managers was not the right way.
Discussion
The aim of this study was to clarify the status of succession planning in nursing management. The main categories derived from this study included barriers to succession planning, facilitators, succession planning requirements, contextualisation, succession planning cycle, the dynamism of the successor organisation and consequences of lack of succession planning. According to the study’s findings, barriers to the implementation of succession planning included succession aversion, non-acceptance of nursing management, inhibitory organisation, complexity of succession planning and incorrect criteria. These barriers were reported by participants to hinder the implementation of succession planning. Philips also noted in their study that when organisations are not prepared to implement succession planning, lack of interest among managers, organisational support and insufficient financial resources hinder implementation of succession planning in nursing organisations.19 Need’s (2015) study found that limited efforts in leadership development and ambiguity about the future state of management are among the barriers to leadership and succession planning in organisations.20 In addition, Ramseur et al identified lack of time and inadequate resources as barriers to implementing succession planning,21 in their study. The study findings revealed that the facilitators of succession planning, as perceived by the participants, included individual motivators, supportive factors and nursing management capacity. Watkins et al suggested that to achieve successful implementation of succession planning, it is essential to facilitate education and the learning process, provide learning opportunities for individuals, and create a positive learning environment for the development of potential successors.22 Patrician et al argue that to facilitate implementation of succession planning, a framework should be established to define the role of nursing management in the organisation and clarify the role of nursing management, as well as support opportunities for other peers.23 The results of the current study indicate that succession planning requirements include the need for succession planning, implementation requirements and equity-based considerations. Barginere et al showed that determining the competency requirements for leaders is one of the requirements for succession planning that should be taken into account.24 Selig stressed in their study the importance of an active approach to selecting successors.25 Al Hosis et al stated that necessary policies should be implemented to execute succession planning and retain potential individuals in the organisation.26 Other findings from this study include the need for a supportive environment, which includes factors such as prerequisites, cultural development, the succession planning organisation (organisational authority). According to Pourmirza et al’s study, environmental complexities, internal factors, political environment, extraordinary pressures, organisational misconduct, competent manager crises, local management, internal managers, policy-making council, non-competitive encouragement and identifying key situations are among the effective factors on the implementation of succession planning.27 The results of Wildani et al’s study showed that to facilitate the implementation of succession planning in the organisation, the development of formal nursing education is not yet optimal and needs improvement.28 The study’s results indicate that the succession planning cycle comprises elements such as talent acquisition, talent identification, validation, selection/appointment, empowerment/enhancement of selected individuals, accountability, experience translation and evaluation. Pourmirza et al identified elements of the succession planning model as management skills, strategic management, human resource management, senior management beliefs, underlying causes, intervening factors and consequences.27 To effectively implement succession planning, attention should be given to developing a strategic plan, determining required skills and needs, identifying potential candidates, determining the need for interim leadership, implementing leadership development programmes, allocating resources and evaluating progress.29–33 The study also found that organisational resilience is a crucial element of succession planning, which includes a focus on futurism and organisational growth. Titzer and Shirey argue that implementing succession planning can lead to important outcomes such as leadership development, cultural growth and improved organisational leadership.31 The implementation of succession planning in an organisation has various outcomes, including preparing leaders to take on important positions, reducing hiring costs, increasing performance standards, promoting career advancement and minimising the loss of highly talented nurses.34 Another finding of the present study is the consequences of not having succession planning, which encompass organisational implications and individual consequences. According to existing research, losing organisational knowledge and expertise, discontinuing organisational programmes, and leadership gaps are among the significant consequences of failing to implement succession planning.35 One of the limitations of this study is the lack of participants providing their experiences, which the researcher addressed by selecting the most knowledgeable individuals to elaborate on their perceptions and experiences regarding the issue at hand.
Conclusion
The findings of this study indicate a lack of necessary measures in implementing succession planning in clinical nursing management. This area has always been neglected in research and overall direction, and the existing measures have not been effective. Understanding and awareness of nurses’ real perceptions help explain the necessity and fundamental needs of succession planning. Therefore, based on the findings of this research, identifying succession planning challenges in the nursing management and searching for effective and efficient solutions can serve as a guide in policymaking and decision-making for officials, improving the quality of information dissemination, reducing stress and anxiety, and improving the safety and quality of managerial and care in hospitals. The findings of this study apply to nursing management in the hospital as one of the professional roles of the field. Therefore, it is necessary to use the findings of the current research to develop the structure of the identification, development and selection of nursing managers.
Data availability statement
No data are available.
Ethics statements
Patient consent for publication
Ethics approval
The study included human participants, but no intervention was performed on them. This qualitative research was approved by the Research Ethics Committee of Iran University of Medical Sciences in Tehran. The ethical code number of this research is (IR.IUMS.REC.1400.1080). Informed consent was obtained from all participants in this research.
Acknowledgments
We would like to thank all the participants who helped us in this research.
Footnotes
Contributors The study design was done with the participation of all authors. Interviews were conducted by MSM. The data were coded by MSM, TS, and MAF. All three authors contributed to the preparation of the manuscript for publication. MSM is responsible for this study.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer-reviewed.