Running head: ANALYSIS OF A NURSE MANAGER 1

Analysis of a Nurse Manager

Angela M. Baird

Ferris State University

ANALYSIS OF A NURSE MANAGER 2

Abstract

The purpose of this paper was to analyze the role of a nurse leader or manager’s functioning in a

clinical setting. An interview was held with Laura Snyder, the clinical director of level six at

Metro Health hospital. Leadership style, legal issues, ethical issues, use of power and influence,

decision making, conflict resolution, research, and cultural diversity will be discussed. A small

introduction of the leader’s education, experience and current position will be explained. This

paper will provide many roles a nurse manager holds to maintain a safe working environment for

nurses and the patients they care for.

ANALYSIS OF A NURSE MANAGER 3

Analysis of a Nurse Manager

Within health organizations there are certain nurses that are designated as managers. A

nurse manager includes top positions of authority as in a Nurse Director or Chief Nursing Officer

(Yoder-Wise, 2007). A nurse manager role involves an individual who has achieved the basic

skills of an RN (registered nurse), and then has acquired additional education and experience to

adequately function as a nurse manager. Healthcare employers look for individuals who have

received a higher level of education for a nursing management position (Yoder-Wise, 2007).

Degrees for nursing management positions include an RN with BSN (Bachelor of Science in

Nursing), MSN (Master’s of Science in Nursing), or doctorate (Careers in Nursing). Position’s

for managing are available in hospitals, long term care, ambulatory care, or

community/public/home health agencies. Nurse Managers direct the delivery of quality nursing

care and manage the environment the care is given in with the responsibility of the personnel,

resources, and patient care of a nursing unit (Careers in Nursing). Skills of an effective nurse

manager are listening, negotiating, collaborating, assertiveness, human relations, coaching, and a

compassionate approach (Careers in Nursing). RN’s may desire a nurse manager position for

personal satisfaction, power, recognition, prestige, economic gain and opportunities for

promotion (Careers in Nursing). Along with the positive attributes of a nurse manager the

position also has drawbacks. These would include hard work, scope of responsibility, pressures

of competition, consumer issues, economy, politics, manpower and technology (Careers in

Nursing).

An interview was held on the sixth floor at Metro Health hospital with Laura Snyder on

Monday the 15th of February at 1:30 p.m. The interview was held in her office directly off of the

visitor’s elevators and was easy to find. Her office was small with a desk, computer, filing

ANALYSIS OF A NURSE MANAGER 4

cabinet and a few extra chairs for sitting. Upon her desk pictures of herself with family members

were proudly displayed, and multiple stacks of papers were scattered around. These papers

portrayed that she had numerous projects or issues that were being worked on. Laura Snyder

currently is the Clinical Director over level six and the IV (intravenous) team at Metro Hospital

in Wyoming, Michigan. Level six at Metro Health hospital includes medical, surgical and

pediatric patients. The IV team provides assistance to the entire hospital staff in maintaining a

patent IV without the incidence of infection, phlebitis or infiltration during a patient’s stay in the

hospital.

Laura originally obtained a diploma from the Blodgett School of Nursing in Grand

Rapids, Michigan in 1987. She worked in the ER (Emergency Room) and ICU (Intensive Care

Unit) at Blodgett hospital and finished her BSN and MSN degrees at Grand Valley State

University in Grand Rapids, Michigan. Laura has been practicing nursing for a total of 23 years

and has held various job positions. In her current position a master’s degree in nursing and prior

experience in management were required. Laura is certified in ACLS (Advanced Cardiac Life

Support) and currently is working on her certification in nursing management (L. Snyder,

personal interview, February 15, 2010).

Leadership Style

Evidence

Laura said that she using a mixture of two leadership styles. Leadership styles include

involving clinical coordinators and other subordinates in decision making and identification of

issues effecting staff nurses and patients on the floor. Laura said that employees are hard

workers; trust worthy and self directed (L. Snyder, personal interview, February 15, 2010).

ANALYSIS OF A NURSE MANAGER 5

Support

Laura currently manages the sixth floor using a laissez-faire and democratic leadership

style. She uses a democratic leadership style when making decisions by receiving input from

four clinical coordinators, a child life specialist, and social worker prior to making the final

decision on issues affecting nursing staff and patients. Allowing clinical coordinators to work

independently to identify and solve nurse and patient concerns is using a laissez-faire leadership

style.

