Manager, clinician or both? Nurse managers' engagement in clinical care activities

Nurse Managers' Involvement in Decision-Making and Associated Factors in Selected Government Hospitals, Addis Ababa, Ethiopia: A Cross-Sectional Study

Introduction

In the healthcare system, nurse managers' participation in decision-making was invaluable in preserving cost-effective service and safe patient care. Despite the fact that nurse managers have the power to ensure optimal health care service, their involvement in decision-making has not been well studied.

Objectives

To assess nurse managers' decision-making involvement and associated factors working in selected governmental hospitals in Addis Ababa, Ethiopia 2021.

Methods

A cross-sectional study was conducted among 176 nurse managers from government hospitals in Addis Ababa, with a response rate of 168 (95.5%). The total sample size is assigned in proportion. The technique of systematic random sampling was used. A structured, self-administered questionnaire was used to collect data, which was then checked, cleaned, entered into EPI Info version 7.2, and exported to SPSS software version 25 for analysis. In a binary logistic regression model analysis, a p-value < .25 was used as the cut-off point to consider variables as candidates for multivariable analysis. A p-value of .05 was used to determine the predictor variables with a 95% confidence interval.

Result

The mean age and standard deviation of the 168 respondents were 34.9 ± 4.1 years. More than half, 97 (57.7%), were excluded from general decision-making. Nurse managers in matron positions were 10 times more likely to participate in decision-making than head nurses (AOR = 10.00, 95% CI: 1.14-87.72, p = .038). Nurse managers who received managerial support were five times more likely to participate in good decision-making than nurse managers who did not receive managerial support (AOR = 5.29, 95% CI: 1.208-23.158, p = .027). Nurse managers who received feedback on their decision-making involvement had 7.7 times more good decision-making involvement than those who did not (AOR = 7.70, 95% CI: 2.482-23.911, p = .000).

Conclusion

According to the findings of the study, the majority of nurse managers were not involved in decision-making.

Nursing leadership and management in home care: A qualitative scoping review

AIM

The purpose is to identify and synthesize the challenges of first-line nurse managers in home care concerning their managerial and leadership role, as described in current qualitative research literature.

BACKGROUND

Increased responsibilities and shifting tasks in home care lead to challenges for first-line nurse managers. These challenges must be identified and evaluated to ensure quality care provision.

EVALUATION

A scoping review mapped current qualitative research on first-line nurse managers in home care, focusing on their managerial and leadership role. A systematic search was conducted in CINAHL, Medline, EMBASE, and SweMed+. A thematic analysis was conducted on the four included studies.

KEY ISSUE(S)

First-line nurse managers' role in home care involves multiple responsibilities. Four themes emerged: "professional responsibilities," "relational responsibilities," "economic and organizational responsibilities," and "juggling responsibilities-a demanding balance."

CONCLUSION(S)

Findings provide new knowledge on how first-line nurse managers balance responsibilities in their role in the home care context-a complex context different from institutional settings like hospitals and long-term care. A focus on first-line nurse managers' support needs is necessary. Furthermore, an extensive research gap concerning first-line nurse managers' leadership and management role in home care indicates a need to increase knowledge from a range of perspectives.

IMPLICATIONS FOR NURSING MANAGEMENT

To develop sustainable and robust nursing leadership and management in home care, there is a need to (a) clarify first-line nurse managers' role and set boundaries around their responsibilities and (b) strengthen support from superiors, which will help empower first-line nurse managers in their daily work.

Staff structural empowerment-Observations of first-line managers and interviews with managers and staff

AIM

The aim was to study how first-line managers act to make structural empowerment accessible for nursing staff and furthermore to relate these observations to the manager's and their nursing staff's descriptions regarding the staff's access to empowering structures.

BACKGROUND

Staff access to empowering structures has been linked to positive workplace outcomes. Managers play an important role in providing the conditions for structural empowerment.

METHOD

Five first-line managers were observed for two workdays. Managers and staff (n = 13) were thereafter interviewed. Field notes and interviews were analysed using directed content analysis.

RESULTS

The managers displayed intentional actions that could enable their staff access to empowering structures. Managers and staff described the importance of staff's access to empowering structures.

CONCLUSION

Staff who perceive to have access to structural empowerment have managers who are present and available. Unanimity among managers and staff existed in regard to the importance of staff having access to structural empowerment. The managers work continually and intentionally, doing many things at the same time, to provide the staff access to empowering structures.

IMPLICATIONS FOR NURSING MANAGEMENT

The study shows the importance of promoting managers' awareness of staff's access to structural empowerment and maximizing managers' presence and availability to their staff.

Nurses' role in accomplishing interprofessional coordination: Lessons in 'almost managing' an emergency department team

AIM

To describe how nurse coordinators accomplished day-to-day interprofessional coordination in an Australian emergency department team, drawing some lessons for the design of nurse coordinator roles in other settings.

