Nurse executives' values and leadership behaviors. Conflict or coexistence?

Nurse leaders struggle to provide for the delivery of humanistic and holistic healthcare that is consistent with nursing values in a changing economic environment. There is concern that nurse executives find it increasingly difficult to reconcile the differences between organizational economics and their personal and professional identities. The purpose of this study was to examine the relationship between nurse executives' perceived personal and organizational value congruence and their leadership behaviors (i.e., transformational, transactional, and laissez-faire). Four hundred and eleven nurse executives employed by American Hospital Association hospitals located east of the Mississippi participated in the study. Findings provide insight into the values held by nurse executives, personal and organizational value congruence and conflict perceived by nurse executives, and the leadership behaviors used by nurse executives. For example, the findings indicate there is a moderate degree of value congruence between nurse executives' personal and organizational values; however, the degree to which specific values are important is significantly different. Nurse executives report that they most often engage in transformational leadership behaviors, but there was no relationship between their leadership behavior and the degree of personal and organizational value congruence. Implications for nursing and nursing research are discussed.     

Developing a decision support system to meet nurse managers' information needs for effective resource management

This article describes the development of a decision support system called CLASSICA, which assists nurse managers in financial management, resource allocation, activity planning, and quality control. CLASSICA integrates information about patient flow and activity, staffing, and the cost of nursing care at the nursing-unit level. The system provides assistance in planning activities, balancing the budget, and identifying barriers to unsatisfactory resource management. In addition, CLASSICA contains forecasting and simulation options to analyze the influence of factors that affect nursing costs. This article describes the system's development process steps to tailor it to the needs of nurse managers and their existing work practices. Nurse managers actively participated in defining their tasks and responsibilities; identified barriers and difficulties in managing these tasks; defined information needs, data input, and output and interface requirements; and identified expected benefits. Clear communication of project goals, strong user involvement, and purposeful benefit planning was used to achieve the goals for CLASSICA: (1) to provide essential information and decision support for effective financial management, resource allocation, activity planning, and staffing; (2) to improve nurse managers' competence in financial management and decision making; (3) to improve cost containment; and (4) to provide a helpful and easy to use tool for decision support.     

A patient-centered framework for restructuring care

Restructuring to meet patient care needs is the greatest challenge facing nursing and hospitals today. As leaders of the largest clinical discipline, nurse executives have a professional responsibility to assist hospitals to design delivery systems that will ensure high-quality care and financial viability. The author describes how one nursing division formulated its values and beliefs into a framework for practice and operationalized the framework into a patient-centered care delivery system.     

Developing financial management skills: an educational approach

One of the nurse executive's most important activities is responding to the new financial pressures in health care. Nurse executives can effectively address this concern through developing nurse managers' financial skills. Financial management seminars can be an effective way to address this development need. This article reports on a seminar in which managers are shown how they can best motivate staff nurses, and provide them with new tools and techniques to perform in a more cost-effective manner.     

Caseload management skills for improved efficiency

This article provides information about caseload management, which was one of a group of six competencies identified by nurse administrators as needed by new baccalaureate graduates. Caseload management is an important skill for nurses who work with caseloads of patients or clients (e.g., home health nurses, public health nurses, case managers, ambulatory care nurses). Because inadequate information about caseload management is contained in community health nursing textbooks, continuing education and staff development programs need to include caseload management skills to improve the efficiency and quality of nursing care.     

Using the “big picture” to get what you want

Few basic nursing education programs provide the student nurse with courses in business and finance. Those skills were most often acquired by nurse managers when they were promoted from a staff position to a management position and they were acquired on the job. As the health care environment becomes more complex, so too does the scope of business and financial skills. Today's nurse manager must develop a wider range of skills to survive. Among the most important is an ability to connect unit level needs to the overall goals of the organization.     

Perspectives on nursing issues and health care trends

A national survey of nurse administrators from magnet hospitals and faculty directors of graduate programs in nursing administration delineated perspectives on the foremost issues facing professional nurses and the most significant trends in health care policy and delivery. The findings are useful in developing data-based nursing curriculums sensitive to an increasingly market-oriented economy, and for resource-conscious nurse executives struggling to prioritize which issues to address and which directions to take when spending is restrained.     

Management development: a needs analysis for nurse executives and managers

Clearly, both the nurse executive and nurse manager roles are becoming more complex. I feel an enthusiasm by the professionals in those positions to pursue development activities that will help them do their jobs better and with less discomfort. Nurse executives obviously know the power of combining knowledge with experience. How do the different leadership and management development needs identified by these NE fit with your organization's needs? What is the content in your leadership and management development programs? Are your programs meeting the real needs of your executive and management-level staff? One way to find out is to do a simple survey. Today, nurse executives are responsible and accountable for challenges we never considered possible, even a few years ago. But along with the new challenges came the flexibility and positive attitudes of NEs to respond to changes and acquire new skills such as cost accounting, computers, or marketing. It's this type of proactive thinking that helps nurse leaders turn problems into opportunities and their situations into success stories.     

Leadership roles, competencies, and education: how prepared are our nurse managers?

Although they are responsible for the operation of business units, nurse managers are often less well prepared to manage the business activities than the clinical activities. Perceptions of nurse managers and nurse executives regarding competencies required for nursing management roles and the educational preparation required to attain them were examined. Results indicate the groups are in basic agreement about required competencies, though nurse managers appear less clear about nurse executive role responsibilities. Nurse executives value the acquisition of a master's degree as essential for nurse manager performance, while fewer nurse managers agree. Strategies nurse executives may employ to develop nurse manager business knowledge include traditional undergraduate and graduate degree programs, online programs, certificate programs, continuing education, inservice education offerings, seminars, and mentoring activities.     