Analysis

Yoder-Wise (2007) defines management as individuals who work to guide others

through routines, procedures, or predefined practice guidelines. These individuals are important

to ensure that patient care is provided in a safe and efficient environment. Nurse managers

develop leadership styles through experience and expectations. Many leadership styles and

theories have been developed and include authoritarian, democratic, laissez-faire, and multicratic

(Yoder-Wise, 2007). The democratic leader involves all subordinates in the decision making

process, sees themselves as coworkers rather than a superior and stresses communication,

consensus and teamwork (Ellis & Hartley, 2009). The laissez-faire leader disperses the decision

making throughout the group and allows coworkers to develop their own goals, make their own

decisions, and take responsibility for their own management (Ellis & Hartley, 2009).

The sixth floor has a history of working as a team, liking their job, a high morale, and

low nurse turnover (L. Snyder, personal interview, February 15, 2010). Laura has trust in her

team members until the trust is broken and keeps in touch with employees special circumstances.

For example, a family member of an employee had surgery and she always checks with this

employee to see how the surgery went and how their family member was recovering. With

ANALYSIS OF A NURSE MANAGER 6

Laura using this approach of leadership allows nurse satisfaction in their job. When a nurse is

satisfied with their job this allows them to function highly in their position and give high quality

care to patients (Yoder-Wise, 2007). Nurse satisfaction within the workplace is very important

to nursing and healthcare administration. With high turnover this becomes costly to the

organization in areas of finance, expertise, knowledge and quality of patient care (Yoder-Wise,

2007). Patients ultimately have faith and trust in their nurses and will want to return to the

hospital for the same quality of care. Stories of the great care they received will trickle to other

individuals of the community and will boost the reputation of the hospital organization.

Legal Issues

Evidence

Laura identified one legal issue that she was involved with as a nurse manager in the past.

This was when Laura was approached by night employees with a complaint of another staff

member sleeping during the night shift. After a thorough investigation the employee confessed

to the allegations and was released from Metro Health hospital. The employee requested

unemployment benefits from the hospital and was denied. Laura participated that eventually

overturned the denial for unemployment (L. Snyder, personal interview, February 15, 2010).

A potential legal liability issue identified by Laura was on adequate staffing. Laura said

that she needs to make sure that there is adequate and knowledgeable staffing for all shifts to

provide quality safe patient care. Laura does what she can do to fill short staffing issues by

calling in staff or even working as a staff member on the floor herself. If the problem persists

she must inform her nursing supervisor or director of nursing that there is an issue with short

staffing that she needs assistance with. This is a requirement of nurse managers in order to

protect the patient’s welfare (Yoder-Wise, 2007).

ANALYSIS OF A NURSE MANAGER 7

Laura deals with employment laws within the work settings and that FMLA (Family

Medical Leave Act) is one that frequently is an issue. Laura said that she actually had two

requests for FMLA on the day of the interview that she would have to address (L.Snyder,

personal interview, February 15, 2010). Laura said that approval for FMLA was directed

towards an outside agency but she and clinical coordinators need to make sure that benefits are

not abused by employees (L. Snyder, personal interview, February 15, 2010).

Support

The Federal-State Unemployment Insurance Program provides temporary benefits to

eligible workers. Individuals qualify depending on state eligibility and that the unemployment

was not the fault of the individual (United States Department of Labor Employment and Training

Administration).

The Family and Medical Leave Act of 1993 allows employees job security when having

to care for a new born or another family member’s healthcare problem (Yoder-Wise, 2007).

Laura said that this law was beneficial to employees and was glad that the decision to approve or

disapprove benefits was taken out of her hands.

Joint Commission on Accreditation of Healthcare Organization (JCAHO), Community

Health Accreditation Program (CHAP), state and federal standards mandate that adequate

staffing be provided with the accurate number, qualified personnel, and legal status of employees

(Yoder-Wise, 2007). For example, critical care, emergency room, and post anesthesia care

require a higher number of RN’s to LPN’s and extended care facilities may have equal or less

number of RN’s to LPN’s (Yoder-Wise, 2007). Courts determine understaffing on an individual

basis based on the number of patients, acuity of patients, and the number and status of staff

(Yoder-Wise, 2007).

