What Makes an Effective Nurse Manager?

It can be argued that not all nurse leaders are managers, and not all nurse managers are leaders. However, it is likely that the most successful nurse managers are also excellent leaders.

The study by Vesterinan et al. (2013) explored nurse managers of hospitals in Finland. It was found that the nursing managers considered the following forms of leadership to be ‘very important’ or ‘important’: coaching, visionary, affiliate and democratic. The study conveys that the job satisfaction of employees, as well as the department’s success, are affected by the nurse manager’s competence to reflect upon, comprehend and alter their leadership style to meet the contextual or situational needs.

Highlighted, is the importance of nursing managers’ (especially new managers’) engagement in evidence-based theoretical learning in order to cope and gain competence. It could therefore be considered that postgraduate management and leadership study is recommended for managers in nursing.

Negussie and Demissie (2013) concluded in their study of nurse managers, that nurses’ job satisfaction was improved by the implementation of transformational leadership styles by nurse managers. This was as opposed to nurse managers implementing a more transactional leadership style. This aligns with the findings of Vesterinan et al. (2013), in that the nurse managers respected visionary leadership styles.

Environment and Wellbeing

These suggestions can be reinforced by evidence such as the literature review by Twigg and McCullough (2013), which concludes that quality client care and nursing retention can be increased by establishing positive workplace environments.

These environments consist of (Twigg & McCullough 2013):

• Empowerment
• Professional development
• Leadership support
• Autonomy
• Appropriate staffing
• Effective skills mix
• Shared governance
• Positive and professional relationships between health professionals/teams

It can be understood that coaching and leadership support needs to involve cognitive decision-making (Shirey et al. 2012). Decision-making is found to be adversely affected by ongoing stress (Shirey et al. 2012). Chronic stress also negatively impacts the wellbeing of the nurse manager (Shirey et al. 2012). Clearly, these outcomes have the potential to influence individuals, clients, and the organisation (Shirey et al. 2012).

Job Satisfaction

Job satisfaction is believed to be dependent on the internal enjoyment of the work that stems from ‘recognition, advancement, and responsibility’ (Worrell 2004 cited in Vesterinan et al. 2013). Moreover, job satisfaction also comes from external enjoyment of the job that results from aspects such as wage/salary, ‘supervision and working conditions’ (Worrell 2004 cited in Vesterinan et al. 2013).

Warshawsky and Havens (2014) found in their study of US acute care hospital nurse managers that the majority (70%) of participants were satisfied with their nurse management jobs and that up to 68% of participants expressed that they would likely recommend this role.

However, it was interesting to note that most (72%) nurse managers were likely to leave their job within five years. This was due to: ‘burnout, career change, retirement, and promotion’ (Warshawsky & Havens 2014). Warshawsky and Havens research recommends that the workload of nurse managers is reviewed, and that nursing leaders access career counselling to construct succession plans.

Strategic Succession Planning

Titzer, Shirey and Hauck (2014) explain that without appropriate and evidence-based action, such as strategic workforce planning, the future nursing leadership needs will not be met and there may be a nurse manager shortage.

Alike Warshawsky and Havens (2014), Titzer et al. (2014) support the need for succession planning. In Titzer et al.’s (2014) quasi-experimental mixed-methods study, they found that participants of a leadership program improved their leadership and management competence greatly. Specifically, ‘One year after program completion, 100% of the program participants have been retained at the organization and 73% had transitioned to leadership roles.’ (Titzer et al. 2014). Thus, Titzer et al. (2014) conclude that succession planning is a crucial strategy for transforming quality staff into leaders, and also maintaining a ‘pipeline’ of future nurse leaders.

Warshawksy et al. (2013) raise an important practice point that high nurse manager turnover is associated with a higher incidence of pressure ulcers. Again, Warshawsky et al. (2013) support Warshawsky and Havens (2014) and Titzer et al. (2014), in the claim that effective succession planning is necessary for the nursing industry. Strategic planning and ‘stable nursing management’ is evidently needed to promote quality client care (Warshawsky et al. 2013).

What Should a Succession Plan Look Like?

From the literature in this Ausmed article, it can be considered that effective succession planning should involve training high quality nursing staff members in theoretical transformational leadership. This may mean providing scholarships to high-performing positive workplace role models to study postgraduate healthcare leadership and management degrees. This could also perhaps entail utilising existing effective transformational leaders within the workplace to coach emerging workplace leaders or quality staff nurses. This could help to generate a ‘pipeline’ of future nursing leaders for the workplace/organisation that could promote stable nursing management. Hence, adverse client outcomes could be prevented, and the reinforcement of transformational leadership culture in the workplace may encourage job satisfaction amongst employees.

References

• Shirey, MR, Ebright, PR & McDaniel, AM 2013, ‘Nurse manager cognitive decision-making amidst stress and work complexity’, Journal of Nursing Management, vol. 21, no. 1, pp. 17-30, viewed 29 November 2017, https://www.ncbi.nlm.nih.gov/pubmed/23339492
• Titzer, JL, Shirey, MR & Hauck, S 2014, ‘A Nurse Manager Succession Planning Model With Associated Empirical Outcomes’, Journal of Nursing Management, vol. 44, no. 1, pp. 37-46, viewed 29 November 2017, http://journals.lww.com/jonajournal/Abstract/2014/…With.10.aspx
• Twigg, D & McCullough, K 2013, ‘Nurse retention: A review of strategies to create and enhance positive practice environments in clinical settings’, International Journal of Nursing Studies, vol. 51, no. 1, pp. 85-92, viewed 29 November 2017, http://www.sciencedirect.com/science/article/pii/S0020748913001582
• Vesterinen, S, Suhonen, M, Isola, A, Paasivaara, L & Laukkala, H 2013, ‘Nurse Managers’ Perceptions Related to Their Leadership Styles, Knowledge, and Skills in These Areas—A Viewpoint: Case of Health Centre Wards in Finland’, ISRN Nursing, vol.  2013, viewed 29 November 2017, https://www.hindawi.com/journals/isrn/2013/951456/
• Warshawsky, NE & Havens, DS 2014, ‘Nurse manager job satisfaction and intent to leave’, Nursing Economic$, vol. 32, no. 1, pp. 32–39, viewed 29 November 2017, https://www.ncbi.nlm.nih.gov/pubmed/24689156
• Warshawsky N, Rayens MK, Stefaniak K & Rahman R 2013, ’The effect of nurse manager turnover on patient fall and pressure ulcer rates’, Journal of Nursing Management, vol. 21, no. 5, pp.  725–32, viewed 29 November 2017, from http://onlinelibrary.wiley.com/doi/10.1111/jonm.12101/full