Managing in a changing world

Few nurse managers would dispute the fact that maintaining and developing service provision whilst taking account of the human and financial resource issues associated with it is a complex business. The range of topics covered by the papers in this issue bears testament not only to the complexity of day-to-day matters being dealt with by managers, but also to the level of skill and knowledge expected by anyone moving into a managerial position. 2010 sees the 100th anniversary of Florence Nightingale’s death – a woman credited with stimulating the birth of what can be seen as ‘modern’ nursing, although she would possibly not recognise it as such. It is timely then, that Stanley and Sherratt, in our first paper, consider the differences between ‘clinical’ leadership and nursing leadership per se. The arguments debated, and criteria used to assess the premise, give pause for thought in terms of what we are expecting our leaders, in what ever capacity we frame them, to be and to do. Stanley and Sherratt claim that ‘Miss Nightingale was not a clinical leader, she was a powerful and successful role model for the academic, political and managerial domains of nursing.’ They suggest that there are other types of leaders in nursing that need to be recognised, and that ‘clinical leaders should be celebrated and recognised in their own right. Both clinical leaders and nursing leaders are important and need to work collaboratively to enhance patient care and to positively enhance the profession of nursing.’ I would suggest that not many people would disagree with that conclusion, but the distinctions identified between these perceived different kinds of leaders throw up questions about what we expect leaders and managers to do and how we expect them to act. Our second paper draws attention to one contributory issue in terms of how senior nurse managers perceive their participation in decision making at high levels. Wong et al. report a study involving 63 senior nurse leaders and 49 chief executive officers from 10 Canadian provinces. A telling conclusion is that the CEOs rated the senior nurses’ involvement in decision-making more highly than the nurses themselves. The nurses’ breadth of content expertise and the number of decision activities they were involved with were significant predictors of decision influence, explaining 22% of the variance in influence. This reinforces findings from previous studies, that links confidence in decision-making with perceived authority and experience influenced by gender and cultural issues. Similarly, the next author Pillay used a questionnaire survey with 171 nurse managers in South Africa to identify competencies seen as important for nursing management and assess the proficiency of those responding. He concludes that public sector managers self-rated as less competent than private sector managers; despite the fact that both groups shared the largest skills gaps in ethico-legal and task-related elements of their roles. Public sector managers also identified ‘controlling’ functions as a deficit, whilst the private sector ranked ‘health-related’ in their top three list. Rubin concludes that there is a ‘confirmed lack of management capacity within the health sector’ and identified areas in which the skills deficit was most significant for both the public and private sectors. This conclusion is borne out by the range of papers submitted to this Journal which tackle the issues of dealing with troublesome human relationship skills. The next four papers represent examples of these, in addressing conflict communication (Brinkert, USA); communication between delegating nurses and nursing assistive personnel (Potter et al., USA); overcoming ignorance and stigma relating to intellectual disability (While and Clark, UK) and the construction of a multidimensional model of bullying in the nursing workplace (Hutchinson et al., Australia). The latter paper suggests that in ‘contrast to common explanations of bullying as a form of escalated interpersonal conflict’ their study demonstrates that ‘nursing workforce organisational factors may be more important in influencing the occurrence of bullying’. Arising from all four papers are suggestions for the ways that managers can review their practice in dealing with negative inter-personal influences impacting on people’s working lives. Levels of satisfaction with life at work are known to have causative effects on the decision to stay in a role, as well as contentment and happiness in the job. Badr et al., in a study of an overview of the status of the nursing profession in Lebanon, conclude that ‘nurses are more likely to be satisfied and committed to their profession when they feel that their opinions are being heard and that their work environment promotes professional advancement’. These sorts of issues are confirmed by Suzuki et al.’s study in Japan of the turnover of novice nurses in University hospitals. Reasons for leaving in the 10–15 month period post qualification were given as ‘burnout, dissatisfaction with the workplace and the hospital location in Tokyo’, contrasting markedly with reasons for leaving in the previous time period as ‘education, undesired ward assignment and lack of peer support’. The last of three papers tackling satisfaction issues considers Canadian cancer nurses’ views on recruitment and retention (Bakker et al.), which identifies two out of four key factors as to do with the working environment – gratification as a retaining factor, and relationships as being dependent on the environment. All three papers reinforce the notion that nurse managers have a crucial responsibility in building a working environment in which nurses feel appreciated want to work through choice. On a similar theme, Yukari Takeno identifies factors that facilitate the transition of Asian nurses to working in Australia, suggesting that it is the cultural aspects of working in another country that nurses find most difficult to assimilate – including language, differences in cultural practices and beliefs about the nurse’s role. Although derived from a very small study sample, the author draws attention to issues that are often overlooked by managers focussing on staffing ratios and the need for qualified nurses to provide a service. The issues identified within all of these papers can be seen as more to do with people management and managerial skills than to do with the notion of clinical leadership identified by Stanley and Sherratt. Indeed, it raises the question often asked by those outside clinical disciplines of whether it is necessary to be a clinician in order to be a manager of practitioners. Clearly, there are successful examples of both types of manager functioning in health care provision world-wide, and this is not the place to debate the issue. But, what I would like to end with, is in returning to the point of whether we need to be clearly identifying different kinds of leadership, and management, and valuing these through professional development strategies in order to ensure we promote the good and dedicated practitioners appropriately to leadership posts, and not expect them to leave their spheres of expertise in order to progress up a career ladder.

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