ANALYSIS OF A NURSE MANAGER 8

Analysis

The issue of having an employee sleeping on the job affects all staff members working

that particular shift. This places an increased workload for employees which can affect the care

of all patients. One nurse doing the work of two may tire easily and become angry. This anger

then can be directed at other staff and even patients. Staff that feels frustrated at work can lead

to dissatisfaction in their job and eventually wanting to leave. A patient that does not get the

care he/she expects may have a delay in healing and may have to spend extra time in the

hospital. A patient that does not receive a high level of care remembers this and eventually tells

family and friends. This then gets out to the community and the reputation of the organization is

jeopardized.

With there being no legal issues being manage at this time other then routine issues made

Laura’s unit appear it had a healthy number of knowledgeable staff to provide safe and quality

patient care.

Ethical Issues

Evidence

Laura said that ethical issues on her unit are not huge but that ethical issues for staff are

related to end of life situations and pain medication administration. Staff on the sixth floor see

family members extending the life of a loved one and ignore the wishes written in their loved

ones living will. Staff becomes frustrated with administering pain medications every two hours

around the clock. Especially if the patient has been viewed has having “drug seeking”

tendencies.

ANALYSIS OF A NURSE MANAGER 9

Support

Ethics in clinical practice is becoming more prominent. A nurse manager must have a

knowledge base of ethical principles because they are looked upon as mentors and counselors by

employees for ethical or difficult situations (Yoder-Wise, 2007). An end of life issue identified

by Laura was when she was working in the ICU. She stated that patients were on life support

and obviously dying, but family members were not ready to let go. Other times patient’s living

will wishes were ignored and physicians were administering life sustaining procedures and

treatments that the patient did not want. Often meetings were held with family, the ethics

committee, physician and nurse at the hospital to educate the family members on the dying

process and family members were able to let their loved ones die peacefully (L. Snyder, personal

interview, February 15, 2010).

The American Pain Society developed and published a quality assurance standard for

pain management in 1995. Even with this standard there are many issues faced by nurse

managers, staff, and pain management specialists as they continue to improve the management

of pain (Stenger, Schooley, & Moss, 2001). Laura’s goal is to be available for discussions with

staff to voice their opinions and frustrations about this delicate ethical issue. This ultimately

lessens frustrations with pain management and makes it easier to care for these patients on the

floor (L. Snyder, personal interview, February 15, 2010).

Analysis

Nurses need to continue to be an advocate for all patients’ and provide the best possible

care that he/she can. This at times may include giving some additional treatments or medications

that he/she feels is prolonging the inevitable.

ANALYSIS OF A NURSE MANAGER 10

With the frustration by Laura’s staff on giving pain medications to certain individuals as

prescribed and per patients request may lead to inadequate pain relief. All nurses need to

remember that pain is only as bad as the patient says it is and we as nurses have to provide

quality of care to all patients.

Use of Power and Influence

Evidence

Laura uses power and influence to subordinates carefully and respectfully. Laura is able

to reward individuals with pay raises for a job well done and to punish those by not granting

certain days off requested.

Support

Yoder-Wise (2007) defines the word power as the ability of influencing others to achieve

goals. “What makes a powerful nurse?” Laura indentified that a powerful nurse may be looked

at in a negative way, but to her it is more positive. A powerful nurse is one that has the ability to

be a patient advocate and to go above and beyond the normal duties of a nurse. Laura has many

opportunities to be a patient advocate and has even gone above and beyond her normal nursing

duties to give quality patient care. One incident was while working in the ICU. Laura said that a

patient of hers was dying and the family requested that she sing the patients favorite song. So

this is what Laura did, she sang the song for the patient and made the family extremely happy.

Laura said that this makes her a powerful nurse in a positive way.

Analysis

Laura portrays a level of power by having self-confidence, good communication skills,

and 23 years of nursing experience, and with a positive attitude and likeable personality, makes

ANALYSIS OF A NURSE MANAGER 11

her approachable and allows her floor to give quality patient care (L. Snyder, personal interview,

February 15, 2010).

