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Analysis of a Nurse ManagerRhonda JonesFerris State UniversityAnalysis of a Nurse ManagerA manager in any organization is responsible for a multitude of different functions that relate to the day to day operations of a department in an organization. According to Stalbaum & Valadez (2011) a nurse manager “must be able to balance three sources of demand: upper management requests, consumer demands, and staff needs” (p. 59). The role of manager does not automatically make that person a good leader. Successful leadership involves the ability to motivate and provide direction to all that they encounter. Evans (2011) discusses the importance of leadership skills in any nurse role and further states “management and leadership, although different constructs, can be a strong combination for success” (p. 47). Transformational leadership includes employees in a collaborative process that promotes involvement and ownership for organizational evolution and changes (Evans, 2011). Transformational leadership has shown to result in: increased employee retention, increased employee job satisfaction, and improved patient outcomes (Evans, 2011). This paper addresses the importance of an effective nurse manager as a transformational leader in health care that includes many components: collaboration, legal and ethical issues, the attributes of power and influence, the use of decision making and problem solving techniques, and the importance of management and conflict resolution. I conducted an interview with Joseph (Joe) Effa who is the director of four departments at Lakeland Regional Health System: Homecare, Home Infusion, Health Services (private duty caregivers), and House Calls (provides home physician services). Lakeland is not-for-profit organization. Joe has worked at Lakeland for 30 years; he began his career in acute care and then transferred to homecare as a staff nurse. He continued his education by obtaining a Bachelor in Science and a Master’s degree in business. Eventually he was promoted to supervisor of homecare then the director of homecare and four years ago he became director of all four departments. Joe’s job duties are vast and include day to day operations of the department, projecting objectives and goals six months to one year in advance, budgeting for each department, managing evolving technologies, ensuring regulatory compliance, semi-annual strategic planning meetings, collaboration with all department directors and managers, and communication with upper management, mid management, and interdisciplinary staff. He states his main job duties are that of fiduciary management and ever changing regulatory compliance. He has to ensure that each department remains financially stable as well as monitoring regulation compliance issues from payers such as Medicare, Medicaid, and private insurance as well as overall corporate compliance regarding policies and procedure issues. The organizational structure can be defined as a hybrid structure that has incorporated elements of bureaucratic and functional structures. Joe reports to the Vice President of Administration who reports to the CEO. The managers of the four departments report directly to Joe but he is also in close contact with supervisors that are in charge the two homecare offices (J. Effa, personal communication, September 19, 2013). Collaboration Role and Ethical IssuesCollaboration in the current heath care environment is essential to any department of an organization. No one department operates independently. During the interview process with Joe it became evident that this is the case for the departments that he manages. The Chaos theory applies to organizations that are cognizant that change is a part of the industry and to prosper change must be embraced (Mancini, 2011). Joe is in constant contact with the acute care directors and manager on changes that are occurring in their departments that require homecare to change and adapt to work as a fluid system that produces positive outcomes for the organization and patients. This all too evident in the new reimbursement guidelines that have been implemented by Medicare regarding re-hospitalization of Heart Failure patients and the role homecare is providing by working in tandem with the hospital system to provide disease management and prevention strategies. Johnson, V., Wessel, & Johnson, K. (2013) state that “…true collaboration is a complex process” (p. 58). Joe was able to elaborate on the amount of time and effort it takes to collaborate with other department managers, directors, and other interdisciplinary teams to accomplish goals that are productive and positive both for the organization and patient outcomes (J. Effa, personal communication, September 19, 2013). As a nurse Joe states he is bound by the Code of Ethics for Nurses but he must also combine that with an ethical and legal business mentality. He has to be aware of staffing issues that affect patient care. He states he struggles most with ethical issues that directly relate to patient care. Lakeland does have a multidisciplinary ethics committee that is available to resolve ethical concerns with difficult cases. One of the most difficult areas that Joe states he faces is with the agency refusing to care for a patient due to non-compliance issues. He states that being a part of a not-for-profit organization we are legally obligated to care for all patients referred to us but we can also legally turn down referrals based on severe non-compliant issues. He states has an internal conflict while reflecting on the Code of Ethics for Nurses (ANA, 2001) that promotes being committed and advocating the patient’s right receive health care without bias and the legality not being required to accept these patients into homecare (J. Effa, personal communication, September 19, 2013). Analysis of IssuesPower and InfluenceKelly (2011) defines power as “the ability to influence others in an effort to achieve goals” (p. 176), influence as “the process of using power” (p. 179), and empowerment as “the process of exercising one’s own power” (p. 180) and the ability to “facilitate the participation of other in decision making and taking action so they are free to exercise power” (p. 180). Power by itself is not enough to be an effective manager in an organization; one must also use influence and empowerment to accomplish positive organizational and patient outcomes. Laschinger, Purdy, & Almost (2007) use the work empowerment theory in a study designed to assess the value of empowerment with job satisfaction of managers. The authors discuss