Nowadays, nurse managers need certain managerial competencies to promote quality nursing care and satisfaction among its subordinates, and to implement health regulations efficiently in their services. The nurse managers should demonstrate competencies in his or her role along with other members of the multi-disciplinary team to satisfactorily address the health care needs of the clientele. Managerial competencies according to Lorber and Skela (2011) are ‘sets of knowledge, attitudes, skills, and behaviors that a person needs to be effective in a diverse kind of managerial works in different kinds of organizations’. Indicators of managerial competencies are essential for a nurse manager being the main decision-makers in dealing with administrative and structural problems of a health care unit and in managing resources in the delivering of health care.
The competencies of the nurse managers are related with managerial skills that prepare them for different roles and accountabilities (Mousavi, Aryankhesal, Haghani, 2015). Regardless of where and what to manage, managers are responsible for four general duties, namely planning, organizing, leading, and controlling (Lussier, 2011). They need to be highly competent to perform their managerial roles efficiently and effectively (Walshe and Smith, 2011). Studies have identified the following competencies of the nurse managers: people management, self management, strategic thinking, and knowledge about health care delivery (Pillay, 2008 and Winterton et al, 2009).
According to the World Health Organization (2007), the management of health unit is as serious as their implementation in order to sustain developments of public health outcomes. Management is a social discipline concerned with the performance of individuals within health institutions as influenced by procedures, standards, structures, methods and the context within which it is practiced (Hooijberg and Quinn, 1992). According to Rockers and Barnighausen (2013), managerial competencies are the glue that ensures the proper functioning of different components or building blocks of the health unit. The need to have competent managers at all levels of the health systems can therefore not be overstated.
Competent Nurse Managers, in a dynamic and essential healthcare management role, are practicing in a time of significant change. Ever-changing political and social issues, including developing care models, focus on quality, access to care and informative reform add to an already intricate industry. Persistent issues include fewer nurses to deliver the care but with an increasing number of patients needing care (Aiken, 2008; Fennimore & Wolf, 2011; Tanner & Weinmann, 2011). According to Domrose (2002) and Robert Wood Johnson Foundation (2012) Nurses are in the forefront of healthcare transformation being the largest number and most trusted health care providers, putting them in an exceptional position to lead inspire and lead during these turbulent times. The Institute of Medicine (2010) encourages the nurses to be prepared as managers; ready to sit at the policy table and to lead transformation to develop our nation’s health. This task raises a question of the issues that contribute to the effective and fruitful competencies of nurse managers required to lead through this time of great change in health care. Previous studies have also shown that nurse managers in both the public and private sectors with the essential competencies and expertise will help to improve efficient management, effectiveness, responsiveness and productivity in the delivery of healthcare services in a sustainable manner (Chadwell et al, 2012 and Levenson et al, 2006).
Remarkably, the competencies of the nurse manager have become gradually complex due to the ever-changing environment of health care delivery due to the rapid development of nursing. Remarkable changes includes management of increased complexity in clinical nursing practice, shorter hospitalizations for more acutely ill patients and pressures from compliance and regulatory agencies. According to Kleinman (2003), advances in technology, structural operations in delivery systems and modifications in healthcare economics have caused organizational transformation in healthcare institutions impacting nurse managers. Nurse Managers are influential in role modeling and setting expectations for staff nurses concerning the significance of high quality, transparent and patient-centered care. Furthermore, they serve as a link of communication between upper management and the staff nurses, providing key messages and setting the culture for their units and organization. The importance of these competencies cannot be underestimated in successful healthcare organizations today. Hence, this situation needs to be studied to have an appropriate understanding of the different indices of managerial competencies of the nurse managers.
In the Philippines, the Association of Nursing Service Administrators of the Philippines (ANSAP) has spearheaded the formulation of Nurse Manager Competencies. However, this has been formulated last 2007 and needs to be revisited. Literatures concerning the basis of the competencies seem to be scarce. Hence, this study seeks to identify the managerial competencies of a nurse manager.
Due to the lack of in-depth inquiry on the managerial competencies as perceived by different levels of nursing personnel, this study is deemed appropriate and necessary. While many studies and theoretical connections primarily speak to the why and the how of nursing competency, there appears to be a dearth of research conducted on the competency of nurse managers according to the perceptions of their different positions, specifically the what. Hence, this study will be conducted to determine the competencies of a nurse manager based on the perceptions of the staff nurses, nurse managers themselves, and the nursing directors.
Statement of the Research Problem/Question
This study aims to answer the question “What are the indices of nurse managers’ competencies as perceived by the top-level management (nursing director), middle-level management (nurse manager) and staff nurses in Iloilo City?”
Description of Research Tradition in Phenomenon of Interest
Nurse Managers are licensed professionals, nursing leaders with round-the-clock supervising and managing responsibility for a nursing unit. Nurse Managers are accountable for establishing and leading the culture of one unit and the everyday operations while communicating the vision of senior leadership to staff nurses. Competencies on the other hand are knowledge, abilities, virtues, cognitive and practical skills, and attitudes that establish a comprehensive capacity and ability to be effective, successful and efficient in the performance at the workplace. Hence, nurse managers’ competencies are essential skills, abilities, and behaviors needed for achieving quality care and to be effective in the role of the nurse manager (Lorber and Skela, 2011). As persons, they face various circumstances and positions that would either strengthen or weaken the performance of their roles as nurse managers. It is of great significance to know and discover these managerial competencies to gain perception and understanding of these competencies that could give us a lesson. This study aims to discover the indices of nurse managers’ competencies as perceived by their positions whether as they are on top-level management (nursing director), middle-level management (nurse manager) and staff nurses.
