Talent identification and succession planning strategies for the appointment of nursing unit managers: A systematic review

Abstract

Talent acquisition and succession planning are critical to the appointment of nursing managers to ensure high-quality leadership and improved outcomes in healthcare organizations. This review was carried out with the aim of systematically reviewing the literature on talent identification and succession methods for the appointment of nursing unit managers in the Islamic Republic of Iran (IRI). In this study, a comprehensive literature search was conducted using electronic databases, including PubMed, Cochrane Library, PsycINFO, Scopus, Web of Science, and Google Scholar, to identify relevant studies published between 2010 and 2023. The quality assessment of the selected studies was performed using the Critical Appraisal Skills Program (CASP) tool. Moreover, data extraction and synthesis were conducted to summarize the results of included studies. A total of 11 studies were included in this systematic review. The studies selected for this review were interventional (n = 7) and review studies (n = 4). The findings of this review demonstrated that the most important of talent acquisition and succession planning strategies included competency assessment, leadership development programs, coaching programs, and performance evaluation. The strategies are effective in identifying and developing managers of nursing units with high potential. Health policy and health promotion benchmarks emphasize the importance of ensuring a skilled workforce in healthcare settings to provide high-quality care to patients. By implementing talent acquisition and succession planning strategies, healthcare organizations can develop the next generation of nursing unit managers, which will ultimately lead to increased patient satisfaction and improved health outcomes.

Introduction

Nursing unit managers are nurses who supervise nursing staff in healthcare facilities such as hospitals, clinics, and care centers. They are responsible for patient care, staff scheduling, budget management, and ensuring compliance with healthcare regulations.[1,2] Talent identification and replacement are measures for the appointment of nursing managers. These actions include identifying individuals with the skills required, abilities, and knowledge to assume leadership roles in nursing.[3,4] To effectively identify talent, organizations can implement various strategies. Nursing managers must actively evaluate the performance of their team members.[5]

Moreover, organizations should provide opportunities for professional development and training for nurse managers.[6,7] This can include management workshops and leadership programs. Succession planning is another important procedure for the appointment of nursing department managers.[8,9] This includes identifying candidates for future leadership roles and creating opportunities to gain experience and skills. Succession planning focuses on creating a pool of talented individuals to be recruited when a vacancy occurs.[10]

One of the important aspects of talent search and succession planning is mentoring. Establishing mentoring programs can help individuals groom their potential successors by providing support and opportunities to learn from experienced nurse managers.[11] It is important to ensure that the appointment of nurse managers is fair. This includes specifying the qualifications, skills, and competencies required for the intended role.[12,13]

In addition, organizations should have a consistent interview process that assesses the suitability of candidates for the position.[14] Global organizations, such as the World Health Organization (WHO) and the International Council of Nurses (ICN), have emphasized the importance of nurse leadership quality in achieving organizational goals and promoting quality healthcare.[15] These organizations support effective talent identification and succession planning methods to ensure the availability of competent nurse managers.[16,17]

Several studies have investigated talent acquisition and succession planning strategies for the appointment of nursing managers. Manning et al.[18] conducted a study on planning to assess the smooth transition of a succession planning program and reported a succession plan for future nursing unit managers[19] Stephens also investigated a succession plan for nurse managers with the aim of creating a leadership path for their future. In this study, Stephen evaluated the comprehensive Nurse Manager Succession Planning (NMSP) program that showed an increase in the retention of assistant nurse managers (ANM) and internal promotion of the nurse manager’s role.[3] Moreover, Witges evaluated becoming a nurse manager from the perspective of nurse managers using a modified strategic talent management framework. This study considered organizational leadership practices that influence nurses to become nurse managers.[20] Similarly, Du Plessis designed a succession planning framework for the leadership development of nurse educators in nursing education institutions in South Africa.[8] Titzer et al.[21] conducted a study on the NMSP using evidence synthesis and observed that new nurse managers need months to adjust to their positions.

Furthermore, Phillips et al.[22] also performed a study on the NMSP based on cost–benefit analysis. The results of this study showed that comparing the costs of the official NMSP strategy with the existing situation resulted in a positive cost–benefit ratio. In addition, Yudianto et al.[23] evaluated the leadership model of succession planning for nursing managers in hospitals. Besides, LaCross et al.[24] evaluated the NMSP by evaluating the impact of a pilot program on self-perceived readiness.

Despite the identified challenges, several studies have investigated the methods of talent identification and succession for nursing managers. However, the existing literature lacks a comprehensive synthesis and a systematic review to evaluate the effectiveness of these methods.[25] Considering the vital role of nursing unit managers in healthcare environments, it is necessary to identify and develop people who have the skills and characteristics necessary to succeed in these positions.[26]

The novelty of this study was its focus on talent identification and succession training for nursing unit managers. Although numerous studies have been conducted on talent management in healthcare, very few of these studies have specifically examined nursing unit managers. These managers play an important role in ensuring the smooth operation of hospital units, which is very necessary in this area. Therefore, the review aimed to contribute to the body of knowledge by combining existing literature and identifying effective methods of talent identification and succession planning for nursing unit managers.

