This chapter reinforces your ultimate accountability as the nurse manager to ensure that professional nursing practice is alive and well in your workplace. It also serves to remind you that despite the heavy demands of managing day-to-day operations, nurse managers are accountable for managing an interprofessional and diverse staff, while ensuring practice that is collaborative, evidence based, and guided by professional standards of practice and codes of ethics. In this chapter, you will learn: 1. The nurse manager’s accountabilities and responsibilities for leading professional practice environments in a rapidly changing health care system 2. Specific strategies for demonstrating leadership and “walking the talk” about professional practice in the workplace The role of today’s nurse managers is a work in progress that is rapidly evolving within frenetically paced and changing health care environments. Today’s nurse managers, in addition to managing the operations of a particular service, are now required to have an organizational and community presence, effectively pulling them away from their geographical area of responsibility. When they are in their clinical areas (sometimes multiple areas), in addition to managing operations, they serve as nursing practice leaders, facilitators, coaches, and traffic cops (spending their time directing any number of individuals coming at them from all directions). In addition, inspiring trust and generating attitudes promoting collaboration and professionalism, they are ever mindful of creating an environment where people want to work (let us not forget many “other related duties,” as well). Above all, managers have responsibility for safe, competent, and ethical practice in the provision of nursing care. Added to their workload are managing patient care and family crises, committee participation, and possibly covering another clinical area for a vacationing colleague. Is it any wonder that many nurse managers question their sanity as they try to keep all the balls in the air? Many nurse managers continue to have little or no formal preparation for this vital role. Most stepped into the role as a temporary replacement, were “promoted” for their clinical excellence, or “volunteered” when no others would step up to the plate. Moreover, most receive little organizational support, and funding seems minimal for professional development of middle management. Owing to the gradual recognition that the nurse manager is the key to clinical excellence this situation is (thankfully) improving. A day in the life of a nurse manager usually means 80% of his or her time is spent managing operational issues and dealing with erratic, unexpected, or unpredictable incidents (hereafter fondly referred to as “brushfire management”). Most nurse managers are ultimately professionally accountable and responsible for the overall quality of care delivered to patients and clients 24 hours a day, 7 days a week, 365 days a year. However, much of their time is spent away from the practice setting. How do mangers find the time to ensure that professional practice is alive and well within their service area(s)? All too often, many nurse managers reluctantly admit that they do not have enough time to monitor practice because of other demands, are not physically present in their clinical settings long enough to know what is really going on, or confess that it has been a long time (if ever) since they actively promoted the standards in everyday practice. Despite the fact that individual nurses and other health care professionals are accountable and responsible for their individual practice, and the availability of clinical support (if they are lucky) from clinical nurse educators, mentors, and nurse specialists, no one but the nurse manager has the authority or professional accountability to manage nursing practice to ensure that standards of practice are met. With the increasing demand for evidence-based practice, this becomes a significant additional challenge. Bottom line: the buck stops with the nurse manager who is ultimately responsible for the overall delivery of quality nursing care. Managers must know and never assume that what is going on at the bedside is delivered by the right person, at the right time, and in the right way according to the care provider’s scope of practice, standards, and code of ethics. When significant organizational change challenges the practice environment individuals and teams react. How well they navigate change depends on many factors, including the leadership and culture of the unit or service and the broader organization. Professional caring behavior can be influenced positively or negatively by variables that include past experience with change, quality of communication during the change process, workload, physical and psychological well-being of individual staff members, attitudes of other staff members, professional autonomy, and nursing leadership. In situations where change is managed well, staff is inclined to thrive despite the challenges when professionalism and excellence in care provision become the goals of the practice environment and staff members are led and inspired by a strong nurse manager. When change is not managed well staff feels disconnected, powerless, disrespected, and anxious about their future. This uncertainty and anxiety may lead to physical, emotional, and psychological strain causing staff to retreat into survival mode. In an environment that seems to be spinning out of control, with ever increasing burdens of rising acuity levels, task-focused care, lack of time, and inadequate staffing, nurses draw upon their energy reserves and vigorously focus on the tasks related to getting the job done. The risk is great of focusing exclusively on the tasks and technical aspects of nursing practice, and believing that “there isn’t time for that other touchy-feely stuff.” But when nurses do this they place their professional practice in jeopardy, falling well short of their scope of practice by losing sight of the nursing process outlined in the legislation and standards and upon which their license depends. When nursing and staff practice falls short of professional requirements it is essential that nurse managers not delay in dealing with the situation. Coincidentally, this is usually the time when nurse managers and staff complain about “absent leadership.” Redressing this situation is no easy task for a manager. More than ever nurse managers must be available to make their way back to the bedside or practice setting if for no other reason than to ensure that patient/client care and safety are in no way compromised because of a failure to uphold the standards of practice. How familiar are you, currently, with the standards of practice for nursing and the code of ethics for staff and nursing leadership? While many nurse managers have a tacit understanding of these professional practice guidelines some will readily admit that they do not significantly factor into their daily stream of consciousness. If that is the case, then this must change. Regardless of the demands that are placed on you during organizational change, your commitment to maintaining nursing practice and quality care outcomes according to the standards and code must remain stalwart and at the forefront. To do this, you must first give yourself time to reflect on your own familiarity with the standards; how you use the standards to guide your administrative practice; and the degree to which you model the standards among your staff on a day-to-day basis. It might also be helpful to answer the following questions: • To what degree do the standards of practice and the code of ethics influence our professional practice environment? • In what ways do all staff members demonstrate evidence of utilization of the standards of practice in their everyday practice and therapeutic relationships with patients and clients? • How do staff members treat one another professionally, and in what way do they apply the standards to their collegial and professional relationships? • In what ways do the standards of practice influence patient/client care communication? • How much do the standards factor into creating a respectful workplace and healthy workplace relationships? • How much time each day do you allocate to discussing patient care and nursing practice and linking them to the standards of practice?
The Buck Stops Here
Managing Professional Practice
TOWARD A NEW WAY OF BEING
24/7/365 IS NOT ENOUGH TIME
MANAGING CHANGE TO ENSURE SAFE, COMPETENT, ETHICAL PRACTICE
PROFESSIONAL PRACTICE STANDARDS CHECK-IN
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