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The challenges of nurse management

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The challenges of nurse management

While the role of manager can be one of the most rewarding in the nursing and allied health professions, it pays to be aware of some of the ongoing challenges affecting leadership roles, writes Belinda Smart
Heather Buttigieg has worked in a wide number of roles ranging from floor worker in varied clinical arenas, to nurse unit manager (NUM), to educator and assistant director of nursing. 
With a wealth of experience under her belt, she is well positioned to comment on numerous challenges faced by nurse managers and leaders. These, she notes, are vastly different from those of the days of the ‘charge nurse,’ when the bulk of the emphasis of the role was based around the clinical management of the ward or unit.
“The current role of nurse or mid unit managers (NUM) is to ‘manage
their business unit.’ Many managers have clinical training and expertise only; in other words they do not have academic qualifications in a business related field, but nevertheless are expected to manage matter such as budgets, OH&S, rostering and clinical issues, training, conflict resolution, organisational behaviour and so on.”
Some managers attend rudimentary ‘first line management programs’ to assist them in gaining a degree of business acumen, Heather says, but this doesn’t necessarily factor in associate unit managers (AUM) who are predominantly of the ‘clinical mindset’ without grounding in the business arena. “This frequently causes friction from the AUM level as many demands are often seen merely as ‘pressure from above’, also leading to frustration for the NUM. It is a difficult role juggling many hats.”
A major issue for managers remains one of training, largely due to funding restrictions, she says. “Where is the line between paying staff for ‘mandatory training,’ and expecting staff to attend training programs in their own time? The majority of NUMs firmly believe that staff should be paid for their training days and that there should be ‘backfill’ to enable staff to be out of the unit. This can be a bone of contention between NUMs and those to whom they report. The various codes of ethics, professional standards and conduct all support the training and professional development of nurses and midwives, but it can be a logistical nightmare for managers to orchestrate this in an equitable and acceptable way as they are often locked into scaling down expenditure.”
And despite the often aired discussions about the importance of nurse to patient ratios, she adds that staff are frequently cut or not replaced if they are off sick, as the constraints of budget take precedence. Similarly when one to one care is required for either staff or patient safety, the bureaucracy encountered in gaining appropriate staffing numbers can lead to frustration. The result is that a key challenge for managers is to control staff morale.
Meanwhile preceptor programs, which are designed to enable more experienced nurses to lead and mentor their juniors within a formal framework, are “great in theory but fraught with difficulty in practice,” she says. 
‘Convenience preceptoring’ that is not based on merit or experience, in other words the role of preceptor (or mentor) simply being given to the nurse who turns up to work first, is “sadly a fact of life that happens all too often, again due to inadequate funding,” she says. 
“In an ideal world only those who have undergone preceptor training should be preceptoring. They should also have a lighter clinical load as it is virtually impossible to provide full care to a full patient load and precept a junior staff member who also has a full patient load. In the real world this is not the case however, so it becomes a huge issue and strain on those undertaking the preceptor role. There are many situations where preceptees may have a different preceptor every shift they work.” 
Gilly Johnson concurs. A leading commentator on the subject of preceptoring, Gilly has been involved in education, mentoring and learning and development since 1993 and has designed and implemented national mentoring programs for tertiary nursing students across Australia. More recently she helped drive the creation of adult education and professional development centre, the Australian Mentor Centre.
She comments that good preceptoring is vital to the future success of the profession as the preceptor role is part of the public relations framework that promotes nursing both to new comers to the profession and ultimately the public. 
“Nursing preceptors are the frontline Public Relations for the nursing profession, the healthcare organisation, the specific workplace, and most of all, for their own personal professional standing. The role has the power to exert a significant influence and impact, both positively and negatively, on nursing learners of all types.”
However Heather believes that thanks to the current funding squeeze, the hurdles standing in the way of effective preceptor programs, along with the wider challenges faced by managers, do not look set to be resolved any time soon. Yet despite all that, while those entering management positions within the nursing and allied health sectors should be mindful of the trials affecting such roles, she maintains nurse management remains one of the profession’s most rewarding spheres. 
“It is exhilarating to be able to lead a team towards optimum care - to educate and encourage them in their professional development and then to see the level of knowledge and care they can achieve. The more you lead and face the challenges of the role head on, the more you grow as a professional.” 
Heather has now given up her nurse manager roles and returned ‘to the floor’ as a clinical midwife. While she says she sometimes misses the leadership role, she also says her experiences in management have made her “a much better clinician with much greater understanding of why things happen the way they do.” 
“I have every confidence I will return to a management or leadership role at some stage – I’m just enjoying some time out and a change of scenery!”
She agrees with Gilly Johnson that good leadership plays a key ‘PR’ role in promoting the growing stature of the profession. 
“When I first started nursing it was an apprenticeship model of training, one that was thought of as bed pan attendants and something you did if you were either a ‘born nurse’ or didn’t get enough marks to get into uni. We have now fought long and hard to promote our status as professionals, highly skilled professionals at that, and to be recognised for our academic achievements. We need to shed those prior images - I think we’re getting there - and promote the profession for what it is. After all, how many careers are there where you can have multi career moves within the same profession, taking you in so many directions?” 
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