Material and Methods

The aim of this systematic review was to synthesize the existing literature on talent identification and succession methods for the appointment of nursing unit managers. The primary research question in this systematic review was “What are the methods of talent identification and succession methods for the appointment of nursing unit managers?”. A study protocol was developed to describe the objectives, research questions, and methods used in this systematic review. It defined the methodology, study design, search strategy, inclusion and exclusion criteria, data extraction process, quality assessment, data synthesis, the interpretation and reporting of results.[27]

Study design

This study used a systematic review design that involved searching, selecting and systematically analyzing research studies and systematic reviews relevant to the study topic. The studies were selected based on the in-depth insight into talent identification and succession methods for the appointment of nursing unit managers. This review followed the guidelines outlined by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).[27]

Search strategy

The used search terms were “Talent identification,” “Succession plans,” “Strategies,” “Nursing unit managers,” “Nurse leaders,” and “Leadership development”. Studies that met specific inclusion criteria were selected for analysis. The search included studies published in English from various databases, such as PubMed, Cochrane Library, PsycINFO, Scopus, Web of Science, and Google Scholar from 2010 to 2023.

Combine search terms

In the study, the combinations of (“Talent identification” OR “talent management” OR “talent development”) AND (“Succession planning” OR “succession management” OR “succession development”) AND (“Strategies” OR “approaches” OR “methods”) AND (“Nursing unit managers” OR “unit nurse managers” OR “nurse unit leaders” OR “head nurses” OR “charge nurses” OR “nurse administrators” OR “nurse executives”) AND (“Leadership development” OR “leadership training” OR “leadership programs”) were provided.

Inclusion and exclusion criteria

The inclusion and exclusion criteria of the systematic review have been described in Table 1.

Table 1.

Inclusion and exclusion criteria

Inclusion Criteria		Exclusion Criteria
Studies published in peer-reviewed journals.		Studies that are not published in peer-reviewed journals.
Studies that examine the strategies of talent acquisition and succession for the appointment of nursing unit managers.		Studies that do not specifically examine talent acquisition and succession planning strategies for the appointment of nursing unit managers.
Studies that focus on healthcare organizations or institutions.		Studies that do not focus on healthcare organizations or institutions.
Studies conducted in the last 13 years (2010-2023).		Studies that were done before 2010.
Studies that include explicit information about talent acquisition and succession strategies used in the appointment of nursing unit managers.		Studies that do not provide explicit information about talent acquisition and succession strategies used in the appointment of nursing unit managers.
Studies that provide clear results or findings regarding the effectiveness or impact of talent identification and succession planning strategies.		Studies that do not provide clear results or findings regarding the effectiveness or impact of talent acquisition and succession planning strategies.

Data extraction

Data extraction was systematically performed using a predetermined data extraction form. This form included information about study characteristics, participant demographics, research methods, and key findings. The extracted data were then synthesized and analyzed to identify common themes and patterns related to talent acquisition and succession planning strategies in nursing unit managers.

Quality assessment

The CASP tool was used to assess the quality of studies, which is designed to assess the methodological rigor and reliability of the studies.[28] The CASP tool consists of 10 questions that guide reviewers in evaluating various aspects of a study, including the research question, design, data collection and analysis, ethical considerations, and relevance to the public health field [Table 2]. In this method, each study was critically appraised by two independent reviewers, and any disagreements were resolved through discussion.[28] For this, checklist A adapted from CASP was used to assess the quality of qualitative studies and checklist B adapted from CASP was used to assess the quality of systematic reviews. In this study, scoring was used to evaluate the quality of studies. For qualitative and systematic reviews, a total score of 20 was calculated for each article and graded as high quality (score = 20-16), moderate quality (score = 10-15), or low quality (score = 1-9).

Table 2.

The CASP questions for quality assessment of the included studies[28]

Question
Are the objectives of the study clearly stated?
Is the study methodology appropriate?
Is the study design properly considered?
Is the research strategy properly designed?
Are the research inclusion criteria selected correctly?
Is the data extraction selected correctly?
Is the study quality assessment tool selected correctly?
Is the data synthesis done correctly?
Is the data interpretation performed correctly?
Is the report of results clearly stated?

Data synthesis

The combined data from the included studies were analyzed using meta-synthesis. Common themes and patterns related to the talent identification and succession methods for the appointment of nursing unit managers were identified. The findings were then interpreted to generate meaningful insights and recommendations.

Interpretation of results

The interpretation of the results involved analyzing the identified themes in relation to the research questions and objectives. Then, the existing literature and theories related to talent identification and succession methods for the appointment of nursing unit managers were reviewed.

Reporting

The results of the systematic review were reported following the guidelines of the PRISMA statement [Appendices 1 and 2]. This report provided a clear and concise overview of the study design, search strategy, inclusion criteria, data extraction methods, quality assessment, data synthesis, and interpretation of results. Recommendations for practice and future research were also included.

Results

Description of the included studies

After a complete search in the selected databases based on the methods described in the methodology, 10 articles were selected from 1255 related studies. The selected studies for this review were interventional (n = 7) and review studies (n = 4). The PRISMA Flow diagram is shown in Figure 1. Moreover, the characteristics of included studies in the review are described in Table 3.

Figure 1.

Trend of screening and choosing articles based on PRISMA flow diagram

Table 3.

