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Running head: INTERVIEW

NURSE LEADER INTERVIEW

Ashlee Knoll

Ferris State University

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Nurse Leader Interview

Leadership is very complex and should be demonstrated by all nurses. Yoder-Wise

(2015) defines a leader as an individual who works with others to develop a clear vision of the

preferred future and to make that vision happen. The purpose of this paper is to share the

characteristics and responsibilities that RD exemplifies as a mentor in leadership. RD attended

Eastern Michigan University where she obtained her Bachelors of Science in Nursing in 1996.

She began her career at Ascension St. Mary’s Hospital as a graduate nurse and has remained

there for 22 years while expanding her career. She started as a floor nurse on the Neuro

Progressive Unit (NPC), became the unit coordinator, and then transitioned to the role of nurse

manager for NPC and NICU. She has remained in that position for eight years and has recently

accepted a position as Administrative Manger responsible for the staffing and throughput for the

hospital and will begin next month. RD also holds certifications as a Stroke-Certified Registered

Nurse (S.C.R.N.) and Certified Neuroscience Registered Nurse (C.N.R.N.). An overview of

R.D.’s role and responsibilities of a nurse leader will be discussed. The Nurse Manager

Competencies (NMC), from the American Organization of Nurse Executives (AONE), will be

described and R.D.’s fulfillment of them will be analyzed.

Role and Responsibilities

Ascension St. Mary’s Hospital is a smaller facility when compared to other Ascension

ministries nationally. This often forces management to operate within several disciplines to be

effective and affect change within the organization. The managers are typically responsible for

more than one nursing unit, which increases the number of direct reports they oversee. The

managers will assist in quality assurance by collecting data, staffing coverage, case management,

associate education and engagement and a variety of other tasks that can become overwhelming.
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Role

As a manger, R.D.’s role fluctuates based on the needs of the unit. Her knowledge base is

expansive regarding the functionality of her areas and she uses her time to the most productive,

even if it is assisting with call lights, answering phones, or even passing medications. RD serves

as a voice for frontline staff to be heard and represented to higher-level management. By being a

voice and a resource to frontline staff, RD understands barriers and can develop solutions to help

them complete their jobs. Cathcart, Greenspan, and Quin (2010) explain that:

Expert nurse managers in their best practice are able to engage in demanding relational

work, to see what is at stake in particular open-ended situations and to intervene in ways

that assure good outcomes while supporting the ongoing development of nursing staff

and other members of the healthcare team. (p. 441)

She engages with the staff fully to help develop and support the staff as they continue expanding

their education and career.

Responsibilities

The responsibilities of the nurse manager seem never ending. There are a lot of the tasks

that must be completed very often go unnoticed by others. Cziraki, Peachey, Baxter and Flaherty

(2014) state that the first-line nurse manager position is one of the most challenging in health-

care because of the broad range of responsibilities. The responsibilities of the nurse manager are

defined in depth within the NMC. The American Organization of Nurse Executives (AONE)

developed the NMC and divided them into three different domains including the science, the

leader within and the art, that all must be present for successful nurse leaders (AONE, 2015).

RDs daily routine of responsibilities includes staffing management, safety huddle, payroll,

productivity management, and human resource management. There is a lot of problem solving
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that is essential day to day for RD. Often she feels like she is unable to complete the daily tasks

of her position because there are so many issues that arise that must be dealt with timely. Since

RD has learned and understands the available resources within the organization, it allows her to

better solve the problems at hand. Other responsibilities that must be completed by the nurse

managers in the organization include ordering supplies (office supplies/furniture/equipment),

participating in different committees, evaluating safety events, chart audits, environment of care

rounds, and maintaining patient satisfaction.

