Analysis of a Nurse Manager



Analysis of a Nurse Manager

Angela M. Baird

Ferris State University

Abstract

The purpose of this paper was to analyze the role of a nurse leader or manager’s functioning in a clinical setting. An interview was held with Laura Snyder, the clinical director of level six at Metro Health hospital. Leadership style, legal issues, ethical issues, use of power and influence, decision making, conflict resolution, research, and cultural diversity will be discussed. A small introduction of the leader’s education, experience and current position will be explained. This paper will provide many roles a nurse manager holds to maintain a safe working environment for nurses and the patients they care for.

Analysis of a Nurse Manager

Within health organizations there are certain nurses that are designated as managers. A nurse manager includes top positions of authority as in a Nurse Director or Chief Nursing Officer (Yoder-Wise, 2007). A nurse manager role involves an individual who has achieved the basic skills of an RN (registered nurse), and then has acquired additional education and experience to adequately function as a nurse manager. Healthcare employers look for individuals who have received a higher level of education for a nursing management position (Yoder-Wise, 2007). Degrees for nursing management positions include an RN with BSN (Bachelor of Science in Nursing), MSN (Master’s of Science in Nursing), or doctorate (Careers in Nursing). Position’s for managing are available in hospitals, long term care, ambulatory care, or community/public/home health agencies. Nurse Managers direct the delivery of quality nursing care and manage the environment the care is given in with the responsibility of the personnel, resources, and patient care of a nursing unit (Careers in Nursing). Skills of an effective nurse manager are listening, negotiating, collaborating, assertiveness, human relations, coaching, and a compassionate approach (Careers in Nursing). RN’s may desire a nurse manager position for personal satisfaction, power, recognition, prestige, economic gain and opportunities for promotion (Careers in Nursing). Along with the positive attributes of a nurse manager the position also has drawbacks. These would include hard work, scope of responsibility, pressures of competition, consumer issues, economy, politics, manpower and technology (Careers in Nursing).

An interview was held on the sixth floor at Metro Health hospital with Laura Snyder on Monday the 15th of February at 1:30 p.m. The interview was held in her office directly off of the visitor’s elevators and was easy to find. Her office was small with a desk, computer, filing cabinet and a few extra chairs for sitting. Upon her desk pictures of herself with family members were proudly displayed, and multiple stacks of papers were scattered around. These papers portrayed that she had numerous projects or issues that were being worked on. Laura Snyder currently is the Clinical Director over level six and the IV (intravenous) team at Metro Hospital in Wyoming, Michigan. Level six at Metro Health hospital includes medical, surgical and pediatric patients. The IV team provides assistance to the entire hospital staff in maintaining a patent IV without the incidence of infection, phlebitis or infiltration during a patient’s stay in the hospital.

Laura originally obtained a diploma from the Blodgett School of Nursing in Grand Rapids, Michigan in 1987. She worked in the ER (Emergency Room) and ICU (Intensive Care Unit) at Blodgett hospital and finished her BSN and MSN degrees at Grand Valley State University in Grand Rapids, Michigan. Laura has been practicing nursing for a total of 23 years and has held various job positions. In her current position a master’s degree in nursing and prior experience in management were required. Laura is certified in ACLS (Advanced Cardiac Life Support) and currently is working on her certification in nursing management (L. Snyder, personal interview, February 15, 2010).

Leadership Style

Evidence

Laura said that she using a mixture of two leadership styles. Leadership styles include involving clinical coordinators and other subordinates in decision making and identification of issues effecting staff nurses and patients on the floor. Laura said that employees are hard workers; trust worthy and self directed (L. Snyder, personal interview, February 15, 2010).

Support

Laura currently manages the sixth floor using a laissez-faire and democratic leadership style. She uses a democratic leadership style when making decisions by receiving input from four clinical coordinators, a child life specialist, and social worker prior to making the final decision on issues affecting nursing staff and patients. Allowing clinical coordinators to work independently to identify and solve nurse and patient concerns is using a laissez-faire leadership style.

