Kelly Vana's Nursing Leadership and Management

Managementis defined as a process of coordinating actions and allocating resources to achieve organizational goals. It is a process of planning, organizing and staffing, leading, and controlling actions to achieve goals. Planning involves setting goals and identifying ways to meet them. Organizing and staffing is the process of ensuring that the necessary human and physical resources are available to achieve the planning goals. It also involves assigning work to the right person or group and specifying who has the authority to accomplish certain tasks. Finally, controlling is comparing actual performance to a standard and revising the original plan as needed to achieve the goals. The daily activities of managers are diverse and fast paced, with regular interruptions. Priority activities are integrated among inconsequential ones. In the scope of one morning, a nurse manager may make serious decisions about a critically ill patient, a staff or patient complaint, a shortage of nurse staffing, and so forth. A nurse manager's work is driven by problems that emerge in random order and that have a range of importance and urgency. These circumstances create an image of the nurse manager as a firefighter involved in immediate and operational concerns. A significant proportion of a manager's time is spent in interaction with others, and more of the work is concerned with handling information than in making decisions (McCall, Morrison, & Hannan, 1978). Nurse managers constantly interact with other members of a health care administrative team. This administrative team can include nurses, various clinical practitioners, unit staff, and staff from other departments who share information and assure that quality patient outcomes are achieved.

One of the most frequently referenced taxonomies of managerial roles is from an in‐depth, month‐long study of five chief executives by Henry Mintzberg. A taxonomyis a system that orders principles into a grouping or classification. Mintzberg's observations led to the identification of three categories of managerial roles: (a) information‐processing role, (b) interpersonal role, and (c) decision‐making role (Mintzberg, 1973).

A role includes behaviors, expectations, and recurrent activities within a pattern that is part of the organization's structure (Katz & Kahn, 1978). Specific or distinct roles are part of each of the three categories of managerial roles. The information‐processing roles are monitor, disseminator, and spokesperson, each of which is used to manage the information needs that people have. The interpersonal roles are §head, leader, and liaison, and each of these roles is used to manage relationships with people. The decision‐making roles are the entrepreneur, disturbance handler, allocator of resources, and negotiator roles that managers use to act when making decisions.

Newly graduated nurses are concerned about their abilities to perform as nurses. They are worried about their skills and abilities and about advancing to independently manage a full patient load. New graduate nurses also deal with the emotional and physical realities of full‐time work and the transition from the role of student into professional nurse. To help support this transition, all new nurses are included in our year‐long Nurse Residency Program. This program provides them with a monthly opportunity to learn new skills and affirm their current skills and abilities through a variety of learning activities, including simulation. The new nurses also discuss their challenges and experiences when discussing tales from the bedside .They learn how to take the theory of EBP and apply it to a unit‐based issue. They create change within the Medical Center through their EBP projects! This often is the highlight of the first year of transition.

Katherine Pakieser‐Reed, PhD, RN

Director, Center for Nursing Professional Practice and Research

University of Chicago Medical Center

Chicago, Illinois

In the early 1900s, an emphasis on management as a discipline emerged with a focus on the science of management and a view that management is the art of accomplishing things through people (Follet, 1924). Henri Fayol, a manager, wrote a book in 1917 called General and Industrial Management . He described the functions of planning, organizing, coordinating, and controlling as the management process(Fayol, 1917/1949). His work has become a classic in the way that we define the process of managing. Two other individuals, Gulick and Urwick, in some part resulting from their esteemed status as informal advisers to President Franklin D. Roosevelt, defined the management process further according to seven principles (Fayol, 1917/1949). Their principles form the acronym POSDCORB, which stands for Planning, Organizing, Staffing, Directing, Coordinating, Reporting, and Budgeting (Fayol, 1917/1949; Gulick & Urwick, 1937). Their work is also considered to be a classic description of management and is still a relevant description of how the management process is carried out today.

More recently, Yukl (2013) and colleagues (Kim & Yukl, 1995; Yukl, Wall, & Lepsinger, 1990) followed this classic work by describing 13 management functions that address two broad aspects of the management process: managing the work and managing relationships. The management functions for managing the work are planning and organizing, problem solving, clarifying roles and objectives, informing, monitoring, consulting, and delegating. The management functions for managing relationships are networking, supporting, developing and mentoring, managing conflict and team building, motivating and inspiring, and recognizing and rewarding.

The amount of time managers spend on particular roles or functions varies by the level of their positions in organizations, ranging from the first‐level management positions, to the middle‐level management positions, to the executive‐level management positions. A first‐level managerial role or function in health care organizations is the nurse manager at the clinical bedside. First‐level nurse managers spend the majority of time directly managing patient care and supervising others as they deliver care. The next highest percentage of their time is spent in planning. The rest of first‐level nurse managers' functions typically take fewer than 10% or less of their time: planning and organizing, problem solving, clarifying roles and objectives, informing, monitoring, consulting, and delegating.

Select three opportunities to observe interactions by the nurse manager of the unit where you are doing your clinical rotation or where you are a new graduate nurse. These opportunities could be during a unit staff meeting, when the nurse manager makes rounds, and during conversation with others at the nurses' station. Which of the following nurse management functions do you see your unit nurse manager performing?

–Managing the work–Planning and organizing– Problem solving– Clarifying roles and objectives– Informing– Monitoring– Consulting– Delegating

–Managing relationships– Networking– Supporting– Developing and mentoring– Managing conflict and team building– Motivating and inspiring– Recognizing and rewarding

In contrast, middle‐level managers, usually called nursing directors, spend less time in direct supervision and more time in the other managerial roles or functions, particularly, planning and coordinating. At the highest level of the organization, usually described as the executive level, planning and being a generalist are greatly expanded role functions. Direct supervision is not a major aspect of the executive role as it is in the other two levels. Nurses in executive‐level roles in health care organizations usually have the title Chief Nurse Executive or Chief Nursing Officer or, in acute care hospitals, the title may be Vice President of Patient Care Services.