Nurse Managers Need a Body of Knowledge and Skills - Assignment Example

Running Head: NURSE MANAGERS NEED A BODY OF KNOWLEDGE AND SKILLS Nurse Managers need a body of knowledge and skills distinctly different from those needed for nursing practice" (Sullivan & Decker, 2005:44). Critically discuss [Writer's Name] [Institution's Name] Nurse Managers need a body of knowledge and skills distinctly different from those needed for nursing practice" (Sullivan & Decker, 2005:44). Critically discuss Introduction This paper shall argue if the knowledge and skills required by the community nurse manager different from those required by staff nurses. Rafferty (1993) believed that both are quite different and therefore both need different traits and qualities to manage their tasks. Nursing leadership has been the subject of numerous studies in the latter half of the twentieth century. However, there is still no single clear and consistent definition of leadership or its characteristics. Bass (1990) noted that there appear to be as many definitions as there are researchers of the topic. The concept of leadership in nursing can be traced back to Florence Nightingale. In the late nineteenth century, she exercised power autocratically and promoted her model of leadership through the role of matron. She called her nurse managers 'specials', and until the 1960s, they were similar to their military counterparts. Discussion Nurses have been taught traditionally to be acquiescent, even submissive, helpers of doctors (Alimo-Metcalfe 1996 22-24), and nursing has been described as 'an oppressed discipline' (Jooste 2004 217-223) that remains the underdog in relation to medicine (Carney 2004). There have been changes in recent years however caused in part by feminism and demands for female equality, but also by employment legislation that has allowed most nurses to pursue clinical, educational or management career pathways. (Upenieks 2003 456-467) Nevertheless, as Alimo-Metcalfe (1996) suggest, many nurses working on wards retain a submissive role and do not assert themselves well. Yet this role does not necessarily reflect the relationship between nurses and doctors; as this paper into nurses' use of effective nursing management finds, nurse managers can also inhibit effective nursing management in nurses. Nurse Managers have demonstrated an array of different skills and abilities compared to regular nursing staff. Skills and qualities required for an effective nurse manager include essential communication skill with nurses who wish to develop professionally (Hersey 1982, Anthony 2005: 146-155). Alimo-Metcalfe (1996) identify several factors that prevent nurses from using nursing management skills, including a knowledge about their personal or professional rights, concern about what others will think about their behaviour, and anxiety caused by lack of confidence and poor self esteem. Effective nursing management skills education and training can alleviate some of these factors. Indeed, Hersey (1982) suggests that such training can help nurses to develop professional confidence and so collectively enhance the growth and development of the nursing profession. A descriptive paper by Bondas (2006 332-339) supports this view, in which a random sample of 800 nurses were asked to complete a questionnaire that incorporated both the Alderman effective nursing management schedule (Alderman 2001: 49-50) and a personal and professional data form. Findings from the 500 responses show that gender, age, years of experience and clinical setting do not influence individual effective nursing management levels. However, nurses with higher levels of education and previous effective nursing management training were more assertive. King (1996 3-14) also fined that training can increase levels of nursing management skills; although they suggest that workplace factors primarily promote or inhibit its use. The hierarchical nature of nursing, Hersey (1982) suggests, means that nurses have not always been encouraged by nurse managers to be assertive. Bondas (2006 332-339) paper supports this view and shows that nurses are more assertive than research literature generally indicates, and that they have the skills to use nursing management skills. However, it also shows that the management style employed by many nurse managers militates against its use. Moiden (2002 20-25) find that hierarchical management results in job dissatisfaction among nurses, and in staff feeling that nurse managers undervalue the work they do. They conclude that cohesive ward nursing teams that support-nursing colleagues are needed to ensure job satisfaction and good patient care. McCarthy (1997) paper of the function of nurse managers concludes however, that participation in management education programmes will not in itself facilitate or predict a successful management role. Instead, nursing staff as key indicators for successful management regard demonstration of higher-level clinical expertise and physical presence on the ward. King (1996 3-14) suggests that factors that support or inhibit nurses' use of skills and qualities required for an effective nurse manager in the workplace need to be identified. The aim of this paper, therefore, was to explore nurses' views and identify factors that support or inhibit it. Alimo-Metcalfe (1996) find that fear of punishment or being disliked and isolated by nursing colleagues ranked highest as barriers to using skills and qualities required for an effective nurse manager in the workplace; these barriers were ranked second and third respectively in the studied literature. (Sellgren 2006: 348-355) Alimo-Metcalfe (1996) also find that nurses and midwives frequently practise management skills like effective communication, delegation, authority and decision making skills among peers but less often when