Reexamining Nurse Manager Span of Controlling

Reexamining Nurse Manager Span of Controlling ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Reexamining Nurse Manager Span of Controlling Instructions: Read – Journal Article: Reexamining Nurse Manager Span of Control with a 21 st Century Lens Submit – Two-page APA 6 th edition reflective response to the article with at least two references. Reexamining Nurse Manager Span of Control Essay attachment_1 Nurs Admin Q Vol. 43, No. 3, pp. 230–245 c 2019 Wolters Kluwer Health, Inc. All rights reserved. Copyright Reexamining Nurse Manager Span of Control With a 21st-Century Lens Anna Omery, DNSc, RN, NEA-BC; Cecelia L. Crawford, DNP, RN; Ann Dechairo-Marino, PhD, RN, NEA-BC; Beverly S. Quaye, EdD, RN, NEA-BC, FACHE; Jim Finkelstein, MBA, BA The primary aim of this literature review was to examine the quantity, quality, and consistency of evidence regarding the span of control (SOC) speci?c to nurse managers. A secondary aim was to meaningfully translate the evidence and offer guidance to 21st-century nurse leaders. The review results were categorized using Donabedian’s (2003) Structure-Process-Outcomes model. The Structure-Process-Outcomes approach was used to review the literature and consider SOC recommendations for today’s health care environment. Structures outlined the conditions for current SOC, which included material resources, human resources, and organizational characteristics. Processes were de?ned as activities or actions stemming from identi?ed structures that led to outcomes. Examples included management/administrative activities, as well as frontline staff participation in these tasks. Outcomes were performance measures of human resources, ?nancial, and quality metrics. The review revealed that an SOC model built on a simplistic full-time employment ratio is outdated. Yet, nurse managers remain in their role in the face of these simplistic models despite feelings of inadequacy, exhaustion, and failure because they passionately care about patients and staff. New attitudes and integration of advanced technologies, pioneering tools including SOC assessment tools, and ongoing competency developments will result in different needs of SOC as health care moves deeper into the modern era. This evidence is offered to inform and drive conversations focused on providing optimal nurse manager SOC for maximum effectiveness within unique and ever-evolving care environments. Key words: manager span of control, nurse managers, span of attention, span of authority Author Af?liations: Clinical Practice (Dr Omery) and Evidence-Based Nursing Practice (Dr Crawford), Kaiser Permanente Southern California, Regional Patient Care Services, Pasadena; Providence Holy Cross Medical Center, Mission Hills, California (Dr Dechairo-Marino); California State University, Fullerton, School of Nursing, College of Health and Human Development, Fullerton (Dr Quaye); and FutureSense, LLC, San Rafael, California (Mr Finkelstein). The authors declare they have no con?icts of interest, including ?nancial, consultant, institutional, and other relationships that might lead to bias or a con?ict of interest Correspondence: Cecelia L. Crawford, DNP, RN, Evidence-Based Nursing Practice, Kaiser Perma- B EFORE the restructuring of health care in the 1990s, novice nurses worked closely with nurse leaders in an “apprenticeship system” that fostered professional development. Reexamining Nurse Manager Span of Control Essay 1,2 This vital mentoring process facilitated the growth of nursing professionals. However, nurse managers’ (NMs’) span of control (SOC) widened during the turbulent 1990s, with staff nurses spending less nente Southern California, Patient Care Services, 393 E Walnut St, Pasadena, CA 91188 (Cecelia.L. [email protected]). DOI: 10.1097/NAQ.0000000000000351 230 Copyright © 2019 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited. Reexamining Nurse Manager Span of Control time with their nurse leaders. The negative effects of increased SOC continued into the 21st century, with dramatic in?uences on staff development, job satisfaction, and structural empowerment.1,3-5 Nurse managers have seen their relationship management/ staff empowerment diminish and job satisfaction decrease.2,5-7 Ensuring that NMs have reasonable SOCs not only assists in their personal, leadership, and clinical development but also allows them to empower frontline nurses in practicing to the full scope of their professional role.2,8,9 Patient outcomes are enhanced by strong competent nurses at the bedside and in the boardroom. This narrative review of the literature will present the integration of research, commentary, opportunities, and potential solutions, with the focus on NMs’ SOC. The impacts of outcomes and correlates, such as the scope of complexity and leadership style, are also presented. We offer evidence-based recommendations for nurse executives and other nurse leaders to consider regarding appropriate SOC and administrative decisions for their organizations. THE REVIEW Review aim and