Characteristics of included studies in the review study

Study No.		First author		Year		Country		Title		Study type		Aim		Methods		Results and conclusion		Quality assessment
1		Manning et al.[18]		2015		Australia		Planning for a smooth transition: evaluation of a succession planning program for prospective nurse unit managers		Interventional		Report on a succession plan for future nursing unit managers		In this study, eight prospective management candidates participated in the future nursing unit managers program. The effectiveness of the program was measured by comparing pre- and post-program surveys regarding participants’ perceptions of personal leadership and management skills.		The results showed that there was a significant difference in the scores from the baseline to the 6-month follow-up examination in the confidence of the participants to assume the role of the nursing unit manager and in their management skills. It was concluded that investing in structured programs to prepare nurses for leadership roles is recommended as a workforce management strategy.		15/20
2		Stephens[3]		2019		USA		Nurse Manager Succession Planning: Building a Leadership Pipeline for the Future		Interventional		Develop, implement, and evaluate a formal NMSP program for the nurse manager role, with the goal of reducing turnover and filling nurse manager positions with internal nurse manager candidates		A comprehensive evaluation of the NMSP project and outcome measures, nurse manager retention and promotion of nurse manager, as well as improvement of candidate perception of leadership competence and management skills after the leadership development program was conducted using a valid and reliable instrument.		Increased internal retention and promotion findings from this evidence-based project indicated that formal and deliberate succession planning, along with individual development plans, has positive implications for the preparation of future nurse managers.		16/20
3		Witges et al.[20]		2015		Canada		Becoming a nurse manager: from the perspective of nurse managers using a modified strategic talent management framework		Interventional		Examining the perceptions and experiences of nursing managers from holding nursing management positions		Using a modified version of Collings and Mellahi’s (2009) strategic talent management framework, two main themes emerged from the data that provide insight into how nurses become nurse managers.		The findings of this research were consistent with the literature on understanding work motivations, as well as effective leadership practices believed to support career aspirations in nursing leadership.		17/20
4		Hampel et al.[29]		2010		Australia		A model of succession planning for mental health nurse practitioners		Review		The review of the current literature on succession planning for mental health nurses		This study identified succession planning as a means of managing the present and future workforce, while simultaneously addressing individual and organizational learning and practice developmental needs.		Succession planning done effectively and in partnership with the wider clinical service has the potential to develop nurse leadership and transition leadership broadly.		16/20
5		Du Plessis et al.[8]		2019		South Africa		A succession planning framework for leadership development of nurse educators in nursing education institutions in South Africa		Interventional		Development of a succession planning framework for leadership development of nurse educators in nursing education institutions in South Africa		A mixed-methods sequential descriptive design was used to examine current succession practices and processes for the leadership development of nurse educators in nursing education institutions in South Africa. This study was guided and informed by Matsu’s (2010) conceptual framework for succession planning and management. The researcher conducted this study in three stages.		Phase 1 results showed that current succession practices are unstructured and succession processes are unclear. Therefore, there is a need for formal succession planning for the leadership development of nursing educators.		18/20
6		Titzer et al.[21]		2013		USA		Nurse manager succession planning: synthesis of the evidence		Review		A review and synthesis of the literature on nurse manager succession planning to explore the best practices for identifying and developing future nurse managers		A systematic literature search assessed and summarized the current literature supporting nurse manager succession planning. Several reviewers were used to increase the reliability and validity of article selection and analysis.		Organizations that identify and develop internal human capital can improve role transition, reduce nurse manager turnover rates, and reduce replacement costs. Despite the clear benefits of succession planning, studies show a lack of resource allocation for the proactive and intentional development of current and future nurse leaders.		18/20
7		Griffith et al.[30]		2012		USA		Effective succession planning in nursing: a review of the literature		Review		Evaluation of succession planning initiatives in nursing and proposal of a new and comprehensive planning model		Databases and Internet information contributed to this review. Because the problems of identifying, attracting, developing, and retaining nursing leaders are linked to the global nursing shortage, multiple sources from countries and international organizations were used.		Nursing leaders must plan for succession at all levels of management. To confirm the benefits of this planning, three issues were suggested for future research.		17/20
8		Jennifer Titzer et al.[31]		2014		USA		A nurse manager succession planning model with associated empirical outcomes		Interventional		Assessing the perception of leadership and management competence after succession planning of the official nurse manager		A mixed semi-experimental research design, one pre-test/post-test group was used. Nurses working in an acute care hospital were selected for the study and selected using an objective assessment process.		Participants’ perceptions of leadership and management competencies increased significantly after the leadership program. One year after completing the program, 100% of program participants have been retained in the organization and 73% have moved into leadership roles. Succession planning and leadership development serve as beneficial and strategic mechanisms to identify and develop high-potential individuals for leadership positions.		19/20
9		Phillips et al.[22]		2018		USA		Nurse manager succession planning: A cost–benefit analysis		Interventional		Provide a cost-benefit analysis to support the use of succession planning to reduce the problems associated with nurse director turnover		A cost–benefit analysis of a formal surrogacy program was conducted in a hospital. Assumptions of cost–benefit analysis of nurse manager succession planning are identified and discussed.		Implementing nurse manager succession planning effectively reduces replacement costs and transition time to a new role. Using real cost–benefit analysis equips nurse managers with valuable evidence that demonstrates succession planning as a viable business strategy.		15/20
10		Yudianto et al.[23]		2023		Indonesia		Succession Planning Leadership Model for Nurse Managers in Hospitals: A Narrative Review		Review		Identification of nurse succession model and its application in clinical practice		This study uses the validity review of the literature approach. Article search was done using electronic databases (PubMed and Science Direct). The researchers found 18 articles.		Training and guidance related to leadership, human resource support, and adequate funding are the main factors in implementing effective succession planning. Succession planning can also help nurses find qualified leaders. But in its application in clinical practice, the recruitment and planning process for nurse managers that happens in this field is not optimal; hence, succession must exist and be integrated with organizational needs.		18/20
11		LaCross et al.[24]		2019		USA		Nurse manager succession planning: evaluating a pilot program’s effect on self-perception of readiness		Interventional		Assessing perceived readiness to transition to nurse manager roles and demonstrated leadership behaviors among participants in a nurse manager succession pilot.		Quasi-experimental and correlational design methods were used to measure changes in nurses’ readiness to enter nursing manager roles during a 90-day pilot.		The results indicated that participants’ perceived readiness for transition into nurse manager roles and demonstrated leadership behaviors that increased between days 1 and 90 of the program. Moreover, a statistically significant increase in their participation in the experimental group of substitute parenting of the nurse manager was reported.		17/20

