Running head: NURSE MANAGER

Managing Effectively

Linda C. Hansen

Ferris State University

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Abstract

This paper serves to explore the some of the challenges and rewards of being a nurse manager in

a busy acute care hospital. Included is an analysis of leadership and management techniques.

Comparisons were made through personal communications with a nurse manager and various

research avenues. An interview with Chris Wilson, nurse manager of pediatrics and Women’s

Health Services (C3) as well as several clinics at Munson Medical Center in Traverse City,

Michigan was conducted. An introduction of Ms. Wilson including her education, years in

practice and additional qualifications was provided. Cultural diversity, legal issues, use of power

and influence, decision-making and problem-solving processes, managing conflict and

participating in research were analyzed. The effect on the staff, patients and organization were

included in the analysis. Comparison and support of Ms. Wilson was provided with research

from several sources. This project allowed me to analyze the differences and similarities between

being a manger and a leader as well as how the relationship affects staff, patients and the

organization.

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Managing Effectively

A nurse manager/leader in today’s healthcare environment can be a challenging yet

rewarding career. The nurse manager must wear many hats to fulfill obligations required to be an

effective nurse manager which include patient and employee satisfaction as well as the business

aspects of running a unit. It is important for a nurse manager to have critical thinking skills and

the ability to look at situations from different perspectives to see the big picture. One analogy

given in Ellis and Hartley describes the manager having six hats that all look at a situation from a

different perspective including facts and data, pessimistic and optimistic viewpoints, creativity

and feelings (2009). By looking at situations from different viewpoints, the manager can

understand a situation better (Ellis & Hartley, 2009). According to Yoder-Wise, the roles of

leader and manager are different even though both must possess some similar qualities (2010).

Some of these qualities include knowledge, integrity, ambition, judgment, administrative abilities

and communication skills (Yoder-Wise, 2011). Several differences in the roles of leader and

manager are that a manager works with meeting the budgetary needs of the organization and

staffing the unit appropriately while a leader develops a vision (Yoder-Wise, 2011). To be an

effective manager, one must possess the above skills to guide her staff to not only provide

competent care for the patients her unit serves but meet the needs of her staff as well as her

superiors.

Introduction of the Manager

Chris Wilson RN, BSN, is the manager of C3 as well as several clinics at Munson

Medical Center Traverse City, MI 49684. C3 is the pediatric unit, the unit for women’s health

and the plastic surgery unit. The clinics that she manages include 1) the immunization clinic 2)

genetics clinic 3) oral cleft clinic and 4) visiting specialties clinic. Ms. Wilson has been a

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Registered Nurse for forty years – working at the bedside for thirty years, as a pediatric educator

for five years and as a nurse manager on this unit for five years (C. Wilson, personal

communication, 2011). She received her Associates Degree in Nursing many years ago and

recently received her Bachelor’s Degree from Phoenix University. Ms. Wilson has received her

pediatric certification and is currently working on her Master’s Degree in Nursing (C. Wilson,

personal communication, 2011).

Ms. Wilson describes herself as a “servant leader,” making sure that her staff have what

they need to function at the bedside. One definition of servant leader simply states that serving

others is the number one priority (Campbell & Rudisill, 2005). There are several important

characteristics of servant leaders which can include “listening, empathy, persuasion, foresight,

stewardship and commitment to the growth of people” (Campbell & Rudisill, 2005, p. 27). Ms.

Wilson has many of these characteristics as outlined in the analysis that follows.

Cultural Diversity

Culture has many different meanings. One definition states that culture is a “guide for

determining one’s values, beliefs and practices” (Hart, 1999, p.255). According to Yoder-Wise,

while healthcare in the United States focuses on each person, cultural issues are left unidentified

(2011). The United States is composed of people from a variety of cultural, demographic and

social backgrounds. Changes are taking place that indicate there will be a shift even further as

more people move into the United States. One segment of the population that is showing a

dramatic increase in immigrants is the pediatric population (Hart, 1999). As this occurs it will be

even more imperative that nurses are culturally competent.

Effect on Patients

This nursing unit sees a culturally diverse population including Mexicans, African

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Americans, Native Americans, Laotians and Croatians. According to Ms. Wilson, one of the

challenges in dealing with different cultures is recognizing cultural differences in response to

illness (C. Wilson, personal communication, 2011). Challenges can arise because of cultural

belief differences in the family as compared to the health care system beliefs (Hart, 1999).

