Research Paper On Roles And Responsibilities Of A Nurse Leader/Manager
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In light of healthcare reform, hospitals are doing their best to find ways to provide better quality and safer nursing. Providing that the nursing staff is a hospital’s largest resource, many organizations spend significant amounts of time and energy to maximize the productivity of this department, especially frontline nurses. In order to achieve that, they focus on the role of the nurse manager, who is believed to play a vital role in staff management, quality outcomes, productivity, and positive experiences. A nurse manager’s roles include a variety of responsibilities and duties, which will be discussed throughout this paper.
Nurse Managers & Staff Retention
According to research, retaining nurses is crucial to delivering the safest and highest quality care (Shirey et al., 2010). Again, the key to staff retention and satisfaction is the nurse manager, due to their role in their work environment (De Campli, Kirby, & Baldwin, 2010). The nurse manager has become a consistent presence, especially within clinical units, and the responsibilities that were once burdening nurse directors, have now been integrated into the nurse manager’s role. The nurse manager is present in all patient-nurse and nurse-physician intricacies, as well as the complexities involved between nurses and interdisciplinary teams (De Campli, Kirby, & Baldwin, 2010). Furthermore, a nurse manager has to make sure nurses work in an environment that fosters nursing excellence and oversee the day-to-day demands of unit operations while also keeping the nursing staff engaged and motivated. What is more, nurse managers comprise a valuable clink between nurses of direct care and senior executives. Taking all that into consideration, it becomes apparent that nurse managers are an important cogwheel in the machine called health care, and a hospital’s operation. However, the nurse manager’s role seems to ever-expand and given the complexities and pressures of the current healthcare environment, it requires a wide array of talents, skills, and knowledge to manage to balance all these dynamics, and provide a healthy work environment, at the same time (De Campli, Kirby, & Baldwin, 2010). With today’s system where demand is, usually, more than human resources (and, maybe, financial, too), the hospital’s quality performance is under the microscope and patient satisfaction and outcomes are the factors that are taken into account, when determining whether a nurse manager has fulfilled their duties and roles within the hospital. Inescapably, this adds extra stress to an already stressed daily routine of a nurse manager.
Nurse Managers and Stressful Factors
Research has shown that managing frontline nurses is unrealistically configured, due to the demanding nature of the role. Some of the issues that make a nurse manager’s role even more complex and stressing is the lack of time to complete the work and having to endure multiple interruptions within the day to attend committee meetings, among others (Shirey et al., 2010). Job stress also increases for a nurse manager for a variety of other reasons, including:
organization red tape, and
change in regulatory requirements (Shirey et al., 2010).
A Nurse Manager’s Responsibilities: The Nurse Manager’s Perception
As previously mentioned, a nurse manager’s responsibilities include meetings, review and analysis of financial reports, ensuring regulatory compliance, and process improvement planning (Baker et al., 2010). However, when nurse managers were asked about what duties they felt were more important and should focus more on, they replied that addressing patient satisfaction issues and staff issues, and reviewing schedules, alongside rounding on the unit with the staff and patients and monitoring and flexing the staff to the volume of the work were the most significant tasks that should be performed by them (Baker et al., 2010).
Nurse managers know that patient safety is mainly driven by a learning culture. In an instance that never made it headlines, where a 73-year-old widow was admitted to a typical suburban hospital (Hospital Hope) and experienced three preventable conditions during her hospitalization, namely hypoglycaemia, central line infection, and pneumonia, the nurse manager begum collecting quality data, analysed and reported all information, to improve the performance of their unit (Sammer, 2011). The patient could not have suspected that nearly one in every 20 patients that are hospitalized in a US hospital every year develop infections acquired their hospital stay or that infections associated with central line blood stream are among the most lethal types of infections one could possibly acquire within a hospital. Mortality rates for central-line-associated blood-stream infections reach up to 20 percent, according to the Centers for Disease Control and Prevention (Sammer, 2011). The nurse manager in this case shared lessons learned with nurse managers of other units of the same hospital and agreed to help one another through good communication and teamwork to improve the outcomes of their unit. Such decisions should be made clear to all team members, from the chief of staff to the young nursing student. For example, when a new graduate nurse observed and spoke to a doctor that was not following the recommended practice to prevent infections during central line insertion, she knew she had her unit manager’s support (Sammer, 2011). Therefore, a nurse manager’s effectiveness is improving day by day, while their responsibilities pile up.
Nurse Manager as a Command Central
The majority of nurse managers have command central responsibilities. These include providing support and recognition, making sure all the required information is delivered in a timely manner, keep a cool head and a calm hand during emergencies, and advocacy for staff, families, and patients (Cipriano, 2011). Moreover, they also have the duty to encourage professional growth and personal development among members of the staff. However, above all, nurse managers have to see the impact of the care their nurses provide to patients and how this care effects on both patients and their families. Everything regarding providing healthcare should be excellent, and it is the nurse manager’s role to set the expectations and stage for excellence (Cipriano, 2011). When the system fails, no one puts the blame of practitioners. On the contrary, it is the nurses that are held accountable, most of the times. However, that does not mean there is tolerance for reckless behaviors, and nurse managers have to instill determination, as well as hope for nurses and teams to perform at the best of their abilities (Cipriano, 2011).
Truth is the larger the organization, the more a nurse managers need to make sure there is a unified approach when delivering healthcare, in order to reach the organization’s objectives and goals. Administrators and directors that are responsible for more than one department rely on nurse managers to provide clear direction and expectations so the staff is aware of their accountabilities and roles (Cipriano, 2011).