Decision making and Problem Solving

Evidence

Laura said that when faced with a problem she has to do a thorough investigation and get

both sides of the story. Laura then will collaborate with individuals involved in the situation,

think about possible ways to solve the problem, and propose a solution to the problem.

Support

Decision making and problem solving abilities are vital to nurse managers. Nurses must

have the basic knowledge and skills for effective problem-solving and decision-making and these

are especially important for those in a leadership/management position (Yoder-Wise, 2007).

Yoder-Wise (2007) lists steps in problem solving: (1) define the problem, (2) gather data, (3)

analyze data, (4) develop solutions, (5) select a solution, (6) implement the solution, and (7)

evaluate the result.

Analysis

Laura’s decision making and problem solving abilities mimic her leadership style. Laura

involves using the appropriate personnel in the decision-making process, which is a

characteristic of involving subordinates in the process of making a decision in a democratic

leadership style (Yoder-Wise, 2007). Laura is flexible and open minded and can offer a large

range of options to be considered with problem solving and decision making. One thing that can

be a negative with this approach to problem solving is not being able to make a quick decision

when it is needed. Having to get multiple opinions or stories to an issue can take time and this

ultimately can affect patient care and safety.

ANALYSIS OF A NURSE MANAGER 12

Conflict Resolution

Evidence

Laura said that conflict is something that she does not like and would rather not deal with

(L. Snyder, personal interview, February 15, 2010).

Support

Conflict stems from a disruption of an individual or groups values, beliefs, attitudes, and

expectations (Conerly & Tripathi, 2004). Yoder-Wise (2007) lists five major modes of conflict

resolution: (1) avoiding, (2) accommodating, (3) competing, (4) compromising, and (5)

collaborating. Laura is the closest to the avoiding mode of conflict resolution. This approach

can be both positive and negative. It is very unassertive and may lead to not pursuing individual

goals and encouragement of other staffs goals or concerns. In a positive way it may be a way of

stepping back from a “no-win” situation or postponing a situation until a better time (Yoder-

Wise, 2007). A trigger of conflict for Laura is confronting employees of mistakes. Laura said

that some employees become defensive when confronted on a mistake that they made. Laura

wishes that everyone can just own up and accepting the mistake that was made and learn from it

(L. Snyder, personal interview, February 15, 2010).

Analysis

Laura wants to avoid conflict as much as possible. Avoiding conflict can make for

unhappy staff that leave their job and cause short staffing. This can lead to staff that are tired

and frustrated. This leads to a bad picture of the nursing staff and organization as a whole. With

this come unsatisfied patients that will not return for continued services at the organization and

branches of the organization. Taking care of conflict as it comes only leads to a strong nurse

manager that directs the path for safe quality patient care.

ANALYSIS OF A NURSE MANAGER 13

Research

Evidence

Laura said that research is important to the nursing profession and that Metro does not

base current nursing practice on any nurse theorist. She is currently not involved in any research

projects but said that evidence based nursing practice is needed to provide the best possible

solutions to quality patient care (L. Snyder, personal interview, February 15, 2010).

Support

Research is the “diligent, systematic inquiry or investigation to validate and refine

existing knowledge and generate new knowledge” (Burns & Grove, 2005, p.2). “Evidence-based

practice is the integration of the best research evidence with clinical expertise and the patient’s

unique values and circumstance in making decision about the care of individual patients” (Straus,

Richardson, Glasziou, & Haynes, 2005, p. 1).

Analysis

Laura does not seem up to date on nursing researchers and said that her unit patient care

is not based after a particular nursing researcher. This can have a negative effect on nursing staff

and patient care. Nurse managers need to keep themselves informed on current nursing research

literature and where it can be found. Nurse managers are ultimately the leaders and mentors of

their staff and need to be prepared for any research issues. A good knowledge base of research

and evidence-based practice leads to a higher level of patient care.

