Nursing News

The Challenges and Rewards of Nurse Management


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By Debra Wood, RN, contributor

January 14, 2011 - Nurse managers lead their units, implementing their facilities’ visions while balancing patient and staff needs. They are in a challenging position, requiring stellar leadership and communication skills to bring out the best in people and achieve quality outcomes for patients.

nurse manager at Children’s Healthcare of Atlanta
Rana Roberts, RN, BSN, MBA, calls being a nurse manager at Children’s Healthcare of Atlanta the most amazing job in the world.

“I have the most amazing job in the world,” said Rana Roberts, RN, BSN, MBA, manager of clinical operations for the Michael P. Fisher Cardiac Intensive Care Unit of Children’s Healthcare of Atlanta.

Roberts considers creating a great work environment and balancing the interests of staff, physician and other stakeholders a key and rewarding aspect of her role. She relies on her direct-care staff’s expertise to come up with solutions to problems.

“I realize they are the experts, and we work together,” Roberts said. “People who go into this field are driven. It’s highly specialized and important work. It draws a certain personality. The challenge of my job is to find how I can help that shine.”

Nurse managers hold the responsibility for fiscal matters, human resources and the environment of care on their units, said Katherine McDonough, RN, DNP, visiting clinical instructor at the Bouve School of Health Sciences at Northeastern University in Boston, who has researched the role and its challenges.

“There are lots of competing priorities and lots of unexpected issues that come up,” McDonough said. “In addition, the nurse manager is the ‘go-to’ person for the patients’ families. I use the analogy that it’s like being in a box and squeezed from four sides.”

Despite the difficulties associated with being held accountable for many different things, nurse managers have found rewards in advocating for staff and patients, and developing additional skills, according to McDonough’s research.

“It’s wanting to make a difference on a broader level and being ready for something different in their practice,” McDonough said. “The nurse manager role is the most pivotal role in any organization. Organizations live and die by their nurse managers.”

Constance J. Hardy, DNP, CNL, RN, assistant professor at Saint Xavier University School of Nursing in Chicago, agreed on the important role nurse managers play. She added that nurses who succeed in the position typically possess innate or learned emotional intelligence, the ability to delay gratification and can control their own emotional reactions to events. 

“An awareness about your effect on other people and being able to regulate yourself is a huge attribute for nurse managers,” Hardy said. “Candidates for middle management with high levels of emotional intelligence are able to address challenges more effectively and get more satisfaction. Much of the satisfaction of being in a pressure cooker is to delay gratification.”

While some people are born with that ability, Hardy said nurses can learn it, often with the help of a coach. She teaches her graduate and undergraduate students about it, because even bedside nurses need to understand how their display of emotions affects those around them.

Effectuating change and improving patient outcomes offers rewards to Darlene Parmentier, RN, MSN, MBA, nurse manager of the ICU/CCU and telemetry unit at Glen Cove Hospital in Glen Cove, N.Y., for the past 20 years. She enjoys mentoring her staff, helping them develop their talents.

Vanderbilt University School of Nursing
Terri Crutcher, RN, MSN, aims to involve her nursing staff in more quality initiatives and get them excited about improving outcomes.

“The challenge is in re-empowering the nursing staff to go back to collaboration of care and be the gatekeeper of care,” Parmentier said. To help facilitate that, the unit has switched to a shared governance model, with nurses self-scheduling, investigating root causes of infections and leading change efforts. Their efforts have led to zero central line infections during the past three years and no ventilator associated pneumonia cases for the past two years.

“When the staff are empowered to make effective changes, it goes faster,” Parmentier said. “It’s change from the bottom up.”

For Terri Crutcher, RN, MSN, a nurse manager at Vanderbilt University School of Nursing’s midwifery clinic, West End Women’s Health Center in Nashville, Tenn., watching others succeed and knowing she played a role in that has kept her in management positions for 30 years.

“The staff works well together and with the providers; that goes together to have good patient outcomes,” Crutcher said.

Challenges come with trying to keep patients, staff and providers happy and working as a team. In the year ahead, she expects to become more involved in quality improvement.

“I want to get people excited about quality,” Crutcher said. “I want to help them see they have a big role in the quality of the clinic.”

Nancy Lee, RN, MN, OCN, ICU nurse manager at Saddleback Memorial Medical Center - San Clemente in California, will guide her unit through the implementation of an electronic medical record system this year. She finds nurses excited about the prospect, because it offers opportunities for spending more time at the bedside and improving quality of care.

“There’s not a day that goes by that I don’t thank my staff for doing a great job,” Lee said. “Nurses must be recognized. You have to make them feel good about what they do and listen to them. Communication is the number one essential. You cannot manage unless you are on the unit, walking around, knowing what is going on on the units you supervise, so you can address and prioritize needs and issues.”

Lee considers multitasking and prioritizing part of the job. Filling vacancies and keeping her unit fully staffed is one of Lee’s greatest challenges. She tackles that head on by working to keep nurses satisfied and allowing them professional development to excel in nursing.

“It’s a love for providing health care and knowing I can make a difference in patient outcomes or employee satisfaction,” Lee concluded.

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