1. Discuss the role of the manager. 2. Review the different management levels in nursing. 3. Identify differences between a nurse manager and a nurse executive. 4. Differentiate between the various types of competencies of client care managers. 5. Compare the nursing process and the management process. 6. Discuss activities used by the nurse manager to support the nursing and management processes. As you advance in your nursing proficiency, you will eventually take over some managerial tasks. You may even be asked to become a nurse manager. Just because you take on some managerial tasks does not necessarily make you a nurse manager rather than just a nurse performing some managerial tasks. Also, just because you are an excellent clinical nurse does not mean that you will become an excellent manager. In some organizations, the only promotion opportunities occur through progression to management. If you do not see yourself in such a role, it will be important for you to work in an organization that also has promotion opportunities for nurses who remain at the bedside. The competencies of a nurse manager need to be developed, and the process of manager development occurs through education, mentorship, and professional growth. As discussed in Chapter 1, management is not synonymous with leadership, although management is a part of leadership. As stated in Chapter 1, management and leadership are different. To review (Bennis, 1994, p. 45): • The manager administers; the leader innovates. • The manager maintains; the leader develops. • The manager focuses on systems and structure; the leader focuses on people. • The manager relies on control; the leader inspires trust. • The manager has a short-range view; the leader has a long-range perspective. • The manager asks how and when; the leader asks what and why. • The manager has his or her eye on the bottom line; the leader has his or her eye on the horizon. • The manager imitates; the leader originates. • The manager accepts the status quo; the leader challenges it. • The manager is the classic good soldier; the leader is his or her own person. • The manager does things right; the leader does the right thing. Management is a complex process of coordinating and directing the actions of others to accomplish an organization’s objectives. It also involves the assignment of resources to these groups so that the objectives can be met. It is achieved through six functions: planning, staffing, organizing, directing, controlling, and decision making (Carroll, 2006). Planning determines what needs to be done. This may refer to what needs to be done for a single shift or for a longer period, such as the year. Staffing refers to the selection and assignment of specific people to accomplish the tasks (see Chapter 3 for discussion on delegation). Organizing is the process of coordinating all resources to meet the goals. Organizing is a fluid activity requiring knowledge of the organization and people and having the ability to alter the plan, staffing and organization if the goals are not being met. Directing deals with the skills necessary to motivate the staff to accomplish the assigned tasks. In this activity, you need to be able to provide the proper resources, set clear goals, and foster a work environment that encourages goal achievement. Controlling is accomplished through the setting of professional standards, compliance with standards of performance, and the ability to lead a staff to excellence. Last, decision making is the result of these five actions. According to Sullivan and Decker (2001), the key steps of decision making are (1) identification of the problem, (2) establishment of criteria that can evaluate potential solutions to the problem, (3) seeking alternative solutions, and (4) selection of the best alternative based on the organizational mission, vision, strategic objectives, and available resources. There are levels of patient care management in most institutions. The organizational structure of the organization will determine the titles and the span of authority of the various levels of patient care management (Box 9-1). The first-level manager, also known as a first-line manger, nurse manager, or head nurse, is responsible for supervising the work or nonmanagerial personnel and the day-to-day activities of a specific work unit or units (Box 9-2). This manager is responsible for the units on a 24-hours-a-day/7-days-a-week basis. Key tasks for a first-line nurse manager may include the following (adapted from Carroll, 2006, p. 32): • Preparation of orientation schedule in collaboration with nursing education department • Submission of time schedules for nursing shifts • Staff assignments for patient care during shifts • Making budget recommendations to the middle and upper levels of management. These budget needs are made based on unit needs and patient acuity (see Chapter 14) • Calculating the amount of staff needed per shift, per day, etc. This will also include the alteration of staffing plans based on emergencies, sick calls, and changes in patient acuity • Conducting employment reviews, including counseling reports and termination • Interviewing potential staff members (this is often done in conjunction with middle management) • Participating in performance improvement activities; review of unit performance on CORE measures, National Patient Safety Goals, and other unit-based performance indicators • Setting goals with individual staff and for patient care areas The middle-level manager, also known as supervisor, director, or assistant or associate director of nursing, supervises a number of first-level managers. These managers usually are within the same specialty or the same geographic location. They may spend more time planning, evaluating, and coordinating and less time with direct patient care supervision than the first-line manager (Box 9-3). They are responsible for the people and activities within the departments they supervise on a 24-hours-a-day/7-days-a-week basis. Key tasks that the middle level manager may perform include the following (adapted from Carroll, 2006, p. 33): • Assessment: Observe whether unit policies and objectives are meeting the needs of the patients and staff. • Planning: Set short-term and long-term goals for patient care; revise as needed. • Organization: Put plans in action via delegation and committee work. • Control: Analyze results of action plans, make changes as necessary, facilitate the growth of staff, and communicate changes and opportunities to upper-level staff and to staff reporting to manager.
Developing Management Skills
LEADER VERSUS MANAGER
LEVELS OF MANAGEMENT
FIRST LEVEL
MIDDLE LEVEL
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Developing Management Skills
