Four parts or one whole: The National Health Service (NHS) post-devolution

Aim(s) There is a need for nurse and midwifery managers to have an understanding of devolution and its implications for them and their colleagues. This paper will explain devolution, consider some health and social care policy including similarities and differences, and assess the impact of devolution on the nursing workforce and the regulation of nursing across the four countries of the United Kingdom (UK). Background If managers are to manage effectively it is critical that they remain aware of emerging policy development and outcomes across the UK. It is now more important than ever that nurses maintain a keen eye on the impact divergent policy is having on practice as well as the UK nursing workforce. Evaluation The impact of devolution across the UK will be explored using convergence and divergence as a framework; commencing by providing an overview of devolution and health, moving on to examine health policy in action across the four countries. Key issues Healthcare is highly political in nature. Devolution has implications for all, and adds to the complexity of health and social care provision. If managers are to manage effectively it is critical that they remain aware of emerging policy development and outcomes across the UK. Conclusion It is equally important that nurses, and nurse managers, develop and draw upon their political leadership skills, actively engaging in policy debates to ensure that when policies are translated into practice their outcomes are optimal in terms of quality, efficiency and sustainability. Implications for nursing management There is a need for nurse and midwifery managers to have an understanding of post‐devolution structures and how they operate in order to work effectively, as well as to learn from the experiences of other parts of the UK.     

Modernizing the British National Health Service (NHS) -- some ideological and policy considerations: a commentary and application

The modernization of the British National Health Service, discussed by Peter Bradshaw in his paper, is having profound effects on nursing and patient care. The aim of this paper is to engage with the debate he has initiated in order to demonstrate its importance to nursing. The focus will be on key elements of the policy process not addressed by Peter Bradshaw as his emphasis was mainly on ideological concerns, but which nonetheless warrant consideration. These include the increasingly important role of evidence in policy making, and the role of nurses in the policy process. To this end four main themes are explored. First, specific comment is made on some of the points raised by Peter Bradshaw, in the context of the available evidence; secondly the role of evidence in the formulation and evaluation of policy is discussed; thirdly the policy process and nursing is examined; finally some tentative suggestions are made concerning the actions nurses and nurse managers can take to become more active in the health policy arena. The intention is to use Peter Bradshaw's work as a point of departure in examining further, some of the issues he highlights and to contribute to the debate.     

The nature of leadership style in nursing management

The purpose of this study was to explore the nature of leadership styles used by nurse managers, and describe staff nurses' perceptions of leadership styles. Effective leadership among nurse managers has been associated with staff nurse job satisfaction and retention. Twenty staff nurses from two hospitals in Ghana responded to tape-recorded interview questions. Four themes emerged from inductive analysis of the data. Findings suggest that nurse managers employed intimidation and minimal consultation to control their employees. The study further indicated that nurse managers were perceived as 'figure-heads', who are weak and inarticulate at the level of policy planning and implementation. It was therefore concluded that staff nurses in the study site hospitals lack confidence, trust and satisfaction with the current style of leadership. Staff nurses preferred a more proactive, articulate and independent nursing leadership at the top level. It is recommended that effective leadership training be instituted for prospective nurse managers before appointments are made into management and administrative positions.     

The use of metaphor in district nursing: maintaining a balance

AIM OF THE STUDY: To explore with practitioners and others, their priorities for and definitions of district nursing. BACKGROUND/RATIONALE: This paper discusses whether the use of metaphor in nursing literature and research can offer particular insights about the situation and experiences of nurses. DESIGN/METHODS: A case study approach was used to examine district nursing during a time of policy change. The study was undertaken in two stages using a range of qualitative methods of enquiry. Participants of the study were district nurses, General Practitioners (GP) and Community Nursing managers. RESULTS/FINDINGS: Qualitative data from interviews and periods of observation revealed that district nurses, and to a lesser extent General Practitioners and nurse managers used a shared group of metaphors to try and capture district nursing work. The paper suggest that this recurring group of metaphors demonstrated coherence between the language used, observed practice and accounts of how district nurses worked which provided useful insights for district nursing. The metaphoric language revealed both negative and positive dimensions of district nursing work. It illuminated the context dependent nature of district nursing work and the conflicting interests they had to accommodate. It also revealed the emotional work, skills and strategies district nurses employed in order to achieve their work. CONCLUSIONS: The paper concludes that an examination of metaphoric language offers an opportunity to examine what otherwise would be tacit or even misunderstood in nursing work.     

