Learning Objectives
By the end of this section, you will be able to:
- Analyze the attributes needed for nursing management
- Describe different management structures
- Identify how to implement and manage change as a nurse manager
- Explain management functions in nursing
In nursing, the concepts of leadership and management are both pivotal yet distinct elements that drive the success and efficiency of healthcare delivery. Leadership, as explored in the previous module, is the practice of guiding, influencing, and motivating individuals or groups toward achieving a common goal. It is about setting a vision, inspiring nurses to strive for excellence, and fostering an environment where each team member can thrive and contribute to patient care and organizational objectives. Leadership focuses on the “why” and “what” of work, emphasizing direction, inspiration, and the broader picture of healthcare outcomes.
Contrastingly, management in nursing takes a more structured approach to achieving healthcare goals. It involves the practice of determining what tasks need to be completed to accomplish a particular goal and ensuring all team members complete those tasks effectively and efficiently. Management is concerned with the “how” of work, focusing on planning, organizing, coordinating, directing, and controlling (Greenhalgh, 2023). It ensures that the resources are appropriately allocated, the nursing staff is adequately supported, and the operational aspects of patient care are conducted within established guidelines and standards. While leadership seeks to motivate and engage—often in the service of transformational change—management aims to establish order and consistency through predictable processes and systems (Gavin, 2019).
Understanding the distinction between leadership and management is crucial for nursing professionals. While a nurse leader might inspire their team to adopt new patient care innovations, a nurse manager ensures that the day-to-day operations support these innovations. Both roles are essential in a healthcare setting and require a keen understanding of how to get the best out of a team. Often, effective nurse managers embody qualities of both leaders and managers, blending inspiration with organization to meet the complex demands of modern health care.
Management Attributes
In nursing management, certain attributes stand out as essential for ensuring that a healthcare team operates smoothly and effectively (Table 18.3). These attributes not only facilitate the accomplishment of tasks and goals but also contribute to a positive and productive work environment. Effective nurse managers possess a blend of skills that enable them to address the multifaceted challenges of healthcare management. Among these, conflict resolution and employee engagement skills are particularly vital, impacting everything from team cohesion to patient care quality.
| Skill | Key Points |
|---|---|
| Conflict resolution skills |
|
| Employee engagement skills |
|
| Mentoring skills |
|
| Decision-making skills |
|
| Technical skills |
|
Conflict Resolution Skills
Conflict resolution skills are crucial in nursing management due to the high-stress, fast-paced nature of healthcare settings. Conflicts may arise from a variety of sources, including interpersonal disagreements, workload disparities, or differing opinions on patient care. Effective conflict resolution involves identifying the root cause of a dispute, facilitating open communication between the parties involved, and negotiating a solution that is acceptable to all. For example, if two nurses disagree over patient care priorities, a nurse manager with strong conflict resolution skills might arrange a meeting to discuss each nurse’s perspective and mediate a consensus that aligns with the patient’s best interest and team capabilities. This not only resolves the immediate issue but also models constructive communication and problem-solving techniques for the team, fostering a culture of collaboration and mutual respect.
Employee Engagement Skills
Employee engagement skills are equally critical for nurse managers, as engaged employees are more likely to be committed, motivated, and satisfied with their work. Engagement in nursing can influence job satisfaction, retention rates, and ultimately the quality of patient care (Wei et al., 2023). Nurse managers can foster engagement by providing clear communication, recognizing and valuing employees’ contributions, offering professional development opportunities, and creating an inclusive work environment that respects diversity and individuality. For instance, a nurse manager might implement regular feedback sessions to understand and address nurses’ concerns, celebrate team achievements, and involve staff in decision-making processes related to patient care protocols or department policies. By engaging employees, nurse managers not only enhance team morale but also drive improvements in care delivery and operational efficiency.
Mentoring Skills
Mentoring skills in nursing management involve guiding and supporting less-experienced nurses to develop their professional competencies, confidence, and career paths. Effective mentorship is crucial for fostering a learning culture within the healthcare environment, enhancing staff retention, and ensuring high-quality patient care. A nurse manager with strong mentoring skills can identify individual strengths and areas for growth among their team members, offering personalized advice, setting achievable goals, and providing constructive feedback. For example, a nurse manager might pair a newly graduated nurse with a more-experienced nurse for shadowing opportunities, facilitating hands-on learning and professional development. Additionally, by organizing regular career development workshops and one-on-one coaching sessions, nurse managers can inspire their staff to pursue further education and specialty certifications, thereby strengthening the overall skill set of the nursing team.