Conflicts between nursing staff and families can arise due to differences in communication

styles, food practices or even belief in what causes different types of illnesses (Hart, 1999). One

example of this is that while it is very common for a parent to stay with and ill child, cultural

differences may not allow for this (C. Wilson, personal communication, 2011). Ms. Wilson states

that her staff needs to acknowledge different cultures and not judge a parent as being less

involved if they do not stay (C. Wilson, personal communication, 2011). Culture and language

can have effects on health, healing and wellness, and it is important for care providers to treat

patients according to the patient’s cultural beliefs and not the provider’s own belief or value

system (United States Department of Health and Human Services (USDHHS), 2005).

Ms. Wilson states that cultural issues present challenges due to the low volume seen of

these patients (personal communication, 2011). Munson Medical Center employs a low number

of culturally diverse staff. According to Yoder-Wise, this is common as Whites (non-Hispanic)

make up 84% of the registered nurses in the United States (2011). Cultural competence is

important to help patients and doctors freely discuss health issues without feelings of bias which

will promote positive patient outcomes (USDHHS, 2005).

Organizational Support of Cultural Diversity

Munson Medical Center has a “culture cart” that gives nurses the ability to research a

particular patient’s culture and be more aware of the customs that this culture may employ. Items

included on the “culture cart” include a reference book entitled Culture & Nursing Care which

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allows nurses to look up a specific culture and learn about normal response and cultural customs.

In addition, “Health Stream,” Munson Medical Center’s competency testing center addresses

some cultural issues by having a presentation on “Diversity,” assuring the staff is exposed to

information from other cultures, including how to access information they might not be

knowledgeable about (Munson Healthcare, 2011a). This testing takes place yearly and is

mandatory education for all employees. There is also an interpreter/translator page on the

Munson intranet website that includes contact information for interpreters as well as some

graphic pictures for patient use to various issues including pain, wanting to eat or using the

bathroom (Munson Healthcare, 2010a).

Legal Issues

Patient safety is an area that is always a concern for unit managers. One patient safety

initiative at Munson Medical Center is the ARTT program (ambulating, rounding, toileting and

turning) (Munson Healthcare, 2010b). The staff is required to round hourly on each patient, offer

toileting and turn according to specific guidelines. This department recently won the ARTT

trophy for their continued efforts in this initiative.

Another patient safety issue specific to the pediatric population is the risk of abduction.

Munson Medical Center uses the HUGS infant protection system (HUGS, 2003). This system

requires that a HUGS tag is attached to the infant or child when they arrive on the unit. An alarm

will sound if the tag is tampered with, removed or if the patient passes any exit points that are set

up with an alarm. The HUGS tags are password protected so they cannot be removed without

knowledge of the nursing staff caring for the patient (HUGS, 2003).

Other legal issues that Ms. Wilson faces are those related to labor laws. Ms. Wilson states

that it is important to treat everyone the same with regard to these laws (personal

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communication, 2011). Because of the relatively small size of this unit, staffing issues can

develop with sick calls, medical leaves and vacations. She follows the guidelines developed in

Human Resources at Munson Medical Center with respect to the disciplinary process, attendance

issues and use of mandatory on call and overtime as well as the federally-mandated labor laws

(Ms. Wilson, personal communication, 2011).

Another ethical/legal issue that this department faces involves mandatory reporting laws

for suspected child abuse. Nurses need to be aware of signs of abuse or neglect and report to the

appropriate person, which is social work at Munson Medical Center. Michigan has mandatory

reporting laws for cases of suspected abuse and neglect as indentified in Yoder-Wise (2011).

Another required “Health Stream” course entitled “Abuse and Neglect” affords the opportunity

to help all staff be aware of potential issues (Munson Healthcare, 2011a).

Effects on Staff, Patients and Institution

The ARTT program has had a positive effect on patient satisfaction as patient needs are

met in a timelier manner (Munson Healthcare, 2010b). Patient needs can be anticipated and can

help staff be more attentive to needs. All nursing units have found that ARTT helps to decrease

interruptions during report time as patient needs are addressed earlier. The HUGS tags have

given reassurance to parents as well as hospital staff assuring that the infant or child is in a

protected environment.

To help ensure adequate staffing, the hospital has a Maternal Child Health Pool. The staff

of C3 float between Maternal Child Health units when the need arises. Guidelines are followed

for fairness of all staff and to ensure adequate staffing amongst the units. Yoder-Wise

recommends that staff float to units like their own and Munson has determined the importance of

“sister” units for this purpose (2011).

