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The Path to Success for Nurse Managers

Monday March 22, 2004
Heather Zeveney, RN, BSN, BC, (left), and Sharon Haskins, RN, BSN, BC, (middle), are nursing care coordinators who work under Director of Nursing Michele Langevin, RN, MSN, (right) at Bayshore Community Hospital.
Heather Zeveney, RN, BSN, BC, (left), and Sharon Haskins, RN, BSN, BC, (middle), are nursing care coordinators who work under Director of Nursing Michele Langevin, RN, MSN, (right) at Bayshore Community Hospital.
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"In any hospital, the patient-care unit is the operational hub -and the nurse manager is at the center of this universe. On any day, she may be called upon to defend a staff nurse's actions to an irate physician, to start an IV when a patient refuses to allow a medical student to stick him one more time - or to promise the laboratory director (for the nth time) that she'll make sure her staff knows how to collect and transport specimens. These are the responsibilities of the job. Good nurse managers accept them as de rigueur."1
The nurse manager holds the most challenging and important role in the hospital because of the current nursing shortage crisis, according to Patricia Folcarelli, RN, MA, a member of the advisory board for the Institute for Nursing Healthcare Leadership (INHL) and a nurse manager for 10 years at NYU and Beth Israel Hospital in Boston. As the chief retention officer, the nurse manager must recruit and retain nurses and create a work environment that allows staff nurses to do their jobs.
"They're really creating an environment for practice to flourish and acting as the CEO for the unit," says Folcarelli. "They take care of all the needs that a typical business would have, including staffing, budget, and the demands of the organization, while at the same time being mindful of the patient's/customer's reactions."
Leadership skills are important. Michele Langevin, RN, MSN, the director of nursing at Bayshore Community Hospital in Holmdel, NJ, believes good judgment, motivation, flexibility, willingness to change, clinical expertise in the area of management, and a balance of personal and professional lives are vital. She likes to see the nurse manager act as a resource, mentor to staff, and an advocate for patients and families.
"We're very focused on patient satisfaction," says Langevin. Nurse managers make daily rounds and address patients' problems and concerns in a continual effort to provide quality care.
Sharon Haskins, RN, BSN, BC, and Heather Zeveney, RN, BSN, are nursing care coordinators who work under Langevin at Bayshore. Haskins has been a nurse manager for 13 years, while Zeveney has managed for one year. Both agree that the most exciting part of being a nurse manager is the ability to make positive changes for staff and patients. On the other hand, the greatest challenge is being "sandwiched" between staff and administration.
Being in the middle, in their case, is relatively easy because they enjoy a good relationship with Langevin and their staff members. Haskins emphasizes that success comes from having good communication (especially listening) skills, good coaching and mentoring skills, an ability to collaborate with other hospital departments, and from staying current on clinical changes within her field.
Zeveney's belief that nurse managers should seek ongoing and higher education and practice their clinical skills, is fully supported by Bayshore, which provides $5,000 in tuition reimbursement each year. Both Zeveney and Haskins are enrolled in master's programs.
Folcarelli has gained insight into nurse management through her experience with the INHL. The nurse manager's goal, she says, should be to develop and retain a strong team by acquiring the following abilities -
· Communications skills to develop collaborative relationships with physician partners and hospital leaders
· Coaching/mentoring skills to work with the strengths and weaknesses of staff members
· Conflict resolution and negotiation skills to scan, assess, and think strategically
· Monitoring skills to assess quality of care, identify performance problems, and offer opportunities for improvement
· Financial acumen to plan a budget and advocate budgetary changes within the practice area.
· Time management skills
Although development of skills is important, self-awareness and continuing self-assessment is equally vital. Self-evaluation can be difficult, but there are several indicators that can assist a nurse manager to determine whether he or she is doing a good job. These include -
· Staff turnover on the unit
· Nursing satisfaction surveys that include questions about the nurse manager
· Informal meetings with staff focus groups in which the nurse manager might open a discussion by saying, "It's time for me to be reviewed by the director. How do you think I'm doing?"
· Staff exit interviews
If nurse managers determine they are not doing as well as they would like, asking senior nurse leaders and other nurse managers for advice can be helpful. At the beginning of their employment, nurse managers often are not oriented to the myriad tasks expected of them. There may be basic orientation from human resources or perhaps a mentor (usually another nurse manager) to provide guidance, but most training is on the job.
Nurse managers should seek additional education, mentoring, and support wherever it's available. They may decide to consult with other nurse managers, join local leadership programs, take seminars, or meet regularly with people outside the profession who can enhance their development.
Folcarelli believes a nurse manager should try to gauge how much support an institution offers before agreeing to work there. Here are some key questions to ask during the job interview -
· Is this an organization that nurtures and develops staff and managers?
· What is the turnover rate among nurse managers?
· Describe the "reporting line." Do I report to the director of nursing or am I four "layers" down?
· What is the orientation program and what are the resources to help me within this organization?
Folcarelli is committed to the idea that managers of nursing units must be nurses. Some might argue that a person educated in business might be able to deal more effectively with the budget or other business aspects of the job. But, Folcarelli argues, it is of the utmost importance that managers understand the work of a nurse so they can create an environment that supports the best patient care possible.
Robyn DeSantis Ringler, RN, Esq., is a frequent contributor to Nursing Spectrum.
1. Bensing K. Open letter to nurse administrators: Conserving a precious resource. Advance for LPNs [serial online] February 28, 2001. Available at: http://www.advanceforlpns.com/common/Editorial/Editorial.aspx? CC=9946. Accessed February 24, 2004.