Decision-Making Skills
Decision-making skills are indispensable for nurse managers, allowing them to navigate the complexities of healthcare delivery and administrative responsibilities effectively. This involves analyzing information, weighing the benefits and risks of different courses of action, and making choices that best support patient care, staff well-being, and organizational goals. In the context of nursing, decision-making can range from clinical judgments about patient care to operational decisions regarding staff scheduling or resource allocation. For instance, a nurse manager faced with a sudden influx of patients must quickly decide how to redistribute tasks and resources to maintain patient care standards without overburdening the staff. This might involve reallocating nurses from less critical areas or approving overtime work. Effective decision-making ensures that nurse managers can respond swiftly and appropriately to changing conditions, optimizing both patient outcomes and team performance.
Clinical Safety and Procedures (QSEN)
QSEN Competency: Safety: Patient Acuity Change
Definition: Reduce the risk of harm to patients through effective, efficient, and competent performance.
Knowledge: The nurse manager will create a culture of safety with the nursing staff, allowing them to recognize elevated acuity and care limitations of the unit.
Skill: Demonstrate effective communication to the healthcare team to deliver adequate patient care. The nurse manager will do the following:
- Assist nursing staff in notifying the provider for a change in patient acuity.
- Monitor the patient along with nursing staff until the provider arrives.
- Advocate for patient safety with the provider, to facilitate transfer to an upgraded level of care.
- Explain to the patient and family/caregivers what is happening and allow the patient to express any concerns. Provide reassurance to the patient.
- Facilitate transfer to an appropriate unit.
- Assist with the patient transfer, if necessary, or monitor the nurse’s other patients while they travel with the patient.
Attitude: The nurse manager will value the vigilance and prompt communication of the nursing staff in recognizing a change in patient acuity and advocating for safe and appropriate patient care.
Technical Skills
Technical skills in nursing management encompass both hard skills (technical, measurable abilities acquired through education, training, or job experience) related to healthcare technologies and clinical assessment and soft skills such as time management, organization, and communication. In today’s healthcare environment, nurse managers must be proficient in using electronic health record systems, understand the latest medical devices, and stay informed about advancements in patient care techniques. For example, a nurse manager should be able to troubleshoot a malfunctioning patient monitoring system or guide staff in implementing a new telehealth service. Equally important are soft skills (interpersonal and behavioral traits that facilitate effective interactions, collaboration, and adaptability at work), which enable nurse managers to efficiently plan schedules, manage patient information, and facilitate clear and effective communication among staff and with patients. For example, a nurse manager might use project management software to organize team assignments or implement communication protocols to ensure that critical information is shared promptly and accurately. Together, these technical skills are vital for managing the operational aspects of nursing care, leading to innovations in patient services, and enhancing team collaboration.
Management Structures
Management structure in an organization delineates how decision-making authority is distributed across various levels. In the realm of nursing and health care, understanding the nuances of different management structures is crucial for effective administration and leadership. Two primary management structures are centralized and decentralized (Figure 18.2). Each of these structures has its implications on how decisions are made, how information flows within the organization, and how responsive the organization can be to changes in the healthcare environment. While centralized management features a top-down approach, where higher-ranking managers hold the decision-making authority, decentralized management adopts a more diffuse approach, spreading authority across various individuals and teams, regardless of their rank within the organization (Mishra, 2021).
Centralized Management
In centralized management structures, decision-making authority is concentrated at the top levels of the organization. This structure is characterized by a clear hierarchy where directives flow from higher-ranking managers down to the frontline staff. In the context of nursing, a nurse manager operating within a centralized structure might receive specific protocols and policies from the hospital administrators regarding patient care standards, staffing ratios, or budget allocations. For example, the implementation of a new electronic health record system would be decided by senior management, with nurse managers then responsible for ensuring their teams are trained and compliant with this system. While centralized management can ensure uniformity and consistency across a large healthcare organization, it may limit the flexibility of nurse managers to make swift decisions based on immediate patient care needs or to innovate based on frontline experiences.
Decentralized Management
Decentralized management structures distribute authority more evenly across different levels of the organization, empowering a wider range of individuals and teams to make decisions. In nursing, this means that nurse managers and even frontline nursing staff may have more autonomy to develop and implement practices that best meet the needs of their patients and work environment. For instance, in a decentralized management structure, a nurse manager may have the authority to adjust staffing levels or to pilot a new patient care initiative without needing approval from higher up the hierarchy. This approach can lead to increased responsiveness to patient needs, greater job satisfaction among nursing staff due to a sense of empowerment, and more innovative problem-solving. However, it also requires strong communication and coordination to ensure that decentralized decisions align with the organization's overall goals and standards. Furthermore, decentralized structures still require leaders to set the organization’s core values and direction and hold teams accountable for their decisions. Table 18.4 lists advantages and disadvantages of each type of structure.
| Management Structure | Advantages | Disadvantages | Best Suited for . . . |
|---|---|---|---|
| Centralized |
|
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Large healthcare organizations where uniform standards and policies are critical for cohesive operation |
| Decentralized |
|
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Smaller clinics or units within a hospital where rapid adaptation and innovation are necessary |
Implementing and Managing Change
In the dynamic field of health care, change is both inevitable and essential. For nurse managers, being prepared to implement and manage change is not just a skill but a necessity. The healthcare environment is continually evolving due to advancements in medical technology, changes in patient care standards, regulatory updates, and shifts in patient demographics. Each of these changes has the potential to significantly impact nursing teams, requiring adjustments in workflows, roles, practices, and even in the organizational culture itself.
