Session: Supporting a successful transition from clinician to leader

Editor’s Note

New nurse leaders thrive when organizations invest in practical training and relationships, according to Aubrey Pepper, MSN, RN, DHA, CNOR, NE-BC, senior director of surgical services at St Jude Children's Research Hospital. In this session, Pepper said the most predictive skill for a smooth clinician-to-leader transition is “relationship management and influencing others,” with human resources acumen close behind. Financial and technology skills matter, yet “it’s all important,” she noted, and the emphasis shifts by stage of the role.

Turnover, retirements, and widened spans of control have elevated the risk of burning out novice leaders, Pepper said. Many are promoted because of clinical excellence into jobs that demand business, people, and quality management from day one. As such, mentorship for new leaders is key. Formal mentor pairings boost competence, engagement, and retention. In the absence of an internal mentor, she added, leaders should “seek out mentors outside the organization” through professional networks and even neighboring facilities over lunch. One mentor’s advice reshaped her own practice: “You taking on every single aspect and responsibility of this job, and not delegating, is denying other people the opportunity to grow.”

Structured onboarding is another key element for successful transition. Pepper differentiated it from general leadership development. New managers need hands-on, role-specific orientation to systems and reports. Questions like “How do I log into the timekeeper and approve time? How do I run a supply variance? How do I read my budget?” need to be answered. Tool-based onboarding improves confidence and department performance because leaders can execute the job mechanics on day one, she stressed.

Formal curricula matter too. Programs like fellowships and institutes that run over months create durable gains in competencies and retention. A Yale nurse manager residency tested a 6-week immersive model and learned that flexibility and convenience are essential, Pepper said. Rigid scheduling became a participation barrier, so the team pivoted to extended timelines and asynchronous elements. Another example cited is the East Tennessee State University 12-month residency that combined class time, mentorship, applied projects, and executive visibility; participants reported clearer roles, higher confidence, stronger engagement, and better retention.

Wellness and resilience training is not optional. Pepper highlighted brief, evidence-based modules that improved perceived stress, self-compassion, mindfulness, and emotional intelligence in leaders. “You cannot pour from an empty cup,” she said, urging leaders to set boundaries, avoid after-hours email except for true emergencies, and normalize recovery time so “we remember our why.” And succession planning closes the loop. Pipelines that identify emerging leaders, pair them with mentors, and provide progressive responsibility stabilize retention and internal promotion.

Pepper is translating these lessons into a Nurse Leader Transition to Practice program using AONL competencies, embedded mentorship, simulation, web-based prework, didactics taught by organizational subject matter experts, and intentional networking. The 11 modules will unfold across 12 months and leverage existing HR and learning resources. “Leadership is a transition, not just a promotion,” she said. “Improvement requires intention.”