Running Head: NURSE MANAGER/LEADER 1

Analysis of Nursing Clinical Manager/Leader

Nathan Griswold & Chris Haan

Ferris State University

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Abstract

An interview of a seasoned clinical Manager was performed and analyzed. The textbook Yoder-

Wise’s, “Leading and Managing in Nursing” is referenced to supply accurate guidelines of an

effective nurse manager or leader. Several characteristics of the experienced nurse manager are

addressed during the essay including, job description, legal/ethical issues, collaboration, power

and influence, decision-making, policy and structure, management, conflict resolution, and

participation in research. The correlation between Yoder-Wise’s guidelines and the nurse

manager being interview are critiqued and evaluated throughout the course of this essay.

Keywords- Manager, leader, RN, nurse, resolution, problem- solving, power, influence.
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Interview and Analysis of Nursing Clinical Manager/Leader

As a student of the nursing profession, we have learned there are many areas of the

nursing field that we can strive to work. One area is a nurse manager. The purpose of this essay

is to provide an analysis of a nursing manager that was interviewed and knowledge gained on

how the nurse manager uses his skills in the clinical setting. According to Yoder-Wise (2011),

“Nurses must have leadership to move forward in harmony with changes in society and in health

care” (p. 38). Analyzing this nurse manager will give us the visualization into the nurse

manager’s everyday duties and be able to understand how in the nurse in a management position

utilizes management and leadership skills.

Nurse Manager/Leader Background

An interview with Ken Fisher, CRNA of West Shore Medical Center in Manistee,

Michigan was conducted on January 21, 2015. Ken stumbled on nursing in a unique way. In

attending college, his initial goals were to become a doctor but could not juggle a full time job

and the workload of school. With his financial struggles, he decided to join the Army. He

became an LPN/corpsmen in the army and gained an immense amount of medical experience

and leadership skills. After completing his military commitment, Ken then decided to forgo

becoming a doctor and set his sights on working towards attaining his Bachelors of Science

Nursing (BSN). While attending George Mason University Bachelors of Science nursing

program, Ken worked as a LPN in his free time to put himself through school and gain more

medical experience.

Ken graduated with his BSN from George Mason University. He wanted to move to the

west coast, so he applied for RN jobs in California. He then accepted a job at Encino

Hospital/Medical center to be trained as an Intensive Care Unit ICU/CCU, RN. Ken’s military
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leadership qualities and medical background in the military as an LPN/corpsman and also his

experience in being a LPN in the hospital setting were helpful. This allowed Ken to progress

quickly. After only two years as an ICU/CCU, RN, Ken was offered a job as Nurse Manager of

ICU/CCU, and Medical Surgical Unit at Encino hospital. This started Ken’s extensive career as

nurse manager. After four years of being the nurse manager of Encino Hospital ICU/CCU and

Medical surgical unit, Ken was offered an important job to be the Director of Cardiovascular

Services at Encino hospital/medical center in their catheterization laboratory (Cath lab). After

five years of being the Director of Cardiovascular Services, Ken set his sights on further

education. Ken was accepted to University of Missouri in Kansas City and to Truman Medical

Center School of Nurse Anesthesia to get his masters as a Certified Registered Nurse

Anesthetists (CRNA). Ken has much experience as a nurse manager. In this paper we are

focusing on the most significant job in Ken’s nurse managing career that is being the nurse

manager/director of Cardiovascular Services.

Job Description and Duties

As the nurse manager/ Director of Cardiovascular services at Encino Hospitals

Cath lab, Ken has many jobs duties. Ken was hired due to his successful track record of being a

nurse manager of Encino Hospitals ICU/CCU, and medical surgical unit. Ken was hired to

recreate the structure and functionality that lacked due to the incompetency of the prior nurse

manager. Ken’s job duties were to directly report to the CEO and COO of Encino

Hospital/Medical Center. He reported the progress made to restructure the cath lab. Daily job

responsibilities consisted of being in charge of scheduling all cath lab services for patients such

as echoes, stress tests, coronary angiography or coronary catheterization, coronary angioplasty or

percutaneous coronary intervention / PCI, closure of some congenital heart defects, treatment of
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stenotic heart valves, permanent and temporary pacemaker implantations, electrophysiological

studies such as AV node ablation, Rotablation of heavily calcified vessels, left and right Sided

pressure studies, and radiofrequency catheter ablation. As Ken scheduled these procedures, he

knew he had to collaborate with doctors to work around their busy schedules to make the cath

lab run smoothly. Ken also had to coordinate staff with the right certifications for each

procedure. Meaning, Ken had to collaborate with RNs, CRNA’S, radiology techs, X-ray techs,

and other staff that may need to follow hospital policy and protocol for the specific procedures.

