1. Richmond, Patricia A. MSN
  2. Book, Karyn MSN
  3. Hicks, Mary MSN
  4. Pimpinella, Annette MSN
  5. Jenner, Cathleen A. PhD

Article Content

Integral to the hospital organization, the nurse manager has many roles to juggle simultaneously, often leading to role strain. Role strain is defined as the "subjective feeling of discomfort experienced as a result of role stress; it may manifest itself through increased frustration, heightened emotional awareness, or emotional fragility to situations."1 This article describes the diverse roles nurse managers perform, associated role strain, and the use of communication, organizational climate, mentoring, and empowerment (C.O.M.E.) strategies to prepare nurse managers to be effective leaders in their healthcare institutions.


The challenge of multiple roles

The activities included in the job description for a nurse manager are:


* staffing for patient care


* developing goals and objectives for the unit


* establishing standards of care


* developing budgets and using resources in a cost-effective manner


* implementing quality improvement activities to affect patient outcomes


* engaging in problem solving


* planning, organizing, managing, controlling, and directing unit activities


* hiring, orienting, evaluating, and educating staff


* mentoring and developing staff


* identifying systems problems and suggesting solutions


* acting as a resource for clinical issues


* ensuring compliance with policies, procedures, and accrediting or regulatory agencies


* recruiting and retaining staff


* participating in organizational committees and task forces


* acting as a corporate supporter.2



Nurse managers today have experienced changes in their roles. Responsibilities that were once performed by nursing directors have been incorporated into nurse managers' scope of practice. These include emphasis on efficiency, human resource issues, increased use of technology, the multidisciplinary nature of healthcare, and the constancy of change. Often, managers have more than one unit to supervise and they always have 24-hour accountability. When a unit is short on nurses, many managers may work as staff in order to provide adequate coverage for patient care; this is in addition to their management responsibilities. When managers don't successfully balance all their roles, they're at risk for not meeting their responsibilities, which may impact the organization as well.


Consequences of role strain

Many aspects of the organizational healthcare environment are affected when the nurse manager isn't able to adequately fulfill her role as a nursing leader. Communication may break down with staff, physicians, and patients and their families. The quality of care that's provided to the patient may become compromised. Patient, staff, and physician satisfaction may decline as a result. Ultimately, the healthcare team may become fragmented and less cohesive. Staff will begin to feel frustrated and overwhelmed in their roles; this may lead to increased nursing turnover. The organization suffers in that the manager loses respect and credibility from the staff and physicians as she loses control of the day-to-day operations of the unit. Financial repercussions may develop and productivity may decrease.


On a personal level, when a nurse manager hasn't met her roles and responsibilities, a sense of failure may result. Intense frustration and anxiety about not being able to perform the job to the best of her ability may lead to personal problems in the form of stress, emotional fatigue, physical aliments, and a change in interpersonal relationships. Ultimately, the manager may leave the field of nursing administration, feeling overwhelmed and unfulfilled.


Strategies for successful management

The strongest predictor of job satisfaction is effective administrative support.3 Many articles have focused on the retention of nursing staff and nurse satisfaction; however, few articles have addressed satisfaction among nurse managers.4 The staff nurse is often promoted to the position of nurse manager with little formal management training.2 While new managers may incorporate the skills they already possess, such as communication, planning, organization, prioritization, and documentation, into their new roles, they also need a more formal, ongoing structured program in place to assist them to develop a different set of skills that are essential for managing and leading. Vague job descriptions, the absence of a formalized orientation, inadequate feedback and guidance, and lack of mentorship contribute to the difficult adjustment many new managers encounter.2 Strategies based on C.O.M.E. are useful ways nurse executives can ease the transition for clinicians to the nurse manager role. Application of these strategies can assist nurse managers to embrace their role in fulfilling the organization's mission of quality patient outcomes. This type of support may be crucial in retaining qualified managers. Let's take a closer look.


* Communication


- clear expectations and written job descriptions


- establishment of goals with regular assessment of progress in achieving them


- regularly scheduled meetings between the manager and immediate supervisor


- group management meetings that are focused with an agenda and timeframe


- open communication between the nurse manager and immediate supervisor


- timely feedback to assist with development of leadership and management skills


- regular interaction with the chief nursing officer


- opportunity for interaction and communication with senior administration


- appropriate clerical support for writing reports, schedules, and other activities


* Organizational climate


- the organizations' vision, mission, and goals are shared with nurse managers


- opportunity for nurse managers' individual and professional development


- accomplishments are recognized and rewarded


- compensation is commensurate with the nurse manager's level of responsibility and accountability


- the organization supports an environment in which there's a balance between work and personal life


* Mentoring


- orientation to the role of nurse manager


- regular coaching sessions by the immediate supervisor based on assessment of strengths and weaknesses


- formal peer mentorship program


- workshops or conferences that address human resources and financial management issues relevant to nurse managers


- training and support in the use of technology


* Empowerment


- the power of nurse managers to use their own judgment to manage their departments


- support for decisions made by the nurse manager


- involvement in planning and decision making within the nursing department


- encouragement to be creative in solving problems


- recognition for quality care and service to patients


- reward for patient satisfaction scores that meet or exceed goals


- participation in strategic planning and institutional committees.



Support is the key

Every day nurse managers strive to please patients and their families, staff, nurse executives, hospital administrators, and physicians. It's increasingly difficult to manage all of them effectively. In order to maintain middle-level nursing leadership that has a positive impact on the quality of patient care, managers need attention paid to orientation, education, and mentoring. "C.O.M.E. be a nurse manager" will then be an inviting phrase to RNs seeking to pursue a career in nursing management.




1. Yoder-Wise PS. Leading and Managing in Nursing. 4th ed. St Louis, MO: Mosby; 2007:610. [Context Link]


2. Morelli TM. The Nurse Manager's Survival Guide. St Louis, MO: Mosby; 2004:3. [Context Link]


3. Parsons ML, Stonestreet J. Factors that contribute to nurse manager retention. Nurs Econ. 2003;21(3):120-126. [Context Link]


4. Thorpe K, Loo R. Balancing professional and personal satisfaction of nurse managers: current and future perspectives in a changing health care system. J Nurs Manag. 2003;11(5):321-330. [Context Link]