The Working World of Nursing Unit Managers: Responsibility without Power
Paliadelis, Penelope S., Australian Health Review
This paper seeks to explore the responsibility and power of the role of nursing unit managers (NUMs) in rural New South Wales using Kanter's theory of organisational power as a framework. Using in-depth individual interviews with twenty NUMs, data were analysed from four perspectives to gain a deep understanding of the NUMs' working world. The findings show that the NUMs' role is substantive, encompassing both clinical and managerial functions. Overall, the findings indicate that the participants lacked power commensurate with their role responsibilities.
Aust Health Rev 2008: 32(2): 256-264
THERE IS A GREAT DEAL of nursing literature that describes the role of nurses within the health care system. However, little is known about how nurses who hold management positions negotiate their role. This study aimed to explore the working lives of nursing unit managers (NUMs) employed in the public health care system in rural New South Wales. It was anticipated that by exploring the working world of this specific group of nurses, more could be learnt about how they fare within the system. Such insights could contribute to enhancing the job satisfaction of this group, which in turn could allow them to more fully support the nursing workforce and meet the goals of the organisation.
In Australia, as in many other countries, NUMs have replaced the senior nurses or charge nurses of the 1980s, and with the change in title came a change in the level of responsibility.1 There are three levels of NUM recognised by the NSW Public Hospital Nurses (State) Award. NUMs at Level One are in charge of a ward or unit of 20 to 50 beds. NUMs at Level Two have responsibility for wards or units of 50 to 75 beds, while Level Three NUMs have responsibility for wards or units of more than 75 beds. In NSW, nursing unit managers are the first line of management in the nursing career structure and their job encompasses managing the human, physical and financial resources of a ward, interpreting policies, maintaining standards, and providing nursing leadership,1,2 all within tight budgetary constraints.3
Herein lies a major dilemma for nursing unit managers, in that they are expected to combine a demanding professional nursing role with administrative, financial and human resource management in a workplace that is dogged by limited resources and nursing staff shortages.4-6 Another difficulty is that management is commonly perceived as a role concerned with resource manipulation, objectivity and control,7-9 yet the nursing profession values caring and compassion above these traits.4,10 A lack of research about the NUM's role has meant that little is known about how NUMs actually experience their day-to-day working lives, nor is there much known about the power, or lack of it, inherent within the role.
Nursing still carries an entrenched image, and a traditional role, based on a set of cultural and organisational assumptions that have made it difficult for nurses to be accepted as equal players in the health care arena.11-15 For example, an editorial in the British Medical Journal16 stated:
Doctors and nurses are divided by gender, background, philosophy, training, regulation, money, status, power, and - dare I say it? - intelligence (doctors are usually top of the class, nurses in the middle).16
Daiski14 argues that nurses continue to be cast into subservient roles because they have come to accept the existing power relations in health care as normal. Similarly, Kane and Thomas12 warn that "the oppressive nature of nursing must be transformed before nurses can be empowered". Des Jardin15 asserts that a nursing image based on traditional gendered assumptions "suffocates or represses" nurses, which in turn limits their ability to fight for greater power. Spence Laschinger17 links nurses' lack of power to the hierarchical organisational culture of health care. However, others describe how the image of nurses is both created and maintained by the socially constructed nature of public and organisational perceptions about the identity and power of certain roles. …