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"Why do nurses believe they are management material?"

Should nurses focus on nursing and leave management to the managers?

Remember the three golden rules: 1. It was like that when I got here; 2. I didn’t do it; 3. (to your boss) I like your style. This advice comes from that most famous of bad managers, David Brent, from The Office. Part of the success of this comedy series came because it struck a chord with many people.

Bad management is probably as prevalent in nursing as in any other profession - but much more dangerous. A brief trawl through nursing forums supports my theory. Managers are criticised for providing little direction, failing to communicate expectations or goals, being indecisive, having favourites and being just plain rude. While this does not reflect well on those whose good work isn’t so readily reported, it still raises a question or two.

There are nurses and there are managers. Why mix two different skill sets? Could we manage time, people and resources better and improve care by eliminating the concept of a nurse having management duties?

The practice of promoting long-serving nurses to managerial positions seems logical - they are likely to have highly developed clinical skills; administrative, rostering and budgetary experience; and (hopefully) good relationships with staff. But the nebulous skill of leadership often considered vital to managers is not easily picked up by observation. The mysterious art of people management is a profession and a vocation in itself. Does it matter if a manager doesn’t possess this subtle skill?

People with leadership capabilities can improve others’ motivation. They help staff to be positive about work, run daily tasks and responsibilities effectively, treat clients and workers with respect, and reach objectives. Conversely, poor leaders lower morale, have difficulty in keeping good workers and see output falling, be it in sales of paper (as it was at The Office’s Wernham Hogg) or quality of patient care.

Models of nurse leadership all value general notions of having a vision, being motivational and an agent of change, as well as an advocate for staff and a role model. Nurse training includes leadership to varying degrees. But are we missing the point?

Surely, if nurses wanted to be managers they would have taken this career path in the first place. Many nursing teams are led by weak and inefficient leaders promoted by virtue of their longevity spent using a different skill set. Even the best managers are so stretched they become bad ones. How can anyone focus on the professional development of their staff if they’re overseeing umpteen nurses across all shifts, working on the floor and dealing with administration, budgets, complaints and doctors?

Wanting to progress is natural. But surely nurses with significant experience could be more productively promoted to be “senior nurses” - expert trainers concentrating on sharing their knowledge. Management could then be provided by staff trained to work in this sphere and able to provide the kind of leadership the profession is crying out for. It’s horses for courses - we wouldn’t attempt to fix an electrical or plumbing problem, so why do we think we are management material?

Stephen Riddell is a district nurse working in Dumfries and Galloway

Readers' comments (10)

  • You make some very relevant points. I am only a student nurse but I can't see why any nurse would want to be a manager. Before nursing I worked in retail and was well on my way to management but I got out because it wasn't right for me. I am becoming a nurse because its the patients and the clinical care I am interested in, not budgets and rosters! I agree that many nurses have great leadership skills but they should be put to better use as senior nurses who lead the nursing team in their clinical work not waste their talent and make them into administrative managers.

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  • Anonymous | 17-Nov-2011 5:51 pm exactly, well said. There are many different types of management, and many different types of leadership. The big problems at the moment are: a) There are far too many unneccasary non clinical managers in the NHS, and Nurses who move up the ladder are being forced to work within these business/profit management models that do not work for us and we are not trained in, and b) the areas where Nurses SHOULD be leading and managing in, ie clinical areas, are simply not there, and Nurses are not being allowed to develop in these roles.

    It is as ridiculous as having a building site with an experienced site foreman who leads and manages from a building expertise/paradigm, and replacing that foreman with a shop manager. Both are 'managers', but with completely different skill sets that do not work when applied to each others role.

    So yes, Nurses can be leaders and managers, but from a CLINICAL perspective which is where our expertise lies. Certain things that are the norm for most management, such as rosters and budgets can easily be incorporated into the clinical role without dominating it. That is the key. Patients should be the focus, not paperwork.

    I think if this was much more the norm, the 'management' as it is now simply will not be needed, or at least not in the quantities it is now, and Nurses would be allowed to lead and manage their team from a clinical, Nursing paradigm where the needs of the patients are focused on.

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  • Many nurses I have met have been great healthcare managers. Many non nurses I have met have been useless healthcare managers. The answer is in the recognition of skills attributable to the individual and their ability to have a vision and attain their goal, whilst developing staff to develop and create change. It is not a top down approach, it is a bottom up approach. This is a rare occurence these days, which is why nursing has lost any momentum it had in being more successful in management as a discipline.Lack of proper training within organisations has also contributed to this. Nurses need to be respected for their management potential and not dismissed!!

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  • Managers are nothing. Anyone but anyone can be a manager including window cleaners, road sweepers, bankers, doctors, and yes, you've guessed it - nurses!

