Building Buy-In Isn’t Passive: It Has to Be Intentional
By James Fly
The jump from nurse manager to director of surgical services isn’t a promotion in scope, it’s a promotion in who you now have to actively manage relationships with. Surgeons, anesthesia, and staff were always the job. Finance, the executive team, materials, other nursing leaders, and HR become the job the day the title changes, and nobody hands you a map for it.
That widening only works if it’s deliberate. Pick up the phone and ask another director for ten minutes. Walk to someone’s office instead of sending an email. Grab breakfast in the cafeteria before a hard conversation instead of during it. None of this happens by accident, and a director who treats relationship-building as passive will run out of runway fast.
Surgeons will be the hardest relationships in the building, and that’s normal, not a personal failure. Expect strong working relationships with roughly three-quarters of them. The rest may never fully open up, no matter how many times you catch them in the surgeon’s lounge between cases or run an idea by them for input. That’s a common theme across directors, not a signal something’s wrong with the approach.
Watch for two signals that a relationship is thinner than it looks: pushback on a new process, and a process that quietly reverts to the old way within a few weeks of being “fixed.” Both mean it’s time to revisit the plan, not push harder on the same one. Before any change that touches block time, staffing, or standardization, explain the burning platform, the actual reason the change has to happen, before it happens, not during a case when someone notices the supplies changed. Bring data every time. “This equipment has been used twenty percent of the time over the last nine months” moves a conversation further than any opinion does.
Saying no doesn’t have to cost the relationship if it’s paired with honesty. A surgeon asking for new equipment the department already owns two of deserves a real answer, not now, here’s why, and here’s when the budget conversation happens again. Being a visibly good fiscal steward, not an obstacle, is what keeps that no from becoming personal.
The most overlooked relationships in this job aren’t clinical at all, they’re HR and finance. An above-average relationship with HR means a vacancy that’s actually hurting the department, financially or through burnout, gets treated with urgency instead of sitting in a queue. That only works because the relationship was built long before it was needed.
Every tactic here rests on the same foundation: trust. Once a director earns real credibility, staff, surgeons, and everyone else in the building follow. Without it, none of the other tactics matter.
