What would you do if two registered nurses called in sick for the 12-hour night shift?
What if you were a manager for a specialty unit and received a call for an admission, but had no more beds? Or what if you were a pediatric oncology clinic manager and a patient’s sibling exposed a number of immunocompromised patients to chickenpox? Planning for crises such as these are examples of contingency planning.
Strategic planning refers to the process of continual assessment, planning, and evaluation to guide the future (Fairholm & Card, 2009). Its purpose is to create an image of the desired future and design ways to make those plans a reality. A nurse manager might be charged, for example, with developing a business plan to add a time-saving device to commonly used equipment, pre- senting the plan persuasively, and developing operational plans for implementation, such as ac- quiring devices and training staff.
Organizing Organizing is the process of coordinating the work to be done. Formally, it involves identifying the work of the organization, dividing the labor, developing the chain of command, and assign- ing authority. It is an ongoing process that systematically reviews the use of human and material resources. In health care, the mission, formal organizational structure, delivery systems, job de- scriptions, skill mix, and staffing patterns form the basis for the organization.
In organizing the home phototherapy project, Antonio develops job descriptions and pro- tocols, determines how many positions are required, selects a vendor, and orders supplies.
CHAPTER 4 • LEADING, MANAGING, FOLLOWING 47
Directing Directing is the process of getting the organization’s work done. Power, authority, and leader- ship style are intimately related to a manager’s ability to direct. Communication abilities, moti- vational techniques, and delegation skills also are important. In today’s health care organization, professional staff are autonomous, requiring guidance rather than direction. The manager is more likely to sell the idea, proposal, or new project to staff rather than tell them what to do. The manager coaches and counsels to achieve the organization’s objectives. In fact, it may be the nurse who assumes the traditional directing role when working with unlicensed personnel.
In directing the home phototherapy project, Antonio assembles the team of nurses to provide the service, explains the purpose and constraints of the program, and allows the team to decide how they will staff the project, giving guidance and direction when needed.
Controlling Controlling involves comparing actual results with projected results. This includes establishing standards of performance, determining the means to be used in measuring performance, evaluat- ing performance, and providing feedback. The efficient manager constantly attempts to improve productivity by incorporating techniques of quality management, evaluating outcomes and per- formance, and instituting change as necessary.
Today, managers share many of the control functions with the staff. In organizations us- ing a formal quality improvement process, such as continuous quality improvement (CQI), staff participate in and lead the teams. Some organizations use peer review to control quality of care.
When Antonio introduces the home phototherapy program, the team of nurses involved in the program identify standards regarding phototherapy and their individual performances. A subgroup of the team routinely reviews monitors designed for the program and identifies ways to improve the program.
Planning, organizing, directing, and controlling reflect a systematic, proactive approach to management. This approach is used widely in all types of organizations, health care included, but Clancy (2008) asserts that today’s rapidly changing health care environment makes it more difficult to control events and predict outcomes.
Nurse Managers in Practice Putting nursing management into practice in the dynamic health care system of today is a chal- lenge. Organizations are in flux, structures are changing, and roles and functions of nurse man- agers become moving targets.
Titles for nurse managers vary as widely as do their responsibilities. The first level manager may be titled first-line manager or unit manager. A middle manager might be deemed a depart- ment manager. The top-level nursing administrator could be named executive manager, chief nursing officer, or vice president of patient care. In addition, clinical titles might include profes- sional practice leaders who are clinical nurse specialists or nurse practitioners. Regardless of their titles, all nurse managers must hold certain competencies.
Nurse Manager Competencies The American Organization of Nurse Executives (AONE), an organization for the top nursing administrators in health care, identified five areas of competency necessary for nurses at all lev- els of management (AONE, 2005). Nurse managers must be skilled communicators and rela- tionship builders, have a knowledge of the health care environment, exhibit leadership skills, display professionalism, and demonstrate business skills (see Table 4-2). These characteristics intersect to provide a common core of leadership competencies (see Figure 4-1).