Cultural Diversity

Evidence

Laura said that her staff and patient population on level six at Metro Health hospital has a

mixed culture. Most of the current staff are white but vary from new grads to seasoned nurses of

ANALYSIS OF A NURSE MANAGER 14

20 plus years. Patients are white, black, Hispanic and Vietnamese. Laura said that having

knowledge in cultural diversity helps improve patient and staff satisfaction. At Metro Hospital

there is no cultural diversity training at this time, but Laura identifies that there has been training

in the past (L. Snyder, personal interview, February 15, 2010).

Support

Diversity is everywhere in life and there is no exception for healthcare. A nurse manager

needs to have knowledge and experience with different cultures. Knowing the culture of

employees and patients helps charge nurses make assignments for the shift and alleviate any

uncomfortable feelings between a nurse and patient (L. Snyder, personal interview, February 15,

2010). According to the Code of Ethics for Nurses (ANA) nurses believe that care must be equal

and the same no matter what differences there may be and this includes cultural differences

(Code of Ethics for Nurses, 2001). Nursing a person back to health from another culture is a

complex experience (Yoder-Wise, 2007).

Analysis

Laura does not show any concern that Metro Hospital does not provide cultural training or

workshops with the amount of cultural diversity at the hospital and on her unit. She does appear

to feel comfortable with the amount of cultural diversity in both her staff and the patient

population.

Conclusion

In conclusion, healthcare today is complex and the need to keep up to date on new

knowledge should be the goal of any organization. Nurses can assist in this goal by developing

and improving their leadership/managing skills. Effective nurse manager’s are the future to

ensuring safe, efficient patient care is provided to all.

ANALYSIS OF A NURSE MANAGER 15

References

Burns, N. & Grove, S. (2005). The practice of nursing research: Conduct, critique, and

utilization (5th ed.). St. Louis: Elsevier Saunders.

Careers in nursing. Student’s Corner.

http://www.nurse.com/students/CareersInNursing/NursingPositions/MA.htm

Conerly, K. & Tripathi, A. (2004). What is your conflict style? The Journal for Quality &

Participation, 27 (2), 16-20.

Ellis, J. & Hartley’s, C. 2009. Managing and Coordinating Nursing Care. Lippincott:

Philadelphia.

Leadership styles. Leadership Skills. http://www.niagara.com

State unemployment insurance benefits. United States Department of Labor Employment and

Training Administration. http://workforcesecurity.doleta.gov/unemploy/uifactsheet.asp

Stenger, K., Schooley, K., & Moss, L. (2001). Moving to evidence-based practice for pain

management in the critical care setting. Critical Care Nursing Clinics of North America,

13, 319-327.

Straus, S., Richardson, W., Glasziou, P., & Haynes, R. (2005). Evidence-based medicine: How to

practice and teach EBM (3rd ed.). Edinburgh: Churchill Livingston.

Snyder, L. Personal interview. February 15, 2010.

Yoder-Wise, P. 2007. Conflict: the cutting edge of change. Leading and Managing in Nursing.

(4th ed.). Missouri: Mosby Elsevier.

Yoder-Wise, P. 2007. Cultural diversity in health care. Leading and Managing in Nursing. (4th

ed.). Missouri: Mosby Elsevier.

ANALYSIS OF A NURSE MANAGER 16

Yoder-Wise, P. 2007. Legal and ethical issues. Leading and Managing in Nursing. (4th ed.).

Missouri: Mosby Elsevier.

Yoder-Wise, P. 2007. Power, politics, and influence. Leading and Managing in Nursing. (4th

ed.). Missouri: Mosby Elsevier.

Yoder-Wise, P. 2007. Translating research into practice. Leading and Managing in Nursing. (4th

ed.). Missouri: Mosby Elsevier.

Grading Rubric for Analysis of a Nurse Manager

HeadingsPossible PointsSubheadings

Pts Earned Comments

Introduction(Background on Nurse Leader or Manager to

include name, position, education, years in practice

and role, additional qualifications for role, etc.)

(No subheading)

20

20 Thorough.

Leadership StyleCompare the manager’s

stated leadership style with evidence of situations and actions described in the

interview. Analyze it using support, include potential effects on patients, staff

and organization)

20

Evidence 4Support 6 Analysis 10

19469

The sections are mixed up, but after sorting through it, it seems all necessary information is present. -1 point for the trouble.

