Running head: NURSE MANAGER ANALYSIS

Analyzing the Role of a Nurse Manager Denise S. VanderWeele Ferris State University, NURS 440

NURSE MANAGER ANALYSIS Analyzing the Role of a Nurse Manager The role of Nurse Manager has evolved over the past 36 years of my career. A position

that used to be heralded as the Head Nurse is now called the Nurse Manager, evoking a more business-like model of job behavior. Nurse Managers have become so much more than expert clinicians who dole out assignments and write evaluations. This paper presents reflections of an experienced nurse manager, a look at her job description and current theory on management in nursing. It is the purpose of this analysis to highlight the qualities and practices that produce an effective nurse manager. Background L.M., BSN is the nurse manager of an obstetric unit that consists of eight triage beds, eight labor/delivery/recovery suites, an operative suite, 20 postpartum beds, a newborn nursery and an eight bed special care nursery. Her unit is located in a medium-sized hospital in a large Midwestern city. Her leadership team includes four Clinical Coordinators (Charge Nurses) who oversee over 100 RNs, CNAs and surgical technicians that provide inpatient care, prenatal education and lactation support services. L.M. answers directly to the Chief Nursing Officer. Job Description The job description for the nurse manager of the Childbirth Center lists specific expectations under the headings of administrative, operational, quality and clinical management skills. Administrative management includes supporting the institutional philosophy, goals and objectives, developing and updating nursing policy, monitoring departmental productivity, acting as a liaison to other departments, and participating in various hospital committees. Operational management ensures the documentation of policies, procedures and protocols and assures that all AOA (American Osteopathic Association), state and federal regulatory and reimbursement

NURSE MANAGER ANALYSIS agency requirements are met. Quality management encompasses hiring and supervising personnel, mentoring Clinical Coordinators, implementing quality improvement initiatives, reviewing unit objectives and all aspects of the department budget. Clinical management requires the appropriate knowledge base for the Childbirth Center, and evaluating staff

performance. The eight-page job description also lists communication expectations, standards of practice, working relationships with all members of the health team, participating in professional activities, and personal knowledge, behavior expectations and physical requirements for the job. L.M. sums up her job duties in one word: communication. She claims that everything depends upon how well she listens, processes the information and then communicates her problem solving process with her team. She emphasizes that active listening is the most important skill that she has because it allows her to fact-find and determine the root of a problem or situation that needs her attention. . McEachen & Keough (2007) agree that communication is essential to the nurse manager role. Other skills that make an effective manager are planning, decision making, delegating, resource managing, staff supervision, trouble-shooting, clinician, leader, and diplomat (McEachen & Keough, 2007). Our text succinctly states that the nurse manager role incorporates communicating goals and objectives, motivating others, analyzing performance, developing people and dividing activities and decisions into tasks that can be accomplished (Yoder-Wise, 2011). The Role as Collaborator The role of communicator and collaborator for a leader cannot be overemphasized. L.M. pointed out that her nursing unit is just one small part of an interdependent organization that cannot function without the other pieces of the whole. L.M. acknowledges that the manner in

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which she communicates with other departments and nurse leaders influences their perception of her department and fosters either cooperation or competition from the other departments. Todays healthcare environment requires the Nurse Manager to spend more time working across organizational boundaries to interact with peers and to negotiate partnerships within and beyond their own department. Negotiating skills become essential (McEachen & Keough, 2007). It is clear from the literature that collaboration and negotiation is a part of the nurse managers role. L.M. is required to attend a meeting with other nurse managers, case workers and risk management leaders each month. This meeting, along with another one that includes all department heads throughout the hospital (e.g. housekeeping, pharmacy, marketing, and human resources) fosters communication and collaboration within the whole organization. Within the department, L.M. encourages collaboration between nurses and with nonnursing personnel. It is an expectation that interaction and cooperation will take place. In the event of a conflict or a problem that cannot be resolved between the parties, L.M. diplomatically assist them in reaching a mutually agreeable conclusion. A Legal & Ethical Issue A legal and ethical issue that occasionally presents itself to L.M. involves her being told confidentially that a nurse is giving substandard or dangerous care. She must handle the information without compromising the confidentiality of the information. If she discovers that the allegation is true and does not address the behavior, she is at risk of legal repercussions. Yoder-Wise (2011) states that knowingly allowing a staff member to function below the acceptable standard of care subjects both the nurse manager and the institution to potential liability.

