Running head: INTERVIEW AND ANALYSIS OF A NURSE MANAGER

Interview and Analysis of a Nurse Manager

Kyle Freund and Amy Lewis
Ferris State University

Interview and Analysis of a Nurse Manager

As nurses who both work currently in the profession of nursing, and also as nursing
students completing our BSN degrees, this is the time when we are evaluating and developing
nursing leadership skills. By interviewing and analyzing the role of a nurse manager, we are able
to compare and contrast the leadership style used by this particular manager, with some of the
reading and studying we have done about this role in the health care field. Our interview was
conducted with Carol Sadate-Akhavi, RN, BSN, MSN to examine her role as nurse manager of a
busy 30 bed Cardiothoracic Intensive Care Unit (CTICU) at Spectrum Health, Grand Rapids,
Michigan.
Carol has worked at Spectrum Health in many capacities, including staff nurse in the
ICU, Infection Control nurse, Manager of a Medical-Surgical Unit, and as a Nursing Supervisor.
She recently completed her MSN at Northwestern University, and has the additional certification
of Critical Care Registered Nurse (CCRN).

INTERVIEW AND ANALYSIS OF A NURSE MANAGER

Roles and Responsibilities

The expectations of the role of a nurse manager are to continually improve the safety and
quality of care within the budgetary constraints of the organization, to constantly increase
productivity, and to consistently meet external regulations and standards (Effkin, Brewer, Logue,
Gephart & Verran, 2011). There are many ways to fulfill these expectations, and empowerment
of the staff members is one way to facilitate and encourage their involvement in decision-making
and also into taking action (Yoder-Wise, 2014).
Having shared vision with the staff has helped to create an environment that is both
educational and promotes involvement of staff with unit activities. With many of the staff
having the same or similar thoughts on a particular issue, collectively more can be accomplished
(Yoder-Wise, 2014). Carol is responsible for setting standards and outcome measurements for
her patients, and is constantly striving to improve these. By having staff actively involved in
these processes via shared governance, she feels that there is more of a personal investment on
the part of the staff members to meet quality and safety outcomes (Effkin et al., 2011).
While Carol functions as the nurse manager of the CTICU, there is also a physician who
is the Medical Director with whom she collaborates closely. Nurses that are supervisors on the
off-shifts report directly to Carol, and she has 130 staff members that she manages. A Nursing
Director and the Vice President of Nursing are the upper levels of management that she reports
to. Interacting with the upper levels of the functional management is crucial to the organization
(Yoder-Wise, 2014), and Carol states that this can also be one of the greatest challenges of her
role.
Relationship Building and Communication
Earning the trust and respect of the staff that Carol manages was a major priority when
taking over the role of nurse manager of the CTICU two years ago. By working several days on
each shift, she was able to meet the staff on their territory, and she was able to forge new
relationships with her staff while also letting them know her expectations regarding staff and

INTERVIEW AND ANALYSIS OF A NURSE MANAGER

patient care. Showing the nurses that she would advocate for them gave the nurses the
empowerment that they needed as nurses who are empowered make professional practice
possible (Yoder-Wise, 2014, p. 183) and is more satisfied as an employee.
Carol maintains an open door policy for her nursing staff, encourages them to page her
any time of day or night, and has also seen improvement in staff involvement through her efforts
to develop shared governance. Maintaining an environment that demonstrates clear and open
communication has been one of the ways that Carol has helped to create a work environment that
is positive and healthy for her staff. By doing these things she has seen an increase in staff
satisfaction as well as improved patient outcomes.
Managing personal stress related to the high acuity of the patients in the ICU, as well as
the stress that a nurse manager has in the same setting, is important in maintaining a healthy
workplace environment (Shirey, Ebright & McDaniel, 2013). There is great potential for
personal stress to impact decision-making ability, as well to cause imbalance in ones work and
home life. As part of her management routine, Carol makes it a point to both manage her own
stress and offers opportunities for her staff to learn about managing their stress levels, such as
posting offerings of exercise classes, ensuring uninterrupted breaks, and the employee assistance
stress management program (personal communication, September 16, 2014).
Knowledge of the Health Care Environment
Having current knowledge in the ever-changing field of health care has been an
additional challenge that Carol has dealt with as a manager. She utilizes her Clinical Nurse
Specialist (CNS) to help maintain the units practice of the latest nursing research, and they are
constantly evaluating new techniques and equipment. There are clinical trials that are being done
on the unit, in efforts to improve and update the patient care and outcomes.
Meeting every three months with a cohort of other nurse managers from similar units at
other facilities has helped Carol to evaluate the latest in evidence based practice (personal
communication, September 16, 2014). Carol networks regularly with other managers and CNSs