Analysis

Yoder-Wise (2007) defines management as individuals who work to guide others through routines, procedures, or predefined practice guidelines. These individuals are important to ensure that patient care is provided in a safe and efficient environment. Nurse managers develop leadership styles through experience and expectations. Many leadership styles and theories have been developed and include authoritarian, democratic, laissez-faire, and multicratic (Yoder-Wise, 2007). The democratic leader involves all subordinates in the decision making process, sees themselves as coworkers rather than a superior and stresses communication, consensus and teamwork (Ellis & Hartley, 2009). The laissez-faire leader disperses the decision making throughout the group and allows coworkers to develop their own goals, make their own decisions, and take responsibility for their own management (Ellis & Hartley, 2009).

The sixth floor has a history of working as a team, liking their job, a high morale, and low nurse turnover (L. Snyder, personal interview, February 15, 2010). Laura has trust in her team members until the trust is broken and keeps in touch with employees special circumstances. For example, a family member of an employee had surgery and she always checks with this employee to see how the surgery went and how their family member was recovering. With Laura using this approach of leadership allows nurse satisfaction in their job. When a nurse is satisfied with their job this allows them to function highly in their position and give high quality care to patients (Yoder-Wise, 2007). Nurse satisfaction within the workplace is very important to nursing and healthcare administration. With high turnover this becomes costly to the organization in areas of finance, expertise, knowledge and quality of patient care (Yoder-Wise, 2007). Patients ultimately have faith and trust in their nurses and will want to return to the hospital for the same quality of care. Stories of the great care they received will trickle to other individuals of the community and will boost the reputation of the hospital organization.

Legal Issues

Evidence

Laura identified one legal issue that she was involved with as a nurse manager in the past. This was when Laura was approached by night employees with a complaint of another staff member sleeping during the night shift. After a thorough investigation the employee confessed to the allegations and was released from Metro Health hospital. The employee requested unemployment benefits from the hospital and was denied. Laura participated that eventually overturned the denial for unemployment (L. Snyder, personal interview, February 15, 2010).

A potential legal liability issue identified by Laura was on adequate staffing. Laura said that she needs to make sure that there is adequate and knowledgeable staffing for all shifts to provide quality safe patient care. Laura does what she can do to fill short staffing issues by calling in staff or even working as a staff member on the floor herself. If the problem persists she must inform her nursing supervisor or director of nursing that there is an issue with short staffing that she needs assistance with. This is a requirement of nurse managers in order to protect the patient’s welfare (Yoder-Wise, 2007).

Laura deals with employment laws within the work settings and that FMLA (Family Medical Leave Act) is one that frequently is an issue. Laura said that she actually had two requests for FMLA on the day of the interview that she would have to address (L.Snyder, personal interview, February 15, 2010). Laura said that approval for FMLA was directed towards an outside agency but she and clinical coordinators need to make sure that benefits are not abused by employees (L. Snyder, personal interview, February 15, 2010).

Support

The Federal-State Unemployment Insurance Program provides temporary benefits to eligible workers. Individuals qualify depending on state eligibility and that the unemployment was not the fault of the individual (United States Department of Labor Employment and Training Administration).

The Family and Medical Leave Act of 1993 allows employees job security when having to care for a new born or another family member’s healthcare problem (Yoder-Wise, 2007). Laura said that this law was beneficial to employees and was glad that the decision to approve or disapprove benefits was taken out of her hands.

Joint Commission on Accreditation of Healthcare Organization (JCAHO), Community Health Accreditation Program (CHAP), state and federal standards mandate that adequate staffing be provided with the accurate number, qualified personnel, and legal status of employees (Yoder-Wise, 2007). For example, critical care, emergency room, and post anesthesia care require a higher number of RN’s to LPN’s and extended care facilities may have equal or less number of RN’s to LPN’s (Yoder-Wise, 2007). Courts determine understaffing on an individual basis based on the number of patients, acuity of patients, and the number and status of staff (Yoder-Wise, 2007).