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In cases of suspected abuse or neglect, the social worker meets with the family and/or

patient, makes an assessment and refers to Child Protective Services (CPS) if determined

appropriate. The bedside nurse is responsible for initiating contact with the social worker but it is

the social worker’s responsibility to take care of the paperwork and initiate contact with the CPS

worker. Unit rounds, which include the social worker, utilization management nurse, charge

nurse and bedside nurse, occur Monday through Friday. All patients on the unit are discussed

and needs are identified. Patients and/or family members are interviewed as appropriate.

Use of Power and Influence

Ms. Wilson sees her role as a coach and counselor to her staff and believes that her role

can change base on the circumstances presented (Ms. Wilson, personal communication, 2011).

She regularly collaborates with other departments, particularly the Maternal Child group, sharing

information and resources as there are several committees that cross the boundaries of multiple

units (Ms. Wilson, personal communication, 2011). Yoder-Wise defines power as “the ability to

influence others in an effort to achieve goals” (2010, p. 176). Ms. Wilson’s quiet demeanor has a

way of its own to influence others to do what is expected of them. Seeing her interact with

patients or staff, one would observe Ms. Wilson to be calm and even-keeled, not easily riled. Ms.

Wilson states that her staff would describe her as a “slave driver, educator and being in a state of

constant readiness with expectations” (Ms. Wilson, personal communication, 2011). To that end,

the staff recently worked on a project to increase efficiency in processing new admissions,

specifically room readiness. They are celebrating their success in achieving that goal this week.

Empowering Staff through Opportunities

Ms. Wilson believes in motivating staff by giving opportunities for involvement and

allowing decision making to take place in a variety of situations (personal communication,

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2011). She realizes that motivating one person may not be what motivates another (Ms. Wilson,

personal communication, 2011). She allows many opportunities for staff involvement regardless

of job classification from what color to paint the break room, deciding on how to spend

educational dollars or other decisions that affect patient care. Relationship-Based Care is one

thing that she is passionate about and involves her staff in this education. She sees this as an

opportunity to develop a working relationship with the patient and family (Munson Healthcare,

2011c).

Organizational Effects

Ms. Wilson supports the goals of Munson Medical Center to encourage nursing staff to

become certified in their specialty or continue education to achieve higher levels of education

(Ms. Wilson, personal communication, 2011). As she herself continues her pursuit of attaining

higher degrees, she is influencing her staff in a positive way. Munson Medical Center had a goal

to achieve Magnet status and one way to achieve this goal was by encouraging nurses to advance

in their practice by obtaining higher degrees or certifications. Munson Healthcare first achieved

Magnet status in 2006 and strives to hold this prestigious designation (Munson Healthcare,

2011c). Hospitals that achieve Magnet status show how their organization provides excellent

care in fourteen different areas with a focus on quality (Yoder-Wise, 2011). Munson’s support of

continued education includes prepaying for certification testing, a generous $5000 per year

tuition allowance for nursing staff and a clinical advancement system for increased pay when

higher educational goals are achieved (Munson Healthcare, 2010c). There are personal and

professional rewards to obtaining a certification in a specified field, including increased job

satisfaction, increased autonomy and increased monetary rewards (Yoder-Wise, 2011). Magnet

hospitals also tend to have nurses that report higher job satisfaction as well as decreased staff

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turnover (Ellis & Hartley, 2009).

  Decision Making or Problem Solving Process

Ms. Wilson uses the participative approach as much as possible to involve staff in

making decisions that affect patient care and their work environment. One way that she does this

is by having a variety of committees that staff can serve on for particular issues. “Participative

management has been shown to increase work performance and productivity, decrease employee

turnover and enhance employee satisfaction” (Yoder-Wise, 2011 p. 101). Ms. Wilson points out

that there are times when she has to make decisions without staff input (Ms. Wilson, personal

communication, 2011).

Staff meetings occur on a regular basis as do a fairly new process called “huddles.”

Huddles are five- to ten-minute time outs for staff to get together during their work day to

discuss changes that are occurring. Huddles help staff get information in a timely manner,

occurring on each shift or even twice a shift as needed. Huddles allow the staff to be aware of

issues taking place hospital-wide as well as within the unit. C3 also participates in Shared

Governance and Unit Action Councils. In hospitals with Shared Governance, managers and staff

work together to make decisions that affect a multitude of issues (Ellis & Hartley, 2009). Shared

Governance has positive effects for both the nurse and the institution including saving money,

increased nurse satisfaction and improved patient outcomes (Ellis & Hartley, 2009).