Beyond Nursing Duties
Nurse managers are held responsible for other disciplines that go beyond nursing. They have to coordinate the work on many people, including their team of nurses, social workers, teachers, assistive personnel, technicians, front-office and fiscal staff, pharmacists, and chaplains, among others that relate to patient care (Cipriano, 2011). Set aside that, nurse managers also interact with staff that help the nurses deliver patient care. In addition, they also interact with ancillary personnel, such as those that provide nutritional services, care for the environment, and sustain physical facilities. Finally, a nurse manager is called to have the required expertise and experience to handle complex operations and staff with different backgrounds.
An organization’s goals and direction is assisted greatly by the help of clinical leaders, frontline managers, and nurse management teams. Together they do their best for accountability and consistent practices all across an organization, set goals to support the organization’s direction, monitor the performance of a unit or entire department, monitor the performance of their unit or department, and assess results build across the organization ( Cipriano, 2011).
Nurse Managers as Executives
A nurse manager, depending on their aspirations and personal goals for professional development, may choose to step into a nurse executive role. Besides being responsible for practice, as an executive, their duties include strategic planning, fiscal issues, promoting professional achievement, advocacy for HR (Human Resource) matters, and making sure there is supportive environment that promotes clinical excellence (Cipriano, 2011). Nurse executives serve as liaisons, and as such, they partner with other colleagues (multidiscipline ones), and put their stepping stone in the organization’s leadership, setting the vision and acting as external ambassadors, trying to establish collaborative spirit and relationships with lawmakers, the public, and academic groups, alongside other nursing partners (Cipriano, 2011).
Nurse Management vs. Nurse Leadership
There is much confusion in regards the roles of a nurse leader and a nurse manager. Some people argue that it takes more skills to become a nurse leader than a nurse manager. Others view leadership as one of the many function of a nurse manager. According to Curtis, Vries, and Sheerin (2011) “managers maintain, leaders develop, managers control, leaders inspire, managers have a short-term view, leaders have a long-term view, managers ask how and when, leaders ask what and why,  managers accept the status quo, leaders challenge it” (p.307). However, it is the behaviour that determines a leader. Positive work attitudes and behaviors are highly needed, and the same applies to emotional intelligence, which is the ability to manage and integrate emotions and reason (Curtis, Vries, and Sheerin, 2011). Based on recent research, there is strong correlation between emotional intelligence and nursing leadership. Young nurses have to be communicative and approachable, so they are always able to bridge the gap between practice and training, before they acquire leadership skills through experience. Nurse leaders have to empower nurses and promote positive behaviors within the organization, as a means to ensure patient care is delivered with excellence (Curtis, Vries, and Sheerin, 2011).
Patient Safety Culture and the Nurse Leader’s Role
According to the Agency for Healthcare Research and Quality, culture is an important component of healthcare safety and quality (Sammer, 2011). Every organizational culture comprises of the norms, beliefs, and values that are significant to the organization. A culture of safety includes patient-related behaviors and attitudes that are anticipated to promote patient safety. Therefore, it is paramount a nurse leader assesses the safety culture in their work environment and develops a framework for their staff to follow, in order to improve patient safety (Sammer, 2011).
Hospital leaders have the responsibility to assess the safety culture within the organization frequently, as per the Joint Commission’s regulations (Sammer, 2011). A unit-based safety culture survey is believed to be able to evaluate the conditions within the work setting that may result in either patient harm or critical events. At the same time, this survey can also raise awareness in regards issues related to patient safety, assess the current safety status, promote interventions, and evaluate the effectiveness of various improvements made from time to time (Sammer, 2011). Organizations use their front-line safety-related cultural measurements and the actions that followed, in order to compare their safety record with one another, as a means to promote behaviors and attitudes focused on safety, start interventions, and then measure their effectiveness (Sammer, 2011). Given that a strong patient safety culture can predict falls injuries, treatment errors, injuries and accidents in the work environment, and errors in medication, and considering that organizations rely heavily on frontline nurses to fulfil their objectives and goals, it is evident that a nurse leader’s role is crucial. Culture changes require hard work. Since culture is perceived as somewhat foggy in nature, a framework, or any other patient safety culture tool, may provide valuable assistance to a unit’s nurse leader to improve the unit’s patient safety culture (Sammer, 2011). This could be achieved by making the particular driving factors of a safety culture more concrete. Nurse leaders have seven patient-safety-culture-related driving factors available, which include: (1) teamwork, (2) leadership, (3) communication, (4) evidence-based practice, (5) e-learning culture, (6) patient-focused culture, and (7) just culture (Sammer, 2011). With mutual respect among all team members, and Situation-Background-Assessment-Recommendations, nurse leaders can achieve transparent and clear handoffs.
Taking into consideration the various responsibilities of a nurse leader, it has become apparent that there are not many significant differences between the responsibilities of the one or the other. Both a nurse manager and nurse leader are accountable for ensuring healthcare is delivered excellently, making sure the organization’s objectives and goals are achieved, interacting with other nurse groups and ancillary personnel to maintain the smooth running of their unit or department, instill positive behaviors and promote personal growth and professional development in their staff and maximizing the productivity of frontline nurses, with the use of various means. All in all, a nurse manager is a crucial part of an organization and has a very important role in providing high quality healthcare.
Baker, S., Marshburn, D., Crickmore, K., Rose, S., Dutton, K., Hudson, P. (2012), What do you do? Perceptions of nurse manager responsibilities. Nursing Management, Volume 43, Number 12, p.24 – 29.
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