Quality assessment of the intended studies

The results of this systematic review that provided insights into the talent identification and succession methods for the appointment of nursing unit managers were identified. This study followed the CASP guidelines for assessing the quality of included studies. The quality assessment of the interventional (n = 7) and review studies (n = 4) included in the current review are shown in Tables 4 and 5, respectively. The quality assessment of the interventional studies (n = 7) is provided in checklist A [Table 4]. As shown in this table, the scores of studies 1, 2, 3, 4, 5, 6, and 7 are 15, 16, 17, 18, 19, 15, and 17 respectively. The results of the quality assessment of the interventional studies indicated that 5 studies were of high quality and also 2 studies were of moderate quality. Moreover, the quality assessment of the review studies (n = 4) is described in checklist B [Table 5]. As demonstrated in this table, the scores of studies 1, 2, 3, and 4 were 16, 18, 17, and 18 respectively. The results of the quality assessment of the systematic reviews indicated that all 4 reviews were of high quality. In general, from 11 studies reviewed in this research, 9 studies were of high quality and 2 studies were of moderate quality. The completed questionnaire is included in Appendix 3.

Table 4.

Quality assessment of interventional studies applied from CASP (checklist A)

References		Question																				Score Max=20
		1		2		3		4		5		6		7		8		9		10
Manning et al.[18]		2		0		2		2		1		2		2		2		0		2		15/20
Stephens et al.[3]		1		2		1		2		2		1		2		2		1		2		16/20
Witges et al.[20]		2		0		2		2		2		2		2		2		2		1		17/20
Du Plessis et al.[8]		2		2		2		2		1		1		2		2		2		2		18/20
Jennifer Titzer et al.[31]		2		2		2		2		2		2		2		1		2		2		19/20
Phillips et al.[22]		2		2		2		2		0		1		2		2		2		0		15/20
LaCross et al.[24]		1		2		1		1		2		2		2		2		2		2		17/20

Table 5.

Quality assessment of review studies applied from CASP (checklist B)

References		Question																				Score Max=20
		1		2		3		4		5		6		7		8		9		10
Hampel et al.[29]		2		1		0		2		2		1		2		2		2		2		16/20
Titzer et al.[21]		1		2		2		2		2		2		2		2		2		1		18/20
Griffith et al.[30]		2		1		2		1		2		2		2		2		1		2		17/20
Yudianto et al.[23]		2		2		2		1		2		2		2		1		2		2		18/20

Discussion

The results of the included studies were compared and combined to draw conclusions and identify common effective factors. This search that yielded a total of 11 studies, which examined the talent identification and succession methods for the appointment of nursing unit managers, were identified [Table 3]. The quality assessment results showed that most of the included studies were of high quality [Tables 4 and 5]. In addition, some specific duties of nurse managers have been provided in Table 6. Furthermore, some methods for talent identification and succession planning in the appointment of nurse managers are described in Table 7.

Table 6.

Some specific duties of nurse managers

Duty		Explanation
Managing the nursing staff		This includes hiring and training nurses, assigning duties and responsibilities, and evaluating and providing feedback to staff.
Patient care coordination		By coordinating and collaborating with other healthcare professionals, including physicians, therapists, and social workers, nurse managers ensure that patient care is provided efficiently and effectively.
Staff scheduling		Nurse managers create work schedules for nurses, ensure adequate coverage for all shifts, and minimize overtime.
Budget management		Nursing managers are responsible for managing the budget of the nursing department. They monitor costs, allocate resources appropriately, and justify costs to senior management.
Quality improvement		Nurse managers implement and oversee quality improvement initiatives to improve patient care outcomes and optimize workflow processes.
Nursing policy and procedure development		Nursing managers are involved in developing, revising, and updating nursing policies and procedures to ensure compliance with regulatory standards and best practices.
Staff development and education		Nurse managers provide educational and training opportunities for their staff to enhance their knowledge and skills and promote professional growth.
Conflict resolution		Nursing managers resolve conflicts between employees and deal with issues that arise in the nursing department.