    Not anyone can be a nurse. So if I had the choice whether to hire a nobody to be an NHS manager or a nurse with managerial experience in the health sector, a management degree, on top of their own professional nursing degrees, I think I know who I'll be hiring!

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  • NHS has suffered in recent years as a result of having too many "managers" who have no clinical experience. Many of the new breed of managers come into the NHS with degrees in all sorts of irrelevant areas which do not transfer effectively to health related issues. Nurses should have the opportunity to progress if that's what they want to do. However, do we really need so many layers of management, I personally think not whatever happened to the old style matron who knew exactly what was needed and made sure standards were implemneted, she was respected - there is no respect for the many layers of management we have now. It's become so business like the poor patients have been forgotten!!

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  • I suppose it depends on what exactly they (nurses) are being called on to manage. Some things can (should?) be delegated to non clinical personnel whereas others surely need the knowledge and experience that would only come from actually doing the job. I do think that sometimes someone who is non clinical can be more objective and look at the bigger picture without being clouded by their own expectations and thought patterns. On the other hand (playing devil's advocate) the non clinical manager would surely not be able to understand the sheer complexity, the physical and psychological demands placed on nurses today; unless they were willing and able to listen to their staff, go out and see for themselves but to be real how many managers do that? So overall I would have to personally choose nursing experience and knowledge over taught management skills. I am sure, however, that there are many nurse managers reading this who would argue that they are still hands on enough to know what is going on "on the floor". As a final note, I've always believed that a manager's job is to support the workers as well as wielding the big stick, but as a nurse that has not been my experience at all!

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  • I mean "why do nurses believe they are management material?". What a stupid question. Was it Nursing Times that asked this particular question just to stir debate? Yes lets not ask whether doctors make good managers, or firefighters, or police officers, or bankers, or teachers... Why? Because we want to pick on the humble, passive, weak, and inferior 'nurse'. Nurses have to be poor managers because they are 'just' nurses. This sums up the UK mentality on RNs...

    7 years of dedicating my life to saving lives, with a diploma, undergraduates and a masters under my belt, publishing and teaching and supporting all my pre-reg and post-reg students. I have continued to support the profession but the minority in the UK continue to corrupt our image.

    Perhaps all us nurses should just leave the UK to go to places that truly value us. Lets just see how this country will cope without us.

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  • George Kuchanny

    There are huge differences in nebulous 'management' skills in all walks of life. Let us take the merchant navy as something quite different to healthcare to illustrate.
    On deck getting us from a to b we have
    1. DHU (deck hand unqualified)
    2. Able Seaman
    3. Boatswain (pronounced bosun)
    4. Captain
    Then on a passenger liner we have catering.
    1. Purser
    2. Chief Steward
    3. Chef(s)
    4. Galley hands
    5. Scullion (honestly!)
    6. Steward
    7. Waiter.
    And so on - at each level there are 'management' skills involved. At some levels this mat be simply managing your own time. Now who has ever asked "Why do Boatswains believe they can be Chief Stewards?" Yep, nobody. And so it is with this question. My perspective is that a nurse - especially a motivated nurse who cares about patients and may well have some impressive clinical knowledge to boot is far more valuable than most junior/middle managers. Only those managers who truly understand human factors and how to instil a thriving culture of good work and are fortunate enough to have the power to do it are in any way as valuable. End of story. In the merchant navy just as anywhere else, running a tight ship depends on the person management skills of the Boatswain on and hourly basis and the Captain on a per voyage basis. However, and it is a big however! Exactly how far does the ship get without Able Seamen?
    P.S. In the old four masted sailg days (a bit before my time admittedly) the most feared man on any ship was the Boatswain - not the Captain. Shades of oooh! Matron nooo! methinks.

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  • Good managers in any industry combine two major qualities:
    * Knowledge of the industry
    * Leadership
    For the NHS the industry is health and too few managers in the NHS actually understand what they are managing which reflects in poor, short term decisions which may meet today's targets but not the health needs of individual patients or the population.
    The NHS seems to be one of the few organisations that really believes that a generic manager exists and is all that is needed. Skills can be transferred from other industries but an immersion in health is required if people have no background in the health industry.

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  • There are some extremely valid points being made in this discussion forum, and I concur with many of those opinions.

    However, the negativity expressed by the anonymous participant, who states he/she has 7 years service and a diploma/undergraduates (?)/masters is, quite frankly, of some concern to me.

    Surely, in light of their scathing attack on the UK's health provision, and if this person is responsible for educating pre and post registration students, they should re-consider their role and analyse whether their suitability to their current role.

    If we are to preserve and promote our profession, is it right to have such negativity at the helm of education, albeit at a local level?

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