ANALYZING A NURSE IN A LEADER OR MANAGER ROLE

Analyzing a Leader or Manager Role

Daphne Fitzpatrick and Hope Oudbier
Nursing 440
Ferris State University

ANALYZING A NURSE IN A LEADER OR MANAGER ROLE

Analyzing a Nurse in a Leader or Manager Role

The American Organization of Nurse Executives (AONE) is a professional nursing
organization whose membership goals include advancing nurse practice and policy through
leadership. The AONE (2011) has published and updated Nurse Executive Competencies (NEC)
that provide guidelines for the role and function of nurses in executive practice (p.3). These
guidelines were reviewed and questions for a nurse manager interview were formed. The
purpose of this paper is to describe the roles and responsibilities of the manager that was
interviewed and to describe and analyze the communication, knowledge, leadership,
professionalism, and business skills that take place on his floor. Analysis will compare the skills
of the manager interviewed with AONE NEC standards and that of peer reviewed publications.
For this assignment, we were to interview a nurse leader or manager of a nursing floor.
We interviewed a nurse manager who will be known in the course of this paper as T.S. T.S.s area
of expertise currently is nurse managing, but before that he had a background in emergency care
nursing. Straight out of nursing school T.S. got hired into the emergency department at
Butterworth hospital. From there he became the night manager for the emergency department at
the same hospital and for a while because of some staffing issues, he was the only night manager
for the emergency department for a while, so he got some experience in running a hospital unit
by himself. After that they made him the manager of the entire emergency department, including
all shifts. The next management opportunity T.S. moved into was a hospital supervisor position
which helps with the general flow of the hospital and problem situations. He fulfilled this role for
2 years then tired of coordinating things for the whole hospital and had a desire to return to a
home unit. So, when the position opened for a nurse manager of the Orthopedic Trauma floor
of 4North, he took that position and has been there for 8 years. He stated that his previous

ANALYZING A NURSE IN A LEADER OR MANAGER ROLE

experience in management made for an easy transition to 4 North. The education that T.S. has is
a Bachelors of Science in Nursing and a Masters in Health Administration.
Roles and Responsibilities
The role that T.S. has on the 4 North floor is one with many different facets. He is a
motivator for his staff, a mediator in times of discourse, an overseer of the floors problems such
as falls, and safety, and gives 4North a voice in the large sea that is Butterworth hospital. When
he walks onto the floor one of the first things he does is goes and talks to his charge nurse to
make sure nothing has happened on the floor while hes been in meetings. He makes sure that his
floor has been running well while hes been gone, and if something has happened since hes been
there last, he immediately brainstorms with those involved, whether it be nurses, care
management, social work, ect, then comes to a decision of what is going to happen. Recently
while we were on the clinical floor there was a fall that resulted in the patient having to have
surgery to fix injuries from the fall, and as soon as T.S. got there in the morning, he was right
there working with staff trying to figure out what happened and how to make sure such a
problem can be prevented in the future. In situations like this, T.S. displays the Positive
Communication model where instead of blame, the leader engages in acknowledgement of the
person, in this case the staff (Yoder-Wise, 2011, p.331-332). In terms of the organizational
structure, the charge nurse, and the floor nurses report to him, while in turn he reports to the
hospital supervisors and if needed the Chief Nursing Officer of Spectrum Health Butterworth
Hospital.
Communication
Communication in management can be used to foster relationship building and
influencing behavior. A primary goal of effective communication can convey a message as

ANALYZING A NURSE IN A LEADER OR MANAGER ROLE

intended both verbally and written. Managers can use communication to interact with their team
to keep an open flow of information which can develop team and shape how the staff interacts in
a caring manner with patients and each other. When asked about the importance of
communication T.S. stated he spends a lot of time making his words reflect the people he is
speaking with to ensure he is communicating correctly. He stated this involves breaking specific
information down to share with staff, yet being able to take the same topic and explain the
complexity of things to the director of nursing.
T.S. does have an open door policy, and encourages interaction between staff. If an
employee comes to him with a conflict he questions if they have addressed the other(s) involved
before coming to him. This open type of communication affects patients for the better because
nurses are encouraged to talk to their peers and charge nurse if they have a problem, so less time
is spent in waiting around for the nurse manager to help solve the problem. Because the nurse
manager goes to many different meetings around the hospital, he is not always in his office. So,
supporting a team with open communication helps problems get resolved with good strategy,
quickly for better patient care outcomes. This can help the organization as a whole because it
facilitates open communication and camaraderie in the staff, and a staff that is able to
communicate to each other functions more smoothly during a problem. This type of
communication and positive example creates a mentor relationship that can have positive staff
outcomes in job satisfaction (Johnson et al., 2011).
Knowledge
The managers knowledge of the healthcare environment can help support responsibilities
in quality improvement and risk management. Patient safety and outcomes are end goals
throughout the healing process. A manager that looks at current quality and risk factors for

