First‐line nurse managers in university hospitals – captives to their own professional culture?

AIM: This study investigates whether first-line nurse managers in hospitals share common dispositions related to managerial work and leadership, what they are like, and what their relationship is with the various expectations set on them. METHODS: The first data were collected by focus group interviews in the autumn of 2000 and analysed using qualitative content analysis and frame analysis. The second data set were part of a questionnaire survey addressed to the same managers in 2001 with a focus on their diverse leadership roles. RESULTS: Among first-line nurse managers, the management frameworks of a nurturing mother and an administrative nurse displayed the strongest prominence, and the emphasis seemed to be evolving towards the administrative. The results from the survey confirmed the findings of this study in relation to first-line nurse managers' management frameworks. CONCLUSION: The line of development found in this study may add to the permanence of operations and the stability of the operative culture at a university hospital. It may also diminish the opportunities for nursing development in university hospital wards and weaken the potential for a new kind of competence among both managers and their subordinates.     

Profile of first-line nurse managers in New South Wales, Australia, in the 1990s

AIMS: To determine a demographic profile, employment history and career plans of a sample of nursing unit managers (first-line managers) in New South Wales (NSW), Australia in 1999. To compare the profile of first-line nurse managers in 1999 with those in 1989. BACKGROUND: This study replicates another undertaken a decade earlier (see Duffield 1992). Tracking the changes to nurse manager positions is important, given changes to the educational preparation of nurses and restructuring within hospitals which have occurred in the past decade. METHOD: The same questionnaire was used in both studies, with minor amendments and the addition of two items to reflect changes to organizational structures, whereby nurse managers are now responsible for non-nursing staff. In 1999 all first-line nurse managers in the largest health service in NSW were invited to participate in the study. RESULTS: A response rate of 77% was achieved. There were few differences of note in the demographic profile from 1989 to 1999. However educationally, first-line nurse managers in 1999 were more highly qualified. A greater proportion had higher degrees and increasingly, in the management discipline. CONCLUSION: Perhaps reflecting these qualifications, more managers in 1999 indicated their intention to move to more senior management positions in the next decade. The mode for experience in this role of 1 year in both 1989 and 1999 reflects a worrying trend of high turnover and inexperience amongst this group of managers. While maternity relief might account for this result, further research needs to determine more precise reasons. The ad hoc bases on which expert clinicians (clinical nurse specialists) act as the manager in his/her absence need to be critically examined. Alternative strategies such as introducing a formal second- in-charge position may ensure more successful recruitment and retention of staff to these critical management positions.     

First-line nurse managers in the expanded role. An ethnographic analysis.

Authority, accountability, and responsibility invested in first-line nurse managers in acute care hospitals has significantly increased in the past 15 years, creating a role many nurse executives consider pivotal for achieving organizational goals. Little empirical data are available concerning these reorganized roles. In this ethnographic analysis, the author examines beliefs, values, and behaviors of nurse managers considered effective and successful in their practice and the implications of these characteristics for manager selection and development.     

First-line nurse managers: issues in the literature

The purpose of this paper is to describe the major issues from the literature which confront first-line nurse managers. The increasingly complex environment in which these managers function has, at the very least, significantly altered their role. However, there are other issues confronting those in first-line positions and these are discussed under four broad headings: the role of first-line nurse managers; role conflict and confusion; management skills and functions; and education for first-line nurse managers.     

Supporting nurse managers in creating a culture of retention

Dire predictions for the future continue to dominate discussion of workforce issues in today's hospitals. Even organizations not currently dealing with shortages of key personnel will be met with the challenge of maintaining a vibrant workforce in the face of impending baby-boomer retirees. Although nurse managers are considered the chief retention officers for their departments and increasingly are being held tightly accountable for results that demonstrate retention, their capacity for taking on this responsibility must be evaluated.This study investigated what nurse managers actually do that creates a positive work environment in their departments. Based on these findings, recommendations for supporting first-line nurse leaders are offered.     

Maintaining competence for first-line nurse managers: an evaluation of the use of the literature

The use of nursing literature is frequently advocated as a means of maintaining competence. The purpose of this study was to compare the frequency of references to competencies in the literature with those retained for the role of first-line nurse managers by an expert panel involved in the Delphi technique. In this way, the use of literature in maintaining managerial competence for first-line nurse managers was evaluated. When the 20 most frequently mentioned competencies in the literature were compared with the highest mean scores and those ranked as most important by the expert panel, only two competencies appeared on all three lists. Fifteen competencies were frequently mentioned in the literature but were not identified by the expert panel as important to the role of first-line nurse managers. A further three competencies identified in the literature were excluded by the expert panel, indicating they were not perceived to be a function of first-line nurse managers.     

The role and preparation of first‐line nurse managers in Australia: where are we going and how do we get there?

Organizational restructuring is impacting heavily on the first-line nurse managers' role. Given their critical role, it is important that the best and most talented are attracted to and prepared to be first-line managers. The authors provide an overview of the role of first-line nurse managers in Australia, proposing that nurse administrators take a more active role than has traditionally been the case in ensuring staff are appropriately educated and selected for management positions.     

Nurse managers don’t get the corner office

Aim To provide an original perspective on the power and status of first-line nurse managers by observing their working environment. Background The role of first-line nurse managers includes clinical, administrative and managerial components, with their responsibilities not always reflected in their level of organizational power. The business literature suggests that an appropriately resourced workspace is not merely functional, it also confers power and status. Method Twenty Australian rural nurse managers’ workspaces were observed, as part of a larger qualitative study that explored their role and organizational power using semi-structured interviews. The observational data consisted of detailed researcher notes that were analysed thematically. Results The nurse managers’ workspaces were suboptimal and did not provide sufficient physical space or resources for the participants’ to manage tasks effectively. These results were considered using Kanter’s theory of organizational power. Implications for nursing management The findings support those reported in the business literature that inadequate physical workspaces are counterproductive in terms of both functionality and organizational power. Suggestions are made regarding the workspace needs of first-line nurse managers, based on a closer alignment between the work environment and their role responsibilities. These findings have implications for decisions regarding organizational support of first-line nurse managers.     

