Introduction

Healthcare delivery systems are businesses that are economically driven. Whether the setting is inpatient or outpatient, the emphasis is on providing the highest quality of care at an affordable price. The nurse manager is a key individual whose leadership can directly influence many environmental functions. Manion (2005) identifies that nurse managers are considered the chief retention officers for their departments and are increasingly held accountable for results that demonstrate retention. Other functions begin with the selection of the right person for the right position and having the manager function in the role of coach. As a coach, the nurse manager can assist and encourage employees to perform at their highest levels in an empowered and self-directed manner. The nurse manager also clarifies the organization’s mission and expectations.

The role of follower cannot be overrated! A strong patient care unit has both effective leadership and team members who understand their role in meeting the goals for quality patient care. Professional healthcare providers must clearly understand what is expected of their performance, including the ramifications of not meeting those expectations. This performance can be achieved only when all members of the organization have clearly defined roles and overall objectives. Ambiguous roles are more detrimental to role performance and employee work satisfaction than is conflict within the role.

Role Concepts and the Position Description

The acquisition of a role requires an individual to assume the personal as well as the formal expectations of a specified role or position. Many individuals function within multiple roles. As discussed in the Theory box below, role theory provides an appreciable framework for the development and evaluation of staff. Today’s professional nurse is often a parent, spouse, and community volunteer and maintains full-time employment outside the home. Many skills are necessary for each role. In addition, the role-taker (i.e., the individual actually performing the role) has specified performance objectives within the social context in which the role is enacted. The social context includes the physical and social environment.

Role ambiguity in the workplace creates an environment for misunderstanding and hinders effective communication. In this situation, individuals do not have a clear understanding of what is expected of their performance or how they will be evaluated. In contrast, role conflict is easier to recognize. Employees know what is expected of them, but they are either unwilling or unable to meet the requirements.

Employees must have clear role expectations and perceive that their contributions are valued. Empowerment and control for certain aspects of the environment have been linked to increased personal health, job satisfaction, and individual performance. They are then more likely to be committed to the organization and to provide a higher level of patient care. These principles are applicable to both managers and staff members. A consistent focus on developing staff creates a learning environment directed toward excellence.

Acquisition of the role is time-dependent; individuals apply their life experiences to each role and interpret the role within their own value system. As roles become more complex, the individual may take longer to assimilate the components of each particular role. Nursing graduates enter the profession with various levels of educational and life experiences. The nurse manager plays an integral role in assisting these individuals in the development and acquisition of the complex role of the professional nurse. It is important to remember that role development evolves over time and considers individual needs. Role acquisition is something that nurses can encounter numerous times during their career. The RN who completes additional academic education and becomes an advanced practice registered nurse takes on a new role. The staff RN who moves to a new or different specialty acquires a new role. Coaching is a technique that the manager can use to facilitate individual development; this technique is discussed within the context of performance appraisal.

The position description provides written guidelines detailing the roles and responsibilities of a specific position within the organizational context. The position description reflects functions and obligations of a specific work position. It is a contract for the individual that describes responsibilities of the work assignment, as well as to whom the individual reports.

The position description should reflect current practice guidelines for individuals and may have competency-based requirements. As paradigms of nursing delivery systems shift to the home and community, professional nurses must have a clear understanding of the performance that is expected. The nurse is also responsible for clearly understanding the position descriptions of the paraprofessionals to whom care is delegated. Clear and concise position descriptions for all employees are extremely important because they provide the basis for roles within the organization. Example statements from a position description for a staff nurse in a medical/surgical patient care unit appear in Box 15-1.

Selecting Staff

The selection of staff would seem to be a relatively simple process. The manager wants the most qualified individual for the position. Choosing the right individual is the challenge! Brooke (2008, p. 50) notes that the cost of recruiting and orienting a new nurse “drives home the necessity of carefully selecting nurses who’ll work well within your hospital’s culture.” Health care is centered on caring for people, and nurses with appropriate people skills are essential for producing satisfied patients and families. For example, if an applicant values that the needs of the patient come first and this value is also articulated via the organization, he or she has similar values related to the work of the organization. The applicant and the manager must agree on what defines quality care and the manner in which it should be delivered. The manager must also decide whether members of the existing staff are to be included in the screening and interview process for new employees. The following guidelines are suggestions for the manager and staff, as well as for the prospective employee.

The manager’s focus before and during the interview is to be prepared and have well-thought-out questions. The environment should be comfortable and provide privacy without interruptions. Parrish (2006, p. 179) notes that it is important to remember that the “manager’s attitude defines the tone of the interview” and that the “interviewer sets the stage.” The interview questions can be related to the applicant’s experience or be directed to evaluate values and critical-thinking skills. This may be accomplished by asking the applicant to describe his or her reactions to challenging situations previously experienced. Dye (2007, p. 116) notes that highly effective interviewers focus heavily on asking what are known as behavioral questions: “These are questions that seek demonstrated examples of behavior from the candidates’ past experiences and concentrate on job related functions and accomplishments.” A question related to teamwork in an interview could be, Tell me about a time when you were working in a group and there were problems with other individuals who were not pulling their weight. What did you do to maintain a team environment?

Technical skills, such as specific certificates, are also important for the work environment and, therefore, also must be discussed or validated. The applicant may be given a case study to read and discuss with the interviewer. The case study could describe a situation for the unit in which the applicant is being interviewed; the content of the case study may require the applicant to prioritize the care of one patient or a group of patients. Questions from the applicant should be answered honestly. Parrish (2006, p. 179) notes that “an overview of the practice, what the job entails, required work hours, description of benefit package, and any other practice-specific information” should be shared. A tour of the unit and a review of the position description are helpful to give the applicant information about the expectations of the role. Staff members also may be included in the interview and can provide information to the applicant as appropriate. At the conclusion of the interview, it is important for the nurse manager to clarify concrete issues. According to McConnell (2008, p. 53), “All applicants interviewed for a position deserve informational closure after the fact. An indication of follow-up should be more than a don’t call us, we’ll call you.” Applicants should know the time line of when they can expect to hear about their interview result, who will contact them, and how they will be contacted. Thank applicants for the interview, and end interviews on a positive note.

The applicant also has responsibilities in preparation for the employment interview. It is important to be on time and appropriately dressed. Conservative dress is always acceptable. A uniform is not necessary and usually not even preferable. First impressions may be lasting impressions. Previous review of the organization’s goals and mission statement, as well as a review of the position description for which the interview is being conducted, is also appropriate. The applicant should be prepared to answer each question honestly and thoughtfully. It is as important to the prospective employee to make the right decisions as it is to the employer. The manager and the applicant must have a clear understanding of the values and organizational goals for nursing care to ensure that the applicant is well-suited for the role. The applicant should focus on the topic and avoid irrelevant conversations. He or she must prepare for any questions that might be discussed. In addition to describing previous situations and how they were handled, the applicant may be asked to describe personal strengths and weaknesses. At the end of the interview, the applicant should thank the manager for his or her time and verify when the selection will be made and how it will be communicated. It is also appropriate to send the manager a brief note of appreciation for the interview. More information appears in Chapter 29.