Manager, clinician or both? Nurse managers' engagement in clinical care activities

Abstract

In most health systems, nursing wards and departments are run by an experience registered nurse (RN) appointed to a management position, combining the clinical leadership of nurses with the managerial responsibilities of operations. These nurse managers play a crucial role in the organisation and delivery of health services: creating environments where nurses can provide quality patient care, while ensuring that organisational imperatives are met (Labrague, Abstract Aim: To explore the extent of Australian nurse managers' engagement in clinical care activities.Background: Hybrid nurse manager roles lack clarity in the optimal balance between the clinical and other activities, resulting in stress and challenges in recruiting and retaining nurse managers. Methods: In a national survey using the Advanced Practice Role Delineation tool, Australian nurses self-assessed their level of engagement in activities across five domains of nursing practice. The subset sample analysed comprised 2,758 registered nurses, 390 clinical (front-line) nurse managers and 43 organisational (middle) nurse managers. Median domain scores were compared with non-parametric tests of difference. Results: Clinical nurse managers were in a hybrid role, reporting high levels of engagement across the domains. Lower scores observed for organisational nurse managers highlight the shift to strategy-focussed activities that occurs as nurses up the management hierarchy. Conclusions: By indicating their engagement in the clinical care domain, respondents demonstrated that clinically focused activities were not entirely lost from either front-line or middle-management roles. Implications for Nursing Management: Nurse managers equipped with clinical and management skills, and allowed time to remain engage in clinical care activities are critical for patient-centred and cost-effective care in today's complex health care environments. K E Y W O R D S clinical care, direct care, hybrid manager, nurse manager, role delineation

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