design The primary aim of the review was to examine the quantity, quality, and consistency of evidence regarding the SOC phenomenon speci?c to NMs. A secondary aim was to meaningfully translate the evidence and offer guidance to 21st-century executive leaders and NMs. Methodology, appraisal, and evidence abstraction Review phases included creation of clinical and searchable questions and terms; data retrieval; evidence appraisal; data interpretation and synthesis; and a narrative summary. The review question was crafted by the Nursing Leadership Council of the Hospital Association of Southern California.10 A systematic database search structured the review’s sec- 231 ond phase. The review started in January 2014 and the search was updated until October 2016. The search yielded 61 relevant articles. Several rounds of review, elimination, and other article identi?cation resulted in 28 ?nal citations. Evidence evaluation took place during the third phase, with article ranking and grading. Review articles were examined for more than 4 months during the fourth phase of data abstraction (Table 1). The strength of the evidence was graded as moderate to high quality (Table 2). We urge nurse leaders to view low to moderate quality evidence as a springboard for dialogue, innovation, and investigation, rather than an automatic stop.31 Evidence synthesis and limitations Data analysis and interpretation took place during the ?nal phase to establish common categories used in the narrative overview, evidence summary, and recommendations. Result limitations included self-report surveys, mixed response rates, and variations in participants’ demographics. Ten articles were published by Nursing Management and may represent article homogeneity. Some articles may not be generalizable to the United States, as many authors were based in Canada. Finally, the evidence spans decades, with 1 article from 1988, 5 articles from the 1990s, 15 citations during the 2000s, and 7 articles published between 2012 and 2013. Reexamining Nurse Manager Span of Control Essay REVIEW RESULTS We categorized review results using Donabedian’s (2003) Structure-Process-Outcomes model.32 We took the model’s concept and adapted it for NM SOC. The Structure-ProcessOutcomes approach was used to review the literature and consider SOC recommendations for today’s health care environment. Structures outlined the conditions for current SOC, which included material resources, human resources (HR), and organizational characteristics. Processes were de?ned as activities or actions stemming from identi?ed structures that led to outcomes. Examples Copyright © 2019 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited. Case Study Alidina and Funke-Furber (1988)12 Altaffer (1998)13 Nonexperimental Design Systematic Review Grounded Theory Study Armstrong-Stassen and Cameron (2003)3 Brown et al (2013)14 Carney (2004)15 Explore factors known to in?uence NM retention and intention to stay How organizational structure aligns/impacts with strategic management of NM role Examine relationship of nurses’ personal, job, and organizational dimensions Examine organizational support and staf?ng on nurse job dissatisfaction, burnout, and quality of care Discussion of SOC concept, structures, implications, and in?uencing factors Examine FL NM vs non-NM scope, SOC, and perception of effectiveness Multisite Cross-sectional Survey Aiken et al (2002)11 Descriptive Survey Design Purpose Evidence Source Reference Table 1. Literature Review References Common concerns were dissatisfaction, burnout, and quality of care Managerial support/adequate staf?ng plays key roles for quality of care, job dissatisfaction, burnout, and nurse retention Optimal SOC is necessary for NM role and responsibilities Understanding certain in?uencing factors can optimize NM SOC NMs scored greater effectiveness than non-NMs, even though they supervise more staff, have fewer assistive personnel, and paid less Respondents did not rank themselves as highly effective in any dimension; suggests that unstable care environment contributes to negative perception of effectiveness Organizational control predicted changes in support and trust. Although nurses reported low organizational control, more than 1 dimension of control is involved in sense of powerlessness NM retention and intention to stay are multifactorial Executive leadership is responsible for the support of NM in relation to SOC, workload, and work/life balance issues Hierarchy and management layers contribute to NM sense of exclusion in strategy development NM must enable trust and demonstrate leadership by willingness to work in multidisciplinary care models (continues) Conclusions 232 NURSING ADMINISTRATION QUARTERLY/JULY–SEPTEMBER 2019 Copyright © 2019 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited. Explore relationships between SOC and staff engagement relationships Examine relationships between NM leadership styles, SOC, and patient and nurse outcomes Assess nurse retention challenges and strategies, as perceived by Lebanese NM