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Abstract
This paper explores the dynamics of a Nurse Manager with regard to their staff. It examines the role of a Nurse Manager. Gullatte (2008) suggests that the Nurse Manager is a leader who is in charge of a specific number of subordinate staff members. It also discusses Richmond, Book, Hicks, Pimpinella and Jenner’s (2009) research in relation to the responsibilities of a Nurse Manager. These scholars suggest that the role of the staff is determined by the Nurse Manager. This paper examines Gullatte (2008) and Lee’s (2009) research in relation to seven other research articles to suggest that Nurse Managers must have an interactive relationship with their staff.
A Nurse Manager is member of the medical fraternity. Nurse Managers are the people who supervise the subordinate members of the medical community. They are expected to mobilize their staff so that the hospital runs effectively (Gullatte, 2008). They are therefore responsible for the actions of their staff.
Nurse Managers are nurses who have worked in the field of medicine for an unspecified number of years (Aday, 2001). They are licensed nurses who have been part of the medical fraternity for several years.
They are in charge of organizing health services (Gullatte, 2008). They ensure that their staff meets the expectations of the patients (Heitman and George, 2010). They also evaluate their fellow nurses. They monitor the progress of their trainees (Lee, 2009).
Lee (2009) asserts that Nurse Managers are the driving force behind any medical institution. They educate residents and welcome trainees. They also ensure that doctors are not overwhelmed during their rounds at the hospital.
Nurse Managers are in charge of hospital personnel. They are able to make suggestions concerning the promotion of a member of staff. Their staff is governed by the hospital’s budget. Once the staff is selected, the Nurse Manager ensures that the group is cohesive (Liebler and McConnell, 2007).
A Nurse Manager must practice professional integrity (Renz and Herman, 2010). Favoritism is deemed as unethical. In a hospital, there is very little room for marginal error (Bowie and Green, 2005). Incompetent decisions may have dire consequences.
Aday (2001) states that Nurse Managers are expected to facilitate efficiency within the hospital. They have vast experience in the field of medicine. They may not outrank doctors, but their contribution to medicine is equally important (Heitman and George, 2010).
Nurse Managers are expected to have a post-graduate degree (Aday, 2001). This ensures that their level of education is relatively higher than that of their subordinates (Gullatte, 2008). It also gives them more experience in the field of medicine.
Nursing studies can begin immediately after one has received his or her high school diploma (Bowie et al., 2005). They must be done in a registered nursing institution (Aday, 2001). Most employers prefer registered nurses with clinical experience (Heitman et al., 2010).
Gullatte (2008) and Renz et al.’s (2010) research states that nurses with Bachelor’s degrees must be licensed in order to practice medicine. A person must attain a certain level of education before they can practice nursing (Aday, 2001). One of these includes passing a written test that is given by a National Council (Heitman et al., 2010).
Bowie and Green (2005) assert that Nurse Managers may influence the opinions of their subordinate staff. They develop a long-term relationship that goes beyond that of a teacher and a recruit. Nurse Managers and their staff have often developed codependent relationships. Such relationships are usually spawned from team building activities such as retreats and bonding exercises. Such events are usually supervised by the Nurse Manager. They enable recruits to develop a sense of unity. The hospital can be a stressful environment. Recruits may feel depressed if they are left to their own devises. Nurse Managers ensure that the staff works as a single unit that grows in both size and complexity (Heitman et al., 2010).
Nurses who intend to be Managers are advised to emulate their supervisors (Aday, 2001). They are also advised to ‘shadow’ doctors (Liebler et al., 2007). Shadowing refers to accompanying a doctor during his rounds. Doctors usually have years of experience (Crutchfield et al., 2007). Nurses can exploit this knowledge by taking notes and making consultations (Gullatte, 2008). Practical skills like administering insulin are often learned in the field (Lee, 2009).
Having a degree in healthcare management gives a nurse an added advantage over her peers. A nurse with a degree in Business Administration is also a likely candidate for a Managerial position (Renz et al., 2010). Business Administration skills can be used to deal with the financial aspects of Nursing Management (Lee, 2009).
The dynamics of a Nurse Manager can be categorized into four sections, namely, education, leadership skills, technical skills and organizational skills (Lee, 2009). Nurse Managers should have a background in medicine. They should therefore be well versed in the field of nursing. They should be able to delegate responsibly. They should also know how to operate medical equipment.
Nurse Managers are an influential part of the medical fraternity (Renz and Herman, 2010). They are equipped with the knowledge to maintain and improve the running of a hospital. They are responsible for delegating duties to the staff.
Heitman et al. (2010) speaks of a patient suffering from a cardiovascular disease. The patient was diagnosed with a condition that inhibits the amount of oxygen leaving the lungs. Heitman et al. (2010) explains how the Nurse Manager delegated responsibility according to the staff’s level of competency. “One team of nurses was in charge of monitoring the patient’s pulmonary activity. One team was in charge of providing ventilator support” (Heitman et al., 2010). The Nurse Manager monitored and recorded the teams’ progress. She then assessed their ability to consult each other.
