what if you were a pediatric oncology clinic manager?
Staff Nurse Although not formally a manager, the staff nurse supervises LPNs, other professionals, and assistive personnel and so is also a manager who needs management and leadership skills. Com- munication, delegation, and motivation skills are indispensable.
In some organizations, shared governance has been implemented and traditional manage- ment responsibilities are allocated to the work team. In this case, staff nurses have considerable involvement in managing the unit. More information about shared governance and other innova- tive management methods is provided in Chapter 2.
First-Level Management The first-level manager is responsible for supervising the work of nonmanagerial personnel and the day-to-day activities of a specific work unit or units. With primary responsibility for motivat- ing the staff to achieve the organization’s goals, the first-level manager represents staff to upper administration, and vice versa. Nurse managers have 24-hour accountability for the management of a unit(s) or area(s) within a health care organization. In the hospital setting, the first-level
CHAPTER 4 • LEADING, MANAGING, FOLLOWING 49
manager is usually the head nurse, nurse manager, or an assistant. In other settings, such as an ambulatory care clinic or a home health care agency, a first-level manager may be referred to as a coordinator. Box 4-1 describes a first-level manager’s day.
Charge Nurse Another role that does not fit the traditional levels of management is the charge nurse. The charge nurse position is an expanded staff nurse role with increased responsibility. The charge nurse functions as a liaison to the nurse manager, assisting in shift-by-shift coordination and promotion of quality patient care as well as efficient use of resources. The charge nurse of- ten troubleshoots problems and assists other staff members in decision making. Role modeling, mentoring, and educating are additional roles that the charge nurse often assumes. Therefore, the charge nurse usually has extensive experience, skills, and knowledge in clinical practice and is familiar with the organization’s standards and practices.
The charge nurse’s job differs, though, from that of the first-level manager. The charge nurse’s responsibilities are confined to a specific shift or task, whereas the first-level manager has 24-hour responsibility and accountability for all unit activities. Also the charge nurse has limited authority; the charge nurse functions as an agent of the manager and is accountable to the manager for any actions taken or decisions made.
Although often involved in planning and organizing the work to be done, the charge nurse has a limited scope of responsibility, usually restricted to the unit for a specific time period. In the past, the charge nurse had limited involvement in the formal evaluation of performance, but in today’s climate of efficiency, the charge nurse may be involved in evaluations as well. With the trend toward participative management, charge nurses are assuming more of the roles and functions traditionally reserved for the first-level manager.
In some organizations, the position may be permanent and assigned and thus a part of the formal management team; in other organizations, the job may be rotated among experienced staff. The charge nurse, who switches from serving as a manager one day and a staff nurse the next, is especially challenged to balance the rotating roles (Leary & Allen, 2005). In some orga- nizations, a differential amount of compensation is paid to the person performing charge duties; in others, no differential is paid because the position is shared equally among staff or represents a higher rung of a career ladder (possibly the first rung of a management ladder).
The charge nurse is often key to a unit’s successful functioning (Leary & Allen, 2005). A charge nurse usually has considerable influence with the staff and may actually have more infor- mal power than the manager. Therefore, the charge nurse is an important leader and can benefit by developing the skills considered necessary for a manager. Acting as charge nurse is often the first step toward a formal management position.