Table 7.

Some methods for talent identification and succession planning in the appointment of nurse managers

Method		Explanation
Competency-based assessments		Conduct a comprehensive assessment of nurses’ competencies to identify potential candidates for management positions. This assessment can include assessment of clinical knowledge, leadership skills, communication abilities, critical thinking, and problem-solving capabilities.
Performance evaluations		Regularly evaluate the performance of nurses to identify those who consistently demonstrate strong leadership qualities, effective decision-making skills, and motivation for continuous improvement. Performance assessments can provide insights into individual strengths and areas for improvement and help guide succession planning efforts.
Succession planning		Implement formal succession planning that identify high-potential nurses and provide development and training opportunities to prepare them for future management positions. Such programs can include mentoring, shadowing opportunities, leadership workshops, or participation in special projects or committees.
Internal promotion		Consider promoting internal candidates who have demonstrated exceptional performance and leadership potential. Internal promotion fosters a culture of growth and development in the organization and motivates other nurses to strive for improvement.
Job rotation and cross-training		Provide opportunities for nurses to rotate through different departments, divisions, or programs to gain a thorough understanding of healthcare operations and management. Cross-training encourages professional growth, promotes the acquisition of diverse skills, and broadens the perspectives of potential candidates.
Succession planning committees		Create committees comprising nurse leaders and other relevant stakeholders to oversee talent acquisition and succession processes. These committees can evaluate potential candidates, discuss their suitability for management positions, and make recommendations for appointments.
Leadership development programs		Give nurse leaders the opportunity to participate in leadership development programs or courses. These programs can enhance their management and leadership skills, increase their knowledge of healthcare management, and prepare them for higher level roles.
Formal mentorship programs		Pair aspiring nurse managers with experienced mentors who can share their guidance, support, and professional expertise. Mentoring can play an important role in developing future nursing leaders and facilitating a smooth transition into management positions.
Succession planning reviews		Regularly review and update succession plans to ensure they are aligned with the organization’s strategic goals and evolving needs. Evaluating the effectiveness of the talent search and succession methods used and making the necessary adjustments to improve the results.

Talent identification and succession planning are critical processes in the appointment of nurse managers. These procedures help organizations identify and develop individuals with the necessary skills and potential to take on leadership roles within the nursing department.[32,33] Some methods for talent identification and succession planning in the appointment of nurse managers are described in Table 7. According to this table, the methods are assessments that are based on competency, performance evaluations, succession planning, internal promotion, job rotation and cross-training, succession planning committees, leadership development programs, formal mentorship programs, and succession planning reviews [Figure 2].

Figure 2.

Methods of talent identification and succession planning in the appointment of nurse managers

This review found that competency-based assessments assess the skills, knowledge, and behaviors required for nurse managers. These assessments identify people with the necessary competencies for this role.[34] Duffield et al.[35] investigated competency-based assessments that identify nurse manager talents and observed that this approach is effective in ensuring that individuals possess the skills and qualities necessary for leadership roles. Similarly, Griffith concluded that nursing leaders should plan for succession at all levels of management. The author concluded that substitution planning should include identifying, recruiting, maintaining, developing, and coaching potential nurse leaders during their studies. They also reported that communications, cooperation, and coordination between the university and the organization that are in charge of the new nurses are essential.[30]

Moreover, evaluations on regular performance help organizations to evaluate the performance of nursing management unit candidates. These evaluations include feedback from peers, subordinates, and supervisors and can help identify individuals with managerial ability.[36] George and Haag–Heitman[37] studied the use of performance appraisals in identifying potential nurse manager successors and observed that these appraisals are useful in providing feedback on strengths and areas for improvement. In addition, Phillips et al.[22] concluded that the implementation of the nurse’s successor planning effectively reduces the cost of replacement and the time of transition to the new role. The internal pipeline program offers future leaders, who will be more successful than foreign candidates. They reported that the use of cost and benefit analysis helps nursing managers with succession planning.

Additionally, succession planning strategy has been created to identify and nurture nursing managers in the organization. The strategy includes personal development programs and create training opportunities to prepare people for future leadership positions.[38,39] Tourangeau et al.[40] surveyed succession planning strategy in nurse management and highlighted the importance of establishing formal succession plans to ensure there are qualified candidates for leadership roles. Yudianto et al.[23] also evaluated the successful planning model for nursing managers in hospitals. The results of their study showed that leadership education and guidance, human resource support, and adequate budget are the most important factors in implementing succession planning.

Moreover, the present study demonstrated that internal promotion is a common method for talent identification and succession planning, which leads to the identification and development of talented people in the nursing staff who have demonstrated leadership quality.[41] Stephens examined NMSP with the aim of creating a leadership path for the future. The results of the study demonstrated that formal and deliberate succession planning, along with individual development plans, have positive implications for the preparation of future nurse managers.[3]

In addition, creating opportunities for nurses to gain experience in job rotation can identify participants in different fields. This provides valuable insights into their ability to handle managerial responsibilities.[42] LaCross et al.[24] evaluated the Nursing Manager’s succession planning through a comprehensive preparation test. According to the results of this study, the comprehensive readiness of the participants to move to the role of the nurse manager and leadership behaviors increased between days 1 and 90. Moreover, a significant increase in their participation in the Nursing Manager’s succession experiment was observed.

