The purpose of this research was to devise an evidence-based model regarding the profile of an excellent nurse manager. Nurse managers have an impact on staff recruitment, satisfaction, and retention; patient satisfaction, adverse health events, and complications; and organizational performance. Research documents concerns related to the aging and turnover of nurse managers and the lack of interest from registered nurses in this complex and critical position within hospitals.
The conceptual framework for this research was grounded by transformational leadership, which is described as a type of leadership in which the behaviors of an individual with a vision inspire others to act to co-create the vision. The model of Kouzes and Posner (2003a) and the Five Practices of Exemplary Leadership were used. Aspirations, particularly in relation to leadership and achievement, educational, and promotional, was assessed through use of the Career Aspiration Scale (CAS) as developed by O'Brien in 1996 (Gray & O'Brien, 2007) and two additional principal investigator-created questions. Visibility of the nurse manager out on the unit interacting with staff and patients was determined in hours per week and evaluated as an attribute comprising the profile of an excellent nurse manager. Hospitals within the United States were recruited by publicizing the research opportunity in various venues: the Minnesota Hospital Association (MHA) and Minnesota Organization of Leaders in Nursing (MOLN) email lists, the American Organization of Nurse Executives (AONE) eNews Update and AONE Working For You (AWFY), and a letter mailed to the attention of the Chief Nurse Executive (CNE) of each U.S. magnet hospital (a hospital that has received Magnet Recognition Status from the American Nurses Credentialing Center). Criterion for the study was that the hospital had participated in the National Database of Nursing Quality Indicators-Registered Nurses Survey (NDNQI-RN Survey) in 2009, 2010, and/ or 2011. Seventy CNEs replied expressing interest in the study. Of the 40 hospitals that received packets, 29 hospitals completed and returned all data elements by the target date/first run of data. Of the remaining 11 hospitals, 6 completed and returned the packets after the target date/first run of data. From this participation, the principal investigator identified three groups of excellent nurse managers, then compared the profile of each group with competent nurse managers. One group was based on the CNE assessment; a second group was composed of nurse managers who scored at or above the 75th percentile on the NDNQI-RN Survey, and a third group comprised nurse managers identified in both of the other two groups.
Following collection of the data, the principal investigator conducted a statistical analysis to describe the national sample of hospitals and nurse managers. Parametric statistics, including Crosstab with Chi-Square tests, independent-samples t-test, and one-way between group ANOVA with post-hoc tests, were used to explore the associations of excellent nurse manager ratings compared with competent nurse manager ratings.
In this dissertation, the principle investigator presents a profile of an excellent nurse manager based on the Five Practices of Exemplary Leadership (Kouzes & Posner, 2002), career aspiration (Gray & O'Brien, 2007), aspiration, visibility, and demographics compared with a competent nurse manager in the identified three groups. Based on the assessment of the CNE, the profile of an excellent nurse manager includes four of the Five Practices of Exemplary Leadership: Model the Way, Inspire a Shared Vision, Challenge the Process, and Enable Others to Act. Other key elements for the profile of an excellent nurse manager include the CAS--specifically, the participant's favorable response to the statement, "I hope to move up through any organization or business I work in"--and aspiration, measured by positive response to the statement, "I would like to be in a director position" and "If I were offered the director position in my section/department, I would likely accept the offer." Through use of the NDNQI-RN Survey and the subscales Nurse Manager Ability, Leadership, and Support of Nurses/Nursing Management, the RN staff also assessed the profile of an excellent nurse manager to include one characteristic reflecting aspiration--as measured by their agreement with the statement, "I would like to be in a director position" (the preferred response was "moderately true of me"). Based on the assessment of both the CNE and NDNQI-RN Survey (RN staff), the profile of an excellent nurse manager includes four of the Five Practices of Exemplary Leadership: Model the Way, Challenge the Process, Enable Others to Act, and Encourage the Heart.
While the principal investigator concludes that this evidence-based profile can be used to identify, select, recruit, hire, develop, and retain individuals for the nurse manager position, she also discusses the limitations of her investigation and offers recommendations for future research.