NURSE MANAGER ANALYSIS A conversation about the undesirable behavior can be very uncomfortable for both the nurse in question and the nurse manager. These conversations are difficult, says L.M., because no one wants to hear that they are doing a poor job. Even if it is not a legal issue, the

nurse manager is ethically obligated to mentor the nurse to encourage better performance for the advancement of nursing practice, the profession and quality health care (Standard 12, ANA, 2010). Another part of this issue, according to L.M., is that she is unable to tell the nurse who originally reported the problem little more than that she has handled the problem. The reporting nurse wants reassurance that her concerns were addressed, but then the manager is unable to give details about the process. The first nurse sometimes gets the impression that I did nothing with the information, states L.M. Power and Influence Nurse managers have power and influence over a range of people. Within their department, they have power by virtue of their position to initiate change. They can use their power to insist on change taking place and their personal influence to make the change happen more smoothly. A transformational leader engages her staff in proposed changes and inspires them to look beyond their discomfort with change toward the outcome of better patient care (Yoder-Wise, 2011). L.M. uses her power to select individuals who will champion the proposed changes and take ownership of the process. Problem Solving L.M.s process for solving problems and making decisions uses her communication skills to gather facts and opinions. She states, I rarely make a decision on my own, without

NURSE MANAGER ANALYSIS consulting those who will be affected by it. Her decision-making style would be considered to be participative or democratic, according to definitions in Yoder-Wise (2011). When solving a problem, L.M. talks with the persons involved in the problem. She first

gathers facts through listening to staff with specific concerns or conflicts, and rounding quarterly on staff nurses to promote better communication and acquire feedback on staff satisfaction. According to The Studer Group, Leader rounding on staff is the single best way to raise employee satisfaction and loyalty and ultimately attract and retain high performing employees (Studer, 2011). By listening to her nursing staff, L.M. is receiving valuable feedback on the operation of the department and giving her staff a voice in the decisions she makes. She also identifies problems when they are small and manageable instead of waiting for something major to happen. Conflict Resolution Managing conflict and arriving at a resolution that is palatable to both parties is a trait of a good manager/leader that sometimes requires the finesse of a diplomat (McEachen & Keough, 2007). L.M. begins by listening to both parties in a conflict situation. She lets them know that their concerns have been heard without passing judgment on the people involved in the conflict. Once the emotion of the situation has diffused, she directs everyone to identify the root cause of the conflict and focus on the process of arriving at a comfortable resolution. Conclusion Leadership is an art that improves with practice. By using a comprehensive job description as a guide and having self-awareness with a desire for growth, a good leader/manager will rise to the position and continue to improve as time passes (McEachen & Keough, 2007).

NURSE MANAGER ANALYSIS References

American Nurses Association (2010). Nursing: Scope and standards of practice. (2nd ed.) Silver Spring, MD: author. McEachen, I., & Keogh, J. (2007). Nurse Management Demystified. New York, NY: MGrawHill. Studer Group (2011). The nurse leader handbook: The art and science of nurse leadership. Gulf Breeze, FL: Fire Starter Publishing. Yoder-Wise, P. S. (2011). Leading and managing in nursing. (5th ed.) St. Louis. MO: Elsevier Mosby.

NURSE MANAGER ANALYSIS Legal and Ethical Issues An example of an ethical and legal issue that this nurse manager has to contend with is a nurse under her supervision who is not performing her job satisfactorily. L..

reports that handling this situation in particular is difficult for her because no one wants to be told they are doing a poor job (Laura McDonald, personal communication, 2013). A nurse who is performing her job unsatisfactorily becomes both a legal and an ethical issue for the nurse manager. If patient safety is in question, the manager can be held legally responsible for not mitigating the behavior. According to our text, Knowingly allowing a staff member to function below the acceptable standard of care subjects both the nurse manager and the institution to potential liabilty (Yoder-Wise, 2011). The report of a nurse not performing her job satisfactorily is both a legal and ethical issue. First, the legal question is whether the patient remains safe during the care given or not given. If patient safety is in question, then she legally has to talk with the nurse in question and counsel her on what she is or is not doing, question how she may do better, offer additional training or model the correct behavior and let her know what the consequences will be if her behavior were to continue. When she receives information that a nurse is not performing her jog satisfactorily, she first listens to the complainant then does a chart review on the nursing care in question.

Denise:

NURSE MANAGER ANALYSIS

Thank you for your submission of paper #2. You have clearly demonstrated your understanding of the assignment as well as addressed each grading rubric element. What makes this assignment unique is that it provides us with an inside look of the daily component necessary to be an effective leader. For example, as a leader we must be able to collaborate effectively; not just with other nursing staff but with all disciplines that make an organization. Secondly, having a clear understanding of our leadership style helps us to be able to manage situations appropriate; but be willing to flex in and out of each style depending on the situation. For example, if there is a crisis requiring direction, you would drive an authoritative style rather than transformational or participative. As a leader, we must be opened to conflict management because it is everywhere regardless of the position. Conflict management is not necessarily a bad thing (if you will)this is how we solve problems and correct behaviors not appropriate for the organization. Lastly, we must be able to stand on an ethical and legal platform that drives bestpractice. At the end of the day, when we begin the leadership journey with the key elements researched for this assignment in mind and incorporate into our practice, we become effective leaders with a vision to be the premiere organization of choice.
Thanks, Eppie