Analysis

The issue of having an employee sleeping on the job affects all staff members working that particular shift. This places an increased workload for employees which can affect the care of all patients. One nurse doing the work of two may tire easily and become angry. This anger then can be directed at other staff and even patients. Staff that feels frustrated at work can lead to dissatisfaction in their job and eventually wanting to leave. A patient that does not get the care he/she expects may have a delay in healing and may have to spend extra time in the hospital. A patient that does not receive a high level of care remembers this and eventually tells family and friends. This then gets out to the community and the reputation of the organization is jeopardized.

With there being no legal issues being manage at this time other then routine issues made Laura’s unit appear it had a healthy number of knowledgeable staff to provide safe and quality patient care.

Ethical Issues

Evidence

Laura said that ethical issues on her unit are not huge but that ethical issues for staff are related to end of life situations and pain medication administration. Staff on the sixth floor see family members extending the life of a loved one and ignore the wishes written in their loved ones living will. Staff becomes frustrated with administering pain medications every two hours around the clock. Especially if the patient has been viewed has having “drug seeking” tendencies.

Support

Ethics in clinical practice is becoming more prominent. A nurse manager must have a knowledge base of ethical principles because they are looked upon as mentors and counselors by employees for ethical or difficult situations (Yoder-Wise, 2007). An end of life issue identified by Laura was when she was working in the ICU. She stated that patients were on life support and obviously dying, but family members were not ready to let go. Other times patient’s living will wishes were ignored and physicians were administering life sustaining procedures and treatments that the patient did not want. Often meetings were held with family, the ethics committee, physician and nurse at the hospital to educate the family members on the dying process and family members were able to let their loved ones die peacefully (L. Snyder, personal interview, February 15, 2010).

The American Pain Society developed and published a quality assurance standard for pain management in 1995. Even with this standard there are many issues faced by nurse managers, staff, and pain management specialists as they continue to improve the management of pain (Stenger, Schooley, & Moss, 2001). Laura’s goal is to be available for discussions with staff to voice their opinions and frustrations about this delicate ethical issue. This ultimately lessens frustrations with pain management and makes it easier to care for these patients on the floor (L. Snyder, personal interview, February 15, 2010).

Analysis

Nurses need to continue to be an advocate for all patients’ and provide the best possible care that he/she can. This at times may include giving some additional treatments or medications that he/she feels is prolonging the inevitable.

With the frustration by Laura’s staff on giving pain medications to certain individuals as prescribed and per patients request may lead to inadequate pain relief. All nurses need to remember that pain is only as bad as the patient says it is and we as nurses have to provide quality of care to all patients.

Use of Power and Influence

Evidence

Laura uses power and influence to subordinates carefully and respectfully. Laura is able to reward individuals with pay raises for a job well done and to punish those by not granting certain days off requested.

Support

Yoder-Wise (2007) defines the word power as the ability of influencing others to achieve goals. “What makes a powerful nurse?” Laura indentified that a powerful nurse may be looked at in a negative way, but to her it is more positive. A powerful nurse is one that has the ability to be a patient advocate and to go above and beyond the normal duties of a nurse. Laura has many opportunities to be a patient advocate and has even gone above and beyond her normal nursing duties to give quality patient care. One incident was while working in the ICU. Laura said that a patient of hers was dying and the family requested that she sing the patients favorite song. So this is what Laura did, she sang the song for the patient and made the family extremely happy. Laura said that this makes her a powerful nurse in a positive way.

Analysis

Laura portrays a level of power by having self-confidence, good communication skills, and 23 years of nursing experience, and with a positive attitude and likeable personality, makes her approachable and allows her floor to give quality patient care (L. Snyder, personal interview, February 15, 2010).

Decision making and Problem Solving

Evidence

Laura said that when faced with a problem she has to do a thorough investigation and get both sides of the story. Laura then will collaborate with individuals involved in the situation, think about possible ways to solve the problem, and propose a solution to the problem.

Support

Decision making and problem solving abilities are vital to nurse managers. Nurses must have the basic knowledge and skills for effective problem-solving and decision-making and these are especially important for those in a leadership/management position (Yoder-Wise, 2007). Yoder-Wise (2007) lists steps in problem solving: (1) define the problem, (2) gather data, (3) analyze data, (4) develop solutions, (5) select a solution, (6) implement the solution, and (7) evaluate the result.

