Factors impacting on nurse managers' ability to be innovative in a decentralized management structure

HUMAN RESOURCES AND INNOVATIVE BEHAVIOUR: IMPROVING NURSING PERFORMANCE

This study examines, using the social exchange theory, the mediating effect of employees’ perception of wellbeing on the relationship between two human resource (HR) management factors (satisfaction with teamwork and satisfaction with training opportunities) and innovative behaviour of nurses working in Australian public and private hospitals. Current nurse shortages and limited budgets have increased the need for hospitals to improve their efficiency and cost-effectiveness. It is proposed that fostering innovative behaviour is one way that hospitals can improve the efficiency and effectiveness of nurses. A cross-sectional self-report survey was completed by 220 nurses working within Australian hospitals. The results show that an employee’s perception of their wellbeing completely mediated the relationship between satisfaction with training opportunities and their innovative behaviour and partially mediated the relationship between satisfaction with teamwork and innovative behaviour. The findings shed new light on how HR management factors can foster innovative behaviour. The results raise new implications for managers seeking to stimulate innovative behaviour, highlighting the importance of cultivating an organisational environment conducive to positive perceptions of wellbeing.

What's the diagnosis? Organisational culture and palliative care delivery in residential aged care in New Zealand

Organisational culture has been shown to impact on resident outcomes in residential aged care (RAC). This is particularly important given the growing number of residents with high palliative care needs. The study described herein (conducted from January 2013 to March 2014) examined survey results from a convenience sample of 46 managers, alongside interviews with a purposively selected sample of 23 bereaved family members in order to explore the perceptions of organisational culture within New Zealand RAC facilities in one large urban District Health Board. Results of the Organisational Culture Assessment Instrument (OCAI) completed by managers indicated a preference for a 'Clan' and the structured 'Hierarchy' culture. Bereaved family interviews emphasised both positive and negative aspects of communication, leadership and teamwork, and relationship with residents. Study results from both managers' OCAI survey scores and next of kin interviews indicate that while the RAC facilities are culturally oriented towards providing quality care for residents, they may face barriers to adopting organisational processes supportive of this goal.

Head nurses’ decision-making when managing ethical dilemmas

Purpose

– The purpose of this paper is to characterize issues related to head nurses’ decision making when managing ethical dilemmas.

Design/methodology/approach

– The study is qualitative descriptive, in which researchers stay close to the data. The data were collected in the format of unstructured written reflections. Inductive conventional latent qualitative content analysis was applied to the data.

Findings

– The issues of head nurses’ management of decision making in ethical dilemmas relate to the following aspects: taking risks in deviating from the formalities, balancing power and humaneness, maintaining the professional hierarchy, managing resistance to change, managing with limited options, and experiencing the decline of nurse’s professional and/or human dignity.

Research limitations/implications

– Reflections in written form were preferred to semi-structured interviews and the researchers were unable to contact the participants directly and to ask additional questions. All the reflections were produced in a language other than English.

Practical implications

– The issues of head nurses’ management of decision making in ethical dilemmas reveal the gap between societal expectations and the opportunities to improve nursing leadership in health care organizations.

Social implications

– The issues of head nurses’ decision making when managing ethical dilemmas are related to contexts that reflect the attitudes of society and health care system toward nursing management.

Originality/value

– The study adds to the understanding of issues of the management of decision making in ethical dilemmas. It is an ongoing systematic process that encourages head nurses to learn from practice and manage the quality of care by empowering themselves and nurses to take responsibility for leadership.

Implementation of a participatory management model: analysis from a political perspective

AIM

To analyse experiences of managers and nursing staff in the implementation of participatory management, specifically processes of decision-making, communication and power in a Canadian hospital.

BACKGROUND

Implementing a Participatory Management Model involves change because it is focused on the needs of patients and encourages decentralisation of power and shared decisions.

METHODS

The study design is qualitative using observational sessions and content analysis for data analysis. We used Bolman and Deal's four-frame theoretical framework to interpret our findings.

RESULTS

Participatory management led to advances in care, because it allowed for more dialogue and shared decision making. However, the biggest challenge has been that all major changes are still being decided centrally by the provincial executive board.

CONCLUSIONS

Managers and directors are facing difficulties related to this change process, such as the resistance to change by some employees and limited input to decision-making affecting their areas of responsibility; however, they and their teams are working to utilise the values and principles underlying participatory management in their daily work practices.

IMPLICATIONS FOR NURSING MANAGEMENT

Innovative management models encourage accountability, increased motivation and satisfaction of nursing staff, and improve the quality of care.

Sources of burnout among healthcare employees as perceived by managers

AIM

This paper is a report of a study to investigate healthcare managers' perspectives on factors contributing to the increase of healthcare employees on sick leave for burnout symptoms.

BACKGROUND

Current turbulent healthcare reorganization has resulted in structural instability, role conflicts and vague responsibility commitments, all of which contribute to increasing numbers of sick days caused by burnout symptoms. Managers' perceptions of burnout sources are important as these perceptions guide the actions taken to prevent burnout.

METHOD

Interviews were carried out with 30 healthcare managers, with different occupational backgrounds and from different units. The data were collected in Sweden in 2003 and analysed using thematic qualitative content analysis.

FINDINGS

According to the healthcare managers, continuous reorganization and downsizing of healthcare services has reduced resources and increased demands and responsibilities. These problems are compounded by high ideals and expectations, making staff question their own abilities and worth as well as making them feel less confirmed and less valued as people. The main finding indicates that healthcare employees are thrown into a spiralling sense of inadequacy and an emerging sense of pessimism and powerlessness.

CONCLUSION

To understand and influence people's actions, one has to understand their perceptions and thoughts - their explanatory models. This study shows the complexity and interconnection between sources of burnout as perceived by healthcare managers, and highlights the encouragement of realism without the destruction of enthusiasm as an important factor in management and healthcare practice.