Measuring first-line nurse manager work: instrument: development and testing

Development and Psychometric Testing of a Leadership Competency Assessment

OBJECTIVE

This article discusses the development and psychometric testing of the Nursing Leadership Competency Assessment (LCA).

BACKGROUND

Several leadership assessments are available for purchase, which are aligned with professional organizations. A competency-based leadership assessment is needed to identify the developmental needs of nurse leaders. Competent and confident nurse managers are critical to ensure positive relationships between nurse managers and clinical nurses.

METHODS

A multimethod approach was used to develop and test psychometric properties of the LCA. Items were drawn from 8 sources identifying nurse leader competencies.

RESULTS

The 76-item assessment had a Cronbach's α of 0.99. Confirmatory factor analysis supported 6 hypothesized factors (domains): leading self, people, organizations, change, innovation, and globally. Subscale reliabilities ranged from α = 0.87 to α = 0.98.

CONCLUSIONS

The LCA has demonstrated utility in assessing nurse leader competencies and guiding the development of educational opportunities in targeted content areas for specific leadership roles.

Relationships between nurse managers' work activities, nurses' job satisfaction, patient satisfaction, and medication errors at the unit level: a correlational study

BACKGROUND

Nurse managers play a critical role in enhancing nursing and patient outcomes. The work of nurse managers, who can be described as middle-managers at health care organizations, is complex and changes on a daily basis. Only a few studies have clarified how nurse managers divide their time across various work activities. This study aimed to describe the relationships between nurse managers' work activities, nurses' job satisfaction, patient satisfaction, and medication errors at the hospital unit level.

METHODS

A cross-sectional and correlational study design was used. The data were collected from nurse managers (n = 29), nursing staff (n = 306), and patients (n = 651) from 28 units across three Finnish acute care hospitals between April and November 2017. In addition, data concerning medication errors (n = 468) over one calendar year (2017) were acquired from the hospitals' incident reporting register. Analysis of covariance (ANCOVA) was used to estimate relationships between data from subareas of Nurse Managers' Work Content Questionnaire, Kuopio University Hospital Job Satisfaction Scale, and Revised Humane Caring Scale, along with medication error reports. A significance level of 95% was applied when estimating the covariances between variables. Unstandardized regression coefficients (B) were used to explain the relationships between variables.

RESULTS

Multiple relationships between nurse managers' work activities, nurses' job satisfaction, patient satisfaction, and medication errors were identified. Nurse managers' work activities had both positive and negative relationships on the other studied variables. The Requiring factors of work (p < .001) subarea of nurses' job satisfaction, total patient satisfaction (p < .001), and medication errors (p < .001) were identified as the variables most significantly affected by other factors.

CONCLUSIONS

The findings suggest that nurse managers should focus on improving nursing practices by managing and organizing nurses' work in a way that makes their employees feel supported, motivated and secure. Furthermore, nurse managers should adopt a leadership style that emphasizes safe and patient-centered care. The results also suggest that the administration of today's health care organizations should actively evaluate nurse managers' share of work activities to ensure that their daily work is in line with the organizational goals.

A Complexity-Informed Model to Guide Nurse Manager Practice

Nurse manager practice is a broad concept that reflects the defined role responsibilities and the manner in which nurse managers perform their role. The outcome of nurse manager practice is commonly known as their job performance. The job performance of nurse managers reflects their effectiveness and is assessed by organizational, staff, and patient outcomes. There is strong evidence that nurse managers with relational leadership styles are the key drivers of positive practice environments and job satisfaction among nurses. Concluding that the solution to positive environments and satisfied nurses rests solely on the leadership style of the nurse manager seems logical; however, it ignores the role of the larger organizational context. This article applies a complexity lens to understand nurse manager practice and other organizational factors influencing job performance. The evidence developed thus far yielded the identification of dimensions of the organizational context that support nurse manager practice and nurse manager job performance. Additional research is needed to identify the essential ingredients to support nurse manager practice. Organizational success depends on developing synergy among the administrative, adaptive, and enabling leadership functions of organizations.

Nurse managers' work content: development of the questionnaire and results of the pilot study

AIM

To develop the Nurse Managers' Work Content Questionnaire (NMWCQ) and to describe nurse managers' work content.

BACKGROUND

Restructuring within health care has expanded the nurse manager's role to include organisational, patient and staff demands.