Nursing leadership in an academic hospital in Gauteng

Aim This study was aimed at describing nursing leadership in an academic hospital in Gauteng, South Africa. Background Nurse managers’ leadership styles affect nurses’ attitudes, behaviour and work performance. However, little is known about how nurses experience nurse leadership and what leadership styles are found in academic hospitals in Gauteng. Methods The study was based on Maxwell’s framework of leadership (relationships, equipping, leadership and attitude). A qualitative design was used in order to describe the experiences of registered nurses and nurse managers. The population of the study was all registered nurses and nurse managers of the hospital in which the study was conducted. In phase one of the study, a discussion group with 35 registered nurses using the nominal group technique was held to respond to the following statement: ‘Please explain how you have experienced leadership by nurse managers in this hospital’. In phase two of the study, five nurse managers were interviewed individually, using a semi-structured interview guide. Results Some nurse managers were practising autocratic leadership in this hospital. Implications for nursing management The nurse managers need to be taught about contemporary leadership styles such as transformational leadership and visionary leadership and also about supervision, role modelling and caring.     

Developing effective institutionai managers in the 1980s-Part 1: A current analysis

Two dominant themes are developed in this two part paper. One is that the organizational behaviour of nurse managers has its origins in the social defence system learned during early nursing; the other is that many of the assumptions which underpin current thinking on management training can do little either to help unlearn these early behaviours or to enable managers to be more innovative in their roles. In part one management training is examined in some detail from the three perspectives of the institution, the management trainers and the nurse managers, and in particular the widely differing assumptions and expectations which each have about the management training process. The social defence system of nursing is then analysed and tentative evidence is offered to illustrate how nurse managers transfer this system to managerial positions, with dysfunctional consequences. Although primarily concerned with nurse management training, there are implications for managers and management trainers in a much wider range of institutions and professions.     

Nurse managers in Australia: mentoring,leadership and career progression

Identification of those leadership qualities which nurses believe led to their successful attainment of a nursing management position may help in understanding how to identify and foster leadership potential amongst nursing staff. This study asked nurse managers to indicate the important factors which influenced and facilitated their entry to management positions with a particular reference to the development of leadership characteristics. The results suggest that the leadership qualities we expect nurse managers to display evolve in a largely random way. Additionally, there is evidence that the development of leadership skills and attainment of management positions remains fragmented and random in nature. Because of this, individual nurse managers develop leadership skills almost by default using informal strategies to learn and develop. These findings should provide direction to educational providers and senior managers who seek to develop future leaders and managers.     

A Critical Examination of the U.S. Nursing Shortage: Contributing Factors,Public Policy Implications

BACKGROUND. Despite short‐lived periods of adequacy in nurse availability, the nursing shortage has endured. In order to better understand the myriad factors that influence the current shortage of nurses, as well as possible solutions, this project addresses the influence of social factors and government policy on nurse staffing inadequacy. When the government intervenes in a philosophically free‐market economy, the assumption is that a problem, such as the current nursing shortage, could not be solved without such intervention. PURPOSE. Nursing care arguably falls into the realm of protecting the common good, and therefore requires government oversight. We provide a critical analysis of policy intervention efforts into the nursing shortage debate by examining the passage of legislation, the provision of educational assistance, and the establishment of minimum staffing requirements and minimum quality standards for reimbursement, which all impact nursing supply and demand. RESULTS. Arguments supporting and opposing policy intervention in general, and its impact on the overall provision of nursing care in the United States, were examined. Without policy incentive to place financial value on the quality of care provided by nurses, a simple increase in the number of available nurses is unlikely to solve the current problem. IMPLICATIONS. Important considerations that should be factored into policy creation include measurement and compensation for quality care, the nature of recruitment efforts of new nurses, and the complex nature of a nursing work.     

