Nurse managers - a professional scope of responsibilities

What is the scope of professional responsibilities that we could, or should, expect from our nurse managers? Is nursing management only about the effective provision of a service, or does it encompass wider issues to do with strategic thinking, cultural context, staff recruitment, development and satisfaction at work; beyond that to work-life balance and career development, morale, image and engagement, perhaps, with political and social issues impacting on nursing care? Where does the balance lie in awareness of the global issues affecting nursing, and those pertaining more locally? Of course, there is no one universal answer, and there is as much diversity in nurse managers’ roles as there are nurse managers. The content of this issue has been deliberately chosen to reflect that diversity, in ranging from the identification of global challenges at a particular time and place, to more specific issues of dealing with conflict, job satisfaction and generational differences. Hence, this issue touches on a range of topics that a nurse manager, or leader, may encounter within their role on an everyday basis. Unlike many of our issues which address a specific management theme from a range of perspectives, I have pulled together an eclectic mix of papers to illustrate the many concerns that our nurse managers are called on to address in the course of their working life. Our first paper, from Gantz et al, a year on from when the authors collectively presented at the American Organisation of Nurse Executives Annual Meeting in San Diego 2011, identifies issues facing nursing leaders from a global perspective. Despite hugely different healthcare systems and cultures, the contributors demonstrate the commonality of challenges facing nurse leaders the world over. Reading through this paper a year on, I am struck by how little has changed since this time last year, yet pause to consider what nurse leaders a decade ago, 20, 30 or 40 years ago, would have considered their major challenges in worlds of different healthcare services, medical technologies, and demographics. Whilst recruitment, retention and management of staff, standards of care and delivery of service are undoubtedly constants throughout nursing history, the additional responsibilities for nurse managers at most levels within organisations now ask them to consider complicated financial management issues, staff education and development, and change at an unprecedented level, together with higher patient acuity, and a workforce who have more choice than ever before in career decisions. This latter point is illustrated in three papers from Australia (Hutchinson et al.) the USA (Sparks) and the USA (Klaus et al). All authors draw the conclusion that different generations of nurses have different expectations of their working lives in relation to job satisfaction, retention and psychological empowerment, providing challenges for nurse managers in accommodating workers in the profession where there is a shortage of registered practitioners globally, and where increasing specialisation means skills’ shortage is a looming issue. Laschinger’s paper considers job satisfaction and turnover intentions of newly-graduated nurses in Canada, whilst Bennett et al ask what newly-qualified nurses in Australia want from jobs in rural and remote communities. Both papers conclude that the quality of working environments, including structural and personal factors (Laschinger) and structured support for new graduates were important in retaining graduates within the workforce. However, in contrast, Leong, reporting a study conducted in Macao, found that communal factors, such as inadequate staffing numbers, and increasing demands on the nursing service contributed significantly to nursing shortage, suggesting that nurse managers need to address the management of nursing workloads and communication mechanisms as a matter of urgency to prevent nurses leaving their jobs. This is reinforced in the next paper, presented by Chou et al, which identifies job demands, available resources and emotional labour as predictors of nurses’ well-being. They conclude that managers’ engagement in providing organisational support and the provision of training programmes to enhance job satisfaction and reduce emotional exhaustion are key to maintaining a workforce. In addition, Munir et al, identify the mediating factor of transformational styles of leadership on work-life conflict, job satisfaction and psychological well-being amongst staff in a Danish elderly care establishment, emphasising the effects that differing leadership styles can have on the working environment. Whilst job satisfaction is a recurrent topic in papers in this issue, it is addressed from many different perspectives, drawing attention to the wealth of knowledge and expertise that we, as nurse academics and managers, are building on what is significant and important to nurses in their working lives. This is definitely a global issue, if the submissions to the Journal on the topic are an indication of how it influences the delivery of nursing care world-wide. In the first of two papers generated from Iran in this issue, Ravari identifies very clearly how cultural contexts of working conditions are vitally important in different parts of the world. She suggests that ‘highlighting the sacred and spiritual value of the nursing profession, which is rooted in religious values and culture, provides additional reinforcement for enhancing job satisfaction’. This reminds us that, in a need to generalise from our data, with large samples, and validate reliable research instruments, often we omit the very components that make nursing care specific to the cultures and populations they serve. The Journal is increasingly receiving papers that have tested instruments in different countries, or cultural contexts, yet do not generate the instrument itself from qualitative beginnings; or, instruments are translated from an original without exploration of the cultural contexts within which they were developed. We run the risk, within this approach to global inclusivity, or attempting to standardise knowledge of nursing, of missing or ignoring the very features that make nursing nursing – the ability to design and adapt care to the needs pertaining to the situation or individual. We need to remember that whilst nursing is undoubtedly a global activity, the forms and functions it takes are not necessarily uniform and need to accommodate the cultural norms within which it operates in order to be effective. This notion of the effects of migration is highlighted in Newton et al’s paper exploring the experiences of internationally educated nurses working in Canada. One often considered solution to nursing shortages is to recruit nurses from other countries, with the assumption that, as registered practitioners, they are equipped to work within any nursing context. Indeed, this is not a new phenomenon, as we have seen the migration of healthcare professionals encouraged worldwide for decades, often with the motivation of global transfer of knowledge and the gaining of experience that broaden skills capacity, and often in a humanitarian capacity. Yet, Newton et al conclude that ‘the huge advantages in professional skill and cultural diversity that IENs (internationally educated nurses) can bring to any nursing unit will not be fully realised without substantial efforts to reduce practice limitations (deskilling) and discrimination’. Managers need to remember that the motivation for working in another country may not be entirely altruistic, with nurses often relied upon to send money back to their home country to support a family, and tailored approaches to inclusion and enculturation need to be developed to ensure they are able to function to the best of their ability within a supportive environment. We need also to remember that expectations of nurses and nursing differ between cultures, as is clearly identified in papers from Iran (Varaei et al), where family member experience of nursing, and societal expectations are shown clearly to affect how nurses themselves perceive nursing; and Canada (Andrews et al) where an exploration of gender differences and similarities as predictors of job satisfaction identified fewer gender differences than expected in issues influencing job satisfaction. A key finding of this latter study however, was the need for managers to ‘increase their awareness of the potential for workplace aggression towards male RNs'. Finally, a paper from Greece (Kaitelidou et al) explores how conflict is managed and suggests that ‘major changes are needed regarding human resource management, work incentives and dynamics of teamwork in order to improve working conditions’ drawing our attention to the experiences of nurses within their working environment, and how these, as opposed to job content, can affect job satisfaction. The diversity of papers presented in the journal are but a snapshot of the range of issues being addressed by nurse managers on a daily basis. Juggling priorities of immediate service delivery with more long term and strategic issues is a major challenge for managers in tightening budgetary constraints and ever-changing political and social contexts. However, as the papers in this issue demonstrate, managers cannot afford to ignore the needs of the workforce themselves, in combination with the needs of the people we serve, if nursing is to ride out the threat of a global shortage of educated, registered practitioners, and continue to develop as a profession and career to be aspired to by new recruits. It is clear that nurse managers have a dual responsibility in ensuring optimum working conditions which lead to heightened job satisfaction for nurses in order to provide the quality of care expected by the people who utilise the services within which nurses work.

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