communicating with nursing management or medical staff. These findings support Bondas (2006 332-339) view and Hersey's (1992) that nurses have management skills like effective communication, delegation, authority and decision making skills but are uncomfortable or lack confidence about using them(Rush 2000) According to Barie (2005) and McCarthy (1997), an open-minded, participative and team approach by nurse managers is the most effective way of achieving pleasant and supportive work environments for staff nurses. Moiden (2002 20-25) support this view and suggest that nurses want a pleasant and supportive environment in order to use management skills like effective communication, delegation, authority and decision-making skills effectively and consistently. However, it appears that, with some exceptions, the management styles adopted by many nurse managers are not conducive to a positive, supportive work atmosphere (Moiden 2002 20-25). The respondents in the studied literature appear to feel that they are not effective, equal members of multidisciplinary healthcare teams, and their narratives suggest that they feel disempowered and undervalued, and have a low self-esteem, primarily due to their managers' management styles. This is further evidenced in how they use management skills like effective communication, delegation, authority and decision-making skills. They were generally very good at complimenting their subordinate nurses, making suggestions and allowing them to express their opinions. However, they were worse at making requests of their subordinate nurses, providing them with constructive criticism and disagreeing with them. Usually regular staff nurses' poor grasp of these nursing management skills infers that they are less likely to express their own needs or defend their own views. These results in a nursing workforce that lacks self-esteem and confidence, and that cannot be truly autonomous. The potential impact of this on nursing practice and development, and even the healthcare service as a whole, could be significant because autonomy encourages innovation and increases productivity and job satisfaction, and an autonomous workforce is more cost effective and increases patient satisfaction (Yoder-Wise 1999). Yoder-Wise (1999) suggests that 'it is unfortunate that autonomy for nurses is based on management's trust of the individual nurse instead of the profession'. Empowerment benefits the organisation and the patient. When professionals work together contributing their skills and expertise, a high quality of care can be practised. Patients will benefit from transformational nursing leadership because they will be cared for in a non-prejudicial manner by a team which is inspired, empowered, motivated and which possesses enhanced communication skills. The staff will benefit from a nursing manager who has the necessary knowledge and skills and who is co-operative, collaborative, consultative, courageous, and able constantly to regenerate his or her thinking. Through transformational nursing leadership, the team can utilise and control costs, and nurse patients who are becoming inquiring and educated. Each nurse in the team will be able to enhance his or her role as teacher and advocate. Through the nursing manager's ability to maintain the vision of the team, the core essence of nursing, which is caring, is achieved. This provides a possible explanation as to why some nurse managers are better than others are at creating supportive work environments that encourage autonomous nursing practice. Nurse Managers that can provide this type of work environment might well trust their staff as individuals, but they may also have a fundamental trust in the nursing profession. They may have high professional self-esteem and, along with the clinical experience and specific qualifications required to be a nurse manager, view the support and encouragement of their staff as an important part of their role and success. On the other hand, those who do not provide supportive environments may not be willing to trust their staff or may trust only a select few, leaving the rest feeling suspicious and undervalued, and lacking in self-esteem and confidence. Some nurse managers could be more trusting than others could because they have a greater sense of self-esteem. Many nurses work in unsupportive environments and consistently experience 'horizontal violence' in the workplace, defined by Begley (2002) as behaviour in which nurses redirect their dissatisfaction and frustration towards each other and those they perceive to be less powerful than themselves rather than towards those that cause these feelings. This behaviour manifests as verbal abuse, exclusion, disinterest, withholding of information, humiliation, and intimidation towards new or junior staff nurses, student nurses and other health service employees (Begley 2002 310-317). It is possible that, when they move into management positions, nurses find it difficult to manage situations, or people, in supportive ways because they have not experienced this themselves, and have low professional self esteem and find it difficult to support their own staff. Nurse Managers may not be supportive of skills and qualities required for an effective nurse manager in staff nurses because they are ill prepared and unsupported by healthcare organisations to meet the demands of the job (McCarthy 1997). Modern healthcare systems focus on reducing cost while improving the quality of care (McCarthy 1997). To meet these demands, nurses and nurse managers need to be flexible, and should have multiple abilities to manage changing responsibilities and tasks (Rafferty 1993). They need to manage budgets, information and planning in a managerial climate that strives for cost effectiveness, efficiency and specific patient related productivity as