Achieving consensus about pain content for child branch curricula

AIM: The aim of the study was to identify nurse educators' and nurse managers' perceptions of the educational needs of children's nurses in relation to pain management. RATIONALE: Children continue to suffer unnecessary pain during hospitalization. This has been attributed, in part, to inadequate education among paediatric nurses with a number of studies demonstrating that nursing curricula need re-evaluating with respect to the content relating to pain management. In order to equip nurses to manage pain within clinical practice nurse education needs to provide them with the knowledge and skills required. It is apparent that nurse education is currently failing students in this regard. In order to evaluate nursing curricula with respect to pain management it is necessary for there to be a degree of consensus, among paediatric nurses, regarding appropriate content. METHODOLOGY: A two-round Delphi study was used to ascertain the appropriate pain content for pre-registration child branch courses. When undertaking a Delphi study a number of 'experts' in the field are identified, who complete a series of questionnaires. The first round is used to generate ideas, which are reconsidered in subsequent rounds (Hicks 1999, Reid 1988). Following analysis of the responses to each questionnaire anonymous feedback is sent to the respondents together with the next questionnaire (Walker 1994). Participants were either senior nurse educators or senior nurse managers. RESULTS: Positive correlations were found within the two groups as well as between the educators' and managers' rankings for the 14 categories identified. CONCLUSIONS: The results of this study suggest that nurse educators and nurse managers have similar views about the pain management knowledge they would expect a newly qualified child branch nurse to have. The list of appropriate pain content derived from the results of this study provides a useful tool with which to evaluate the content of child branch curricula.     

Exploring ethical perspectives of nurses and nurse managers

With nursing shortages reaching crisis proportions, staff nurses need to believe that nurse managers are supportive. However, evidence exists that staff nurses view nurse managers as moving away from basic nursing values. Using an exploratory philosophical approach, the authors examine this issue as a function of differing ethical frameworks used by nurses and nurse managers. The main question is whether nurse managers are expected to subscribe to a corporate ethic versus a nursing ethic in making decisions, and whether these approaches are fundamentally different. The authors' supposition was that exposing differences might account for some dissatisfaction that nurses express with regard to nursing leadership. They conclude that there are differences of emphasis in ethical principles that may cause tension. Incongruencies between corporate and individual values emerge under fiscal constraints and with differing perceptions, expectations and decision-making criteria. This paper offers suggestions to help staff nurses and nurse managers reduce tensions experienced when difficult choices, particularly those of resource allocation, are required.     

Being and doing politics: an outdated model or 21st century reality?

Title. Being and doing politics: an outdated model or 21st century reality?. Aim. This paper presents a discussion of how critical social theory can be used as a tool for research, reflection and exploration of the political role of the nurse. Background. Sociological theory can be used to examine ideologies within nursing systems in order to contribute to the future development of the profession. The importance of critical social theory has been identified in the literature as being directly relevant to holism which is central to the nature of nursing. Data sources. Texts published in English were identified from 1990 to 2008 using the keywords critical social theory, community nursing, political advocacy, social justice, sociological theory, health inequalities, health democracy, equity and inequality. Discussion. Critical social theory can be used as a tool to highlight ethical ways to practise nursing. One reason for examination of the community nurse’s political role is a shift in focus from the individual as patient to communities experiencing health inequalities. Nursing needs to decide whether the profession will work at the political level, and where advocacy and citizenship are located within a community role. Conclusion. Nurse educators must prepare nurses for political participation, and nurse managers need to focus on national and local contexts in order to encourage policy analysis and community engagement within nursing practice. An understanding of critical social theory can aid decision‐making in relation to global and local policy, enable the nursing profession to respond to social injustice, and permit nurses to work with communities in the pursuit of community health.     

Feeling the cold: implications for nurse managers arising from the financial pressures in health care in England

Hewison A . (2010) Journal of Nursing Management 18 , 520–525
Feeling the cold: implications for nurse managers arising from the financial pressures in health care in England Aim The purpose of this short paper is to identify some of the implications and opportunities nurse managers in England face as a result of the current global economic recession. Background Government borrowing and poor global economic conditions have combined to create a £175 billion budget deficit in the UK. The National Health Service in England will be required to make substantial savings in order to help offset this shortfall. Key issues This is a brief critical commentary which examines some of the challenges and opportunities for nurse managers in England. It draws on a number of sources to identify key issues concerning nursing management arising from the financial pressures facing health care. Conclusion The next few years are going to be very difficult for nurses and their managers, however, the current situation also presents opportunities to advance the contribution and influence of nursing and nursing management. Implications for nursing management What nurse managers do next will be crucial in shaping the NHS response to the financial storm and the future nature of health care in England.     

