Managing with Style

1

MANAGING WITH STYLE

Managing with Style

Anita L. Riddle

Ferris State University

Introduction

A manager is the lifeline of a nursing unit or department. An effective manager leads with respect and dignity, for staff, co-workers, patients and all individuals whose paths they may cross. They set the tone, the mission, vision and philosophy of the environment they serve. Leading by example, expecting no more from the staff then they expect from themselves. They set the bar high, motivating others, allowing risk taking, and out- of- the box thinking.

As a seasoned registered nurse, I have crossed paths with many management styles, ranging from extremely poor to exemplary. When given the assignment to interview a manager, only one came to mind, Marion Labadie, RN. No fancy credentials behind her name, just a natural born leader in the profession of nursing. It was very early in her career she was introduced to the world of management and leadership in the acute care setting.

Raised in Louisville, Kentucky, Marion had wanted to pursue a career as a nun. It was during the summer following her high school graduation (1972), while looking for an appropriate summer job for a future nun, her career path changed. One day while out driving, she noticed a sign for an extended care facility, something inside her (or from above), guided her through the front doors. Meeting the Director of Nursing, she was interviewed and hired on the spot as a nurse’s aide, without any previous work experience, let alone nursing experience. She was to be an angel of mercy in a nurse’s uniform.

While working in the extended care facility, she was encouraged to advance her education and become a registered nurse (RN). She applied and was accepted to Baptist Hospital’s diploma nursing program (very popular in the early 70’s), with one stipulation, she had to lose weight. Determined to be a nurse, she met their weight goal and graduated with her nursing diploma in 1975. She described her nursing education as very intense, with the expectation student nurses were there to work.

Upon graduation she was paired with an RN, in a critical care unit, who was nearing her retirement. The use of team leading, afforded her the experiences and responsibilities of the registered nurse. While awaiting the results of her state nursing boards she was offered the team leader role. Accepting the challenge, she had her first exposure to leadership. Baptist Hospital was a very progressive institution for the times. They had already instituted computerized order entry and direct deposit of payroll. Baptist had a respected reputation for cardiac care.

In 1978 Marion moved to Illinois, and took a position in a critical care unit, later becoming a house supervisor. In the 1980’s she came to Michigan, taking a job in critical care at Leila Hospital, a catholic hospital still being managed by nuns. Also during this time she served as a clinical instructor for the Kellogg Community College associate degree nurse program. It was in 1986 I met Marion and my respect for her as a nurse, leader and human being began. She continued her career serving as the director of Emergency Services, Critical Care, Cardiopulmonary, and the Cardiac Catherization Lab. She played an integral part in the development of the cardiac cath lab recovery unit and the merger of two hospitals.

For the past 11 years she has been employed by the Community Health of Branch County, in Coldwater, Michigan, serving as the Director of Emergency Services and Obstetrics. She also serves on the county’s Emergency Preparedness Board and secretary of the Medical Control Panel. Marion still enjoys being an educator and is a lead instructor for Advanced Cardiac Life Support. Somehow she is able to manage her time, and provide all of her units and responsibilities with effective, quality leadership and support. She has the skills to lead and manage with style.

Current Job Responsibilities

When asked what her most important duty was she replied, “being a role model for my staff and providing the means for them to provide quality, compassionate patient care” (personal communication, September 22, 2011). She is responsible for not only the day to day issues but the future of her units. Budgets, reimbursements, policy and procedure development and monitoring, marketing, patient satisfaction, staff satisfaction, safety, collaboration with other departments, and keeping her own knowledge base current, were at the top of her list.

She also has the responsibility to respond and guide cultural diversity in her units. The patient mix is a combination of high, middle and low socioeconomic patients, with the highest percentage falling into the lower end. Coldwater has the second highest Yemen population in Michigan. She has provided staff with education regarding their cultural beliefs, and also access to discharge instructions written in their native language. There are also local interpreters on call. There are also many Spanish speaking patients. Here again there are Spanish discharge instructions, and employees who are able to speak conversational Spanish. Any other languages are translated by a service provided by AT&T.

