Running head: NURSE MANAGER

Analyzing a Nurse Manager Michael P Dugan Ferris State University

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Analyzing a Nurse Manager Leaders and managers are seen in every work environment encompassing the entire global setting. They are important in helping a person to develop his/her capabilities to his/her fullest potential which helps the work place and community at large to function in a cost effective and efficient manner (Yoder-Wise, 2011). Leaders are effective by having a vision for which direction a workplace should go, enabling staff to see this vision, and where they fit in to help achieve this new direction. Managers address complex issues by planning, budgeting, and setting target goals. They meet their goals by organizing, staffing, controlling, and solving problems (Yoder-Wise, 2011, p. 55). A good manager is also a good leader. Phyllis, a nurse manager of the cardiac step-down unit known as A4 and of the Clinical Observation Unit named C2, is an example of a good manager possessing good leadership skills. Phyllis started in management early in her nursing career after attaining an Associates Degree in Nursing (ADN) when she became a charge nurse after being on the job for only six months. In four years time she became a house supervisor for Munson Medical Center (MMC) where she worked. Her nurse management career continued with operating and writing grants for various correctional nursing programs. While she was manager of the outpatient infusion and oncology medical unit in California, she took leadership courses which focused on managing people in a relationship based care setting. Phylliss leadership skills were seen when she recognized the need for, proposed, and then developed telemetry on the oncology medical unit. In 2009, Phyllis was recruited to become nurse manager of one of the largest units at Munson, the A4 unit. In two years she was asked to develop and start the C2 unit which had failed twice before under previous management. In three months time Phyllis researched and developed the observation unit which continues to grow and is

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considered a successful part of the hospital. Phyllis is currently working on a Bachelor of Science in Nursing (BSN) degree which is a requirement of the hospital to keep MAGNET status. This paper analyzes Phylliss management style, her manager roles and duties, her influence, and her decision-making and conflict resolving processes. Job Duties Phyllis manages the resources of the A4 and C2 units. One of the resources is people. Phyllis makes sure competent nursing care is provided to each patient by ensuring the staff is current with their licenses and certifications. She is responsible for staff to attend continuing education, skills classes, and workshops. She ensures that she and her staff adhere to the state board of nursing requirements and follow the standards set forth by the hospital and her units. She describes her main duty and philosophy as making sure each patient has a competent nurse. The units have to operate within the organizational structure of the hospital. This means having a budget to adhere to in meeting the needs of the units. Phyllis has a lot of experience with budgets and this shows when she comes under budget while still providing good patient care. One difficulty Phyllis has with administration is the feeling of being punished for doing a good job. When she does come under budget, administration reduces future budget amounts which put a strain on her to continue to operate under reduced funds. Phyllis also sees herself as an educator to the units on the most current practice and policies coming from administration and research. She believes in mentoring leaders for management positions. This is critical since Laschinger, Wong, Grau, Read, and Stam (2011) reports that the average age of nurse managers is 48 years of age and with retirement looming closer there are few staff nurses expressing interest in moving into these management positions citing unreasonable workloads and unrealistic job expectations of these roles (p. 878).

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On the A4 unit Phyllis reports directly to the director of cardiovascular services. On the C2 unit Phyllis is responsible to the vice president of nursing. Munson Medical Center is set up in a more traditional functional organization with a hierarchy seen in most hospitals and businesses. There is some matrix and flat organizational styles seen in the hospital since shared governance and relationship based care is encouraged and practiced. Five coordinators, eleven charge nurses, and 120 employees report to Phyllis. She has an open door policy and finds satisfaction in seeing people succeed and excel. Collaboration The main way Phyllis collaborates with administration and other managers of the hospital is through e-mail and telephone. She attends many management and council meetings. On the units, the main council meeting she attends and is involved in is shared governance. She is involved directly with the president of Munson Medical Center in working on budgetary concerns and problems. A4 is frequently a forerunner of the hospital in that many pilot programs are started there before moving on to the rest of the hospital. Phyllis collaborates with many different personnel in various departments in getting the pilot programs up and running and working out the glitches. This is in line with the way Phyllis operates in seeking the latest in evidence-based practice to provide patients with the best care possible. Legal and Ethical Issues Phyllis faces many ethical and legal issues in managing the staff of A4 and C2. In her four years of managing these units she has had fifteen terminations. Eight were for drug diversions, six were for bullying, and one was for not upholding nursing standards. Consequences for the unit regarding chemical dependency are reduced staff morale due to

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increased stress by the absenteeism and reduced work capacity of an impaired staff member (Yoder-Wise, 2011). Phyllis reports these drug diversions to the state board of nursing. Legally, consequences for her are the loss of her license and job. Ethically, she would not be fulfilling her duty of providing each patient with a competent nurse. Bullying is a big problem encountered in workplaces that also increases absenteeism, avoidance, and altered patient care due to increased stress. It can increase burnout in nurses causing increased staff turnover which reduces patient satisfaction scores and increases hospital costs (Dombrowsky, 2012). Phylliss open door policy creates an atmosphere of openness in which employees who are supported in reporting workplace aggression may feel they have options other than leaving (Yoder-Wise, 2011, p. 506). It is important for staff to feel like they are supported, being heard, and consequences handed out for those doing the bullying. This is high on Phylliss ethical ladder as seen by the high number of dismissals for bullying. Power and Influence Phyllis knows she has a lot of power and influence. She is well respected by other managers and administration in the hospital. Phyllis has integrity which enables her to use power responsibly. She relies on family and faith to keep her grounded and strong. Phyllis realizes she is part of a team and holds each employee responsible for his/her own actions. She uses her power to get what the units need to provide adequate patient care. She uses her influence to help staff achieve greater potentials which in turn benefits the patient and the hospital in a positive way. Staff are more happy and satisfied with their jobs which the patients perceive. The hospital sees increased productions and reduced turnover which saves the hospital money.

