NURSES EDUCATION: A CONTINUED CHALLENGE TO NURSES

SUBMITTED BY

Grace B. Dorgu

ABSTRACT This paper examines the concept of the nursing manager and discusses their role I managing organizational resources. As the fields of Nursing Science has broadened, so has the responsibilities of the professional nurse. The emergence of Free Enterprise and universal practice of democracy in no small way played a pivotal role in this evolution of nursing practice. These promoted considerable growth in the nursing profession and led to a situation where today, we are witnessing the emergence of nursing managers. This paper therefore, concludes that though nursing and management may initially not operable within the concept of a nursing manager, the Area of Specialization provides a bridge for these seemingly opposing extremes where the nurse meets the manager and results in efficient and effective management of organizational resources.

INTRODUCTION Nursing, no matter where it is practiced today, has evolved greatly from its humble origins. No more just a particularly female vocation, nurses are today found in different non-hospital environments; always involved in healthcare-related activities and working for the general well-being of individuals and communities. As the fields of Nursing science has broadened, so has the responsibilities of the

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professional nurse. Spanning a historical pedigree traceable all the way to Hippocrates of the 5th century to the origins of its codification under Florence Nightingale, to a modern era of degree-based nursing, the profession has entered its golden age as nurses have begun to carve a niche for themselves outside the ubiquitous shadow of the medical physician. The emergence of Free Enterprise and universal practice of democracy in no small way played a pivotal role in this evolution of nursing practice. The former (Free Enterprise) ensured cross-pollination of ideas, men and resources across previously impenetrable borders and frontiers while the latter (democratic practice) made for equal rights for men and women. These promoted considerable growth in the nursing profession and led to a situation where today, we are witnessing the emergence of nursing managers. In this paper, we examine the concept of the nursing manager and analyse their role in the management of organizational resources. In doing that, we shall delineate our conception of who the nurse is, our nuance of manager, what we refer to as the nursing manager and how he or she performs the role in managing organizational resources. We shall conclude by pitching the nurse manager within a democratic dispensation showing its prospects and challenges.

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NURSING MANAGER DEFINITION OF TERMS: CONCEPT OF NURSEMANAGER Not a few people have heard of, much less understand, the concept of the Nurse Manager. Thus, a paper with a topic such as this ought to appropriately contextualize that concept ab initio before going on to the crux of the paper itself. Germane to that clarification is the definition of its keywords Nurse and Manager. Who is a nurse? Who is a manager? Are they diametrically opposed or do they have any points of convergence?

NURSE We shall consider several definitions of nurses to afford a varied perspective of the profession and a better appreciation of the value of nurses. A nurse is a healthcare professional who is focused on caring for individuals, families and communities, ensuring that they attain, maintain, or recover optimal health and functioning. Nurses are capable of assessing, planning, implementing and evaluating care independently of physicians and they provide support from basic triage to emergency surgery. Nurses may practice in hospitals, clinics, physician offices, private homes, schools, pharmaceutical companies (usually as researchers), industry (occupational health settings), cruise ships, retirement homes, hospice facilities, long-term care facilities, military facilities, and even camps.

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Some nurses may also advice and work as consultants in the healthcare, insurance or legal industries. Nurses can work full- or part-time, and many work on a per diem basis or as travelling nurses. [1]

According to another source:

Nurses care for individuals of all ages and cultural backgrounds who are healthy and ill in a holistic manner based on the individuals physical, emotional, psychological, intellectual, social and spiritual needs. The profession combines physical science, social science, nursing theory, and technology in caring for those individuals. Nurses follow their personal and professional interests by working with any group of people, in any setting, at any time. Some nurses follow the traditional role of working in a hospital setting. [2]

Basically, these quotes specifically identify and delineate the nurse from a variety of medical professions available. There is no over-emphasizing the over-arching importance of the nurse to general healthcare. It is the most diverse of all healthcare professions. Nurses practice in a wide range of settings but generally nursing is divided depending on the needs of the person being nursed. It becomes apparent that a profession with such diversity of operations must inadvertently be built on a solid educational foundation.