The licensed staff employed on her units is comprised of all RN’s, primarily females. There are not any cultural issues among the current employees. There are also patient care assistants, unit clerks, and patient liaisons. All of these staff members report directly to Marion. Marion in turn has to report to the Corporate Nurse Executive, who reports to the Corporate Executive Officer, who ultimately answers to the Board of Trustees.

Collaboration

Collaboration between units is important within any organization. As the director of obstetrics, she interacts with physicians, staff, laboratory, radiology, pastoral care, patients and families. This unit is somewhat self-contained when compared to the emergency room. Most patient services are provided within the unit or brought to the unit.

In the emergency room setting she has to be on good terms with all units in the hospital and the community. These include, critical care, acute med-surg, pediatrics, surgical services, obstetrics, behavioral health, laboratory, radiology, respiratory care, security, pastoral care, ambulance service, 911, physicians, staff, other unit managers, patients and families. It is also important for both units to have a good rapport with area hospitals to facilitate medical transfers.

Marion is respected within her current setting. Her support of a team approach serves her well. In collaboration there is no hierarchy, each person is respected for their area of expertise and experiences, recognizing the value of each member’s contributions (Kearney-Nunnery, 2008). As a former member of her staff her leadership style supports this. She meets monthly with the other directors. If an issue arises she approaches the director promptly to find resolution.

Ethics

Ethics in the health care setting can be conflicting at best, related to each person’s morals, values, beliefs and life experiences. Marion has recently experienced this with a member of her emergency room staff. A female RN received a cardiac patient into the ER; the patient was a female with breast cancerexperiencing chest pain. The assigned nurse had provided care for this patient in the past (the patient was previously a no code). Since the nurse had cared for this patient before she assumed she still had a no code status. The patient died even though the nurse had followed protocol of IV, 02, labs, monitor, and aspirin. The patient’s sister felt since the nurse was not immediately aware of her sister’s updated code status; the treatment was not aggressive enough to save her. The sister’s accusations surfaced again when the RN began dating the patient’s husband.

A malpractice accusation is an existing fear of any nurse, manager or healthcare organization. “Malpractice, sometimes referred to as professional negligence, concerns professional actions and is the failure of a person with professional education and skills to act in a reasonable and prudent manner” (Yoder-Wise, 2011, p. 71). The sister in this incident feels resuscitation measures would have begun sooner if the assigned nurse would have asked about the code status of the patient. Marion in defense of her nurse shared that, “in spite of the nurse’s assumption of code status, all interventions provided upon the patient’s arrival were consistent with a full code patient and were within the guidelines of the established protocol” (personal communication, September 22, 2011). They were measures to provide comfort and diagnosis. The patient’s physical status did not merit resuscitation at that point. As this case is still being resolved she could not provide any more details. The details she did share have already been published by the media.

This case definitely presents an ethical dilemma for the nurse, the physician, the hospital and Marion. Since an integral part of management is the direct supervision of staff, by “directing, guiding, and influencing the outcome of an individual’s performance of an activity”, this places a manager at risk for malpractice also (Yoder-Wise, 2011, p. 75). In this incident only the RN knows her intent, did she know the patient was now a full code, was she involved with the patient’s husband at this time or did it occur after, and would she, or could she have done anything differently? This was a highly respected nurse, not only by her co-workers but by her manager. Marion showed support for the nurse involved, yet is aware of the follow up needed to prevent this situation from occurring again. It is sad the act of one person, unintentional or not can effect so many.

Power and Influence

The way power is used can affect the outcome of a situation either positively or negatively. In analyzing Marion’s use of power, both from an employee and an interviewer, it would seem she has legitimate power. Her years of experience, successful management, and active organizational participation, have provided her with this form of power and influence. Her professional relationships have been established through her repeated successes, allotting her access to powerful outside people and resources (Kearney-Nunnery, 2008, p. 223).

By using power and influence in a non-threating way, you are more likely to achieve your desired outcome. She has always actively listened to others. She is open to new ideas, and enjoys empowering those around her, instead of overpowering them. By the use of empowerment, she allows the staff to have ownership in the units. This has built self-esteem in her nurses and pride within her units. Self-esteem in themselves and pride in their units, have led to teamwork, and in return has increased patient satisfaction levels. Marion leads by example and would not ask her staff to perform any task she herself has not done or researched. As a former student and employee (staff nurse and charge nurse), Marion is always respected and is known for her accountability and the accountability of her staff.