BACKGROUND

Previous studies have examined leadership within nursing teams, and there are a growing number of registered nurses employed as care coordinators. There is limited literature on how the day-to-day coordination of interprofessional teams is accomplished, and by whom.

METHOD

Nineteen semi-structured interviews with emergency department registered nurses, doctors and nurse practitioners analysed thematically.

RESULTS

Three themes describe how coordinators accomplished interprofessional coordination: task coordination and oversight, taking action to maintain patient flow and negotiating an ambiguous role.

CONCLUSION

Better-defined nurse coordinator roles with clearer authority and associated training are essential for consistent practice. However, accomplishing interprofessional coordination will always require the situated knowledge of the complex nursing-medical division of labour in the workplace and the interpersonal relationships that are only gained through experience.

IMPLICATIONS FOR NURSING MANAGEMENT

The design of nurse coordinator roles must include the thorny question of 'who leads' interprofessional teams in the day-to-day coordination of tasks. New and inexperienced nurses may not have the necessary situated knowledge or interpersonal relationships to succeed. However, such roles offer an important development opportunity for future nurse managers.

Do expert clinicians make the best managers? Evidence from hospitals in Denmark, Australia and Switzerland

Introduction

Hospital quality rests on the morale and productivity of those who work in them. It is therefore important to try to understand the kinds of team leaders that create high morale within hospitals.

Methods

This study collects and examines data on 3000 physicians in hospitals from Denmark, Australia and Switzerland. It estimates regression equations to study the statistical predictors of levels of doctors’ job satisfaction, their intentions to quit or stay in their current hospital and their assessment of the leadership quality of their immediate manager. A particular concern of this study is to probe the potential role played by clinical expertise among those in charge of other physicians.

Results

When led by managers with high clinical expertise, hospital physicians are (1) more satisfied with their jobs, (2) more satisfied with their supervisors’ effectiveness and (3) less likely to wish to quit their current job. These findings are robust to adjustment for potential confounders, including age and job seniority, and pass a variety of statistical checks (including clustering of SEs and checking for omitted variable bias). They are replicated in each of the three nations.

Conclusion

Physicians are happier with their jobs when led by outstanding clinical experts. It is not sufficient, it appears from this evidence, for leaders merely to be clinicians. This suggests that—though only an idealised and presumably infeasible randomised experiment could allow complete certainty—there is a natural case for managers within a hospital hierarchy to be drawn from the ranks of those who are themselves outstanding clinicians.

The impact of nurse staffing methodologies on nurse and patient outcomes: A systematic review

Aim

Aim of this study is to systematically review and synthesize available evidence to identify the association between nurse staffing methodologies and nurse and patient outcomes.

Design

Systematic review and narrative synthesis.

Data sources

A search of MEDLINE (EBSCO), CINAHL (EBSCO) and Web of Science was conducted for studies published in English between January 2000 and January 2020.

Review methods

The reporting of this review and narrative synthesis was guided by the preferred reporting items for systematic and meta‐analysis guidelines (PRISMA) statement and data synthesis guided by the Synthesis Without Meta‐analysis (SWiM) guideline. The quality of each article was assessed using the Mixed Methods Appraisal Tool.

Results

Twenty‐two studies met the inclusion criteria. Twenty‐one used the mandated minimum nurse‐to‐patient ratio methodology and one study assessed the number of nurse hours per patient day staffing methodology. Both methodologies were mandated. All studies that reported on nurse outcomes demonstrated an improvement associated with the implementation of mandated minimum nurse‐to‐patient ratio, but findings related to patient outcomes were inconclusive.

Conclusions

Evidence on the impact of specific nurse staffing methodologies and patient and nurse outcomes remains highly limited. Future studies that examine the impact of specific staffing methodologies on outcomes are required to inform this fundamental area of management and practice.

Competency Model for the Middle Nurse Manager (MCGE-Logistic Level)

Healthcare systems are immersed in transformative processes, influenced by economic changes, together with social and health instability. The middle nurse manager plays a fundamental role, since he or she is responsible for translating the strategic vision, values and objectives of the organization. The objective of this study was to propose the model of competencies to be developed by the middle nurse manager in the Spanish healthcare system. Our methodology consisted in the application of the Delphi method in order to reach an agreement on the necessary competencies, and principal component analysis (PCA) was used to determine the construct validity, reducing the dimensionality of the set of data. Fifty-one competencies were identified for the definition of the model, highlighting decision-making, leadership and communication. The PCA pointed out the structural validity of the proposed model through the saturation of the main components (α Cronbach > 0.631). The results show the model of competencies which the middle nurse manager in the Spanish healthcare system must develop. Middle nurse managers may use these as criteria to plan their professional strategies in the context of management. This model of competencies can be applied to establishing selection processes or training programs for the role of middle nurse manager.