Effective management of change is crucial for maintaining high standards of patient care while ensuring that the nursing team remains resilient, motivated, and cohesive. Nurse managers play a pivotal role in guiding their teams through periods of transition, whether it is adopting new electronic health record systems, shifting to patient-centered care models, or implementing new health policies. Their leadership can make the difference between a team that struggles with change and one that thrives, adapting successfully to new challenges.
Change Theory
There are numerous theories and models regarding change management that can help nurse managers navigate these transitions (Forbes Councils, 2022). These theories offer insights into the processes of change, strategies for effective implementation, and methods for overcoming resistance. By understanding and applying these theories, nurse managers can respond more effectively to change and also leverage it to improve team performance, enhance patient outcomes, and drive innovation within their organizations. Embracing change as an opportunity rather than a hurdle allows nurse managers to lead their teams with confidence and vision, positioning themselves and their staff for success in a rapidly changing healthcare landscape.
One of the foundational theories is Lewin’s model for change management, developed by the psychologist Kurt Lewin in the early 1950s (Figure 18.3). Lewin posited that effective change occurs through three intentional steps: unfreezing, changing, and refreezing (Barrow et al., 2022).
- The unfreezing step involves preparing the organization for change, which may include recognizing the need for change and reducing resistance from team members by communicating the limitations of current practices and the benefits of the intended change.
- Unfreezing sets the stage for moving, when the actual transition occurs. During this step, change occurs as new processes, behaviors, and attitudes are introduced and adopted by the team.
- The final step, refreezing, involves solidifying the new state as the standard practice. This ensures that the changes are integrated into the organization’s culture and operations, thereby preventing a regression to old habits.
Whereas Lewin’s theory focuses on the process of solving a problem, a more recent theory, appreciative inquiry, builds from a foundation of what is already working within an organization (Naca-Abell, 2020). Appreciative inquiry engages team members to envision what their organization could be, based on its successes and peak experiences, rather than dwell on what is lacking. This process is structured around four stages: discover, dream, design, and destiny.
- In the discover phase, nurse managers and their teams identify the best of what is currently happening within the organization.
- During dream, the team envisions what the organization might become.
- During design, the team plans and prioritizes actions for turning their dreams into reality.
- Finally, in the destiny phase, the team implements the proposed design, with an eye toward sustaining the changes and celebrating the successes.
Planned Change
Both Lewin’s model and appreciative inquiry are examples of planned change, a deliberate, systematic process for introducing transformation into an organization or system. In essence, planned change includes any theory that approaches change proactively, in an intentional, systematic way, rather than reactively. As you have seen, there are many different approaches to planned change, from problem-focused theories such as Lewin’s to success-oriented theories such as appreciative inquiry. However, most approaches include the following basic steps:
- First, the organization must recognize the need for change.
- Next, someone must be appointed to lead the change effort, and a team must be assembled.
- Working together, the team must then make several decisions that will drive the change process:
- What are the goals?
- What is the current climate within the organization, and how receptive will people likely be to these goals?
- What approach will likely be most effective at achieving these goals in light of this climate?
- Once these questions are answered, the team is ready to develop and implement a plan for change.
- Finally, the team should evaluate the results of the plan to determine whether the goals were met, whether the reception to change has been positive, and how best to proceed based on these results.
Resistance to Change
Resistance to change is a natural human response, particularly in high-stress environments like health care, where routines and established practices provide a sense of security and predictability. In nursing, resistance might manifest when introducing new technology, shifting staffing models, or altering patient care protocols. For instance, a nurse manager implementing an electronic health records system might encounter resistance from staff who are accustomed to paper records and wary of the learning curve associated with new software. Such resistance can stem from fear of the unknown, perceived threats to job security, or concerns about increased workload. Understanding the root causes of resistance is crucial for nurse managers to address concerns empathetically and effectively, ensuring a smoother transition to new practices.