Performance Improvement Project Descriptive Correlation Survey Design Descriptive Survey Design Literature Review Descriptive Survey Design Comparative Descriptive Survey Study Cathcart et al (2004)1 Doran et al (2004)8 El-Jardali et al (2009)16 Force (2005)4 Hansen et al (1995)17 Johansson et al (2013)18 Examine differences in self-related health between FL NM and RNs on various psychosocial factors Examine NM personality traits and staff perceptions of NM leadership Outlines characteristics of NM leadership style that enhances nurse retention Purpose Evidence Source Reference Table 1. Literature Review References (Continued) Reexamining Nurse Manager Span of Control Essay Retention challenges include salary, shifts, working hours, and better internal and/or external career opportunities Challenges will continue if aforementioned issues are not addressed More information is needed on NM SOC and leadership/ management capacities 5 themes: transformational leadership; transformational leadership; extroverted personality; Magnet hospital structures; tenure; graduate education Themes demonstrate that leadership traits lead to nurse job satisfaction and retention Nurses favorably rated NM on leadership style, power, and in?uence NM personality modestly linked motivation to manage and select leadership aspects First-line NMs can cope with high-demand situations if they have high control over their work High degree of job control and managerial support allows all nurses to function in stressful work environments (continues) Strong relationship between SOC and employee engagement Routine review of NM SOC may address negative impact of large SOC on employee engagement No leadership style can overcome a wide span of control Executive leadership must develop guidelines regarding number of staff NM can effectively lead and supervise Conclusions Reexamining Nurse Manager Span of Control 233 Copyright © 2019 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited. Examine effects of empowerment on staff perceptions of justice, respect, and trust in management Examine NM leader empowering behavior to staff perceptions of empowerment, job stress, and work effectiveness Examine determinants of FL NM job satisfaction Case studies describing the relationship between empowerment and CQI via concept of SOC Model linking nurse perceptions of NM emotional intelligence leadership style, structural empowerment, and impact of NM SOC Nonexperimental Predictive Design Nonexperimental Predictive Design Systematic Review Expert Opinion Laschinger and Finegan (2005)5 Laschinger et al (1999)6 Lee and Cummings (2008)20 Lewis21 Nonexperimental Predictive Design Determine how nursing leadership can improve NM turnover and vacancy rates Performance Improvement Project Jones et al (2012)19 Lucas et al (2008)2 Purpose Evidence Source Reference Table 1. Literature Review References (Continued) (continues) Do more, faster: Reduced SOC increases responsiveness, willing to lead projects, and connecting with supportive personnel Staff empowerment a dramatic impact on NM SOC NMs may not be able to empower their staff if SOC is large, even if they have strong emotional intelligence Senior management must ensure that NMs have reasonable SOC to empower staff to full scope of nursing practice and role Highlights importance of NM leadership traits within changing health care settings NM behaviors impacted perceptions of formal/informal power and access to empowerment structures Higher perceived access linked to lower job tensions and increased work effectiveness Addressing SOC, workload, increased supervisor support, and empowerment may in?uence FL NM job satisfaction Redistribution of operational and administrative resources positively impacted turnover rates, internal transfers, internal promotions, vacancy rates/days open, NM MSN Evaluation of scope/SOC can determine operational and administrative support tiers needed for NM success Structural empowerment has direct effect on interactional justice, respect, and organizational trust NMs have pivotal role in creating/maintaining staff trust Conclusions 234 NURSING ADMINISTRATION QUARTERLY/JULY–SEPTEMBER 2019 Copyright © 2019 Wolters Kluwer Health, Inc. Reexamining Nurse Manager Span of Control Essay Unauthorized reproduction of this article is prohibited. Nonexperimental Predictive Design Mixed Methods (Retrospective Analysis; Survey Design) Descriptive Correlational Survey Design Mixed-Methods Study Descriptive Correlational Survey Design McHugh et al (2013)22 McNeeseSmith (1999)9 Morash et al (2005)23 Patrick and Laschinger (2006)24 Evidence Source McCutcheon et al (2009)7 Reference Purpose Examine relationship of NM motivation to leadership behaviors, staff job satisfaction, productivity, organizational commitment, and patient satisfaction Design/implement SOC tool using evidence, surveys, focus groups, and ?eld testing (Ottawa Hospital Clinical Management SOC Decision-Making Indicators TOH tool) Examine relationship between structural empowerment and organizational support and effect