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Managing the Manager Role

Monday March 20, 2000
Mary Ellen Bonczek, RN, MPA, CNAA, associate executive director and chief nurse executive at the Medical Center of Ocean County, NJ, talks about the pros and cons of the nurse manager role.
Mary Ellen Bonczek, RN, MPA, CNAA, associate executive director and chief nurse executive at the Medical Center of Ocean County, NJ, talks about the pros and cons of the nurse manager role.
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One of the perks of a nursing career is our abundance of choices. We can work in settings as varied as long-term and critical care, home health and occupational health, in a school or clinic setting, or in the operating room or rehabilitation center. We have seen nursing roles expand to include staff nurses, managers, educators, researchers, advanced practitioners, consultants, and administrators. We have the opportunity to practice many roles and specialties during our careers.
One nursing position that has changed dramatically in recent years is that of the nurse manager. Recently, I spoke with New Jersey nursing leader Mary Ellen Bonczek, RN, MPA, CNAA, associate executive director and chief nurse executive at the Medical Center of Ocean County, NJ, about the future of the nurse manager's role. Bonczek has been a member of the Organization of Nurse Executives of New Jersey (ONE-NJ) for the past 10 years and is currently serving as president of the state organization.

What are the challenges facing nurse managers today?
Today's nurse managers have to deal with multiple priorities. On one side, they have inherited additional responsibilities from the financial management of the nursing unit. They must deal with human resources issues, salaries, supplies, and patient length of stay. Add this to the traditional nursing manager responsibilities of patient care, clinical obligations, personnel issues, and family concerns. It is difficult to manage them all.

Why do so few nurses enter the management track, especially when compared with other professions?
It is true that it is tough to recruit nurses into the nurse manager position. There few perks with this position. Often there is not even a financial incentive, though some hospitals are now providing better salaries for managment positions. There is no shortage of capable people. There are nurses out there who have the desire, the ability and the talent. Our job is to get them "hooked." But you're right, compared to other professions there is a smaller pool of interested people to compete for these positions. As nurse executives we need to look at how we can make the position more attractive and how we can mentor the talented potential managers out there.

Is this a historical issue?
I think the pool of potential managers has become more limited over the years. If you remember, in the past, the nurse manager was the best clinician on the unit. The best nurse became the head nurse. The head nurse had control of the unit, control of patient care, and control of the physicians. It was a more enticing role.
Today's nurse manager has dual clinical and financial responsibilities. Despite limited management education in most nursing programs, the nurse manager is expected to have a knowledge of business planning, budgets, resource management, and utilization review. It takes a very brave soul.

What skills does a nurse need to succeed in management?
I think the most important ingredient is the desire to influence - the desire to make a change. A nurse should possess a strong clinical background, dynamic personnel skills, the ability to manage physicians, and
a creative approach to problem-solving. A successful bedside nurse manager must have confidence in interpersonal relations, an understanding of group dynamics, and the ability to solve multiple, complex problems.

Do the skills that make a successful nurse conflict with the skills that make a good manager?
That's a very interesting question, and something that we have discussed at our ONE-NJ roundtables. Caring and compassion, for example. Can a nurse use those skills as a manager? I think so. I think with some fine tuning the skills we learn as nurses can also make us successful managers. I know that the nursing process has never left me. It is how we think as nurses. We can apply the nursing process to every management issue.

How are nurse managers coping with the current nursing shortage?
This is a difficult issue. Today there are so many more opportunities for women, and there are so many other opportunities for nurses. Nurses are working in home care, schools, clinics, and in advanced practice. With shift work, weekends and holidays, we have to ask ourselves why anyone would want to work in acute care? To add to the problem there are few medical surgical floors today that don't have a specialty focus. It is hard to place staff when there are so many specific nursing needs.
Through ONE-NJ, nurse managers are able to attend networking breakfasts and luncheons where they can share strategies from hospital to hospital. Retention is the key issue. Nurse managers need to be "chief retention officers." Managers are discovering that offering a finder's fee for nurses who bring in new nurses is a better incentive than the sign-on bonus. We need to reward those who stay and bring in others.
Just as important, nurse managers need to keep the focus on patient care. The managers must keep the clinicians working and keep the practitioners practicing. By providing supplies, ancillary personnel, a stable nursing staff, and a well managed work environment, nurses can practice nursing in a more effective manner.

How does ONE-NJ help nurse managers?
ONE-NJ is a professional organization composed of nurse managers, directors, and nurse executives. We provide nursing leaders with the opportunity to develop skills and contacts that will help them work in this changing healthcare environment. Our annual meeting is a two-day educational symposium, and we also offer quarterly half-day seminars. We have regular breakfasts and luncheons where members are given the opportunity to network with peers throughout the state. We have an education committee that plans our educational offerings, and a legislative committee that works with legislators and prepares organizational position papers. In addition to providing resources for our members, we also educate the public on healthcare issues.

In your view, what will be the major issues for nurse managers in the future?
Whether it is the past, the present, or the future, nurse managers always have had and always will have to answer three basic questions:
How do we give quality patient care?
How do we ensure good patient outcomes?
How can I provide a good nurse practice environment?
For more information on ONE-NJ, access their website at