well as outcomes that are politically and economically driven (McCarthy 1997). This is in addition to the requirement that nurse managers are clinically expert and work at the bedside if required. It is evident that being a nurse manager is demanding and, as previously discussed, nurse managers need the support of autonomous nursing staff if they are to be successful. Nurse Managers might not think that supporting and encouraging staff nurses to be assertive is a priority. Skills and qualities required for an effective nurse manager are only one of many requirements of autonomous nursing practice and, although it is a key requirement, it may not necessarily be an obvious one. Previous studies did not explore which specific aspects of management behaviour inhibit or promote effective nursing management, but the qualitative feedback from respondents suggested that the most unhelpful aspect is having a hierarchical and autocratic management style, while the most helpful is having a team approach where each individual's contribution is valued and respected. This suggests that further research is needed to explore two areas: * The specific nursing management behaviours that inhibit or promote skills and qualities required for an effective nurse manager in the workplace * The concept of trust and why many nurse managers prefer an autocratic management style. It would also be interesting to explore nurse managers' views on egalitarianism in nursing and the strategies it inspires in the management of nurses. There is a constant shortage of nurses in the hospital setting. If staff is happy at work then they will stay in their present employment. A clinical manager who uses transformational nursing leadership will aim to provide that happiness. Leaders inspire staff to contribute to the organisation's mission. According to Flynn (1998) nurses who feel they contribute, experience job satisfaction, and nurses who experience satisfaction stay where they are. In addition, Joyce (2002 40-41) showed that staff morale has been linked with absenteeism and staff retention. The best retention tool is a manager's ability to lead. According to Jakeman (2004), Yates argued that through transformational nursing leadership the clinical manager can envision, enable, energise (using charisma) and empower his or her staff, thus developing a patient-centred service. The nursing leader's approach to adopting this theory of transformational nursing leadership is vital for its success. The nursing leader needs to establish open communication with the team if a vision is to be recognised and carried through. This will involve efficient and frequent meetings. The agenda should be established in advance and during the meeting, no other items should be discussed. Issues raised should be dealt with as soon as possible. Brainstorming involving all staff should be encouraged to solve problems. The nursing leader will need to be prepared to spend time listening. Hersey (2002) and Bond (2003) suggest it is essential that nurses receive education and training in using skills and qualities required for an effective nurse manager in the workplace at under- and postgraduate level. This is fundamental in equipping nurses with the knowledge and skills they need to interact assertively with the public and other healthcare personnel, including both nurse managers and nursing peers (Bond 2001 463-465). The majority of the research findings point towards the need for further education for nurse managers in leadership. Reay (2003) tells us that 'education for leadership is clearly seen by British nurse writers as an essential requirement of today's nurse'. Managers also need to understand the difference between the concept of management and the concept of leadership. Previous short management courses were merely 'quick-fix' solutions. Adopting transformational leadership requires education for both staff and managers. Open communication should be maintained constantly. The manager needs to have firm grasp of self-awareness, thus creating trust in the staff and a positive working environment where the manager is in tune to the needs of the staff and is able to satisfy those needs. Using skills and qualities required for an effective nurse manager gives nurses the confidence to overcome oppressive nursing management styles and take control of their practices, to become empowered, autonomous nursing practice (Bond 2001 463-465). Conclusion This research may be useful in identifying how nurse managers' experiences as handling subordinate staff nurses influence their management style. This would have implications for nurse manager education programmes and for support structures for newly appointed nurse managers. This paper's findings indicate that nurse managers require significantly different skills and abilities than a regular nursing staff member. These can be developed by education and training in skills and qualities required for an effective nurse manager in the context of a team approach that recognises the link between the use of consistent skills and qualities required for an effective nurse manager in the workplace, where nurses express their needs and views, and autonomous practice. Environments in which nurse managers develop and support their staff towards autonomous practice create successful outcomes in terms of staff development, staff retention, provision of high quality patient care and change management (Yoder-Wise 1999) Therefore, in light of the studied literature and case studies, it is clear that nurse managers need significantly different skills and abilities as compared to regular staff nurses. References Alderman MC (2001) Nursing in the New Millennium: challenges and opportunities. Dermatology Nursing, 13(1), 22-45, 49-50 Alimo-Metcalfe, B. 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