the need for environmental empowerment and psychological empowerment factors to be present and effect to result in the ability for managers to feel empowered. They state that “empowered managers also have the ability to empower others” (p. 222). Effective use of power and influence can lead to exceptional empowerment abilities and staff that “perceive managers to be confident and have influence in the organization, they are more likely to feel empowered themselves” (p. 222). Madigan (2012) discuss the importance of homecare agencies to have strong leaders and managers to provide direction to staff and improve organizational and patient outcomes. Powerful, influential, empowered manager’s results in empowered staff and this directly impacts quality patient care and a strong work culture. Decision Making and Problem SolvingNurses must use decision making and problem solving on a daily basis during interactions with patients, peers, and management. Several different styles can be used in the decision making/problem solving process and each situation needs to be examined for the type of style that needs to be used. Welch (2011) discusses the importance of managers who involve employees in the process. The importance of evidence based care that results in positive patient outcomes has become the standard in health care; homecare is no exception. Over the past two years the entire homecare management team has been reviewing how the structure of the nursing visits could be changed from the number of visit performed per day to a culture of quality during patient interactions. Committees that included management and interdisciplinary team members were formed to plan the direction of our agency. Management provided rationale for changes and encouraged proactive dialogue. One of the decisions made was to change the pay status of nurses in the department from hourly to salary and reduce the number of visits that a nurse performed in one day. Nurses felt they were a part of the change because they were involved in the process and their concerns were being addressed. Evaluation on the change is an ongoing process to assess the impact on patient outcomes. Financially it has benefited the organization since there is no overtime pay. Management and Resolution of ConflictConflict is common in a work environment; if not addressed and resolved can lead to non-productive work environments, employee disengagement, decreased employee retention, and increased job stress. Laschinger, Leiter, Day, Gilin-Oore, & Mackinnon (2012) performed research on how structural empowerment, workplace incivility, and trust in management affect employees and the work environment. A tool was implemented on several units of an acute care facility to determine if there could be an improvement in empowerment, incivility, and trust in management. The interaction and cooperation of upper and middle management were critical in the successful implementation of this program and stress the importance of management’s involvement in processes that improve the work environment. Laschinger et al, (2012) state that “retention of highly qualified staff is a priority in today’s challenging acute care settings, and it is critical to ensuring high quality, safe patient care” (p. 324). Managers can be leaders to effectively and productively resolve conflict. Folse (2011) states that “conflict can be a strategic tool when address appropriately and can actually deepen and develop human relationships” (p. 465). ConclusionA management position requires extensive knowledge in business but also requires detailed interpersonal and team building skills to be an effective leader. Transformational leadership in the health care environment allows managers to include employees in decision making and problem solving the affect the organization and ultimately patient care. Collaboration inside and outside a department is necessary to effectively produce outcomes that are needed. Managers can use power and influence to promote self-empowerment as well as staff empowerment and both results in a positive work environment that fosters trust and civility. Managers must be a role model and offer support to not only those that directly report to them but also to peers and health care executives. Including effective management techniques will result in increased employee job satisfaction, reduced turnover, and employee ownership within the organization and achieve the ultimate goal of exceptional patient care with positive outcomes. The entire health care system can be viewed as an interlocking cluster and if any of the parts of the system are not functioning properly it inevitably affects the entire system. The Chaos theory allows managers to embrace the concept the change is inevitable and will produce conflict but can ultimately provide positive outcomes for both patients and the organization if used in conjunction with transformational leadership. ReferencesAmerican Nurses Association (ANA). (2001). Code of ethics for nurses with interpretive statements. Washington, DC: AuthorEvans, M. (2011). Developing the role of leader. In P.S. Yoder-Wise (5th ed.), Leading and managing in nursing (pp. 36-52). St Louis, MO: Mosby.Folse, V. (2011). Conflict: The cutting edge of change. In P.S. Yoder-Wise (5th ed.), Leading and managing in nursing (pp. 464-481). St Louis, MO: MosbyJohnson, V., Wessel, T., & Johnson, K. (2013, January). Building collaboration between CNO’s and direct-care nurses. American Nurse Today, 8(1), 58-60.Kelly, K. (2011). Power, politics, and influence. In P.S. Yoder-Wise (5th ed.), Leading and managing in nursing (pp. 175-193). St Louis, MO: Mosby.Laschinger, H. K. S., Leiter, M. P., Day, A., Gilin-Oore, D., Mackkinnon, S. P. (2012, September/October). Building empowering work environments that foster civility and organizational trust. Nursing Research, 61(5), 316-325.Laschinger, H. K., Purdy, N. & Almost, J. (2007). The impact of leader-manager exchange, quality, empowerment, and core self-evaluation on nurse manager’s job satisfaction. Journal of Nursing Administration, 37, 221-229.Mancini, M. E. (2011). Healthcare organizations. In P.S. Yoder-Wise (5th ed.), Leading and managing in nursing (pp. 116-136). St Louis, MO: Mosby.Stalbaum, A. L., Valadez, A. M. (2011). Developing the role of manager. In P.S. Yoder-Wise (5th ed.), Leading and managing in nursing (pp. 53-67). St Louis, MO: Mosby.Welsch, R. A. (2011). Making decisions and solving problems. In P.S. Yoder-Wise (5th ed.), Leading and managing in nursing (pp. 98-115). St Louis, MO: Mosby. ................
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