ANALYZING A NURSE IN A LEADER OR MANAGER ROLE

particular diagnoses or reasons for stay can help optimize patient outcomes by creating a plan
specific for that diagnoses and looking at the big picture from the time the patient arrives until
discharge. This helps the patients by reducing the number of secondary injuries sustained in the
hospital, which can cause unnecessary pain and anxiety. Hip fractures in particular have been
addressed by T.S. to his unit as a focus to improving care with hip fractures. The
multidisciplinary collaboration goals were to establish decreased length of ER to OR to 24 hours,
which was a lot of work. Knowledge and team discussions took place as to what screenings were
needed, which were not. This ended up helping the organization by saving time on steps that are
not needed and helped create working orders sets.
Leadership
Leadership roles vary in how they are carried out by the individual, leaving opportunity
for each manager have a style, basis of foundational thinking, and a way they manage changes.
These changes can be carried out with assessing current needs, costs, and methods and
comparing them to what it would be like if change was implemented. The manager should be
seeking to guide the improvement process as well as encourage employees to be team players
and feel comfortable bringing suggestions.
T.S.s prefered route of communication for change is convincing staff through examples
and talking. His style includes a preference of talking to staff, getting feedback, and using visual
cues. He also likes to use visual aids including demonstrations of negative and positive behavior.
T.S. demonstrates an example of transformational leadership, which according to Merill (2015),
is a type of leader that can be proactive and convince followers to strive for higher
performance (p.319). T.S.s leadership affects patients in that his leading, and the changes being
made increase positive patient outcomes, and can lead to a shorter length of stay. For the staff,

ANALYZING A NURSE IN A LEADER OR MANAGER ROLE

T.S.s leadership helps both the staff, and the organization itself to go through a smooth transition
of change due to the leadership style that T.S. uses. This allows the change to be adopted more
quickly and with greater adherence to the change.
Professionalism
Degrees of professionalism that a nurse manager practices include accountability, ethics,
and advocacy. Patient care providers have responsibilities to themselves as well as their patients.
Managers incur the responsibility of their staff, unit, patients and being accountable to the
organization. This creates a constant need to create an environment that keeps staff aware of how
they should behave professionally by communicating or demonstrating how each staff role
should be performed. T.S. mentioned an attention to the floor culture legacy of employees and
spoke of team building quite a bit. When trying to integrate new organizational decisions and
involve his team in the clinical process T.S. finds that sharing workload, meeting with other unit
managers, charge nurses, and staying on top of getting the right people to the right training and
events can help. Per Leach and McFarland (2014) this can be a formula for success
throughout the organization and for job satisfaction and competency.
Professionalism affects the patient population because having a healthcare provider that
engages in professionalism decreases the number of patient errors. Professionalism affects the
staff in that because of team building, it brings them closer together as a unit. Professionalism
affects the whole Spectrum Health organization by reflecting back an image of expertise that
makes people want to come to Butterworth Hospital.
Business skills
Nurse managers use business skills in staff management. A typical hospital unit consists
of a variety of staff and the nurse manager spends a great amount of time doing administrative or

ANALYZING A NURSE IN A LEADER OR MANAGER ROLE

human resource management. This includes time focusing on the needs of employees,
schedules, training, disciplining, and hiring. T.S. meets the criteria of staff management very
well. He tries to be an ever present force with his staff. This being said, his management of his
staff starts hands off as he does not want to smother them, and he wants them to make
independent decisions and try to solve their own problems. When needed, hes on the floor
talking to his staff, looking into their needs and what he can do for the floor to run more
smoothly. The smooth management effects the patients for the better because it means that there
are enough nurses for the number and acuity of patients present, so rarely do nurses ever feel
overwhelmed with their assignment. Effective management helps the staff because it allows them
less stress about their assignments because they know that they will have the right number of
staff to run the floor efficiently. If they fall short of resources or staffing, they know that T.S.
will try and get the resources that they need. This helps the organization as a whole because
when the staffing is correct for the floor, the nurses are less stressed, and being less stressed there
is a far lesser chance of turnover of nurses, and a greater number of turnover for patients coming
through the hospital.
Conclusion
The AONE NEC guidelines (2011) help shape basic administrative responsibilities with
focus on communication, knowledge, leadership, professionalism, and business skills. These
competencies are important to meet because they provide a foundation for the staff and patients
they care for. T.S. exhibits an excellent reflection of these competencies in his experience and
execution of management skills.

ANALYZING A NURSE IN A LEADER OR MANAGER ROLE

References
Leach, L. S., & McFarland, P. (2014). Assessing the Professional Development Needs of
Experienced Nurse Executive Leaders. Journal Of Nursing Administration, 44(1), 51-62.
doi:10.1097/NNA.0000000000000021
Johnson, J. E., Billingsley, M., Crichlow, T., & Ferrell, E. (2011). Professional development for
nurses: mentoring along the U-shaped curve. Nursing Administration Quarterly, 35(2),
119-125 doi:10.1097/NAQ.0b013e31820f69c0
Merrill, K. C. (2015). Leadership Style and Patient Safety. Journal Of Nursing Administration,
45(6), 319-324 doi:10.1097/NNA.0000000000000207
The American Organization of Nurse Executives. (2011). The AONE Nurse Executive
Competencies. (Date file). Retrieved from
file:///F:/1.%20FSU/16%20Spring%202016/440%20Leadership%20&%20Management/
AONE_NEC(1).pdf
Yoder-Wise, P. S. (2011). Leading and managing in nursing (5th ed.). St. Louis, MO: Elsevier
Mosby.