METHODS

The pilot study employed a cross-sectional study design. Based on a literature review, the NMWCQ with 102 items was developed and pretested for this study. Data were collected in 2017 from three Finnish acute care central hospitals that provide specialised health care. A total of 61 nurse managers participated, which represents a response rate of 59%. Principal component analysis was used to test the construct validity of the instrument. Cronbach's alpha values were used to analyse the internal consistency of the instrument. In addition, descriptive and nonparametric analysis was used.

RESULTS

Ultimately, 13 components with 87 items were identified in the questionnaire. The construct validity and internal consistency of the questionnaire were at acceptable levels. Cronbach's alpha rates of the components were 0.554 - 0.890. The most frequently performed daily work of nurse managers was in the component of organising, and the most infrequently performed daily work was in the component of clinical nursing.

CONCLUSIONS

The study shows that the Nurse Managers' Work Content Questionnaire (NMWCQ) is suitable for measuring the current content of nurse managers' work. However, the questionnaire is new and needs additional testing such as confirmatory factor analysis with larger amounts of data.

Difficulties of unit managers in selected district hospitals in Cameroon

BACKGROUND

Being appointed to a managerial position because of one's clinical skills seems to be prestigious, even powerful. However, being a unit manager in a resource-constrained district hospital can be a daunting task. Also, managing a ward unit with no previous training in leadership and management can be very challenging.

OBJECTIVES

The purpose of this study was to describe the difficulties, in the day-to-day activities, of unit managers in selected Cameroonian district hospitals.

METHOD

A constructionist, descriptive Husserlian phenomenological inquiry was conducted to describe the difficulties of unit managers in two district hospitals. Ten unit managers were selected through a purposive sampling scheme, and then interviewed using semi-structured interviews. Coliazzi's qualitative data analysis method was used for analysis.

RESULTS

This study revealed that unit managers looked for assistance because it is not easy to be in their position. Their role implied facing difficulties and making sacrifices for something that is not even worth the trouble. Therefore, as a way to overcome their difficulties, they asked for assistance from the organisation, from their families and from God as strategies to face their difficulties.

CONCLUSION

The difficulties faced by unit managers in the selected district hospitals revealed the need to prepare nurses for managerial positions by ensuring they are trained as managers before commencing employment as a manager.

The content of nurse unit managers' work: a descriptive study using daily activity diaries

BACKGROUND

NUMs' job description in Icelandic hospitals has been revised and now also includes managerial and financial responsibilities.

AIM

To describe the actual work activities of nurse unit managers (NUMs) in surgical and internal medicine services as self-documented and reflected in their job description.

DESIGN

Prospective exploratory study.

METHOD

The study's setting was the largest hospital in Iceland. Data were collected over 7 days from NUMs working on surgical and medical units with an activity diary listing five domains and 41 activities: 'management and planning' (seven activities), 'staff responsibility (seven activities), 'direct clinical work' (five activities), 'service' (12 activities) and 'other' (nine activities).

RESULTS

The managers' spent most of their time within the 'other' domain (32% of their time), then the next significant amount of time on 'management and planning' and 'clinical nursing' (19%), and the least amount of time on 'service' (14%). All reported working on two or more activities simultaneously. NUMs made erroneous estimations approximately half of the time about the domain they spent most of their time in and their satisfaction with their work each day varied greatly.

CONCLUSION

The work of NUMs is highly diverse, including undefined miscellaneous tasks and clinical work beyond their job description.

Time allocation and temporal focus in nursing management: an integrative review

AIM

To describe the time allocation and temporal focus in nursing management.

BACKGROUND

There is limited information about the time allocation and temporal focus of nursing management activities. The role of nurse administrators is changing, resulting in challenges related to time management.

METHODS

Published literature in 2005-2014 related to the time allocation or temporal focus of nurse administrators' management activities was retrieved from five databases, and an integrative review was conducted. Data extraction, quality assessment and quantitative content analysis were performed for eight reviewed articles.

RESULTS

Daily reactive management activities and administrative routines were dominant in the nurse administrators' work, and strategic, proactive activities were scarce. Their daily work was fragmented by a variety of activities and numerous interruptions.

CONCLUSION

Little information exists about time allocation or temporal focus in nurse administrators' management activities. Further research on this topic is needed. The evidence was fairly modest, although the studies' results were generally similar.

IMPLICATIONS FOR NURSING MANAGEMENT

These results can be used to clarify the job descriptions of nurse administrators and to plan and focus their education and training. Organisations need to use evidence to standardise the job descriptions of different levels of nurse managers and directors.