Introduction

Chapter 1 provided a general overview of leading and managing. This chapter looks at management from different perspectives. The core of role theory began with management theory—a science that has undergone numerous changes in the past century. In the early 1900s, the theory of scientific management was embraced—a theory based on the idea that there is one best way to accomplish a task. Practice in the 1930s through the 1970s was dominated by participative, humanistic leadership theories. Although changes in healthcare delivery no doubt are affecting the roles of nurse managers, the relevance of role theory remains a constant. Conway’s (1978) historic definition, “role theory represents a collection of concepts and a variety of hypothetical formulations that predict how actors will perform in a given role, or under what circumstances certain types of behaviors can be expected” (p. 17), is still appropriate.

The evolutionary process of management theories has affected how managers address workers’ concerns and needs. The beginning management theories discounted concern for workers’ psychological needs and focused on productivity and efficiency. When theories relating to human relations came about, workers’ needs and motivations became focal points for the nurse manager. Conversely, situational theories, such as the Path-Goal theory, focused on the environment, clarifying the relationship between the pathway employees take and the outcome or goal they wish to obtain.

What is involved in management? A self-appraisal might lead a potential nurse manager to ask himself or herself the following questions: Do I have career goals that include gaining experience and education to become a nurse manager? What specific knowledge, skills, and personal qualities do I need to develop to be most effective in practice? Do I have a mentor who can guide me in this direction? Does the organization I currently work for have succession planning? If changes need to be made, they must be matched with changes in healthcare agencies and within the larger social system. A nurse manager must recognize the need for growth within, which then translates into improvement of one’s practice. A prerequisite for self-actualization is a bond between the nurse and the community, because a nurse manager’s patients and staff make up the community. Consider also, what is the role of the nurse manager? Practicing nurse managers illustrate role perceptions. Some nurse managers would cite decision making and problem solving as major roles, for which maintaining objectivity is sometimes a special challenge. Others would identify collaboration, especially with other departments, to enhance quality patient outcomes. Truly effective care is the result of efforts by the total healthcare team. Effective collaboration includes honesty, directness, and listening to others’ points of view. However, management is more complex than this.

The Management Role

Management is a generic function that includes similar basic tasks in every discipline and in every society. However, before the nurse manager can be effective, he or she must be well-grounded in nursing practice. Drucker (1974), in his classic writings, identified the following five basic functions of a manager, which are still true today:

Table 4-1 shows how these basic management functions apply to the nurse manager.

Managers develop efforts that focus on the individual. Their aim is to enable the person to develop his or her abilities and strengths to the fullest and to achieve excellence. Thus a manager has a role in helping people develop realistic goals. Goals should be set high enough yet be attainable. Active participation, encouragement, and guidance from the manager and from the organization are needed for the individual’s developmental efforts to be fully productive. Nurse managers who are successful in motivating staff are often providing an environment that facilitates accomplishment of goals, resulting in personal satisfactions.

The nurse manager must possess qualities similar to those of a good leader: knowledge, integrity, ambition, judgment, courage, stamina, enthusiasm, communication skills, planning skills, and administrative abilities. The arena of management versus leadership has been addressed by numerous authors, and although points of view differ, some similarities exist between managers and leaders.

Managers address complex issues by planning, budgeting, and setting target goals. They meet their goals by organizing, staffing, controlling, and solving problems. By contrast, leaders set a direction, develop a vision, and communicate the new direction to the staff. Managers address complexity, whereas leaders address change. Another way of looking at management in contrast to leadership and followership is to look at the common traits of each. In Table 4-2, the characteristics of a leader are compared with those of a manager and a follower.

The literature abounds with complexities that nurse managers face in the everyday roles they encounter when leading their staff. One of those roles is creating a positive workplace environment that now includes four generations of nurses (Veterans, Baby Boomers, Generation X-ers, and Millennials [Generation Y-ers]). Carver and Candela (2008) discuss the importance of nurse managers having a strategy to increase job satisfaction, decrease nurse turnover, and increase organizational commitment by considering the generational differences. Managers who know how to relate to the different generations can improve work environments for nursing. The concept was validated in a study conducted by Widger, Pye, Wilson, Squires, Tourangeau, and Cranley (2007). Data were collected from 6541 registered nurses comprising the Baby Boomers, Generations X-ers, and Generation Y-ers). Although the Baby Boomers showed a high degree of job satisfaction, such was not the case for the Generation X-ers and Millennials. If managers want to be successful in establishing job satisfaction for the younger generations, the study concluded, the following must be considered: (1) creating a shared governance structure in which nurses are encouraged to make decisions; (2) providing opportunities for self-scheduling; and (3) providing opportunities for career development and supporting education.