Overcoming Resistance to Change
Overcoming resistance to change involves a combination of communication, education, and support. Clear, transparent communication about the reasons for the change, its benefits, and its impact on staff can help alleviate fears and build trust. For example, in the case of transitioning to electronic health records, a nurse manager might organize demonstrations to showcase the system’s efficiency benefits and patient safety improvements. Education and training are also vital, providing staff with the skills and confidence needed to adapt to new systems or procedures. Furthermore, creating a supportive environment where staff can express concerns, ask questions, and provide feedback on the change process encourages participation and ownership of the change. To foster a positive attitude toward change, nurse managers can recognize and celebrate milestones and successes, reinforcing the value of new practices. By employing these strategies, nurse managers can transform resistance into engagement, leading their teams through change with resilience and optimism.
Goals of Nurse Managers
Nurse managers play a critical role in healthcare settings, bridging the gap between the administrative and clinical sides of nursing. Their goals encompass a wide range of responsibilities aimed at ensuring the delivery of high-quality patient care, fostering a positive work environment, and maintaining operational efficiency. To achieve these objectives, nurse managers engage in planning, staffing, organizing, directing, and regulating. These foundational management activities enable nurse managers to effectively lead their teams, optimize resources, and navigate the complexities of the healthcare landscape. By setting clear goals in these areas, nurse managers contribute to the overall success and sustainability of healthcare organizations, ensuring high-quality patient care.
Planning
Planning is the first critical step in achieving the goals of nurse managers. It involves setting objectives for the nursing team and developing strategies to reach these goals within the constraints of available resources. Effective planning requires a deep understanding of the healthcare facility’s needs, patient care standards, and capabilities of the nursing staff. For example, a nurse manager might plan to implement a new patient triage system in the emergency department to reduce wait times and improve patient outcomes. This would involve assessing current processes, forecasting future patient flow, and determining the staffing and training needs to support the new system. By carefully planning, nurse managers ensure that initiatives are well-designed, achievable, and aligned with broader organizational goals.
Staffing
Appropriate staffing is another essential goal for nurse managers, who must ensure their team includes the right number of staff with the appropriate skills to meet patient care needs at all times. Effective staffing involves not only recruiting and hiring but also scheduling, developing, and retaining nursing staff. For instance, a nurse manager in a pediatric unit might identify a need for more nurses trained in pediatric oncology due to an increase in patient admissions. Addressing this need could involve hiring new staff with specialized skills or providing existing staff with targeted training opportunities. Additionally, the nurse manager would need to consider the optimal scheduling patterns to cover all shifts adequately while allowing for rest, thereby reducing the risk of burnout. Proper staffing ensures that the nursing team can provide high-quality, continuous care to all patients, reflecting the nurse manager’s commitment to excellence in patient care and staff well-being.
Organizing
For nurse managers, organizing involves the arrangement of resources, staff, and processes to ensure efficient operation and high-quality patient care. Effective organization requires a clear understanding of the department’s goals, the roles and responsibilities of each team member, and the resources available. In the context of nursing, organizing might include developing a streamlined process for patient admissions and discharges to minimize delays and improve patient flow. For example, a nurse manager might reorganize the shift patterns to ensure that staff with specific skills are available when most needed, such as having more experienced trauma nurses during peak emergency room hours. Additionally, organizing can involve setting up interdisciplinary teams for complex patient care, ensuring that all necessary specialists are coordinated to provide comprehensive treatment plans. By effectively organizing, nurse managers create a structured and supportive environment that enables staff to focus on delivering the best possible care to patients.
Directing
Directing involves leading and motivating staff to achieve the healthcare facility’s goals. This goal is crucial for nurse managers, as it encompasses guiding the nursing team through daily tasks, addressing challenges, and ensuring that everyone remains focused on providing exceptional patient care. Effective directing requires strong leadership, clear communication, and the ability to inspire and engage team members. For instance, a nurse manager might direct the team through a significant change, such as the adoption of a new policy or procedure, by clearly explaining the benefits, providing training, and offering support throughout the transition. Another aspect of directing is offering regular feedback and recognition, which are key to motivating staff and promoting a positive work culture. Through directing, nurse managers ensure that the nursing team is aligned with the organization’s vision and values and that all team members are working cohesively toward common objectives.
Regulating
Regulating encompasses establishing and enforcing standards and policies to ensure the nursing team’s activities align with clinical quality, financial accountability, and regulatory compliance. This goal is vital for maintaining the integrity of healthcare services and ensuring patient safety. Nurse managers play a crucial role in regulating by implementing evaluation systems that monitor performance in areas such as patient care, staff efficiency, and resource utilization. For example, a nurse manager might introduce a quality improvement program that regularly assesses patient outcomes and identifies areas for enhancement, such as reducing hospital-acquired infection rates. Additionally, regulating involves ensuring financial accountability by managing budgets effectively, optimizing resource use, and justifying the need for additional resources or staff when necessary. Through careful regulation, nurse managers ensure that their departments not only meet but exceed the standards set by healthcare authorities and accreditation bodies, thereby upholding the organization’s reputation and commitment to excellence in patient care.