The influence of leadership practices and empowerment on Canadian nurse manager outcomes

Aim To examine the influence of senior nurse leadership practices on middle and first-line nurse managers’ experiences of empowerment and organizational support and ultimately on their perceptions of patient care quality and turnover intentions. Background Empowering leadership has played an important role in staff nurse retention but there is limited research to explain the mechanisms by which leadership influences nurse managers’ turnover intentions. Methods This study was a secondary analysis of data collected using non-experimental, predictive mailed survey design. Data from 231 middle and 788 first-line Canadian acute care managers was used to test the hypothesized model using path analysis in each group. Results The results showed an adequate fit of the hypothesized model in both groups but with an added path between leadership practices and support in the middle line group. Conclusions Transformational leadership practices of senior nurses empower middle- and first-line nurse managers, leading to increased perceptions of organizational support, quality care and decreased intent to leave. Implications for Nursing Management Empowered nurse managers at all levels who feel supported by their organizations are more likely to stay in their roles, remain committed to achieving quality patient care and act as influential role models for potential future leaders.     

18家不同级别医院护士长管理知识培训需求调查分析与对策

目的:探讨不同级别医院护士长对职业化管理培训需求的差异。方法:以问卷选答的形式调查该省不同级别在职护士长424人。结果:对职业化管理培训的需求,不同级别医院护士长既相同,也有差异。结论:必须认清不同级别医院护士长对职业化管理培训需求的共性与差异,有针对性地开展在职继续教育。     

Reasons to leave: the motives of first-line nurse managers' for leaving their posts

OBJECTIVE: To study the reasons for first-line nurse managers to resign, their perceptions of difficult situations, experience of support and satisfaction with work. BACKGROUND: The intentions of first-line nurse managers' to stay at their posts varied between 45% and 75% in different studies. METHODS: Data were collected by questionnaire and letters from 32 first-line nurse managers who had left their posts. Qualitative content analysis was used to analyse the letters. RESULTS: Eleven first-line nurse managers resigned due to reorganization or other changes and 19 due to their own accord. Reasons to leave were personal, organizational, as well as lack of support from and relations to the head of department. Difficult situations were unclear conditions, lack of support from supervisors and, implementation of changes, staff matters and economy. Important support was personal, organizational, practical and to have opportunities for development and education. The perception of work satisfaction was higher after resignation. CONCLUSIONS: The dominant reason to leave was reorganization and other changes. The relation to the head of department influenced the first-line nurse managers' overall work situation.     

Predictors of nurse manager stress: A dominance analysis of potential work environment stressors

Background

Nurse managers have important but stressful jobs. Clinical or bedside nurse predictors of stress have been studied more frequently, but less has been done on work environment predictors for those in this first-line leadership role. Understanding the relative importance of those work environment predictors could be used to help identify the most fruitful areas for intervention, potentially improving recruitment and retention for nurse managers.

Objective

Using Role Stress Theory and the Job Demands-Resources Theory, a model was tested examining the relative importance of five potential predictors of nurse manager stress (i.e., stressors). The work environment stressors included role ambiguity, role overload, role conflict, organizational constraints, and interpersonal conflict.

Design and settings

A quantitative, cross-sectional survey study was conducted with a convenience sample of 36 hospitals in the Southwestern United States.

Participants

All nurse managers working in these 36 hospitals were invited to participate. Of the 636 nurse managers invited, 480 responded, for a response rate of 75.5%.

Methods

Questionnaires were distributed during nursing leadership meetings and were returned in person (in sealed envelopes) or by mail.

Results

Because work environment stressors were correlated, dominance analysis was conducted to examine which stressors were the most important predictors of nurse manager stress. Role overload was the most important predictor of stress, with an average of 13% increase in variance explained. The second- and third-most important predictors were organizational constraints and role conflict, with an average of 7% and 6% increase in variance explained, respectively.

Conclusion

Because other research has shown deleterious effects of nurse manager stress, organizational leaders are encouraged to help nurse managers reduce their actual and/or perceived role overload and organizational constraints.     

Redesigning management roles. The executive challenge

The revolutionary changes that have occurred in healthcare during the past decade challenge nurse executives to analyze and redesign managerial roles. To confront future change and developments in nursing and management practice, the role of the first-line nurse manager must take on new dimensions to facilitate quality outcomes in patient care and empowerment of nurses at all levels of practice. The author presents a model of job redesign for nurse managers with emphasis on the motivational approach. Role outcomes for nurse managers are also detailed.     

护士长服务型领导行为与护士职业倦怠的相关性研究

目的：本研究旨在了解护士感知的护士长服务型领导行为以及护士职业倦怠的现状,并探讨护士长服务型领导行为与护士职业倦怠之间的相关性。方法：采用问卷调查法,对上海市各级医院临床护士进行随机分层整群抽样,抽取一级、二级、三级医院各2家,共计1511名护士进行问卷调查。结果：护士长服务型领导行为的平均得分为（84．54±17．98）分,状态较好;护士职业倦怠检出率为92．5％,情绪衰竭维度分数最高;护士长服务型领导行为与护士职业倦怠之间呈负相关,相关系数达到-0．626（P〈O．01）。结论：鼓励和培养护士长服务型领导行为,可降低护士职业倦怠感,使其为患者提供更加优质的护理服务。