The review indicated that the succession planning committees can be established to oversee talent identification and succession planning. The committees are responsible for evaluating potential candidates, creating developmental plans, and ensuring an efficient pipeline of candidates for nurse management.[43] Hampel et al. presented a model of succession planning based on the principles of leadership development, workforce involvement, and customer involvement. This study identified succession planning as a tool for managing the current and future workforce, while simultaneously addressing individual and organizational learning and practice developmental needs.[29]

The results of their study showed that broader clinical service involvement increased mental health nurse leadership development and leadership transition in succession planning.[29] Furthermore, Takase et al. evaluated the factors related to self-other agreement and disagreement in nursing competence assessment, highlighting the benefits of providing ongoing training and support for aspiring leaders.[44] The results of Du Plessis et al.’s study demonstrated that the current succession practices are not structured and the succession processes are unclear. Therefore, there is a need for formal succession planning for the leadership development of nursing educators. The steps they proposed for succession include (1) strategic alignment, (2) participation and commitment in leadership development, (3) succession planning process, (4) implementation, and (5) talent management. This study identified an urgent need for a succession planning for the leadership development of nurse educators in nursing education institutions in South Africa. They concluded that communication and teamwork between senior management and the HR department play an important role in succession planning and implementation.[8] The leadership development programs develop the leadership skills of effective nursing managers. The programs include training in areas such as communication, conflict resolution, team building, and strategic thinking.[45]

Witges also evaluated organizational leadership practices that influence nurses to become nurse managers. The results of the study showed that work motivation and the desire to become a leader are effective factors in the appointment of nursing department managers.[20] In another study, Titzer et al.[31] introduced a nurse’s successor planning model with relevant experimental results. The results of their study showed that participants’ understanding of leadership and post-leadership qualifications have increased significantly. One year after the program is completed, 100% of the program participants were retained in the organization and 73% were transferred to leadership roles. It was concluded that succession planning and leadership development are useful and strategic mechanisms to identify people with leadership capabilities.

The review also indicated that formal mentorship programs facilitate knowledge transfer and skill development. Educators can provide helpful support and guidance regarding the nurse manager role. The deliberate planning of the nurse’s successor should be integrated into the organization’s strategic plan and provide an active way to identify and develop potential leaders.

Moreover, regularly reviewing succession planning efforts may identify strengths and ways to improve talent identification strategies. This will prioritize settings to ensure a strong pipeline of qualified nurse managers.[46]

The present study also demonstrated that a combination of these methods identifies talented people and leads to a smooth transition in the appointment of nurse managers.[47] Manning et al.[18] conducted a study on planning to evaluate the smooth transition of a succession planning program for future nursing unit managers. They presented a succession plan for future nursing unit managers. The effectiveness of the program was measured by comparing pre- and post-program surveys on participants’ perceptions of personal leadership and management skills. A statistically significant difference was observed in the scores from the baseline to the 6-month follow-up examination in the participants’ confidence in assuming the role of the nursing unit manager and their management skills. They concluded from the results that investing in structured programs to prepare nurses for leadership roles is highly recommended as a management workforce strategy.

Based on the review of the studies, talent acquisition strategies were primarily focused on assessing competencies, skills, and potential for leadership roles. Common methods included performance evaluation, personality assessment, and structured interview. Succession planning strategies include identifying high-potential candidates, providing targeted development opportunities, and building talent pools for future leadership roles. Mentoring, coaching, and leadership development programs were often used to prepare people for management positions.

Talent acquisition and succession planning are the critical aspects of ensuring a successful and sustainable healthcare organization. When it comes to appointing nursing unit managers, these strategies play a vital role in identifying and developing potential leaders in the nursing staff.[25,48] Talent acquisition helps to identify nursing staff who have the necessary skills, knowledge and characteristics to be successful nursing unit managers. By identifying and nurturing these individuals, organizations can ensure a pipeline of future leaders who are ready to step into leadership roles when needed.[41] In addition, talent acquisition and succession planning can motivate nursing staff to excel in their roles and strive for career advancement. By providing clear pathways for advancement within the organization, employees are more likely to be engaged and committed to their work.[49] Moreover, by investing in talent identification and succession planning, organizations can ensure that nursing unit managers are well prepared and qualified. This can lead to improved patient outcomes, increased employee satisfaction, and overall organizational success.[22] Furthermore, nursing unit managers play an important role in ensuring the delivery of high- quality patient care. By having a strong talent identification and succession planning strategy, organizations can ensure the continuity of leadership and management practices that ultimately benefit patient care.[50,51] In general, talent acquisition and succession planning strategies are essential for the appointment of nursing unit managers. By investing in these strategies, organizations can identify and develop future leaders, promote career development, increase organizational stability, improve leadership quality, and ensure continuity of care. Ultimately, these efforts contribute to the overall success and sustainability of the healthcare organization.