INTERVIEW AND ANALYSIS OF A NURSE MANAGER

through the Internet, interdisciplinary meetings and with phone calls. She strives to help her unit
to be a leader in health care and not simply follow the advancements made on other units. The
profound impact that these advances have on the patient outcomes is measured regularly.
Leadership Effectiveness
Patient outcomes and staff satisfaction are two of the measures that Spectrum Health uses
to evaluate leadership effectiveness, through surveys and review of patient outcomes (personal
communication, September 16, 2014). Carol strives for a high level of effectiveness by
maintaining visibility on the unit, having 24 hour accountability for staffing, addressing provider
concerns and issues related to patient care, financial aspects of unit budgets, and nursing
processes on the unit. At times there have been issues that have necessitated the involvement of
the ethics department, risk management and also the legal department. Carol feels that part of
being a successful leader is knowing the resources available to her and how to access them
(Shirey, Ebright & McDaniel, 2013).
Anticipating problems and also having the foresight to develop methods to deal with
them (Yoder-Wise, 2014) has helped Carol to be an effective leader to her staff. By using a
proactive management style, Carol stated that she hopes this method of management has
prevented some errors from occurring on her unit. When errors or issues do occur, she uses a
self-reflective questioning method, which helps to figure out system issues that could be changed
to prevent future problems. Following preset standards of the organization and dealing with
problems and issues directly are ways that Carol maintains the legal standards.
While conflict is inherent in any healthcare environment (Yoder-Wise, 2014) Carol
strives to promote an environment of openness and safety to bring issues forward. The role of
the manager is to promote conflict prevention and to help to ensure conflict resolution (Behfar,
Peterson, Mannix, & Trachim, 2008). Yoder-Wise states conflict is a catalyst for change and
has the ability to stimulate either detrimental or beneficial effects, (2014, p. 465). By promoting

INTERVIEW AND ANALYSIS OF A NURSE MANAGER

a safe environment for dealing with conflict, Carol has been able to see some of these beneficial
effects on the CTICU.
Professionalism
Examples of ways that nurse managers can promote and model professionalism to their
staff include academic preparation and advancement, roles and function and increasing
autonomy (Yoder-Wise, 2014, p. 65). Ways that a manager interacts with the staff, other
disciplines, as well as with patients and families can also be ways that professionalism is
modeled. Carol feels that being visible to her staff nurses, interacting regularly with patients by
doing daily rounds, and being involved with multidisciplinary rounds are ways that she shows
professionalism in her role.
Providing the unit charge nurses with the responsibility of making assignments fairly,
following acuity needs, and keeping the unit budget in mind has promoted collaboration by
building trust and team orientation. Carol feels that this has created an environment where the
nurses feel valued in their opinions and ability to make staffing decisions.
Offering opportunities for the staff to advance both educationally and with a broad
knowledge base is also a necessity for creating a professional nursing environment (Yoder-Wise,
2014, p. 59). With the constant changes in technology, surgical techniques, and equipment used
for patient care, there is the need for frequent educational offerings and quality improvement
plans (Potter & Perry, 2009, p. 10).
Business Skills
The amount of constant change in the healthcare field has been one of the ongoing
challenges that Carol has faced as manager of this progressive unit. With the amount of new
technology and equipment constantly being introduced, there is a significant portion of the unit
budget spent on orientation of the staff, in order to maintain the safe environment for the patient.
Carol feels that having a financial education background has also helped her to better fiscally

INTERVIEW AND ANALYSIS OF A NURSE MANAGER

manage the CTICU, and has the foresight to know that this will be an even bigger challenge in
the future.
Writing numerous reports regarding statistics about patient outcomes, budgetary issues
and staff concerns has also been an area where having strong business acumen has been helpful
for Carol. The ability to use the many different computer programs available has been
advantageous for her as well, and she states that she also has some very competent administrative
assistants working for her. Being able to delegate certain projects to different staff has also been
strategic in helping her to manage her time as well as to maintain staff involvement and
investment.
Conclusion
Being in the role of nursing manager of the CTICU at Spectrum Health is a multi-faceted
position, and entails the use of many management techniques. Carol has a large number of staff
that she manages, and feels that by engaging and empowering her staff to be full participants in
this healthcare setting, she is achieving her staff members involvement in providing high quality
nursing care. She feels that having a high level of staff satisfaction promotes the high level of
care that she expects the staff nurses to provide, thus constantly improving patient outcomes.
Her conflict resolution strategies promote a healthy work environment with her collaborative
approach to provide a patient-centered work environment.

INTERVIEW AND ANALYSIS OF A NURSE MANAGER

References
Behfar, K., Peterson, R., Mannix, E., & Trachim, W. (2008). The critical role of conflict
resolution in teams: a close look at the links between the conflict type, conflict
management strategies, and team outcomes. Journal of Applied Psychology, 93(2), 170188. doi: 10.1037/0021-901093.1.170
Effken, J. A., Brewer, B. B., Logue, M. D., Gephart, S. M., & Verran, J. A. (2011). Using
Cognitive Work Analysis to fit decision support tools to nurse managers' work flow.
International Journal of Medical Informatics, 80, 698-707.
Potter, P. A. & Perry, A. G. (2009). Fundamentals of nursing (7th ed.). St. Louis, MO: Mosby.
Shirey, M., Ebright, P., & McDaniel, A. (2013). Nurse manager cognitive decision-making
amidst stress and work complexity. Journal of Nursing Management, 21(1), 17-30.
doi:10.1111/j1365-2834.2012.01380.x
Yoder-Wise, P. S. (2014). Leading and managing in nursing (5th ed.) St. Louis, MO: Elsevier
Mosby.