Ken’s job also consisted of collaboration with pharmaceutical vendors and medical

equipment vendors to keep his cath lab stocked with medications doctors preferred. The lab also

needed up to date medical equipment that the doctors and staff could work with. In doing this, he

had to consult and negotiate prices with the vendors to get the best price possible for the

medications and equipment. Following his prices negotiations, Ken had to consult with the CEO

and COO on his decisions when making purchases from these vendors to follow the yearly

budget. As a nurse manager, Ken also had to deal with and solve conflicts amongst the staff

members and patients. These are all daily responsibilities and decisions Ken is in charge of.

Collaboration

As the Director of Cardiovascular Services, the nurse manager collaborates with

physicians on procedures and scheduling to optimize efficiency. Ken meets with all cath lab

staff at the beginning of each day to review areas of success and concern. Ken collaborates with

the nursing staff of the cath lab to make sure when hiring a new employee they have the correct

education pertaining to the cath lab. Ken’s daily tasks are to manage and schedule enough staff

for each day to ensure the lab is not understaffed. Ken is also instructed by the CEO to report

directly to the CEO or COO regarding any changes made in the structure, functionality, and
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policies that might need to be changed to create better care and a better work environment for

staff.

Meetings are significant in covering all the fundamental deliberation preparations in

scheduling, staff hiring, medical equipment, pharmaceuticals, policies, structure, and tending to

whatever other new or continuous concerns physicians and staff has inside the cath lab. He is in

charge of working together with physicians, RNs, laboratory, radiology, anesthesia and the

emergency department when a stat procedure comes into the cath lab. Ken states that having

communication and leadership skills are imperative to have effective collaboration among the

unit and various staff.

Legal and Ethical Issues

Being in a job position as Ken is, legal and ethical issues have risen in the cath lab and

made some complicating situations. It is important for nurse managers to be prepared.

According to the American Nurse Association, it is stated “The registered nurse practices

ethically” (2010, p.47). The ANA also recognizes the importance to uphold the client’s

confidentiality within legal and regulatory considerations and to supply to the resolution of

ethical issues of clients, family members, or systems as evidenced in practicing the ANA

standards when in practice (p.47). The staff leans on Ken when such issues arise in the cath lab.

When providing care to a patient, it is very multifaceted and multiple people are involved with

the care of the patient. Yoder-Wise also states, “Nurse managers have the responsibility to

ensure that those they supervise uphold these patient rights as dictated by HIPAA and to take

corrective actions should these rights not be upheld” (p. 83). Ken does this by making sure that

his staff is accurately documenting the patient’s care from the time the patient enters the cath lab

until they exit. Ken also makes sure his staff is documenting areas of concern and patients
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behaviors exhibited during procedures. Ken also has staff chart focus notes so if any of question

arise from the patient or family is easily accessed and provided to them. The reasoning for this is

if any predicament with the patient and the staff members or vice versa Ken can effectively

advocate for the patient or staff member.

Ken evaluates his RNs and staff members to make sure they are practicing according to

hospital policy and standards of care. This way if RN staff members are not adhering to the

hospital policy and standards of care, Ken can confront them and provide the evidence on the

correct way to provide care. In turn, Ken provides his staff with knowledge of evidence-based

practice to provide high quality of care. Ken is also responsible for making sure that his staff is

adhering to confidentiality laws. According to Yoder-Wise (2007), “The nurse manager is

cautioned to ensure that staff members both understand and abide by rules regarding patient

privacy and confidentiality” (p. 82). Ken’s competency in this provides the privacy that all

patients disserve. “Nurse managers should review the policies and procedures frequently for

compliance and timeliness” (Yoder-Wise, p. 83). Ken explained that he is constantly reviewing

new procedures, policies, and paying attention to his staff’s compliance. It is the responsibility

of the nurse manager to review policies, procedures, and adapt to them accordingly.

One Issue that Ken dealt with working at Encino Hospital was that they were short

staffed. The hospitals inability to hire more staff led to legal and ethical issues. For example,

when an emergency procedure was needed, all the other staff where attending other procedures.

This made it hard to get the staff they needed in time. The doctors would just end up running

their own procedures. By doing this, they were not following hospital policies. This was an area

of concern to Ken because this could lead to detrimental lawsuits on the hospital. So to combat

this, Ken communicated this with the CEO/COO about this issue and he made a plan. His plan
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was instead of hiring more staff they could cross train other staff to get certification in the areas

needed in the cath lab. That way they can be on call or at the hospital to help when an

emergency procedure needs to be performed. This plan would allow the hospital to adhere to

the budget.

Resolution of Conflict

The nurse manager role is faced with many responsibilities. One of the most complex is

dealing with the resolution of conflict. This is a difficult task because of the multitude of factors

that attribute to conflict in the workplace. Factors such as personality types, morals, staff roles,

and emergency situations make resolving conflict a difficult task. To resolve issues of conflict in

Encino Hospital cath lab, Ken established a written set of rules. Each staff member had to sign

the document to prove that established regulations were made aware of and adhered by. By doing

this, Ken made each member of staff equally accountable for their actions.