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These trainings and knowledge equip these nurses for the task set out for them in their chosen profession and even beyond the confines of that profession when they have to act as managers. But the question then arises; who is a manager?

MANAGER We shall apply the same method utilized in designating who a nurse is for outlining the person of a manager. A manager is a person tasked with overseeing one or more employees or departments to ensure these employees or departments carry out assigned duties as required. [3] In other words, ...a manager is the person responsible for planning and directing the work of a group of individuals, monitoring their work, and taking corrective action when necessary. Managers may work directly or they may direct several supervisors who direct the workers. The manager must be familiar with the work of all the groups he or she supervises. The manager may also posses the power to hire or fire employees or to promote them. In addition, the manager has the authority to change the work assignments of worker under his supervision. [4]

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More often than not, a managers title reflects his or her authority and responsibility. But irrespective of the title, the manager remains responsible for planning, directing, monitoring and controlling the people and their work. Together these tasks embody the management of the business. [4] Now, the term management encompasses an array of different functions undertaken to accomplish a task successfully. Simply put, management is all about getting things done! The art of management originated when men started learning the art of organising, strategizing (during wars for instance) and or simply planning. At its core, management was quintessentially considered as an art of managing men, hence the term manage-MEN-t. Management is a systematic and creative flow of knowledge that can be applied when required to produce results by using human and other resources in an effective way. Management is both art and science. It is the art of making people more effective than they would have been without you. The science of management is how the manager goes about achieving this. Modern Management is not often limited to managing human resources; but has been segregated into various branches such as financial management, strategic management, operations management, time management, crises management, marketing management, etc. Each of these is a separate branch that is handled by specialised individuals as managers with expertise and experience in these varying fields. [5]

Today, the importance of management from an organisations point of view has increased multi-fold. Only through effective management that companies are

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developing and executing their businesss policies and strategies to maximize their profits and provide their customers with the best products and services. Today, management combines creative, business, organisational, analytical and other skills to produce effective goal-oriented results! Some of the key functions in management include learning to delegate, planning and organizing, communicating clearly, controlling situations, motivating employees, adapting to change, constantly innovating and thinking of new ideas, building a good team and delivering results which are not just figure-bound but results that also focus on overall growth and development. [5]

NURSING MANAGER With the above conceptual clarification of the key terms of our discourse, a backdrop now exists for the appropriate distillation of the concept of the nursing manager. The Nursing Manager is the primary healthcare professional who, among other strictly nursing duties, also has the added responsibility of overseeing one or more employees or departments to ensure that these employees or departments carry out assigned duties as required. This management task embodies an array of different functions undertaken to accomplish a task successfully. The question that is oft-raised in consideration of this concept is the requirement of experience that management demands. Questions of the capacity of a trained nurse

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to adequately manage employees and or departments put under her nag at the prospect of a nursing manager. Also, people are wont to raise the fact that management has far-reaching objectives beyond managing of human resources alone as there are segregation of management such as financial management, strategic management, operations management, time management, crisis management, marketing management, etc. These, they note, require field-based specialization. [5] There is also the notion raised that since management involves key functions like learning to delegate, like planning and organizing, communicating clearly, controlling situations, motivating employees, adapting to change, constantly innovating and thinking of new ideas, building a good team and delivering results which are not just figure-bound but results that also focus on overall growth and deliverance, how can the nurse manager put up with all these key functions given what we have seen as the already overloaded workload of the practicing nurse of modern day nursing? Do all these not already impinge on the abilities of the nurse to effectively and efficiently handle the role of managing the organisational resources successfully? What is the possibility of a nurse to carry out the managers role and responsibilities and still be a qualified practicing and professional nurse? Can the

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nurse still be nurse and manager or in other words, can the manager still be nurse and run both these roles adequately? The answer to this question would obviously be in the negative if there were no points of convergence in both professional roles. However, they do not cancel out each other as they are not mutually exclusive. In the first instance, the question of experience can be immediately put to rest. Before a nurse attains the role of manager, he or she would have had to go through the rigorous educational path that leads to the highest qualifications attainable for nurses in his or her given or chosen area of specialisation. Though this is not an exclusive prerequisite, it is of extreme necessity that the nurse manager be of high educational qualification and background in the area of management specialisation. With that educational background and years of experience in the area of specialisation, management of employees and departments would definitely result, based on efficient and effective best practices, in successful outcomes. This also answers the question of segregations in the management platform where management exceeds managing just human resources to other managements like financial, strategic, time and crisis management. As previously mentioned, the nurse manager is most productive when he or she manages all resources, human or otherwise within his or her area of specialisation. Because professionalism and