Decision Making and Problem Solving

All nurses are faced daily with the demands of decision making, and problem solving. From whether or not to administer a medication, to establishing a new policy and procedure, the nursing process requires decision making and problem solving at every level. Decisions made can affect someone’s life forever. For instance a poor decision, conscious or unconsciously made, as in the ethical situation above, can end a patient’s life and consequently affect the respect of a unit and or staff.

Marion does not have difficulty in making decisions. She researches the issue, and does not commit to a decision until she feels she has found reference to an evidence-based practice supporting it. She indicated again the importance of empowering your staff, and being an active listener. This method of leadership has also made her staff feel comfortable in identifying problems and bringing them to her attention. She tries to bring more than one solution to the table for consideration, allowing those most closely connected to the problem, the opportunity to provide the best possible answer. “The problem solving process involves the systematic identification of a problem, determination of goals related to the problem, identification of possible approaches to achieve those goals, implementation of selected approaches, and evaluation of goal achievement” (Burns & Grove, 2011, p. 42).

Conflict Resolution

Communication is essential to effective conflict resolution. One must listen and put themselves in the other person’s shoes. How effectively we listen is just as important as how effectively we communicate. A resolution cannot be made until all parties concerned understand each other’s viewpoints. Sometimes a solution can be agreed upon, other times a compromise or an agreement to disagree may be the best resolution. Conflict that goes unaddressed only amplifies the issue in question and prolongs resolution. Ineffective management of conflict can divide a unit or organization. Good nursing leadership creates “a practice environment that fosters open communication and collaborative practices for achieving mutual goals that enable nurses to practice constructive approaches to conflict management” (Yoder-Wise, 2011, p. 475).

One example of a conflict, occurring while working in the emergency room under Marion’s leadership was between the critical care unit and the emergency room. It involved the current procedure for giving report on a patient being admitted to critical care from the ER. It seemed once report had been given via phone to the receiving nurse, the patient still had a one to two hour wait before being transported to their room. Depending on the day this method back logged the ER, resulting in longer patient wait times in the ER, or being placed in a hallway until a room became available.

Once this conflict between units was brought to Marion’s attention, she contacted the critical care director and together they selected a committee to discuss and evaluate the current process of admission to the floors from the ER. After 3 meetings, a resolution was achieved. Report would be faxed from the ER, including nursing notes and pertinent labs and x-rays, along with a copy of the admission orders. A call from the ER nurse to the unit clerk would be made to alert the receiving unit the report was on the way. It was the expectation that the unit clerk would take the report to the receiving nurse to review. The receiving nurse had 2 options, call ER with any questions and/or inform the ER of delays, or if they did not call the ER within 15 minutes the patient would be transported to their admission room. This turned out to be a reasonable solution and decreased waiting time for the patients. It made the nurses accountable for a timely admission and developed a trust between units.

Conclusion

Throughout my nursing career I have been exposed to several management environments, from a dictatorship to an empowering, motivating, teamwork approach. Management styles can make or break even a strong and well established unit. The wrong leadership can take a nursing unit down the path of self-destruction. Some leaders are created through experience, some through education, and a few are born leaders.

When asked what makes a good manager, Marion replied, “always put your patients and staff first, be accountable and hold others accountable, lead knowing best practices, and have faith” (personal communication, September, 22, 2011). As I spoke with her, she had tears in her eyes at times, revealing her passion for her chosen profession. From her desire to become a nun, arose a stronger desire to become a nurse. She may not have wings or wear a halo, but I believe God put her on earth to lead and foremost be a nurse! She truly manages with style.

References

Burns, N., & Grove, S. (2011). Understanding nursing research: Building an evidence-based practice (5th ed.). Maryland Heights, MO: Elsevier/Saunders

Kearney-Nunnery, R. (2008). Advancing your career: Concepts of professional nursing (4th ed.). Philadelphia, PA: F. A. Davis Company.

Yoder-Wise, P. (2011). Leading and managing in nursing (5th ed.). St Louis, MO: Elsevier/Mosby.