12.2: Nursing Leadership

“Nursing leadership plays a pivotal role in the immediate lives of nurses and it has an impact on the entire health system and the Canadians it serves” (CNA, 2009a, p.1). Perhaps nowhere does nursing leadership play a more pivotal role in the immediate lives of nurses than in the case of the nurse manager. A nurse manager is responsible and accountable for the day-to-day operations of the workplace. This includes employee selection, hiring, orientation, staff development and evaluation, resource allocation and management, risk management, patient safety, and financial accountability, among others. Nurse managers are also expected to provide inspiration, guidance, and direction to nurses and other health care providers. They supervise and influence the professional practice of the largest number of frontline nurses, and by that, the largest groups of health care providers in the health system. In 2015, more than 80 per cent of Canada’s nurses worked as staff nurses (CIHI, 2016). On average nurse managers have 56.9 direct reports, with many managers overseeing over 100 staff members (OHA, 2011). Those with a self-reported wide span of control are more likely to have:

• more than 80 staff members reporting to them;
• responsibility for three or more units (physical spaces, which can exist across multiple geographical sites);
• budgetary responsibility; and
• budgets exceeding $7 million.

As such, nurse managers have the greatest opportunity to instill the principles of professional nursing in the nursing workforce. The importance of the relationship between nurses and their leaders began to be explored in US hospital studies in the early 1980s, which found that achieving Magnet status results in higher nurse satisfaction and high-performing work environments with positive patient outcomes. The Magnet Recognition Program® recognizes health care organizations that (1) transform their work environments to create a culture that values excellence in nursing care and professional practice and (2) demonstrate the ability to attract and retain professional nurses.

Nurse managers are also expert knowledge brokers. They translate organizational policy directives into action at the forefront of health care while also bringing information regarding the delivery of health care and practice requirements to senior management to inform organizational policy. In this role, nurse managers are an essential intermediary. Without nurse managers, the knowledge translation of organizational directives would not occur. However, this unique position can be very challenging. It can be demanding, trying to meet organizational demands and priorities while also managing resources to enable staff to provide the highest quality of care. Nurse managers are constantly balancing their responsibilities and accountabilities between their staff and the senior leadership they report to. Increasing job satisfaction, decreasing nurse turnover, managing a multigenerational workforce, supporting research, and meeting quality targets are among the many functions they perform set against a backdrop of continuous quality improvement and, often, fiscal restraint.