Covid-19, ethical nursing management and codes of conduct: An analysis

The conduct of nurse managers, and health service managers more widely, has been subject to scrutiny and critique because of high-profile organisational failures in healthcare. This raises concerns about the practice of nursing management and the use of codes of professional and managerial conduct. Some responses to such failures seem to assume that codes of conduct will ensure or at least increase the likelihood that ethical management will be practised. Codes of conduct are general principles and rules of normative standards, including ethical standards, and guides for action of agents in particular roles. Nurse managers seem to stride two roles. Contra some accounts of the roles of a professional (nurse) and that of a manager, it is claimed that there is no intrinsic incompatibility of the roles though there is always the possibility that it could become so and likewise for codes of conduct. Codes of conduct can be used to support nurse managers in making practical decisions via an 'outside in' approach with an emphasis on the use of principles and an 'inside out' approach with an emphasis on the agent's character. It is claimed that both approaches are necessary, especially as guides to ethical action. However, neither is sufficient for action because judgement and choice will always be required (principles always underdetermine action) as will a conducive environment that positively influences good judgement by being supportive of the basic principles and values of healthcare institutions. The response to the Covid-19 pandemic has created a unique set of circumstances in which the practical judgement, including ethical judgement, of nurse managers at all levels is being tested. However, the pandemic could be a turning point because staff and institutions (temporarily) freed from managerialism have demonstrated excellent practice supportive of ethical and other practical decision making. Organisations need to learn from this post pandemic.

Predictors of toxic leadership behaviour among nurse managers: A cross-sectional study

AIM

To identify the predictors of toxic leadership behaviour in nurse managers.

BACKGROUND

Toxic leadership is becoming increasingly prevalent in nursing; however, the literature provides very limited evidence of the different factors that promote toxic leadership behaviour in nurse managers.

METHODS

A descriptive, cross-sectional design was used. Two hundred and forty nurse managers from ten hospitals in the Central Philippines were included in the study. Data were collected using the Nurse Information Form and the Toxic Leadership Behaviours of Nurse Managers Scale (ToxBH-NM). Hierarchical multiple regression was used to analyse the data collected.

RESULTS

The mean of average item score of the ToxBH-NM was 1.250 (SD = 0.470). Multiple regression analyses identified the years of experience in a managerial role (β = -0.165, p = .031), job status (part time) (β = 0.177, p = .002), ward census (30 patients, 40 patients and above 40 patients) ([β = 0.231, p = .005]; [β = 0.345, p < .004]; [β = 0.262, p = .012]), number of units managed (2 units and > 3 units) ([β = 0.292, p < .001]; [β = 0.235, p < .001]), hospital type (private hospital) (β = 0.271, p = .007) and hospital level (secondary hospitals) (β = 0.226, p = .036) predicted toxic leadership behaviour in nurse managers.

CONCLUSIONS

Overall, nurse managers were appraised as non-toxic leaders. Nurse managers who held a part-time job status, those who had lower experience in the managerial role and those who were assigned to wards or units with high patient admission numbers reported increased toxic leadership behaviours. Further, nurse managers who managed more than 2 units, those who were employed in private hospitals and those who worked in secondary hospitals reported increased toxic leadership behaviours.

IMPLICATIONS FOR NURSING MANAGEMENT

Nurse administrators can consider the different predictors identified when planning and developing leadership interventions and organisational strategies (e.g. limiting the number of units per nurse manager, provision of full-time job employment, assignment of assistant nurse managers, formulation of policy specific to managing toxic behaviours), which may assist in the determent of toxic behaviours in nurse managers.

Competencies of military nurse managers: A scoping review and unifying framework

Aim(s)

To identify competencies of military nurse managers and develop a unifying framework of military nurse managers’ competencies.

Background

Military nurse managers shoulder multiple responsibilities because of duality roles, and they should possess competencies that enable them to manage human and material resources during peacetime and wartime. Therefore, nursing management within military context is demanding, such that a comprehensive understanding of their competencies is needed for effective military nursing management. Although relevant studies have focused on different military branches and different levels of managers, there is no standard evaluation framework.

Evaluation

A scoping review of studies focusing on competencies of military nurse managers from seven databases was carried out.

Key issues

Nine studies were included in this review, and a framework consisting of six domains of military nurse managers’ competencies was identified: clinical expertise, role model, leadership competencies, human competencies, financial competencies and deployment competencies.

Conclusion

Existing knowledge of competencies of military nurse managers is limited, and a comprehensive understanding of this topic can provide direction for future work.

Implications for Nursing Management

Military nurse managers play substantial roles within the military nursing context. A unifying framework can facilitate personnel recruitment and competency measurement, as well as training protocol development.