Nurse Managers use a participatory approach to educate recruits. Other nurses accompany them during their rounds. They are expected to encourage trainees and offer moral support. Working in a hospital can be a tedious and frustrating task (Heitman and George, 2010). Nurse Managers make it seem more bearable by providing recruits with moral support. However, they can also be assertive. In the field of medicine, there is very little room for error (Aday, 2001). Some decisions could mean the life or death of a patient. Nurse Managers should therefore have a zero tolerance policy with regard to the improper treatment of patients (Crutchfield and Grant, 2007).
The Nurse Manager uses a scale of 1 to 5 to determine which recruits are the most competent (Ball, Weaver and Kiel, 1990). This scale helps Nurse Managers to decide whether a nurse should work during a specific shift. Those who have a rank of 3 and above are expected to work during the night shift (Ball et al., 1990).
Nurse Managers use this scale to educate trainees. The first phase can be describing as a building block (Lee, 2009). It is the basic framework that nurses use to establish a bond with their patients. The second phase is simply a transition into the third phase. During the third phase the recruits are taught how to exploit the resources at their disposal (Liebler and McConnell, 2007). These skills are reinforced during the fifth phase (Lee, 2009).
Trainees are expected to use their own discretion during the first phase of their education. They should be well-equipped to deal with a wide variety of patients. Nurse Managers are part of the team that oversees the recruitment of nurses. They ensure that the most competent people are recruited for the job. Medicine is a delicate field that requires an equally delicate approach (Lee, 2009). There have been cases of incompetent nurses in the past. Nurse Managers are therefore expected to make objective decisions with regard to selecting new recruits.
For a hospital to function effectively, it must have a chain of command (Gullatte, 2008). A hierarchy enables leaders to fully exploit the resources at their disposal (Lee, 2009). Nurses assist doctors during surgeries as well as other medical procedures (Ball et a., 1990).
Lee (2009) suggests that a good Nurse Manager must have the ability to motivate her staff. Nurse Managers are like chancellors. They encourage recruits and offer advice when their subordinates are in doubt. Aday (2001) argues that Nurse Managers offer solutions to problems that are related to the effective running of a hospital.
They ensure the highest possible quality of patient care within the hospital (Gullatte, 2008). Nurse Managers maintain a certain level of integrity when dealing with patients (Aday, 2001). They teach their fellow nurses to do the same.
The American Medical Association noted that nurses were more likely to work effectively if their Nurse Manager was a good delegator (Renz et al., 2010). 20,000 nurses responded to questionnaires that were distributed across several states. According to Aday’s (2001) research, more than 87 percent of registered nurses responded well to interactive supervision.
In Bowie et al.’s (2005) research, it was found that Nurse Managers were educated in the principles of compassion. The same skills were taught to the hospital staff. Research confirmed that Nurse Managers were active participants in hospital union groups (Bowie et al., 2005). A Nurse Manager is the unifying factor that enables the staff to develop holistic bonds within the hospital (Crutchfield, et al., 2007).
Nurse Managers often complain about insufficient members of staff (Crutchfield et al., 2007). Nurses are often overworked because the ratio between the patients and the staff is not balanced (Gullatte, 2008).
Richmond, Book, Hicks, Pimpinella and Jenner (2009) assert that “many aspects of the organizational healthcare environment are affected when the nurse manager isn’t able to adequately fulfill her role as a nursing leader. Communication may break down with staff, physicians, and patients and their families. The quality of care that’s provided to the patient may become compromised. Patient, staff, and physician satisfaction may decline as a result. Ultimately, the healthcare team may become fragmented and less cohesive. Staff will begin to feel frustrated and overwhelmed in their roles; this may lead to increased nursing turnover.”
Nurse Managers have a large number of responsibilities. They are therefore unable to maximize their potential. They can deal with a specific number of medical issues. The hospital administration expects them to monitor, evaluate and manage medical resources (Lee, 2009). This can be overwhelming.
Nurse Managers also act as liaisons between the hospital administration and the staff (Liebler et al., 2007). They are participant observers who offer solutions to problems within the medical community (Renz et al., 2010). They also deal with some aspects of financial planning within the hospital (Crutchfield et al., 2007). They prioritize the most exhausted medical resources. They also serve as medical consultants (Liebler et al., 2007). Their experience is often termed as invaluable.
Nurse Managers collaborate with doctors to come up with effective treatment plans for their patients (Gullatte, 2008). They delegate duties with regard to the staff’s level of medical experience (Lee, 2009). Liebler et al. (2007) argues that Nursing Management is crucial to the success of any medical institution.
Nurse Managers are given the authority to supervise their subordinates (Aday, 2001). They act on behalf of the hospital administration. Nurses are therefore accountable to their Managers (Ball et al., 1990).
They help the hospital’s financial department to project the nursing department’s quarterly expenses (Heitman et al., 2007). They also make budget cuts and monitor the use of medical equipment (Gullatte, 2008). For example, the Nurse Manager will inform the hospital’s administrative department if a respirator needs to be serviced. If the hospital is running out of surgical equipment, it is the Nurse Manager’s responsibility to inform the administrative department as well as the finance department.