The nurse manager is the environmentalist of the unit. In other words, the manager is always assessing the context in which a practice and work environment that is positive and healthy can affect people’s performance. Thus the nurse manager’s role is to ensure that the nine principles and elements of such an environment are present as defined by the American Organization of Nurse Executives (2004):

Quantum theory speaks to the uncertainty and the vast number of possibilities that can be used in different situations. Valentine (2002) included Quantum theory when addressing nursing leadership theories. She referred to the work of Porter-O’Grady and his observations that leaders display various roles according to the needs of the system and can be seen in a number of places in the system. Thus his work has opened up new horizons when thinking about leadership and how the ever-changing healthcare environment is requiring new leadership characteristics. Valentine refers to what Porter-O’Grady has written regarding technology and how it has changed the way leadership is viewed. Historically, knowledge increased as the position of the person increased and nurse growth was vertical up the chain of command. Now, when new nurses enter the workforce with enormous technologic knowledge and skills, their professional growth is on a horizontal plane. Thus Quantum theory may be the most significant theory for the nurse manager of the twenty-first century.

To be successful in day-to-day operations, a manager must be concerned with relationships. Chaleff (2009) developed one of the early models of followership to reorient individuals: “Courageous followership is built on the platform of courageous relationship. The courage to be right, the courage to be wrong, the courage to be different from each other. Each of us sees the world through our own eyes and experiences” (p. 4). Chaleff describes five dimensions of the relationship: the courage to assume responsibility, the courage to serve, the courage to challenge, the courage to participate in transformation, and the courage to leave by separating from a leader or group. Table 4-3 poses the possible corollary role of the manager for supporting this courage development in followers.

Consuming Research

The nurse manager’s role calls for a twofold responsibility: that of being a participant in research and that of being an interpreter of research. Nursing literature, especially in nursing administration journals, reflects that nurse managers are contributing to research either by doing unit research or contributing to large-scale agency research projects. (See the Research Perspective on p. 58.) Likewise, the nurse manager also interprets published research findings that have implications for the staff or the patients and makes every effort to incorporate the findings into unit activities so that both staff and patients can benefit from evidence-based care. Nurse managers, as first-line managers, are also in the position of identifying best nursing practices that can be researched through collaborative efforts of service and educational institutions. Nurse managers should also provide and support staff nurses to conduct nursing research studies, as well as present their own findings of current evidence-based practice in the literature.

Research Perspective

Resource: Mackoff, B. L., & Triolo, P. K. (2008). Why do managers stay? Building a model of engagement. Part 1. Dimensions of engagement; Part 2. Cultures of engagement. Journal of Nursing Administration, 38(3/4), 118-124; 166-171.

This descriptive study addresses high-performing nurse managers in six hospital settings. The researchers chose study participants who met two criteria: (1) the nurse manager had been in the position at least 5 years and (2) had been rated as outstanding in the nurse manager role. A convenience sample of 30 nurse managers participated in 90-minute interviews.

The data collected were analyzed from the perspective of individual and organizational signature elements (factors). Ten individual nurse factors were linked to the nurse managers’ engagement, longevity, and vitality. The factors included the following:

1. Mission driven—The mission was meaningful to the manager.

2. Generativity—The manager was delighted to help and contribute to the next nurse generation.

3. Ardor—The manager exhibited enthusiasm and excitement toward his or her colleagues and was dedicated to patient care and the organization.

4. Identification—The nurse manager identified and appreciated how the work of others, such as patient care, affected his or her functioning in a positive manner.

5. Boundary clarity—The nurse manager had strong connections with others without losing a sense of self.

6. Reflection—The nurse manager stood back and learned from both positive and negative experiences.

7. Self-regulation—The nurse manager controlled his or her emotions and chose battles wisely.

8. Atonement—The nurse manager had the insight to appreciate the other person’s perspective and learn to walk a mile in the other person’s shoes before passing judgment.

9. Change agility—The nurse manager addressed change in more than one way, through new knowledge and by challenging the process.

10. Affirmative framework—The nurse manager met the challenges without burnout and remained optimistic and upbeat.

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