Organizational Structure and Philosophy

The Daughters of Charity established Ascension St. Mary’s Hospital, formerly known as

St. Mary’s of Michigan- Saginaw, in 1874. The Daughters of Charity sold health insurance

certificates for five dollars to cover the care of lumbermen in the area with only two stipulations:

the hospital will not treat men who are drunk, and they would not treat those with infectious

diseases because of their ward style of which they cared for patients. Ascension is the largest

nonprofit health system in the United States and the world’s largest Catholic health system. With

a vision to create a One Integrated Ministry across Ascension facilities, the mission, vision and

values were adapted by all Ascension facilities in 2017:

Rooted in the loving ministry of Jesus as healer, we commit ourselves to serving

all persons with special attention to those who are poor and vulnerable. Our

Catholic health ministry is dedicated to spiritually-centered, holistic care which

sustains and improves the health of individuals and communities. We are advocates for

a compassionate and just society through our actions and our words (Ascension, 2018)

Restructuring was completed based on geographical locations where the to share leadership and

resources within regions. Ascension St. Mary’s Hospital belongs to the Mid-Michigan region as
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part of the northern ministries. In June 2018, after a year of discernment plans and rumors,

Ascension announced that they were recommitting to the northern ministries by investing $50

million dollars to revitalize the organization. RD explains that managing her team through the

unknown of the future with Ascension was the most difficult thing she has experienced thus far

as a manager. RD and other staff members continue to feel cautiously optimistic as they watch

Ascension practice their mission and values (reverence, wisdom, dedication, service of the poor,

creativity and integrity) within the organization. RD has been at Ascension St. Mary’s Hospital

for the entirety of her career and she sometimes struggles with the standardization that has been

created. Ascension is moving towards a one integrated vision across all that makes it feel as

though the identity of each place is being stripped away.

Organizational Chart

One of the frustrations that RD has regarding the organizational chart at St. Mary’s, when

compared to other Ascension facilities, even within the same region, it becomes evident how thin

the management structure is in Saginaw. RD is responsible for 90 direct reports and three

separate units with no assistant manager for support. RD reports to JL as the nursing director for

theses three neuro units. In addition to the three neuro departments, JL acts as nursing director

for the following departments as well: orthopedics, respiratory (regionally), Medical ICU,

administrative managers, rapid response team, dialysis, and the cast room. JL has also been at

St. Mary’s for the entirety of her career. JL has been grooming RD as part of a potential

leadership succession plan. It is predicted that the largest group of nurse managers with long

career and practice experience and higher levels of organizational commitment will retire within

the next ten years (Cathcart & Greenspan, 2013). Above JL in the organizational chart is the

regional VP of nursing, and above him is the regional president. The regional president reports to
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the Ascension Michigan leadership team and then from there they report to the Ascension

National leadership team.

Human Resource Management and Human Resource Leadership Skills

One of the most time consuming parts of RD’s position is completing the schedule for

her units. Her goal is to have the schedule as complete as possible when submitting to prevent

the last minute scramble to find staff. She works with the central staffing office to determine the

needs based on census patterns, utilizing a master schedule as a guideline. In effort to ensure that

she is hiring strong associates that will work well with others, RD has certain criteria that she

looks for while interviewing prospective candidates. Experience in customer service, especially

McDonald’s because of their strong policies on serving customers, is one of the first things she

hopes to see on applications. RD also capitalizes on potential she sees in people that are

completing nursing clinical on her units or nursing assistants that are in school by evaluating

their ability. She looks at these opportunities to determine if they would be the type of employees

she would be interested in hiring.

Although there are several people that report to RD, she still attempts to develop

relationships with her staff to better understand them. By taking an interest in the nursing staff, it

humanizes them affecting the way RD listens and interprets situations. When the nurse manager

learns that fairness is best ensured within a blameless, yet accountable culture where intent

determines the appropriate corrective action, they will develop a more trusting environment

amongst staff (Cathcart & Greenspan, 2013). With so many direct reports, RD admitted that a lot

of the human resource leadership skills such as education assessment and performance

development is difficult because there is not enough time. Cziraki et al. (2014) explains how

front line managers are responsible for maintaining current knowledge and experience in their
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specific area of practice, supporting the education and professional development of junior

nursing staff and acquiring knowledge about information technology, risk management, financial

analysis, human resources, and labor relations. These factors are some of the reasons RD made

the decision to change roles to a position that does not have any direct reports. The continuous

interruptions at home by work related issues strongly impacted her decision to transition roles as

well.