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Yoder-Wise (2011) mentions that the most basic power strategy is the development of a powerful image (p. 181). Phyllis does this by having and portraying self-confidence. Her dress and grooming are professional looking, she has good manners, maintains good body posture, and makes good eye contact. She also has excellent communication skills which is a basic power tool aspect in personal empowerment (Yoder-Wise, 2011). It is important for Phyllis to have this powerful image. When nurses perceive their managers to be confident and have influence in the organization, they are more likely to feel empowered themselves (Laschinger et al., 2011, p. 879). Decision-Making and Problem-Solving Phyllis uses common sense in making decisions. She has much experience which makes this a viable option for her. She makes sure her focus is on the patient when making decisions. Making sure the patients are safe and well cared for is her main priority. Her husband is also in nursing management and she uses him as a sounding board for direction. This helps ensure that the decision will benefit the organization as well as the patients. Phylliss decision-making style is supported by Vesterinen, Suhonen, Isola, Paasivaara, and Laukkala (2013) who mention there are situations in which nurse managers have to make difficult decisions. Decision-making is facilitated by sufficient knowledge, work experience, and support from colleagues and supervisors (p. 7). Phyllis withdraws from a situation in order to access a problem. She utilizes what Vesterinen et al. (2013) describes as emotional intelligence in solving problems. Emotional intelligence is the ability to analyze ones own behavior and leadership style and how that affects staff, the unit, and patient care. Phyllis withdrawing from the situation enables her to use emotional intelligence to come up with a solution to a problem. Phyllis identifies the problem

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and develops solutions based on the data presented and gathered. Sometimes she uses council groups to help solve problems such as shared governance. When the problem is beyond her scope of care or under the institutions jurisdiction, she will defer problem resolution to other bodies such as the employee assist program. Management and Resolution of Conflict Phyllis has a philosophy of management in which she ensures that each patient has a competent nurse. She does this by empowering the nurses under her direction. The style of leadership that applies to her is a transformational style. This style shares a vision for the direction in how the units should run to provide the best possible care available. She invites nurses to have a voice in the vision by encouraging committee participation, open communication, mentoring leaders, and delegating tasks so more participation by staff is experienced. Eishout, Scherp, and Feltz-Cornelis (2013) study shows that transformational leadership style improved staff satisfaction through empowerment and decreased absenteeism when compared to the transactional leadership style which is the more traditional boss type leader. Phyllis resolves conflicts by talking to employees individually, offering suggestions, and giving various options for resolution. She deeply believes in good communication. Communication is a very key component in resolving conflicts as it is usually a breakdown in communication that causes the conflict in the first place. Communication is the most important component of daily activities (Yoder-Wise, 2011, p. 349). When communication difficulties arise, patient care suffers because of the preoccupation of staff with the conflict and the organization suffers due to reduced productivity.

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Conclusion Phyllis is a good manager with good leadership abilities. Her main philosophy guiding her decisions, collaboration, problem solving, and job duties is that each patient deserves and has a competent nurse. Using a transformational style of leadership, she empowers staff to see the direction the units are going to provide the latest in evidence based practice health care. She carries herself as the professional she is which helps with staff confidence and morale. Patients and the hospital benefit with the effective and efficient work Phyllis does on her units.

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References Dombrowsky, T. A. (2012). Responding to verbal abuse. Nursing 2012, 42(11), 58-61. doi: 10.1097/01.NURSE.0000421376.75122.4f Elshout, R., Scherp, E., & Feltz-Cornelis, C. M. (2013). Understanding the link between leadership style, employee satisfaction, and absenteeism: a mixed methods design study in a mental health care institution. Neuropsychiatric Disease and Treatment, 9, 823-837. doi: 10.2147/NDT.S43755 Laschinger, H. K., Wong, C. A., Grau, A. L., Read, E. A., & Stam, L. M. (2011). The influence of leadership practices and empowerment on Canadian nurse manager outcomes. Journal of Nursing Management, 20, 877-888. doi: 10.1111/j.1365-2834.2011.01307.x Vesterinen, S., Suhonen, M., Isola, A., Paasivaara, L., & Laukkala, H. (2013). Nurse managers perceptions related to their leadership styles, knowledge, and skills in these areasa viewpoint: Case of health centre wards in Finland. ISRN Nursing, 2013, 1-8. doi: 10.1155/2013/951456 Yoder-Wise, P. S. (2011). Leading and managing in nursing (5th ed.). St. Louis, MO: Elsevier Mosby.