The impact of utilization review on nursing

At first glance, nursing's role in UR appears to be of strategic significance to the profession. But there are several issues that nurse executives need to consider. First, since UR departments are seldom part of the nursing department, UR nurses are practicing outside the realm of nursing. What responsibility, if any, does the nursing department have to nurses practicing in the hospital, yet not in the nursing department? What can the nursing department do to help UR nurses maintain their identification with the profession and appreciate the strategic importance of their role, with its legal and financial ramifications? Second, UR is changing the established role of the primary care nurse. In your institution UR may already have taken the staff nurses' discharge planning function. It appears that several factors are contributing to this role change. Patient acuity has increased the time needed to administer physical care. The nursing shortage means more patients are assigned to each professional nurse and paraprofessionals are doing more patient care. There is less and less time left for the primary nurse to practice the professional attributes of nursing, primarily discharge planning. This function is shifting to the UR Department. Is discharge planning a function nurse executives wish to relinquish? Finally, we are entering another period of severe nurse shortages, where recruitment and retention of staff are paramount. Actively competing for our staff are the UR departments. Forty professional nurses work in three regional centers of the American Health Network, American Group Insurance Company (Dallas, Texas). In one hospital of 450 beds, nine nurses are employed by the UR department.(ABSTRACT TRUNCATED AT 250 WORDS)     

Demystifying critical care management. Part 1

Many nurse executives avoid an active management role in their hospital's critical care areas, a stance that can result in decreased personal, professional, and institutional efficiency and effectiveness. This article is a guide for applying the management process in critical care units and for helping nurse executives gain control of one of the largest consumers of hospital and nursing resources. This is part 1 of a two-part article.     

Is the humanistic view of the nurse role still alive – in spite of an academic education?

AIM: This paper is a report of a study exploring what 'being a good nurse' means by following nursing students during their pre-registration education and for some years after graduation. BACKGROUND: There have been few studies focusing on the nurse role in the transition from student to experienced nurse. Studies with a qualitative design, in particular, are limited in number. METHODS: A longitudinal survey design was adopted, using an open-ended questionnaire at the beginning of education (n = 164), just before graduation (n = 123), and 3-5 years after graduation (n = 77). The participants were students in the nursing programme at a Swedish university. The data were collected during the period 1993-2002. Latent and manifest content analyses were used. FINDINGS: Four categories were identified in the data. 'To do good for others', with the sub-category 'to care for others', was most frequent over time and quite stable. The category 'to be competent and skilled' was frequent and increased over time. 'To have professional courage and pride' and 'to seek professional development' were mentioned to lesser extent and showed a slight increase over time. The meaning of being a good nurse grew in complexity over time and informants' professional awareness seemed to increase, especially concerning 'to be competent and skilled'. CONCLUSION: Attention needs to be paid both to nursing education and practice. Clinical supervision given by nurses with Master's degrees is suggested in order to convey positive attitudes towards nursing development and research into practice. Further studies are needed to compare what 'a good nurse' means to graduate nurses and how they actually behave when performing good nursing care.     

Quality and safety curricula in nursing education: matching practice realities

Health care delivery settings are redesigning in the wake of staggering reports of severe quality and safety issues. Sweeping changes underway in health care to address quality and safety outcomes lend urgency to the call to transform nursing curricula so new graduate competencies more closely match practice needs. Emerging views of quality and safety and related competencies as applied in practice have corresponding implications for the redesign of nursing education programs. Nurse executives and nurse educators are called to address the need for faculty development through strategic partnerships.     

Priorities and challenges of health system chief nursing executives: insights for nursing educators.

The health system chief nursing executive (CNE) is responsible for providing high-quality, service-oriented nursing care; delivering such care with disciplined cost management; leading and developing a group of nursing executives and managers at the facility level to establish nursing professional development programs and to build and maintain an effective supply of nurses; and advocating nurses and patients. This article provides insight into the strategies and priorities of large health system CNEs in balancing their obligations to their health systems, to patients and their families, and to the nurses they lead. It is hoped that these insights will provide perspectives that will support the ability of nursing educators to meet their own obligations to their schools of nursing, the faculty and students they represent, and to the profession. These insights will also set a context for further dialogue between two very important groups of nursing leaders-nursing executives and nursing educators.     

Cost categories, behavior patterns, and break-even analysis

Nurse executives budget and control costs, use those budgets and other management tools to control departmental costs, identify existing programs to drop or change, target new programs and services, and determine fees for nursing services. Knowledge of costs and their behavior patterns assist nurse executives in all of these activities. The author identifies the two cost categories (direct and indirect), explains the basic cost behavior patterns (fixed and variable), and helps nurse executives identify these cost categories and behavior patterns in their own departments.     

Developing a nursing management practice atlas: Part 1, Methodological approaches to ensure data consistency

Challenges associated with the use of secondary data sources for benchmarking in nursing administration research are identified. A methodological approach for ensuring data consistency is presented in part one of this two-part series. Part two (September 2000) will provide an analysis of the nursing management data, based on a set of nursing and financial resource benchmarking variables identified by the senior nurse executives of these sites. Initial findings show evidence of data consistency across similar hospitals.     

Leadership: the key to quality outcomes

Nurse executives are charged with creating a workforce that provides quality care in a creative and cost-effective manner. Style of leadership determines how nurse executives relate to their professional nurses and ultimately how successful their health care institutions will be. The practice-based theory of nursing leadership called the Integrated Leadership Practice Model can be practiced by nurse executives to promote employee satisfaction, assure that quality care is provided based on standards and competencies, and promote an organizational culture committed to quality. This article proposes the application of integrated leadership to the practice of nurse executives and demonstrates how they can foster and support this model for nursing leadership within their nurse managers.