Legal Issue(s)Describe, support, &

analyze 1 or more legal issue(s) this leader or

manager has or is managing (include potential

effects on patients, staff, and organization)

20

Evidence 4Support 6 Analysis 10

204610

Well done!

Ethical Issue(s)Describe, support, &

analyze 1 or more ethical issue(s) this nurse

leader/manager has or is

20

Evidence 4Support 6Analysis 10

15456

Ethical issues in Evidence. Support present. Effects on patients mentioned; no analysis of effects on organization or staff.

ANALYSIS OF A NURSE MANAGER 17

managing (include potential effects on patients, staff,

and organization)Use of Power and

InfluenceDescribe, support, &

analyze the manager’s use of power and influence

(include potential effects on patients, staff, and

organization)

20Evidence 4Support 6Analysis 10

8440

Appropriate Evidence. Brief Support. No Analysis.

Decision-making and Problem-solving

Describe, support, & analyze use of decision-

making or problem-solving process (include potential effects on patients, staff,

and organization)

20

Evidence 4Support 6 Analysis 10

16466

Appropriate Evidence. Good Support. Analysis present with general effects, but does not extend to giving effects on patients, staff and organization.

Conflict resolutionDescribe, support, &

analyze management or resolution of conflict

(include potential effects on patients, staff, and

organization)

20Evidence 4Support 6 Analysis 10

204610

Very well done!

ResearchDescribe, support, &

analyze leader or manager as a user, interpreter or participant in research

(include potential effects on patients, staff and

organization)

20Evidence 4Support 6 Analysis 10

16448

Vague. Some apparent confusion between researcher and theorist nurses.

Cultural DiversityDescribe, support, &

analyze leader or manager in relationship to action or inaction to promote and

support cultural diversity in the workplace. (include

potential effects on patients, staff, and

organization)

20 Evidence 4

Support 6 Analysis 10

13445

Very limited analysis of effects. This section was optional and, because it scored low, was omitted from the grade.

APA Format, Writing Clarity, Grammar,

Spelling, & References

20 10 APA errors in citations of direct quotes and referencing online source. Sections poorly

ANALYSIS OF A NURSE MANAGER 18

organized despite opportunity to organize before resubmitting. Book chapter authors not cited. Variable APA formatting in the References. Grammar errors present.

Total points 200 144/180=80%

ANALYSIS OF A NURSE MANAGER 19

Grading Rubric for Analysis of a Nurse Manager Headings Possible

Points Subheadings

Pts Earned Comments

Introduction (Background on Nurse Leader or Manager to include name, position, education, years in practice and role, additional qualifications for role, etc.)

(No subheading) 20

Leadership Style Compare the manager’s stated leadership style with evidence of situations and actions described in the interview. Analyze it using support, include potential effects on patients, staff and organization)

20 Evidence 4 Support 6 Analysis 10

Legal Issue(s) Describe, support, & analyze 1 or more legal issue(s) this leader or manager has or is managing (include potential effects on patients, staff, and organization)

20 Evidence 4 Support 6 Analysis 10

Ethical Issue(s) Describe, support, & analyze 1 or more ethical issue(s) this nurse leader/manager has or is managing (include potential effects on patients, staff, and organization)

20 Evidence 4 Support 6 Analysis 10

ANALYSIS OF A NURSE MANAGER 20

Use of Power and Influence Describe, support, & analyze the manager’s use of power and influence (include potential effects on patients, staff, and organization)

20 Evidence 4 Support 6 Analysis 10

Decision-making and Problem-solving Describe, support, & analyze use of decision-making or problem-solving process (include potential effects on patients, staff, and organization)

20 Evidence 4 Support 6 Analysis 10

Conflict resolution Describe, support, & analyze management or resolution of conflict (include potential effects on patients, staff, and organization)

20 Evidence 4 Support 6 Analysis 10

Research Describe, support, & analyze leader or manager as a user, interpreter or participant in research (include potential effects on patients, staff and organization)

20 Evidence 4 Support 6 Analysis 10

APA Format, Writing Clarity, Grammar,

20

ANALYSIS OF A NURSE MANAGER 21

Spelling, & References Total points 180