Analysis

Laura’s decision making and problem solving abilities mimic her leadership style. Laura involves using the appropriate personnel in the decision-making process, which is a characteristic of involving subordinates in the process of making a decision in a democratic leadership style (Yoder-Wise, 2007). Laura is flexible and open minded and can offer a large range of options to be considered with problem solving and decision making. One thing that can be a negative with this approach to problem solving is not being able to make a quick decision when it is needed. Having to get multiple opinions or stories to an issue can take time and this ultimately can affect patient care and safety.

Conflict Resolution

Evidence

Laura said that conflict is something that she does not like and would rather not deal with (L. Snyder, personal interview, February 15, 2010).

Support

Conflict stems from a disruption of an individual or groups values, beliefs, attitudes, and expectations (Conerly & Tripathi, 2004). Yoder-Wise (2007) lists five major modes of conflict resolution: (1) avoiding, (2) accommodating, (3) competing, (4) compromising, and (5) collaborating. Laura is the closest to the avoiding mode of conflict resolution. This approach can be both positive and negative. It is very unassertive and may lead to not pursuing individual goals and encouragement of other staffs goals or concerns. In a positive way it may be a way of stepping back from a “no-win” situation or postponing a situation until a better time (Yoder-Wise, 2007). A trigger of conflict for Laura is confronting employees of mistakes. Laura said that some employees become defensive when confronted on a mistake that they made. Laura wishes that everyone can just own up and accepting the mistake that was made and learn from it (L. Snyder, personal interview, February 15, 2010).

Analysis

Laura wants to avoid conflict as much as possible. Avoiding conflict can make for unhappy staff that leave their job and cause short staffing. This can lead to staff that are tired and frustrated. This leads to a bad picture of the nursing staff and organization as a whole. With this come unsatisfied patients that will not return for continued services at the organization and branches of the organization. Taking care of conflict as it comes only leads to a strong nurse manager that directs the path for safe quality patient care.

Research

Evidence

Laura said that research is important to the nursing profession and that Metro does not base current nursing practice on any nurse theorist. She is currently not involved in any research projects but said that evidence based nursing practice is needed to provide the best possible solutions to quality patient care (L. Snyder, personal interview, February 15, 2010).

Support

Research is the “diligent, systematic inquiry or investigation to validate and refine existing knowledge and generate new knowledge” (Burns & Grove, 2005, p.2). “Evidence-based practice is the integration of the best research evidence with clinical expertise and the patient’s unique values and circumstance in making decision about the care of individual patients” (Straus, Richardson, Glasziou, & Haynes, 2005, p. 1).

Analysis

Laura does not seem up to date on nursing researchers and said that her unit patient care is not based after a particular nursing researcher. This can have a negative effect on nursing staff and patient care. Nurse managers need to keep themselves informed on current nursing research literature and where it can be found. Nurse managers are ultimately the leaders and mentors of their staff and need to be prepared for any research issues. A good knowledge base of research and evidence-based practice leads to a higher level of patient care.

Cultural Diversity

Evidence

Laura said that her staff and patient population on level six at Metro Health hospital has a mixed culture. Most of the current staff are white but vary from new grads to seasoned nurses of 20 plus years. Patients are white, black, Hispanic and Vietnamese. Laura said that having knowledge in cultural diversity helps improve patient and staff satisfaction. At Metro Hospital there is no cultural diversity training at this time, but Laura identifies that there has been training in the past (L. Snyder, personal interview, February 15, 2010).

Support

Diversity is everywhere in life and there is no exception for healthcare. A nurse manager needs to have knowledge and experience with different cultures. Knowing the culture of employees and patients helps charge nurses make assignments for the shift and alleviate any uncomfortable feelings between a nurse and patient (L. Snyder, personal interview, February 15, 2010). According to the Code of Ethics for Nurses (ANA) nurses believe that care must be equal and the same no matter what differences there may be and this includes cultural differences (Code of Ethics for Nurses, 2001). Nursing a person back to health from another culture is a complex experience (Yoder-Wise, 2007).