Nurse Managers also keep track of the hospital’s patients (Aday, 2001). They monitor and record the patients’ progress with regard to their treatment (Heitman et al., 2007). They use this data to formulate treatment plans and offer possible alternatives if the initial plans are ineffective (Liebler et al., 2007).
Nurse Managers are also tasked with the responsibility of opening the lines of communication between the staff and the administrative department (Liebler et al., 2007). They represent the staff during board meetings (Gullatte, 2008). They can use such opportunities to highlight the problems within their department (Heitman et al., 2007).
Nurse Managers may have a difficult time boosting their staff’s morale (Lee, 2009). They should give their subordinates moral and logistical support (Liebler et al., 2007).
Discussion
A hospital is a large and complex institution. Its staff is comprised of doctors, nurses, orderlies, technicians and pharmacists. As a result, “Nurse Managers today have experienced changes in their roles. Responsibilities that were once performed by nursing directors have been incorporated into nurse managers’ scope of practice. These include emphasis on efficiency, human resource issues, increased use of technology, the multidisciplinary nature of healthcare, and the constancy of change.
Often, managers have more than one unit to supervise and they always have 24-hour accountability. When a unit is short on nurses, many managers may work as staff in order to provide adequate coverage for patient care; this is in addition to their management responsibilities. When managers don’t successfully balance all their roles, they’re at risk for not meeting their responsibilities, which may impact the organization as well” (Richmond et al., 2009).
Nurse Managers should therefore have several years of experience in nursing (Bowie et al., 2005). They should be able to work well under pressure (Gullatte, 2008). They should therefore be able to keep a cool head because patients are often difficult to deal with. The hospital can be a frustrating environment. Nurse Managers may be expected to meet a large number of demands (Aday, 2001). They should therefore ensure collective responsibility among their subordinates (Liebler et al., 2007). Lee (2009) argues that Nurse Managers should delegate clinical duties responsibly.
They are sometimes expected to monitor the hospital’s expenses (Ball et al., 1990). They may work hand in hand with the hospital’s financial officer (Aday, 2001). Nurse Managers also supervise their medical team by ensuring that patients receive the care and treatment that they deserve (Bowie et al., 2005).
Gullatte (2008) argues that Nurse Managers should give their subordinates moral support. According to Liebler et al.’s (2007) report, clinics and hospitals do not have enough nurses to care for their patients. Some nurses are overwhelmed by the amount of work that they are expected to do. Heitman et al.’s (2010) article, 35 percent of nurses quit their jobs within the first seven months as orderlies. Nurse Managers should therefore have some level of training in guidance and counseling (Aday, 2001). These skills can be used to deal with both depressed patients and frustrated nurses.
In most medical institutions, they are in charge of choosing new employees (Renz, 2010). Nurse Managers are expected to supervise their staff effectively (Liebler et al., 2007). Good management breeds good workers (Aday, 2001). Effective leadership is achieved through an open field of communication (Gullatte, 2008). Nurse Managers should therefore establish a definitive chain of command (Lee, 2009). This enables the staff to operate like a small but effective organization.
Nurse Managers are open to new ideas (Heitman et al., 2007). The staff is therefore at liberty to give suggestions concerning the hospital’s policies. Everyone is entitled to their own opinion. The Nurse Manager can act as a liaison between the staff and the hospital administration (Lee, 2009). For instance, if the nurses need new scrubs, they should discuss the matter with the Nurse Manager (Aday, 2001).
If the staff has limited experience in the field of medicine, members are free to consult with the Nurse Manager. This enables them to bond. It helps them develop a strong and long-lasting relationship (Heitman et al., 2007).
References
Aday, L. A. (2001). At Risk in America. The Health and Healthcare Needs of Vulnerable Populations in the United States, 15(2), 301-327.
Ball, M. J., Weaver, C. & Kiel, J. (1990). Healthcare Information Management Systems. Cases Strategies and Solutions, 31(3), 74-99.
Bowie, M. A. & Green, M. J. (2005). Essentials of Health Information Management. Principles and Practices, 45(2), 257-389.
Crutchfield, L. R. & Grant, H. M. (2007). Forces for Good. The Six Practices of High Impact, 19(1), 316-336.
Gullatte, M. M. (2008). Management. Principles and Practice, 22(3), 114-318.
Heitman, B. H. & George, V. (2010). Peer Review in Nursing. Principles of Successful Practice, 8(1), 200-217.
Lee, F. W. (2009). Information Systems. A Practical Approach for Healthcare Management, 24(2), 225-469.
Liebler, J. G. & McConnell, C. R. (2007). Management Principles for Health Professionals. 10 Steps and Beyond, 15(5), 36-119.
Renz, D. O. & Herman, R. D. (2010). The Jossey Bass Book of Non-Profit Leadership and Management. Essential Texts for Non-Profit and Public Leadership Management, 9(3), 303-313.
EXPLAINING THE DYNAMICS OF A NURSE MANAGER AND HIS / HER STAFF Richmond, P. A., Book, K., Hicks, M., Pimpinella, A. &Jenner, C. A. (2009).
Career Scope Northeast: C.O.M.E. Be a Nurse Manager. In The Nursing Center. Web.
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