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May 30, 1998A recent Wall Street Journal illustration shows a middle manager with six arms juggling pens, paper, and telephones. Add a couple more arms grasping syringes and financial charts and you’ve got the picture of today’s nurse manager.Nurse managers are taking on more responsibilities over a broader area than ever before, and some say the evolution of the nurse manager is just beginning. “We’re in a rethinking mode,” said Patricia McFarland, MS, RN, executive director of the Association of California Nurse Leaders, formerly called ONE-California. “I’m hearing hospitals ask, ‘What is reasonable management?’ “When recent downsizing, mergers, and restructuring eliminated some management layers, the work had to be picked up by the managers who remained. Many are being asked to supervise more people, be financial gurus and literate in communications systems, ensure the quality of patient care and clinical competence across a continuum of care, and exhibit leadership and strategic management skills.”Middle managers are looking at significant change,” said Marjorie Beyers, PhD, RN, FAAN, executive director of the American Organization of Nurse Executives in Chicago. “The trend seems to be expanded scopes and spans of practice. There’s considerable variety, probably more variety than we’ve ever known.”The rat race?The job description, and in many cases, the job itself can be overwhelming. Some managers are supervising more than 100 licensed and unlicensed staff. In some cases, “the shining stars are getting lost in the shuffle, and [nurses] who need mentoring are not getting it,” McFarland said.Some nurse managers themselves are working 12- to 14-hour days and are on call 24 hours a day, seven days a week. “It takes an ability to merge a hectic work life and a home life. Younger nurses who want to move into administration are wondering, How much can I work?” McFarland said. “[Nurse management] is a very hard role.”But many nurse managers welcome the challenges. Nancy Ramirez, RN, manager of patient care services at Motion Picture and TV Fund hospital in Woodland Hills, oversees about 80 staff members in five levels of care. Her biggest challenge is staying aware of the rules and regulations in the various areas, which range from the intensive care unit to long-term care. “It’s a major juggling act to keep switching hats all the time,” she said. “It’s only possible if you have a good nursing administration that’s very supportive and allows you to have the resources you need. I get a lot of fulfillment—it doesn’t feel tough to me.”Ellen Whalen, MS, RN, a former nursing director at USC University Hospital in Los Angeles, liked having the ability to influence hospital management and make changes. “I tried as a director to be the one to lead the staff down a path, to have a vision of where we should be going, to put in place projects to improve patient care,” she said.Now, as senior director for clinical services for USC Care Medical Group-Los Angeles, Whalen is a liaison between private physician groups and the hospital. She never envisioned working outside of a hospital, but new management opportunities are evolving as the healthcare environment changes. “There’s so much opportunity for growth out there,” she said. “It was real exciting to make this move.”High-impact rolesHospitals are trying to attract and retain top nurse managers who can encourage, inspire, and challenge nursing staff, said Donna McNeese-Smith, EdD, RN, coordinator of the nursing administration graduate program at the UCLA School of Nursing.”At one time, middle managers in health care tended to be super clinicians willing to represent management,” McNeese-Smith said. “Now they’re high-impact players. They’re in a role that requires multiple skills and a strong educational background. Without that advanced educational background, they’re stressed beyond their capabilities.” About half of the students in the UCLA graduate program already are in management positions; the other half are staff nurses hoping to move into management.Moving up from middle management into a nurse executive, vice president, or chief executive officer position takes an exceptional administrator, McNeese-Smith said. “The glass ceiling that women hit up against is partly the view of society as well as the view we have of ourselves,” she said. “We haven’t quite reached the point of thinking of ourselves in those positions. But we’re further along in health care [than in other industries] because we have a lot of strong, powerful, competent women.” |
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