Conclusions

A systematic review of talent identification and succession planning strategies for the appointment of nursing unit managers was conducted. The results of the quality assessment of the interventional studies[7] showed that 5 studies were of high quality and 2 studies were of moderate quality. Moreover, the results of the quality assessment of the systematic reviews indicated that all 4 reviews were of high quality. In general, from 11 studies reviewed in this research, 9 studies were of high quality (scores between 16 and 20) and 2 studies were of moderate quality (scores between 10 and 15). This review revealed that the most important of talent acquisition and succession planning strategies included competency assessment, leadership development programs, coaching programs, and performance evaluation. The strategies are effective in identifying and developing managers of nursing units with high potential. Health policy and health promotion benchmarks emphasize the importance of ensuring a skilled workforce in healthcare settings to provide high quality care to patients. By implementing talent acquisition and succession planning strategies, healthcare organizations can develop the next generation of nursing unit managers that ultimately increases patient satisfaction and improves public health.

The strengths of this study

One of the strengths of this review was its systematic review methodology, which ensured that almost all relevant literature on talent acquisition and succession planning for nursing unit managers was thoroughly reviewed and synthesized. It provides an overview of the current state of knowledge in this field.

The limitations of this study

This study also has limitations. One limitation of this study was that it did not consider the nuances and challenges faced by different types of healthcare organizations, which could limit the generalizability of the findings.

Suggestions

This review provided valuable insights into strategies. Healthcare organizations can use these strategies to identify and nurture talented individuals for leadership roles in nursing units. The suggestions presented in this study for future applied studies include conducting longitudinal studies to evaluate the long-term impact of talent acquisition and succession planning strategies on the performance of nursing unit managers. In addition, this study recommends investigating the role of coaching in the development of nursing unit managers.

Abbreviations

• IRI = slamic Republic of Iran

• CASP = Critical Appraisal Skills Program

• WHO = World Health Organization

• ICN = International Council of Nurses

• NMSP = Nurse Manager Succession Planning

• ANM = Assistant Nurse Managers

• PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

Conflicts of interest

There are no conflicts of interest.

Appendix 1.

PRISMA_2020_Checklist

Section and Topic		Item #		Checklist item		Reported (Yes/No)
Title						Yes
Title		1		Identify the report as a systematic review.		Yes
Abstract						Yes
Abstract		2		See the PRISMA 2020 for Abstracts checklist.		Yes
Introduction						Yes
Rationale		3		Describe the rationale for the review in the context of existing knowledge.		Yes
Objectives		4		Provide an explicit statement of the objective(s) or question(s) the review addresses.		Yes
Methods						Yes
Eligibility criteria		5		Specify the inclusion and exclusion criteria for the review and how studies were grouped for the syntheses.		Yes
Information sources		6		Specify all databases, registers, websites, organizations, reference lists, and other sources searched or consulted to identify studies. Specify the date when each source was last searched or consulted.		Yes
Search strategy		7		Present the full search strategies for all databases, registers, and websites, including any filters and limits used.		Yes
Selection process		8		Specify the methods used to decide whether a study met the inclusion criteria of the review, including how many reviewers screened each record and each report retrieved, whether they worked independently, and if applicable, details of automation tools used in the process.		Yes
Data collection process		9		Specify the methods used to collect data from reports, including how many reviewers collected data from each report, whether they worked independently, any processes for obtaining or confirming data from study investigators, and if applicable, details of automation tools used in the process.		Yes
Data items		10a		List and define all outcomes for which data were sought. Specify whether all results that were compatible with each outcome domain in each study were sought (e.g., for all measures, time points, analyses), and if not, the methods used to decide which results to collect.		Yes
		10b		List and define all other variables for which data were sought (e.g., participant and intervention characteristics, funding sources). Describe any assumptions made about any missing or unclear information.		Yes
Study risk of bias assessment		11		Specify the methods used to assess risk of bias in the included studies, including details of the tool(s) used, how many reviewers assessed each study and whether they worked independently, and if applicable, details of automation tools used in the process.		No
Effect measures		12		Specify for each outcome the effect measure(s) (e.g., risk ratio, mean difference) used in the synthesis or presentation of results.		No
Synthesis methods		13a		Describe the processes used to decide which studies were eligible for each synthesis (e.g., tabulating the study intervention characteristics and comparing against the planned groups for each synthesis (item #5)).		Yes
		13b		Describe any methods required to prepare the data for presentation or synthesis, such as handling of missing summary statistics, or data conversions		Yes
		13c		Describe any methods used to tabulate or visually display results of individual studies and syntheses.		Yes
		13d		Describe any methods used to synthesize results and provide a rationale for the choice(s). If meta-analysis was performed, describe the model(s), method(s) to identify the presence and extent of statistical heterogeneity, and software package(s) used.		Yes
		13e		Describe any methods used to explore possible causes of heterogeneity among study results (e.g., subgroup analysis, meta-regression).		Yes
		13f		Describe any sensitivity analyses conducted to assess robustness of the synthesized results.		Yes
Reporting bias assessment		14		Describe any methods used to assess risk of bias due to missing results in a synthesis (arising from reporting biases).		No
Certainty assessment		15		Describe any methods used to assess certainty (or confidence) in the body of evidence for an outcome.		Yes
Study selection		16a		Describe the results of the search and selection process, from the number of records identified in the search to the number of studies included in the review, ideally using a flow diagram.		Yes
		16b		Cite studies that might appear to meet the inclusion criteria, but which were excluded, and explain why they were excluded.		Yes
Study characteristics		17		Cite each included study and present its characteristics.		Yes
Risk of bias in studies		18		Present assessments of risk of bias for each included study.		No
Results of individual studies		19		For all outcomes present for each study include (a) summary statistics for each group (where appropriate) and (b) an effect estimate and its precision (e.g., confidence/credible interval), ideally using structured tables or plots.		Yes
Results of syntheses		20a		For each synthesis, briefly summaries the characteristics and risk of bias among contributing studies.		Yes
		20b		Present results of all statistical syntheses conducted. If meta-analysis was done, present the summary estimate and its precision (e.g., confidence/credible interval) and measures of statistical heterogeneity for all. If comparing groups, describe the direction of the effect.		Yes
		20c		Present results of all investigations of possible causes of heterogeneity among study results.		Yes
		20d		Present results of all sensitivity analyses conducted to assess the robustness of the synthesized results.		Yes
Reporting biases		21		Present assessments of risk of bias due to missing results (arising from reporting biases) for each synthesis assessed.		No
Certainty of evidence		22		Present assessments of certainty (or confidence) in the body of evidence for each outcome assessed.		Yes
Discussion						Yes
Discussion		23a		Provide a general interpretation of the results in the context of other evidence.		Yes
		23b		Discuss any limitations of the evidence included in the review.		Yes
		23c		Discuss any limitations of the review processes used.		Yes
		23d		Discuss implications of the results for practice, policy, and future research.		Yes
Other information						Yes
Registration of protocol		24a		Provide registration information for the review, including register name and registration number, or state that the review was not registered.		No
		24b		Indicate where the review protocol can be accessed, or state that a protocol was not prepared.		No
		24c		Describe and explain any amendments to information provided at registration or in the protocol.		No
Support		25		Describe sources of financial or non-financial support for the review, and the role of the funders or sponsors in the review.		Yes
Competing interests		26		Declare any competing interests of review authors.		Yes
Availability of data, code and other materials		27		Report which of the following are publicly available and where they can be found: template data collection forms; data extracted from included studies; data used for all analyses; analytic code; any other materials used in the review.		Yes