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productivity in management is largely benchmarked on the level of specialisation that manager has with regards to his or her area of expertise, it would be favourable and efficient if the nurse manager is managing organisational resources within the ambit of his or her area of specialisation. Furthermore there is also the notion that given what we have seen as the already overloaded workload of the practising nurse of modern day nursing, how can the nursing manager put up with the numerous key functions mentioned above that pertain to proper management of staff and resources. This notion can be dealt with here. The appropriately-titled Key Functions are sine qua non for good management and no proper management setting would be productive without these functions involved in the running of its activities. Therefore, because of their prime importance in efficient productive organisational management, the nursing manager has the prerogative to prioritize. The priority of importance between his or her primary nursing practice and the demands of nursing management is the only way the issue of overload and balance can be sorted. Walking this equilibrium tightrope, the nursing manager has to bring to bear experience garnered from years of practice as a professional nurse and from his or her depth of knowledge in his or her area of specialisation. This is why educational foundation is necessary. This allows the nurse manager make the best choice possible out of available options and balance management duties with nursing role.

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Applying basic management skills that involve Planning, Organisation, Directing and Monitoring with these key functions is a sure-fire way of maintaining management of organisational resources. It should be also be noted that according to the International Council of Nurses, Advocacy, promotion of a safe environment, research, participation in shaping health policy and in patient and health systems management and education are also key nursing roles. [2] So, right there, we see the origins of the nursing manager entrenched in the role of the nurse.

THE ROLE OF NURSEMANAGERS IN MANAGING ORGANISATIONAL RESOURCES The management of people and resources is seldom easy. Skills, capabilities, experience and educational background all come to play in a co-ordinated blend in the person of the successful manager. And the successful manager is the one who realises that he or she does not have it all and is open to new knowledge that can be obtained from anyone at anytime. That aptly identifies the challenge of the nurse manager especially within a democratic dispensation. The democratic outlook is of primary importance to ensure that the thin line between a thorough and professional manager and a dictatorial overlord is not

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crossed. This is a particularly enormous challenge especially for the nursing manager under pressure to be successful at all costs and by any means possible. It is on record that the pursuit of success by foul means has been the bane of many a good-intending manager who, somewhere along the line, sought other less noble means towards success. Therefore, the democratic dispensation is the matrix within which our nursing manager can best utilize organisational resources optimally for the overall success of the organisation. Operating true democratic system, together with its compositional checks and balances, streamlines the managements procedures and processes, makes the management accountable, affords periodic and seasonal reports and updates, provides a forum for feedback, allows for change of personnel according to stated tenures, rewards hard work and punishes laxity, and maintains law and order using appropriate channels of justice. Thus, the nursing managers prospects are brighter to the extent to which he or she subscribes to this democratic system and applies same to managing the organisational resources, human or otherwise.

SUGGESTIONS AND RECOMMENDATIONS The nursing manager thus has to display some important traits that would brighten his or her prospects of successful management of his or her area of expertise. Here

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are some suggestions and recommendations for the would-be successful nursing manager: Self Motivation The nursing manager must be able to do his or her job without needing any sort of external push. He or she must understand the organisations basic goals and be able to develop personal strategies for the achievement of those goals. He or she should be able to commit everything to the managerial role without any sort of supervision (even though there is a periodic supervision of the role). Interpersonal Skills A manager who excels at dealing with others, whether they be clients, customers or staff, is a huge bonus to the organisation. Though not always in constant and direct contact with clients and customers (or patients, as the case may be), the managers duty to respond to problems and conflicts as and when they arise is better handled by a manager well-versed in interpersonal skills. A manager who can handle even the most difficult patient or staff, grows the business as he or she allows the organisation retain customers and afford a conducive environment for the employees to work. Integrity and Trustworthiness