Ms. Wilson feels that improvements can be made in documentation which will help

healthcare reimbursement. She is collaborating with her Maternal Child Health management

team to develop specific documentation guidelines. Special documentation that already occurs

include the documentation of immunization data which is downloaded into a state-wide system,

couplet (mom and baby) identifiers and adoption or foster care specific information (Spooner,

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2007).

Management of Conflict

One area of conflict that the pediatric staff faces is that parents or other caregivers who

refuse to follow the isolation guidelines that so many pediatric patients require for RSV, strep, or

other communicable diseases. Caregivers do not want to “gown up” to take care of their child or

be in a room with extra garb on. The staff collaborated to come up with a plan to educate the care

givers with consistent information. The Infection Prevention department becomes involved when

caregivers have been instructed and are resistant to follow protocol. The Infection Prevention

team provides further education and support of the isolation procedures.

Ms. Wilson deals with staff conflict by making sure she provides a listening ear. Some

describe listening as the most important communication skill (Campbell & Rudisill, 2005).

Conflict typically occurs when two or more people view a situation differently (Ellis & Hartley,

2009). Sometimes it works to just let issues resolve on their own while other times it is important

to discuss the situation and work on resolution. One way to do this is through negotiation or

mediation (Ellis & Hartley, 2009). Negotiation occurs when two or more people are able to

compromise about a conflict (Ellis and Hartley 2009). Mediation is the next level when someone

else intervenes to help with resolution of an issue (Ellis & Hartley, 2009).

A Participant or Interpreter of Research

Ms. Wilson is aware that many patients search the internet for information about

procedures or disease processes. She feels this presents learning opportunities for the patient

populations she serves as some times information gathered is incorrect (Ms. Wilson, personal

communication, 2011). Collaboration with other institutions can occur in a timelier fashion to

problem solve or just ask for help with a particular issue. Research is particularly important in

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several of the clinics that Ms. Wilson oversees. She can e-mail contacts at other institutions or

search reliable websites for information that may have taken days to obtain a few years ago. Ms.

Wilson gives an example of putting out a search for some information and having 60 responses

in a day. She states that while it may take some time to sort through the information, the benefits

in collaborating with others is worth it.

Effect on Patients, Staff and Institution

Munson Medical Center participates in numerous Evidenced-Based Practice initiatives to

provide quality care to many patient populations. Following guidelines for certain diseases

processes has been found to improve patient outcomes, streamline care and reduce costs.

Because the pediatric unit is relatively small and does not handle higher levels of cases,

collaboration with pediatric specialists is a must. The unit has a resource manual available

entitled the “Helen Devos Children’s Hospital Resource Binder.” In addition, phone numbers of

specialty clinics and physicians are at the ready for medical staff.

Conclusion

There are many rewards and challenges to being a nurse manager today. Satisfying the needs

of patients, staff and the organization can be challenging. Effective management of a unit

requires wearing many hats and looking at issues from different perspectives in addition to

having good critical thinking skills and well-developed communication skills. As is the case in

working with most groups, collaboration is essential to improved patient outcomes as well as

patient and nurse satisfaction. This career choice can be a rewarding and fulfilling experience for

those who are ready for the challenge.

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References

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Leaders. Nurse Leader. Retrieved from CINAHL database.

Ellis and Hartley, (2009). Managing and Coordinating Nursing Care. Philadelphia, PA:

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Hart, D. (1999). Assessing Culture: Pediatric Nurses’ Beliefs and Self Reported Practices.

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HUGS Infant Protection (2003). HUGS will generate an alarm if: System Overview. Retrieved

from www.hospcom.com/.../02%20-%20HUGS%20SYSTEM%20OVERVIEW.pdf

Munson Healthcare. (2010a). Interpreter/translator services. Retrieved from http://mmc-

websrv.net/home/mmc/depts/interpreter/default.htm

Munson Healthcare. (2010b). ARTT. Retrieved from http://www.munsonhealthcare.org/

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courseid

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Spooner, S., (2007). Special Requirements of Electronic Health Records Systems in Pediatrics.

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United States Department of Health and Human Services. (2005). Cultural Competency. Office

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of Minority Health. Retrieved from http://www.omhrc.gov/CLAS

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