From: Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ 2021;372:n71. doi: 10.1136/bmj.n71

Appendix 2.

PRISMA_2020_Abstract_Checklist

Section and Topic		Item #		Checklist item		Reported (Yes/No)
Title						Yes
Title		1		Identify the report as a systematic review.		Yes
Background						Yes
Objectives		2		Provide an explicit statement of the main objective(s) or question(s) the review addresses.		Yes
Methods						Yes
Eligibility criteria		3		Specify the inclusion and exclusion criteria for the review.		Yes
Information sources		4		Specify the information sources (e.g., databases, registers) used to identify studies and the date when each was last searched.		Yes
Risk of bias		5		Specify the methods used to assess risk of bias in the included studies.		No
Synthesis of results		6		Specify the methods used to present and synthesize results.		Yes
Results						Yes
Included studies		7		Give the total number of included studies and participants and summaries relevant characteristics of studies.		Yes
Synthesis of results		8		Present results for main outcomes, preferably indicating the number of included studies and participants for each. If meta-analysis was done, report the summary estimate and confidence/credible interval. If comparing groups, indicate the direction of the effect (i.e., which group is favored).		Yes
Discussion						Yes
Limitations of evidence		9		Provide a brief summary of the limitations of the evidence included in the review (e.g., study risk of bias, inconsistency and imprecision).		Yes
Interpretation		10		Provide a general interpretation of the results and important implications.		Yes
Other						Yes
Funding		11		Specify the primary source of funding for the review.		Yes
Registration		12		Provide the register name and registration number.		No

From: Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ 2021;372:n71. doi: 10.1136/bmj.n71

Appendix 3.

Questionnaire

Study name		1. Clarity of study objectives		2. Appropriateness of the methodology		3. Appropriateness of the study design		4. Suitability of the research strategy		5. Adequacy of inclusion criteria		6. Correctness of data extraction		7. Appropriateness of quality assessment tool researchers		8. Correctness of data synthesis		9. Evaluation of i the results interpretation		10. The clarity of the results report		Overall quality
Manning et al. 2015[18]		+		+		+		-		?		-		-		+		+		?		Moderate
Stephens 2019[3]		+		+		+		+		?		+		?		+		+		+		High
Witges 2015[20]		+		+		+		+		?		+		?		+		+		+		High
Hampel et al. 2010[29]		+		+		+		+		+		+		+		?		+		+		High
Du Plessis 2019[8]		+		+		+		+		+		+		+		?		+		?		High
Titzer et al. 2013[21]		+		+		+		+		+		?		?		+		+		+		High
Griffith 2012[30]		+		+		?		+		+		+		?		+		?		+		High
Titzer et al. 2014[31]		+		+		-		+		+		+		+		?		+		+		High
Phillips et al. 2018[22]		+		+		+		-		+		+		?		?		+		-		Moderate
Yudianto et al. 2023[23]		+		+		?		+		+		+		+		+		+		+		High
LaCross et al. 2019[24]		+		+		+		+		+		+		+		+		+		+		High

Funding Statement

Nil.