The Hardest Job in Healthcare: Partnership is Key for Clinical Managers

April 1, 2021
April 1, 2021

By Mary Koloroutis, MSN, RN, Consultant at Creative Healthcare Management 

I recently surveyed a group of clinical managers who were identified by their supervisors as exemplars based on these key outcomes:

      • high staff engagement
      • high patient satisfaction
      • high cultures of safety
      • low turnover

I asked them questions designed to get at what inspires them about their work, what they need in order to thrive in their work, and what particular ways they think about their work. In a survey that offered dozens of valuable take-aways, I’d like to focus on a few that stood out for me as fundamentally important.  

3 Qualities Shared by Clinical Managers Who Thrive

The nurse managers who described themselves as thriving describe values and beliefs that support the following three areas:

  1. They have a fierce commitment to rendering proficient, safe, and compassionate patient care.
  2. They believe in the sacred nature of caring work.
  3. They hold their staff in high regard, working from the premise that their key responsibility as a leader is to create a healthy environment in which people can fulfill their highest potential.

Imagine a continuum. On one end you’ve got “It’s my job to police these people,” and on the other end you’ve got “It’s my job to believe in, inspire, and support my team.” Obviously, where you sit on that continuum is going to have a very big influence on how your team functions, partly because one way of thinking sets up a “domination paradigm” and the other sets up a “partnership paradigm.”

Domination vs. Partnership

This language—domination paradigm versus partnership paradigm—comes from the work of Dr. Riane Eisler, and since I happened upon it a few years ago, it has helped to put language to what I have experienced in healthcare organizations through the years. I was not at all surprised to see the contrast between partnership and domination thinking show up as a key factor (though not in those words) in the survey of clinical nurse manager exemplars as well.

Domination paradigms set us up to perceive ourselves as either above or below others. Even if we work in a culture that invites those doing the work to take ownership for their own processes and policies, we live in a larger culture in which we can clearly see that there are people “at the top” and people “at the bottom.” In this culture—and really in most, if not all “civilized” cultures—this reality is so pervasive that it becomes invisible to most of us. We look right through it as if it isn’t there. But it is.

Command Action Doesn't Work

It would be easy (in theory) for nurse managers to primarily pull rank and command action. What we find, however, is that that approach to leading simply doesn’t work. It dehumanizes those being led which in turn affects how they relate to those in their care. It’s essential that nurses be respected and granted the autonomy to be creative in their work—to use their critical thinking abilities to respond to their patients’ complex and ever changing issues. This is very likely to happen when clinical nurse managers hold high standards and nurture and support their teams to achieve them. It’s not at all likely to happen when clinical nurse managers are policing those “below them” or when managers are reacting out of fear of displeasing those “above them.”

In a domination paradigm, creativity may be expected from those at the top, but from those at the bottom, we want and expect obedience.

There is no way to fix a domination paradigm. Instead, a domination paradigm is dissolved when partnerships are actively created. The nurse manager exemplars I surveyed seem to be actively creating partnerships with their team members. They describe themselves as being part of the team, and they respect the clinical team as being key to quality care.

It was no surprise to find that those who seemed to have the deepest sense of partnership threading through their work also felt supported by their own supervisors. Here is an excerpt from one participant’s comments:

When I was first in the role of interim manager I asked my supervisor, "What happens if I hate this role in a month?" She replied, "If you hate this role in a month it will be my fault for not providing the support and mentoring you need. I know you have the ability to succeed in this role." 

Perhaps the quickest way to turn clinical nurse managers into good partners is for their own supervisors (and the entire administrative team, of course) to partner with them. It’s even possible for this sort of thinking to become the norm in an organization, provided that it is modeled consistently and visibly. Decrees and edicts can earn obedience or compliance, but it is through partnership that we can invite the full participation and the very best thinking of a dedicated staff into the pursuit of a shared vision. It is through partnerships and fundamental human respect that we create extraordinary cultures with extraordinary results.


As a co-creator, author, and editor of the Relationship-Based Care series of books and seminars, Mary helps health care organizations create a framework for delivering world-class care with strong underlying values and principles, and then works with them to implement that framework. Her most recent book, See Me as a Person: Creating Therapeutic Relationships with Patients and their Families, co-authored with Michael Trout, helps clinicians in all disciplines to connect authentically with the patients and families in their care no matter how chaotic their care environments may be. Contact Mary at