A positive, well-managed team can help turn a difficult and demanding job into one that is supportive and rewarding. Over the years, I have worked for nurses who were good leaders, but poor managers and also for nurses who were good managers, but poor leaders. I've also worked for some who were both good managers and good leaders, although they were in the minority.
What skills does a manager require?
Take a few moments to reflect on managers you have worked for and identify their individual management skills and abilities. Think about your own skills as a manager; what is it that you expect of yourself and other managers, irrespective of the position they hold in the healthcare hierarchy? After you have given this some thought, try to write down, in one short sentence, what you expect of a manager.
The sentence that I have compiled is: ‘A manager is someone who is able to organise and co-ordinate the human, physical and financial resources of their area and communicate the outcomes with others.’
My sentence is not meant to be a text book summary, but one for you to compare your ideas with and look for similarities and differences. Central to my thoughts is the management of resources; be they people, equipment or money. I am also aware that there is a legal aspect in current day nursing practice that can involve coroners' courts, tribunals and official complaints. While this is a routine skill for some managers, for others it may rarely be required. I therefore add an acknowledgement that the manager needs to be aware of their own skill limitations and recognise when to call on experts within the healthcare system. A manager should know their abilities and sphere of authority, but should also know their limitations and when to seek expert advice.
Identifying everyday resource issues
- Human resources: one of the most valuable resources any nurse manager is responsible for is their staff; management of staff is both complex and varied and includes recruiting and keeping a full establishment of staff. A team that is constantly understaffed, or has a heavy reliance on inexperienced agency staff can quickly become drained. A manager is also responsible for the correct skill mix, not just in the team as a whole, but also during each shift; which has implications for the management of annual leave and off-duty requests. Other human resource areas include statutory training, professional development, clinical supervision as well as festive parties and social gatherings!
- Physical resources: take a few moments to think about all the routine equipment that you use in your clinical area each week. There is nothing more frustrating for a clinical nurse than going to the store room to get a catheter or an IV fluid to find that the last one has been used. A ward manager recently told me how she ordered an air conditioning unit for a hot and poorly ventilated room, but had to communicate with about four different hospital areas to get it approved, purchased, fitted on the wall and then wired in. There are so many different types of physical resources that are required, that it is impossible to begin to list them; an important skill of the manager is to listen to the needs of the staff and delegate specific responsibility to individual members of the team for routine monitoring and ordering of stock
- Financial resources: budgets are generally devolved to the clinical level in terms of routine equipment, staff costs and staff training. These tend to be agreed at strategic levels once a year and monitored on a monthly basis. Financial balance sheets in themselves are not that complicated, but consider managing the staffing levels when three essential nurses are on long-term sick and you need to either buy in agency staff or recruit above accepted numbers. The nurse manager must put a revised business plan to a financial manager, who is rarely a nurse, and this negotiation is one of the advanced skills of the nurse manager.
The skills of a manager are wide-reaching and at times complex. It can feel like juggling too many balls at one time. Despite this skilled juggling performance, a nurse manager will still need to find the time, energy and personal skills to communicate all these various actions with their staff in a way that is positive and supportive. This is genuinely difficult, but if the manager doesn't have that final skill then the team will feel managed, but not led.