Performance Improvement and Strategic Management

There are several initiatives in place within the organization to help mange performance

improvement and strategic management. RD works closely with the stroke program coordinator

to ensure that the nursing staff maintains appropriate practice and documentation to be in

alignment with the metrics defined by The Joint Commission to maintain their primary stroke

center designation. Other data that is continually reviewed by RD are the Hospital Consumer

Assessment of Healthcare Providers and Systems (HCHAPS) scores and the Key Performance

Indicators (KPIs). By understanding the information that is collected and the questions that are

asked for these metrics, RD can better focus on the areas of improvement that are necessary for

patient outcomes and satisfaction. RD is also on the patient engagement committee to collaborate

with those that are directly impacted by the care the nursing staff provides.

Ascension St. Mary’s also practices the five principals of high reliability including

preoccupation with failure, sensitivity to operations, reluctance to simplify interpretations,

commitment to resilience, and deference to expertise. These principals, along with error-

prevention techniques, are utilized to maintain a safe environment and are applied to situations

that are reported at the daily safety huddle attended by RD. Listed below are some of the error

prevention tools that are taught and encouraged in a high reliability organization:
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Stop Think Act Review (S.T.A.R.)

Situation Background Assessment Recommendation (S.B.A.R)

Ask a Question, Make a Request, Voice a Concern, Use Chain of Command (A.R.C.C.)

Paying attention to detail (Ascension, 2018)

When there are safety events that occur or events that can be defined as a near miss, associates

will enter them into the electronic safety reporting system-allowing RD to review and respond

appropriately. In a study completed by Gilbert, Von Ah, and Broome (2017) it was determined

that reduction in patient harm may generate cost savings to healthcare organizations, increase the

reputation of the healthcare organization, increase nurse commitment and engagement, and

inform changes in organizational policy and procedure.

R.D. conducts a monthly staff meeting to ensure that the staff maintain informed of

issues, receive safety event follow up, understand change implementation, and have the

opportunity to offer input. She disperses the meeting minutes via email and posts them within the

unit to encourage the staff to engage within the department. Nurses within healthcare

organizations are encouraged to rely on knowledge and data that can be measured and

generalized to manage risk and promote change (Cathcart & Greenspan, 2013).

Relationship Management and Influencing Behaviors

RD has been essential in the development of the team that is present within the neuro

departments. She experiences nurse turnover as every nursing unit does, but of her 90 associates

reporting to her, over half of them have maintained employment for at least three years. R.D.

believes that by practicing transparency, associates feel more supported, empowered and

encouraged to practice effectively. Gilbert et al. (2017) believes that if “trust exists between the
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nurse manager and the nurses on the unit, there will likely be an increase in the feeling of trust

and harmony among team members leading to more effective team dynamics” (p.702). RDs

claims that her biggest goal as a nurse manager was to have her staff understand that she truly

cares about their personal and professional wellbeing. Although she gets along well with the staff

and they have strong working relationships, she continues to hold them accountable for their

actions. Because of this, she is more respected among her reports. The NMCs provide a

framework of the expectation of nurse managers but there is no clear mechanism that has been

identified to define the relationship between nurse managers and the influential relationships

created with staff. It is evident that the relationships between nurse manager and staff has

demonstrated positive or adverse influence on relationships, productivity, turnover, job

satisfaction, and quality patient outcomes (Gilbert et al., 2017).