Changes in nursing identities: supporting a successful transition

This article examines the role of nurse managers in delivering the NHS modernization agenda by supporting the development of new and innovative nursing roles as proposed in recent health care policy. A study by Ewens (1998) indicates that nurses will respond positively to new short-term developments because of the ability to re-conceptualize work roles before actually undertaking them, but that long-term success will depend upon whether the workplace provides the scope and flexibility for integration of new identities into the self-concept. It is argued that when nurses find a gap between what they believe their role could be and what in reality it is allowed to be they separate their self-concept from their work role. In this situation the nurse experiences frustration and disappointment and the work role becomes 'untenable', resulting in them either leaving or retreating back into traditional professional identities. A discussion is provided on the role of nurse managers in the prevention of this negative response by supporting innovative work environments that can accommodate the new roles envisaged in the current policy. The paper concludes with consideration of the current direction of nursing and questions whether this move towards the nurse as 'assistant physician' will, in the longer term, be a good thing for patients.     

Challenges for nurse managers in China

wong f.k.y. (2010) Journal of Nursing Management 18, 526–530
Challenges for nurse managers in China Aim To critically review the challenges facing nurse leaders in China during healthcare reform. Background China is now undergoing a major reform aimed at enhancing the accessibility and quality of its healthcare at a level that is affordable to the people. Nurses have a key role to play in this reform. Evaluation Key documents produced by the government of China were critically reviewed using the strengths, weaknesses, opportunities and threats (SWOT) framework. Key issues A number of factors, including the insufficient number of nurses and the medical orientation of the health system, have hindered the development of nursing. However, healthcare reform has created new opportunities for nurses and nursing. Conclusions This paper reviews the strengths, weaknesses, opportunities and threats faced by nurse managers in China. It identifies barriers but also possibilities for nurse leaders to advance nursing and make nurses visible in this era of transforming healthcare. Implications for nursing management Many of the issues identified in this review, such as the enhancement of quality and accessibility of care, are important to nurse leaders around the world. However, this article reveals the particular challenges faced by nurse leaders in China, with its unique social and historical background.     

Predictors of nursing staff turnover

Nursing turnover is of great concern to patients, management and the profession, and numerous studies have been conducted to increase understanding about this phenomenon. Most of these, however, have focused on staff nurses in the public sector; little is known about nurse manager turnover or the characteristics of nurses leaving the private hospital sector. The purpose of this study was to examine turnover of staff nurses and nurse managers in both the public and private hospital sectors. Variables which appeared to have a consistent relationship with nurse turnover were identified from the literature, and multiple regression methods were used to attempt to identify variables which could be used to predict turnover behaviour of staff nurses and nurse managers. This study encountered methodological difficulties similar to those which have plagued previous studies; nevertheless, a clearer picture of nursing turnover is emerging.     

Nurse managers' challenges in project management

suhonen m. & paasivaara l . (2011) Journal of Nursing Management 19, 1028–1036
Nurse managers’ challenges in project management Aim To analyse the challenges that nurse managers meet in project management. Background Project management done by nurse managers has a significant role in the success of projects conducted in work units. Methods The data were collected by open interviews (n = 14). The participants were nurse managers, nurses and public health nurses. Data analysis was carried out using qualitative content analysis. Results The three main challenges nurse managers faced in project management in health-care work units were: (1) apathetic organization and management, (2) paralysed work community and (3) cooperation between individuals being discouraged. Conclusions Nurse managers’ challenges in project management can be viewed from the perspective of the following paradoxes: (1) keeping up projects–ensuring patient care, (2) enthusiastic management–effective management of daily work and (3) supporting the work of a multiprofessional team–leadership of individual employees. Implications for nursing management It is important for nurse managers to learn to relate these paradoxes to one another in a positive way. Further research is needed, focusing on nurse managers’ ability to promote workplace spirituality, nurse managers’ emotional intelligence and their enthusiasm in small projects.     

Factors of human capital related to project success in health care work units

suhonen m. & paasivaara l. (2011) Journal of Nursing Management 19 , 246–253
Factors of human capital related to project success in health care work units Aim To explore factors of human capital related to project success that employees expect from nurse managers. Background Human capital refers to those resources that managers working with projects possess, such as abilities, knowledge and qualities of character. Method The data were collected by open interviews (n = 14) with nurses, public health nurses and nurse managers working in primary health care and a hospital. Data analysis was carried out using qualitative content analysis. Results The main factors of human capital related to project success proved to be as follows: (1) management of enthusiastic project culture, (2) management of regeneration and (3) management of emotional intelligence. Conclusions Future research is needed on the kind of means nurse managers use in human capital management in projects and how they see their possibilities in managing human capital. Implications for nursing management Human capital management skills should be underlined as an important competence area when recruiting a nurse manager. The success of health care projects cannot be improved only through education or by training of nurse managers; in addition, projects need nurse managers who understand workplace spirituality and have high emotional intelligence.