Instead of beginning with hypothesis, the Grounded Theory (GT) starts with a data collection, through a variety of methods. From the data collected, the key points are marked with a series of codes, which are extracted from the text. The codes are then grouped into similar concepts to make them more workable. Frome these concepts, categories are formed, which are the basis for the creation of a theory. This contradicts the traditional model of research, where the researcher chooses a theoretical framework and only then applies this model to the phenomenon to be studied.
Philosophical/Conceptual Underpinnings of Philosophical Frame of Interest
The philosophical underpinning of grounded theory methodology is based on the work of Glaser and Strauss (1967) that emphasizes on symbolic interaction. However, this assertion is consistently challenged by Glaser, the original and primary author of grounded theory methodology. Probably a more precise characterization is that Glaser and Strauss, the authors of grounded theory, were influenced by different methodological and philosophical ideas during their graduate studies, and that these diverse ideas probably influenced the way in which they later articulated or described grounded theory methodology. Grounded theory operates inductively, in contrast to the deductive approach. This method begins with a question- or even just with the collection of qualitative data. As researchers review the data collected, repeated ideas, concepts or elements become apparent, and are tagged with codes, which have been extracted from the data. As more data is collected, and reviewed, codes can be grouped into concepts, and then into categories. These categories may become the basis for new theory. Several of these influences have been acknowledged in the various books published by them.
Glaser (2002) described grounded theory as an attempt to develop a theory about shared social reality for which the participants may not be aware. This is because the reality cannot be precisely captured due to our own perceptual limitations. This, one could argue is therefore a strictly post-positivist position. The researcher’s role is to attempt to raise these perspectives to an abstract level of conceptualization.
As Corbin and Strauss (2014) expounded that when constructing a theory, it is essential to analyze the data for context because it locates action-interaction within a set of conditions and identifies the consequences that are likely to result of that action and interaction. Developing a “grounded theory roadmap” helped create clarity in all the required steps for the grounded theory approach. In fact, Corbin and Strauss (2014) have acknowledged that new researchers can experience difficulty with deciphering initial data, transitioning through different procedures and comparing data outcomes.
Thus, Grounded theory method according to Glaser emphasizes induction or emergence, and the individual researcher’s creativity within a clear frame of stages, while Strauss is more interested in validation criteria and a systematic approach. This study will discover the different indices of nurse managers’ competencies as perceived by the top-level management (nursing director), middle-level management (nurse manager) and staff nurses.
Significance of the Study
The findings of this study will have manifold benefits to people and organizations towards the following:
Nurse Managers. The indices that will be generated in this study can be used by nurse managers as basis for self-evaluation. They are the ones who manage their subordinates and serve as links to the top-level management. As the respondents of the study, the nurse managers can also better understand the different experiences that they have gone through in their profession. It can help them gain insights in improving themselves. It can also be used as a basis for the orientation and onboarding program of new nurse managers.
Hospital Administrator. In the efforts to promote and retain nurses in hospitals, administrators can refer to the results of this study. This information is important in developing programs and activities in formulating alternative strategies in personnel management and creating an atmosphere that will promote a high level of competency in the organization. If so, a more competent workforce would decrease turn-over costs and improve their level of productivity in the organization.
Nursing Director. This study may provide information that could serve as a sound basis for the Nursing Service Office to assess whether their nurse managers are competent and can contribute to in achieving the organization’s goal and objectives. By knowing this, they will have the chance to target specific components as objectives in conducting seminars, trainings and other projects to increase productivity and competency among their nurse managers.
Staff Nurses. They are the employees of the organization who render direct nursing care to their patients. This study may help them prepare themselves to face more responsibilities and obligations if they aspire to be in a higher position in their institution.
Human Resource Manager. The result of this study may prove beneficial to the Human Resource Department because they are responsible for the hiring and retention of the different employees of their organization. It will also give them more ideas to increase the competency of the employees, specifically the managers. It will provide some additional insights on making plans and programs that will help enhance employee’s competency.
Training Officers. The training officers are responsible for the enhancement and upgrading their personnel in terms of knowledge, attitude, and skills. This study may be used in the development of different training programs for their personnel especially for staff nurses aiming for a higher position.
Other Researchers. The data obtained in this study may also be used as a basis by future researchers in formulating research problems for the betterment of nursing services’ delivery to the clienteles and further researches in managerial competencies.
Scope and Limitation of the Study
The study will be conducted only in a selected teaching and training hospital in Iloilo. This will only concern about the indices of nurse managers’ competencies based on the perceptions of top-level managers, nurse managers, and staff nurses.
The number of participant will depend on the data saturation. The participants are only the top-level nurse managers (nursing director), middle-level nurse managers (nurse managers) and staff nurses that are employed in the tertiary hospital with at least two years of experience within the organization, starting from the time they have worked in the said hospital and with the ability to give informed consent.
The responses and perceptions of the participants may not be generalized to all nurse managers. These perceptions are only true to the participants that had experienced the said occurrence.
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