Nurse Managers with effective skills and knowledge are essential components of our health- and medical-care systems. Studies on the relationship of nurse management with nurse empowerment, staff nurse turnover, management of generational issues are being done in all parts of the world. These studies have established correlations between effective nurse management and increased overall productivity of the healthcare systems. The roles of nurse managers are increasingly recognized as they provide leadership to the largest group of employees (nurses) in any healthcare organization (Mathena, 2002).
Nurse empowerment
Improvement in the present nursing working conditions is critical for retaining the nurses currently in the system and attracting the newcomers to the nursing profession. There are different modules of the nurse empowerment by the nurse managers, viz. Enhancement of the meaningfulness of the work, participation in the decision making, accomplishment of set goals, expression of confidence in performance and, autonomy in action. Good nurse managers empower their staff to exert greater effort for achieving organizational goals. They provide access to the information, support, resources and opportunities necessary for work to the nurses. The objective of empowerment is to give the nurses the feelings of reasonable workload, control over their work, and good working relationships. They should feel that they are treated fairly and are appreciated for their contribution. It is worth mentioning here that ‘bossiness’ or ineffective leadership style of nurse managers cannot lead to nurse empowerment. Nurse empowerment results in less work-stress and increased effectiveness. It can also be further linked to job satisfaction, commitment, fewer burnouts and higher levels of energy (Greco, Laschinger & Wong, 2006).
Retention of staff
The national hospital nurse turnover rates are more than 20% currently. Several nursing research studies point to five common attributes that lead to job satisfaction and staff retention in the hospitals. These attributes are 1) transformational leadership style of the nursing managers, 2) extrovert personality of the manager, 3) magnet hospital set-ups leading to nurse empowerment, 4) autonomy and group cohesion and 5) graduate education. A high leader visibility and shared decision-making led to the nurse retention. Personal and professional communication between the nurses and their managers also increased retention. A recent study involving ED nurse managers and staff nurses from the U.S. academic health centers revealed that transformational leadership styles of the managers led to the lower turnover rates of staff nurses. Therefore, nurse manager leadership strategies are vital for the maintenance of standard of professional emergency nursing practice. We can conclude that affiliation, appreciation and recognition of the nurses by the manager are the key components for nurse retention (Force, 2005; Raup, 2008)
Communication
Communication is the most important variable in the effectiveness of a nurse manager. A good nurse manager is the one who can communicate a clear vision and values to the nurses. Ability to talk freely and a sense of a family improve the job satisfaction and consequently retention of the nurses. It is also noted that the nurse managers who are energetic, having a sense of humor and approachable are liked by the nursing staff. Nurse Managers should provide individual attention to each nurse and recognize his/her strengths and weaknesses at work. Managers should never talk down about their staff and try to understand the audience in order to communicate effectively (Force, 2005).
Management of Generational Issues
Four generations are working in the health- and medical-care organizations today. These generations have been termed as a) the silent generation, b) the baby boomers, c) generation X and, d) generation Y. A major challenge for the nurse manager is that all four generations have different experiences & expectations and consequently they have different approaches and reactions at work. The conflicts between these generations often result in unpleasant atmosphere, decreased productivity and less employee satisfaction. Therefore, the role of a nurse manager becomes important and critical. An efficient nurse manager should acknowledge the differences between the generations to maximize the organizational effectiveness. Nurse Manager has to understand the characteristics (values, ethics, attitudes, and expectations) of each member in the multi-generational workforce and uncover the motivational factors for them. It is important for the nurse manager to promote the friendly relationships between the members of different generations and to build a cohesive team. The nurse manager should be sensitive to the expectations of each generation and provide fair & equitable opportunities (Hu, Herrick & Hodgin, 2004).
Strategies to Building “Dream” Empowered Work Environment
Research on the Magnet Hospitals revealed that hospitals supporting unit-based decision making, having a powerful nursing executive/manager and promoting professional nursing practice provide superior patient care (Armstrong & Laschinger, 2006). Therefore, several strategies of these hospitals can be implemented to other healthcare set-ups in order to build a ‘dream’ empowered work environment for the nursing staff. These strategies are:
- Autonomy: Autonomy should be created by nurturing professional accountability (by eliminating traditional rules). Nurse should be able to practice flexibility to act on their own expert judgment for solving patient-care issues.
- Reward system: Excellence in practice should be rewarded. Nurses should be appreciated for their hard work, sincerity and loyalty to the organization.
- Collaborative nurse-physician relations: Research has shown that collaborative nurse-physician relationships have resulted in a lesser degree of burnouts, in the nurses. They also increase job-satisfaction and overall performance of the nurses.
- Career enhancement: Incentives should be given to nursing staff for pursuing further studies and advanced nursing programs (Force, 2005; Armstrong & Laschinger, 2006)
The above strategies can be implemented successfully in any healthcare system. The role of the nurse managers is pivotal in this implementation. The nurse manager should be a sociable, people-oriented and optimistic person. A good nurse manager is a blend of effective interpersonal skills and clinical expertise.
Magnet Certification
Magnet hospitals are the institutions recognized by the American Academy of Nurses (AAN) for their ability to attract and retain the nursing staff. In such a set-up, the nurses have a greater autonomy in practice and are rewarded & appreciated for their contributions to the organization. Consequently, nurses experience more job satisfaction, fewer burnouts, and higher educational preparation. In the magnet hospitals, nurses are provided with opportunities to make decisions based on their expertise and professional judgment. They have strong working relationships with the physicians and other hospital staff. Overall, the work environment is empowering for the nurses, and they feel more supported to work in a professional manner.
Research has shown that nurses who perceive their managers to be collaborative and supportive are likely to experience greater autonomy, empowerment and job satisfaction. Magnet nurse leaders having transformational leadership qualities and presenting charismatic, visionary and loyal personality are effective in retaining the nursing staff to a greater extent (Force, 2005; Laschinger, Almost & Tuer-Hodes, 2003).
The managers encourage the staff nurses continuously and communicate patient care outcomes. Managers also stimulate and implement new approaches by the staff nurses for problem solving. They create new learning opportunities for the professional growth of the nurses. These activities validate the meaning of their work at the bedside. All in all, the nurse managers with effective leadership characteristics appear to be an essential component for the retention of staff nurses.
References
Force, M. V. (2005). The relationship between effective nurse managers and nursing retention. Journal of Nursing Administration, 35(7/8), 336-341.
Hu, J., Herrick, C., & Hodgin, K. A. (2004). Managing the multigenerational nursing team. The Health Care Manager, 23(4), 334-340.
Raup, G. H. (2008). The impact of ED nurse manager leadership style on staff nurse turnover and patient satisfaction in academic health center hospitals. Journal of Emergency Nursing, 34(5), 403-409.
Mathena, K. A. (2002). Nursing manager leadership skills. Journal of Nursing Administration, 32(3), 136-142.
Greco, P., Laschinger, H. K. S. & Wong, C. (2006). Leader empowering behaviors, Staff nurse empowerment and Work engagement/burnout. Nursing Research, 19(4), 41-56.
Laschinger, H. K. S., Almost, J. & Tuer-Hodes, D. (2003). Workplace empowerment and magnet hospital characteristics. Journal of Nursing Administration, 33(7/8), 410-422.
Armstrong, K. J. & Laschinger, H. K. S. (2006). Structural empowerment, magnet hospital characteristics and patient safety culture. Journal of Nursing Care and Quality, 21(2), 124-132.
