Question

Discuss how nurse managers and nurse leaders contribute to the reengineering of health care.

Answer 1

The Eight “Es” through which nurse mangers and leaders can reengineer the future.

1. Evaluate them.

Let’s face it, some people are just
not cut out for management. Now, more than ever,
we need to make sure we have the right people, on
the right bus, in the right seats. An excellent nurse
manager assessment tool is the one developed col-
laboratively by AORN, AACN, and AONE: the
Nurse Manager Skills Inventory (2004). This
examines financial management, human resource
management, performance improvement, founda-
tional thinking skills, technology, strategic man-
agement, and appropriate clinical practice knowl-
edge. It includes a personal and professional
accountability self-assessment tool completed by
the nurse manager and supervisor to determine
where and why perceptions might differ. A plan
for improvement and professional development is
then developed to assist in guiding future devel-
opmental activities. There are also tools to evalu-
ate emotional intelligence and both need to be put
to use. Many management skills can be learned,
but the ability to work effectively with others and
instill team work is paramount, particularly in
challenging times. If you have managers who
don’t possess the requisite skills and emotional
intelligence, move on: there is no time to waste.
2. Educate them.

It never ceases to amaze me how
many nurse managers lack the management edu-
cation and skills required for success.
Granted, they could use some updating, but the
principals remain the same, as does the lack of
budgeting skills among managers. If we expect
nurse managers to manage some of the largest
budgets and greatest number of staff, we owe it to
them and our patients to make sure they have the
necessary education and tools.
3. Embrace them.

Formal education isn’t enough.
Equally, if not more important, are coaching and
mentoring. Despite the importance of front-line
managers, research confirms a profound lack of
daily guidance, direction, feedback, and support
for nurses from their immediate supervisors
(Tulgan, 2007). New, and some seasoned, nurse
managers need to be embraced and supported in
putting formal classroom education to use. As
Tulgan states, “The best leaders are those that
learn proven techniques, practice those tech-
niques until they become skills, and continue
practicing them until they become habits. (p. 22)”
A study conducted by Multicare Health System
demonstrated an excellent return on investment
through partnering an internal and an external
coach (McNally & Lukens, 2006). This partnership
provided individual and group coaching to 64 clin-
ical leaders. External coaches are more objective,
unbiased, and have broader experience but they
can be hard to find and take time to learn the
nuances of the organization. Internal coaches know
the organization but they can lack commitment
because coaching takes time away from other
duties. A combination of external and internal
coaches works best. At Multicare, internal and
external coaching met or exceeded expectations
with 100% of nurse managers stating they were
more competent and confident and over 50% say-
ing they were more likely to stay in their positions.
Another hospital that successfully tackled this
issue is Bryn Mawr Hospital, a Main Line Health
System Magnet designated hospital in suburban
Philadelphia. Bryn Mawr engaged an experienced
nurse executive to coach new nurse managers for 4
months on site. While participants agreed face-to-
face coaching was the most important component
of this program,

4. Enable them.

Nurse lead-ers must give nurse man-

agers the resources to be successful. They need
both clinical and administrative support. Many
nursing units are larger than other hospital depart-
ments and operate 24 hours a day yet the man-
agers lack clerical support for staffing and sched-
uling, payroll reconciliation, quality and budget
monitoring, and multiple other management
tasks. Many also have limited assistance in devel-
oping, supervising, and evaluating hundreds of
employees. Their scope of responsibility is excep-
tionally broad but their support systems are typi-
cally narrow. We need to start looking critically at
the return on investment that could be gained
from providing proper resources for these key
leaders.
5. Empower them

.new nurse managers expe-rience what Tulgan (2007) calls the number one management myth in today’s workplace: “themyth of empowerment.” This is the myth that theway to empower people (particularly profession-als) is to leave them alone and let them managethemselves. Another myth is the business ofhealth care is patient care and there is no time to manage. The reality is, since time is limited, you don’t have time to deal with things that go wrongwhen you don’t spend enough time up front man-aging people. In this changing health care envi-ronment, nurse managers don’t need myths, theyneed real empowerment. They need to be support-ed in trying new ways to deliver care efficientlyand effectively.

6. Espouse them.

We must do more to support and
champion our front-line managers. The fact is
fewer and fewer nurses are seeking management
roles, and for good reason. Front-line nurse man-
agers typically work far more hours, have far more
headaches, and get far less pay than their staff
nurse counterparts. If we don’t do something to
get them the pay they deserve, reasonable work
hours, and other resources they require, we may
be forced to look at other options for managing
patient care, and that would be costly from both a
financial and quality perspective. Many of us still
remember the days when non-clinical unit man-
agers were introduced and recall how expensive
that exercise was. Let’s not
make that mistake again. Let’s
develop, support, and espouse
the importance of nurses man-
aging nursing work. Budgets,
for an example, are merely a
translation of activities into
dollars and who knows the
patient care activities better than nurses. And
while we are at it, why not give these nurse lead-
ers titles more appropriate to their role? We appro-
priately require them to hold a master’s degree
and give them huge budgets and staff numbers to
manage, so why not consider what some hospitals
are already doing and give them a director title.
Where there is already a director role, savvy
organizations are going to the executive director
or associate chief nurse title. It enhances self-
esteem and recruitment at the same time; two ben-
efits for less than the price of one.

7. Engage them.

If we are to get the full benefit of
skilled front-line nurse managers, we must engage
them in decision making and finding new ways to
deliver care. Nurse leaders will face many chal-
lenges with health care reform. We need the best
and brightest to help identify the best options for
improving quality with fewer resources. The
recession has stopped the nursing shortage for the
time being, but that will change. As millions of
additional Americans gain access to health care
while millions more continue to age, the demand
for health care will skyrocket. This will be cou-
pled with a record number of nurses retiring and
escalating pressure to keep costs down. Many new
nurses will be needed for primary care as nurse
practitioners and other advanced practice roles.
This is good for nursing, but there will still be
increased need for bedside nurses.
Despite the most recent research by Aiken et al.
(2010) showing decreases in patient mortality
associated with higher staffing ratios in California
as compared to Pennsylvania and New Jersey,
how much will the public be willing to pay?
There is truth to the adage, “no margin, no mis-
sion.” We might also ask whether we are making
the right comparisons in looking at California vs.
states without mandated staffing ratios. Maybe we
do need to look at Canada where health care costs
have been contained to 10.1% of the GDP com-
pared to the U.S. system at 16%, while Canadians
live longer and have lower infant mortality
(Gardner, 2010). As Buerhaus (2010) aptly points
out, there are multiple costs to imposing mandato-
ry hospital nurse staffing, not the least of which
are opportunity costs. We must be creative and
find ways to reduce the cost per case and we need
nurse managers to be engaged in the process

.8)Excite them.

Finally, to engage these nurse lead-
ers, we need to excite them about the prospects for
change. We must get them to step outside the box
and think about how teamwork can be enhanced,
how to identify 20% of the work makes 80% of
the difference in patient outcomes, and how to
attract more of the best and brightest into this
challenging but exciting profession.