on NM role satisfaction Examine relationships between leadership style, job satisfaction, patient satisfaction, and SOC, moderating effect of SOC as above Determine whether Magnet hospitals have lower mortality/failure-to-rescue than non-Magnet hospitals Table 1. Literature Review References (Continued) (continues) Combination of organizational support and empowerment is a signi?cant predictor NM role satisfaction Perceptions of organizational support may play an important role in retaining NM and attracting future nurse leaders Tool includes 3 decision-making categories (unit, staff, program-focused) to classify 8 indicators (unit complexity; material management; staff volume; skill/autonomy; stability; diversity; budgetary; and statistical responsibilities) Need for standardization, EBP changes, and assessment of roles/responsibilities of entire nursing group Magnet hospitals had lower mortality/failure-to-rescue odds Better work environment is a distinguishing factor between Magnet/non-Magnet hospitals and key to better outcomes Better outcomes partly attributed to investments in quali?ed educated nurses and environments supportive of quality care “Attention of nurses to your condition” positively correlated with productivity, job satisfaction, organizational commitment, and all 5 leadership practices NM motivation positively correlated with achievement, motivation, and 5 leadership practices Higher SOC decreased positive effects of transformational/ transactional leadership on outcomes Management by exception and laissez-faire leadership styles increased negative impacts on job satisfaction Conclusions Reexamining Nurse Manager Span of Control 235 Copyright © 2019 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited. Nonexperimental Predictive Survey Study Mixed Methods (Focus Group; Survey) Wong et al (2012)28 Wong et al (2013)29 Examine combination of FL NM characteristics and SOC of job and unit outcomes Validate TOH tool and examine relationships between FL NM SOC and manager work outcomes Review of a research study investigating NM stressors and coping experiences Determine optimal number of patient rooms in acute care settings Thematic examination of 2004 National Critical Care Survey Findings Report to determine implications for nursing administrators Purpose Reduce larger units to subunits/clusters ranging 6-12 rooms New clusters increased nursing engagement when NM SOC averaged 50 or less direct reports 4 themes: leadership, practice environment, staf?ng, and professional advancement and recognition Leadership is about people and relationships and is transformational Assess NM SOC and make appropriate changes in structures Monitor the impact of changes in SOC on unit-based and organizational outcomes Reexamining Nurse Manager Span of Control Essay Authors allude to 2 areas for needed intervention: SOC and therapeutic dialogue NM SOC variability is a major threat to NM ability to achieve work satisfaction, engage staff, and affect organizational commitment Manageable SOC essential for quality job/unit outcomes Only SOC predicted adverse unit outcomes Combination of SOC and self-evaluation predicted job satisfaction, work control, and role overload Neither self-evaluation nor SOC predicted unit turnover NMs report high role overload/job demands, limited job work, and moderate SOC satisfaction Increasing system demands contribute to expanded work responsibilities/role overload TOH score signi?cant indicator of NM job satisfaction, job demands, work control, and SOC satisfaction Conclusions Abbreviations: COI, continuous quality improvement; EBP, evidence-based practice; FL, frontline; NM, nurse manager; SOC, span of control; TOH, The Ottowa Hospital. Editorial Secondary Analysis of a Descriptive Survey Study Commentary Evidence Source Shirey (2013)27 Ritchey and Stichler (2008)25 Shirey and Fisher (2008)26 Reference Table 1. Literature Review References (Continued) 236 NURSING ADMINISTRATION QUARTERLY/JULY–SEPTEMBER 2019 Copyright © 2019 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited. Reexamining Nurse Manager Span of Control 237 Table 2. Evidence Appraisal: Ranking and Gradinga,b,c Academy of Evidence-Based Practice Evidence Leveling System Level A B C D E MA LR Description Meta-analysis of multiple large sample or small sample randomized controlled studies, or meta-synthesis of qualitative studies with results that consistently support a speci?c action, intervention, or treatment Well-designed controlled studies, both randomized and nonrandomized, prospective or retrospective studies, and integrative reviews with results that consistently support a speci?c action, intervention, or treatment Qualitative studies, descriptive, or correlational studies, integrative reviews, systematic reviews, or randomized controlled trials with inconsistent results Peer-reviewed professional organizational standards, with clinical studies to support recommendations Theory-based evidence from expert opinion or multiple case repor … Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10