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These qualities provide exemplary leadership for the people under the nursing manager and must not be lacking. Being a person whose word is his or her bond provides an ethical foundation for the nursing manager to expect and demand same from others. Team Player The nursing manager has to be committed to working with a team of people for the improvement of the department he or she manages. Therefore, all selfish tendencies ought to be suppressed and the genuine purpose of growing the organisation to meet and exceed organisational goals by optimal utilization of organisational resources and for the benefit of the team he or she leads should be the paramount motivation. The team, rather than I, the manager, should always come first. Conflict-Resolution Abilities Disputes have a way of cropping up in any group of people who have to work together for one purpose or the other. So, when these inevitable disputes arise, the nursing manager has the additional role of mediator. Skills at managing and handling conflicts are not easily acquired, so the nursing manager has his or her work cut out for him or her. Most management manuals recommend that the easier practice is to be able to identify issues that can metamorphose into conflicts and nip

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them in the bud before they blossom. However, because of those that do blow up, conflict resolution skills are a must. Knowledge of the Industry This cannot be over emphasized and it goes without saying. The nursing manager ought to be able to do the job of those he or she manages. This is basic. Beyond that, it is expected that the manager is abreast of innovations, breakthroughs, updates and progress that arrive daily in the industry within which the organisation operates. This knowledge furnishes the nursing manager with information so that he or she can provide guidance and answer questions on matters that arise in the work place. Dependability The nursing manager must be someone whom the upper-management can count on. He or she must provide examples for the others by resuming early for instance, must not slack on the job, can be counted on for extra hours if the need be and is willing to stay as late as possible for the job to be done. The nursing manager should be the one to whom when a job is given, ensures that the job gets done. Calmness

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Management is no small deal by any means. There is a great load of stress involved daily. Problems are wont to rise and rise as each one is solved and all in a days job. They find a way to come along the following day. The nursing managers job is to handle them; again and again. Handling them would be better achieved by one who can remain calm more often than not. Calmly approaching solutions to these inevitable problems keeps other staff calm, leads to increased productivity and overall success within a conducive working environment. Optimistic Attitude This is the attitude that deals with the flip-side of calmness which is indifference. Indifference is often misconstrued as calmness but is merely cloaked pessimism. The nursing manager must eschew pessimism and approach each day and each project with zeal and optimism as genuinely as possible. If there are concerns, these concerns should be appropriately dealt with so that true optimism is maintained. And it is infectious as it immediately spreads to the rest of the team above and below the nursing manager. Leadership skills This ties all the other traits up and completes them. Self confidence is the key. The nurse manager must exude this everywhere and every time and inspire confidence in others as well, he or she must be a good speaker especially in public, must be

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able to delegate tasks appropriately and have the carriage of a leader from whom people will be comfortable to take directions. He or she must be firm and also persuasive. These traits brighten the prospects of a professional nursing manager to scale through the obvious challenges of his or her management position in the framework of the entire organisation. [6]

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CONCLUSION This paper set out to examine the concept of the nursing manager and discuss their role in managing organisational resources. The conceptual clarification that made for an unobscured comprehension of what the nurse and manager referred, as used in the paper, was immediately followed by the delineation of who a nursing manager is and it identified points of convergence between both concepts. We then identified how the performance of the role of the nursing manager ensures growth and productivity in efficient management of organisational resources. The prospects and challenges of the nursing manager especially within a democratic dispensation was also dissected and we wrapped it all up by identifying traits that make for effective and productive nursing managers. This paper therefore concludes that though nursing and management may initially appear diametrically opposed and thus not operable within the concept of a nursing manager, the Area of Specialisation as earlier defined, provides a bridge for these seemingly opposing extremes. The Area of Specialisation thus becomes a point of convergence where the nurse meets the manager and results in efficient and effective management of organisational resources. Also, it should be noted that a democratic dispensation, in its loose and strict senses, as earlier defined also, provides the best structure for the success of the

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nursing manager and the managers prospects for success are brighter or dimmer to the extent to which he or she is able to keep the tenets of democratic principles that he or she faces as challenges in the management of his or her area of expertise.

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