Analysis

Laura does not show any concern that Metro Hospital does not provide cultural training or workshops with the amount of cultural diversity at the hospital and on her unit. She does appear to feel comfortable with the amount of cultural diversity in both her staff and the patient population.

Conclusion

In conclusion, healthcare today is complex and the need to keep up to date on new knowledge should be the goal of any organization. Nurses can assist in this goal by developing and improving their leadership/managing skills. Effective nurse manager’s are the future to ensuring safe, efficient patient care is provided to all.

References

Burns, N. & Grove, S. (2005). The practice of nursing research: Conduct, critique, and utilization (5th ed.). St. Louis: Elsevier Saunders.

Careers in nursing. Student’s Corner.

Conerly, K. & Tripathi, A. (2004). What is your conflict style? The Journal for Quality & Participation, 27 (2), 16-20.

Ellis, J. & Hartley’s, C. 2009. Managing and Coordinating Nursing Care. Lippincott: Philadelphia.

Leadership styles. Leadership Skills.

State unemployment insurance benefits. United States Department of Labor Employment and Training Administration.

Stenger, K., Schooley, K., & Moss, L. (2001). Moving to evidence-based practice for pain management in the critical care setting. Critical Care Nursing Clinics of North America, 13, 319-327.

Straus, S., Richardson, W., Glasziou, P., & Haynes, R. (2005). Evidence-based medicine: How to practice and teach EBM (3rd ed.). Edinburgh: Churchill Livingston.

Snyder, L. Personal interview. February 15, 2010.

Yoder-Wise, P. 2007. Conflict: the cutting edge of change. Leading and Managing in Nursing. (4th ed.). Missouri: Mosby Elsevier.

Yoder-Wise, P. 2007. Cultural diversity in health care. Leading and Managing in Nursing. (4th ed.). Missouri: Mosby Elsevier.

Yoder-Wise, P. 2007. Legal and ethical issues. Leading and Managing in Nursing. (4th ed.). Missouri: Mosby Elsevier.

Yoder-Wise, P. 2007. Power, politics, and influence. Leading and Managing in Nursing. (4th ed.). Missouri: Mosby Elsevier.

Yoder-Wise, P. 2007. Translating research into practice. Leading and Managing in Nursing. (4th ed.). Missouri: Mosby Elsevier.

Grading Rubric for Analysis of a Nurse Manager

|Headings |Possible Points |Pts Earned |Comments |

| |Subheadings | | |

|Introduction |(No subheading) |20 |Thorough. |

|(Background on Nurse Leader or Manager to |20 | | |

|include name, position, education, years in| | | |

|practice and role, additional | | | |

|qualifications for role, etc.) | | | |

|Leadership Style | |19 |The sections are mixed up, but after sorting |

|Compare the manager’s stated leadership |20 |4 |through it, it seems all necessary information is|

|style with evidence of situations and | |6 |present. -1 point for the trouble. |

|actions described in the interview. |Evidence 4 |9 | |

|Analyze it using support, include potential|Support 6 Analysis | | |

|effects on patients, staff and |10 | | |

|organization) | | | |

|Legal Issue(s) |20 |20 |Well done! |

|Describe, support, & analyze 1 or more | |4 | |

|legal issue(s) this leader or manager has |Evidence 4 |6 | |

|or is managing (include potential effects |Support 6 Analysis |10 | |

|on patients, staff, and organization) |10 | | |

|Ethical Issue(s) |20 |15 |Ethical issues in Evidence. Support present. |

|Describe, support, & analyze 1 or more | |4 |Effects on patients mentioned; no analysis of |

|ethical issue(s) this nurse leader/manager |Evidence 4 |5 |effects on organization or staff. |

|has or is managing (include potential |Support 6 |6 | |

|effects on patients, staff, and |Analysis 10 | | |

|organization) | | | |

|Use of Power and Influence |20 |8 |Appropriate Evidence. Brief Support. No |

|Describe, support, & analyze the manager’s |Evidence 4 |4 |Analysis. |

|use of power and influence (include |Support 6 |4 | |

|potential effects on patients, staff, and |Analysis 10 |0 | |

|organization) | | | |

|Decision-making and Problem-solving |20 |16 |Appropriate Evidence. Good Support. Analysis |