Another change Ken made was the way conflicts were resolved. Previously in the cath

lab, there was no official strategy in the way conflicts were settled. The resolutions were

conducted by an informal as needed approach leaving staff with unsettled issues. This approach

led to rising tensions because quick fixes often did not fully address the situation at hand. Ken

addressed this issue by incorporating meetings with staff. This formal approach was a more

thorough and complete process to address issues.

According to Siu et. all (2008), when nurses and management come together conflict

management is much more cooperative. This type of work setting brings the staff together to

work more effectively as a team. It was found that when a unit displayed open communication

and collaborative conflict management the unit performs more effectively. This in turn increases

the quality of care experienced by patients (p. 255).

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Decision Making and Problem Solving

As the Director of Cardiovascular Services, Ken has to identify unit obstacles that hinder

unit performance. Ken’s previous experiences made him a perfect candidate for this position.

Ken’s challenge was to bring organization to the catheterization laboratory. To establish

standards and regulations that all staff members have to follow in order to have a successful unit.

One the major challenge Ken was faced with was fighting between staff members of the

laboratory. The previous manager let doctors dictate and manipulate scheduling. The doctors also

would not also abide by unit rules. As one can imagine, this type of behavior added stress and

instability to the unit. An example of behavior Ken had to change quickly was the manipulation

of scheduling by the doctors. Doctors would claim priority to the lab due to emergency

situations. This made a significant negative impact on patients, staff, and morale of the unit.

Patients that were scheduled would have to wait for extended periods of time because

inconsistencies in scheduling. Staff would get upset because there was no organizational flow to

the unit. There was constant change and variation in staff roles. These factors led to a poorly

functioning high stress unit.

Ken’s first action was to stop the doctors from making scheduling changes as needed.

Ken understood that a structured schedule was needed and followed to promote progressive

functioning of the unit. He accomplished this task by incorporating all members of staff to

collectively establish policy and regulation of the laboratory. Ken addressed change in a

collective and democratic approach. If change were needed he would only act on it if a majority

of the staff agreed to the proposition. Ken would then directly bring that to the COO and CEO

for approval. Only then would change take place.

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Power of influence.

Power is the ability to influence others in an effort to achieve goals Yoder-Wise (2011).

Ken knew that he needed to use his power and influence to bring the cath lab together as

cohesive unit. Ken accomplished this by establishing democratic style meetings. In these

meetings the doctors and nurses could come together and develop scheduling policies that

worked for the majority. In doing this, Kenneth displays empowerment. Empowerment is the

process of exercising one’s own power Yoder-Wise (2011). According to Purdy et. All (2010)

“empowering work environments for nurses have the potential to impact group processes and

thereby work effectiveness as reflected in patient outcomes (2010).” Empowering staff lets them

feel that they have some control of the work environment. This increases morale and in turn

increases patient care outcomes.

Reflection

Nurse managers and clinical leaders provide an important role in the healthcare system.

Effective nurse managers and leaders establish cultural competency, knowledge of legal and

ethical issues, effective power and influence, decision-making abilities, and resolution of

conflict. Ken exhibits all these ability and behaviors in his time being a successful nurse

manager. He also displays exceptional leadership skills when being a nurse manager. Ken is

highly respected among the staff and the patients he cares for. His staff and patients respect him

because he openly and honestly converses with staff. When he makes decisions, he acts in a fair

manner and taking in account everyone’s opinion. Ken is understandings when scheduling and

laying out assignments for the cath lab. Ken is stern, factual and concrete when delivering

needed disciplinary actions to staff. He is also displays open-minded approach when managing

conflict resolution between staff. These dynamics as a nurse leader donate to successful patient
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outcomes, withholding staff, and quality of care, safe and positive work environment. Overall,

Ken gave excellent insight to the everyday responsibilities and situations that a nurse managers

regularly encounter and how to be successful in ironing out issue and situations in the healthcare

arena. Ken was very educational and is a great role model of an excellent nurse manager.

References

American Nurses Association [ANA]. (2010). Nursing: Scope and standards of practice (2nd

ed.). Silver Spring, MD

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Purdy, N., Laschinger, H. K., Finegan, J., Kerr, M., & Olivera, P. (2010, November). Effects of

Work Environment on Nurse and Patient Outcomes. Journal of Nursing

Management, 18(8), 901-913.

Siu, H., & Laschinger, S. (2008, May). Nursing Professional Practice Environments:Setting the

Stage for Constructive Conflict Resolution and Work Effectiveness. The Journal of

Nursing Administration, 38(5), 250-257.

Yoder-Wise, P. S. (2011). Leading and Managing in Nursing (5th ed.). St. Louis, MO: Mosby

Elsevier.