Personal and Professional Accountability

Because of strong physician involvement regarding cutting edge practices and procedures

over several years, the Neuroscience department at Ascension St. Mary’s Hospital has become

very robust. Because of the growth seen within the department and the designation as a primary

stroke center, it is required by staff to obtain their Stroke-Certified Registered Nurse (S.C.R.N.)

and Certified Neuroscience Registered Nurse (C.N.R.N.) certifications after two years of

employment. RD and the rest of the neuroscience department are continually working towards

obtaining the Comprehensive Stroke Center designation for the hospital. RD is also a member of

the American Association of Neuroscience Nurses and attends a neuroscience conference

annually. She truly has a passion for neuroscience nursing and the innovation within the field.

RD is also a member of the ethics committee that meets monthly. Members of this

committee discuss cases to further develop their ability to respond appropriately and in alliance
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with the Ethical and Religious Directives (ERDs) as defined by catholic healthcare. The ethics

team is consulted to help evaluate patient care, family dynamics and dignity of life when

healthcare providers feel that it is necessary.

Financial Management

RD possesses a strong understanding of productivity and how it is impacted in relation to

the ongoing flexing of nursing associates based on census. Currently Ascension is requiring

100% productivity in at least 80% of their departments at each ministry. This is especially

difficult when all the factors that impact productivity are evaluated. RD doesn't want her staff to

feel as though they are just a number as they have previously expressed. However, in the bigger

picture that is all that is being evaluated which puts an enormous amount of stress on the nurse

leaders. Health care reform, advances in technology, increased budgetary constraints, and

increasing regulations have contributed to feelings of being overwhelmed, burnout, and

increased turnover in nurse managers (Gilbert et. al, 2017). RD also participates annually in the

formation of the budget for the next fiscal year. She states that she often gets frustrated during

budget time because the finance department typically creates the budget and there is not much

room for alterations.

Conclusion

Nurse managers have a very wide range of responsibilities and serve as a communication

link between front line staff and higher-level management. I appreciate and understand the

constant pressure that the nurse manager must experience as well as the inability to maintain a

proper work life balance leading to a high turnover in management. I recognize that nurse

managers often have a conflicted point of view as they relate to both the front line staff as well as

higher-level management. During this interview I explained the roles and responsibilities of
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nurse managers. I also described and analyzed the Nurse Manager Competencies and how they

relate to the overall development of nurse managers.

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References

American Organization of Nurse Executives. (2015). AONE Nurse Manager Competencies.

Chicago, IL: Author. Accessed at: www.aone.org

Cathcart, E., & Greenspan, M. (2013). The role of practical wisdom in nurse manager practice:

Why experience matters. Journal of Nursing Management, 21, 964-970.

doi:10.1111/jonm.12175

Cathcart, E., Greenspan, M., & Quin, M. (2010). The making of a nurse manager: the role of

experience learning in leadership development. Journal of Nursing Management, 18,

440-447. doi:10.1111/j.1365-2834.2010.01082.x

Cziraki, K., Mckey, C., Peachey, G., Baxter, P., & Flaherty, B. (2014). Factors that facilitate

Registered Nurses in their first-line nurse manager role. Journal of Nursing

Management, 22, 1005-1014. doi:10.1111/jonm.12093

Gilbert, J. H., Von Ah, D., & Broome, M. E. (2017). Organizational intellectual capital and the

role of the nurse manager: A proposed conceptual model. Nursing Outlook, 65, 697-710.

doi:10.1016/j.outlook.2017.04.005

High Reliability Organization (HRO) Principles. (2017). In Solutions for Patient Safety .

Retrieved from http://app.ihi.org/FacultyDocuments/Events/Event-2491/Presentation-

10595/Document-8970/Tools_HRO_Principles.pdf

Our Mission. (2018). In Ascension . Retrieved October 16, 2018, from https://ascension.org/Our-

Mission/Mission-Vision-Values

Yoder-Wise, P.S. (2015). Leading and managing in nursing (6th ed.). St. Louis, MO: Elsevier.