|Describe, support, & analyze use of | |4 |present with general effects, but does not extend|

|decision-making or problem-solving process |Evidence 4 |6 |to giving effects on patients, staff and |

|(include potential effects on patients, |Support 6 Analysis |6 |organization. |

|staff, and organization) |10 | | |

| Conflict resolution |20 |20 |Very well done! |

|Describe, support, & analyze management or |Evidence 4 |4 | |

|resolution of conflict (include potential |Support 6 Analysis |6 | |

|effects on patients, staff, and |10 |10 | |

|organization) | | | |

|Research |20 |16 |Vague. Some apparent confusion between researcher|

|Describe, support, & analyze leader or |Evidence 4 |4 |and theorist nurses. |

|manager as a user, interpreter or |Support 6 Analysis |4 | |

|participant in research (include potential |10 |8 | |

|effects on patients, staff and | | | |

|organization) | | | |

|Cultural Diversity |20 |13 |Very limited analysis of effects. This section |

|Describe, support, & analyze leader or |Evidence 4 |4 |was optional and, because it scored low, was |

|manager in relationship to action or |Support 6 Analysis |4 |omitted from the grade. |

|inaction to promote and support cultural |10 |5 | |

|diversity in the workplace. (include | | | |

|potential effects on patients, staff, and | | | |

|organization) | | | |

|APA Format, Writing Clarity, Grammar, |20 |10 |APA errors in citations of direct quotes and |

|Spelling, & References | | |referencing online source. Sections poorly |

| | | |organized despite opportunity to organize before |

| | | |resubmitting. Book chapter authors not cited. |

| | | |Variable APA formatting in the References. |

| | | |Grammar errors present. |

|Total points |200 |144/180=80% | |

| | | | |

Grading Rubric for Analysis of a Nurse Manager

|Headings |Possible Points |Pts Earned |Comments |

| |Subheadings | | |

|Introduction |(No subheading) |

|(Background on Nurse Leader or Manager to include |20 |

|name, position, education, years in practice and | |

|role, additional qualifications for role, etc.) | |

|Leadership Style |20 |

|Compare the manager’s stated leadership style with |Evidence 4 |

|evidence of situations and actions described in the |Support 6 Analysis 10 |

|interview. Analyze it using support, include | |

|potential effects on patients, staff and | |

|organization) | |

|Legal Issue(s) |20 |

|Describe, support, & analyze 1 or more legal issue(s)|Evidence 4 |

|this leader or manager has or is managing (include |Support 6 Analysis 10 |

|potential effects on patients, staff, and | |

|organization) | |

|Ethical Issue(s) |20 |

|Describe, support, & analyze 1 or more ethical |Evidence 4 |

|issue(s) this nurse leader/manager has or is managing|Support 6 |

|(include potential effects on patients, staff, and |Analysis 10 |

|organization) | |

|Use of Power and Influence |20 |

|Describe, support, & analyze |Evidence 4 |

|the manager’s use of power |Support 6 |

|and influence (include |Analysis 10 |

|potential effects on | |

|patients, staff, and | |

|organization) | |

|Decision-making and |20 |

|Problem-solving |Evidence 4 |

|Describe, support, & analyze |Support 6 Analysis 10 |

|use of decision-making or | |

|problem-solving process | |

|(include potential effects on| |

|patients, staff, and | |

|organization) | |

|Conflict resolution |20 |

|Describe, support, & analyze |Evidence 4 |

|management or resolution of |Support 6 Analysis 10 |

|conflict (include potential | |

|effects on patients, staff, | |

|and organization) | |

|Research |20 |

|Describe, support, & analyze |Evidence 4 |

|leader or manager as a user, |Support 6 Analysis 10 |

|interpreter or participant in| |

|research (include potential | |

|effects on patients, staff | |

|and organization) | |

|APA Format, Writing Clarity, |20 |

|Grammar, Spelling, & | |

|References | |

|Total points |180 |

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