This article was downloaded by: [Griffith University]On: 28 December 2011, At: 16:52Publisher: RoutledgeInforma Ltd Registered in England and Wales Registered Number: 1072954 Registeredoffice: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK

The International Journal of HumanResource ManagementPublication details, including instructions for authors andsubscription information:http://www.tandfonline.com/loi/rijh20

Accidental, unprepared, andunsupported: clinical nurses becomingmanagersKeith Townsend a , Adrian Wilkinson a , Greg Bamber b & CameronAllan aa Centre for Work, Organisation and Wellbeing, Griffith University,Queensland, Australiab Department of Management, Monash University, Melbourne,Australia

Available online: 07 Oct 2011

To cite this article: Keith Townsend, Adrian Wilkinson, Greg Bamber & Cameron Allan (2012):Accidental, unprepared, and unsupported: clinical nurses becoming managers, The InternationalJournal of Human Resource Management, 23:1, 204-220

To link to this article: http://dx.doi.org/10.1080/09585192.2011.610963

PLEASE SCROLL DOWN FOR ARTICLE

Full terms and conditions of use: http://www.tandfonline.com/page/terms-and-conditions

This article may be used for research, teaching, and private study purposes. Anysubstantial or systematic reproduction, redistribution, reselling, loan, sub-licensing,systematic supply, or distribution in any form to anyone is expressly forbidden.

The publisher does not give any warranty express or implied or make any representationthat the contents will be complete or accurate or up to date. The accuracy of anyinstructions, formulae, and drug doses should be independently verified with primarysources. The publisher shall not be liable for any loss, actions, claims, proceedings,demand, or costs or damages whatsoever or howsoever caused arising directly orindirectly in connection with or arising out of the use of this material.

Accidental, unprepared, and unsupported: clinical nurses becomingmanagers

Keith Townsenda*, Adrian Wilkinsona, Greg Bamberb and Cameron Allana

aCentre for Work, Organisation and Wellbeing, Griffith University, Queensland, Australia;bDepartment of Management, Monash University, Melbourne, Australia

To what extent have hospitals developed their skilled clinicians to perform theadministrative and human resources (HR) manager role of the ward manager? Weconsider this research question through an analysis of an acute hospital called ‘TheHospital’ where the executive team is aiming to adopt a form of high-performancework system (HPWS). We focus primarily on explanations in terms of conditions,rather than the personalities of individual managers, which are most powerful inshaping their behaviour. There has long been a failure of hospitals (and otheremploying organisations) to develop fully the skills required by employees before theybecome line managers. Line managers are a critical link in the high-performance chainand this study illustrates that, despite their rhetoric, hospitals may still have muchpotential for implementing schemes to develop nurses further to prepare them for line-manager positions and to support them after they move into such roles. We infer fromthis study that such hospitals may not yet have completed the journey to having HPWS.Hence, there is still much scope for such hospitals to progress and enjoy the benefitsthat proponents claim for HPWS.

Keywords: career development; high performance work systems; hospitals; humanresource management; line managers; nurses

Introduction

Hospitals in most countries are of much interest as subjects of research, not least since they

have faced growing challenges in recent years (Degeling, Meaxwell, Kennedy and Coyle

2003). These challenges include increased costs, per capita decreases in their funding and

technology that delivers both less invasive surgery (consequently a capacity to perform

more procedures) and the capacity to deal with more complex medical interventions. One

important way of improving and maintaining service delivery is to manage the HR- or

people-management function more effectively (Townsend, Bartram and Wilkinson 2011).

There are various paradigms through which people management can be considered.

In this article, we are using a high-performance work system (HPWS) approach to suggest

that in terms of people management, there are potential benefits for hospitals that shift

from an old style of ‘personnel administration’ towards fostering HPWSs.

We use the term ‘HPWS’ in this article, even though there are other terms used

elsewhere, which have similar implications, for example, high-performance HR, high-

involvement work practices, strategic human resource management (HRM) and so on.

In the literature, there is a widely accepted assumption that there are clusters or bundles of

HR practices, which are at the core of HPWSs. The high-performance paradigm is

ISSN 0958-5192 print/ISSN 1466-4399 online

q 2012 Taylor & Francis

http://dx.doi.org/10.1080/09585192.2011.610963

http://www.tandfonline.com

*Corresponding author. Email: k.townsend@griffith.edu.au

The International Journal of Human Resource Management,

Vol. 23, No. 1, January 2012, 204–220

Dow

nloa

ded

by [

Gri

ffith

Uni

vers

ity]

at 1

6:52

28

Dec

embe

r 20

11

promoted as ‘best practice’ on the grounds that these bundles of HR practices yield better

performance levels than those associated with more traditional personnel and employment

relations practices (Godard 2004).

Hospitals are different from most other types of enterprises in that their effectiveness

can be measured through their success in treating illness, avoiding deaths or in the case

of palliative care units, making death as humane as possible. Hospitals have a unique set of

performance measures, for example, staff per bed workloads, number of patients treated,

patient mortality (West et al. 2002; Buchan 2004; West, Guthrie, Dawson, Borrill and

Carter 2006). In these circumstances successful management of hospital workforces is

vital to improve a hospital’s performance.

HPWSs involve the successful use of complementary HR policies to enhance

employee skills and commitment as a means of improving an organisation’s performance.

While slow to adopt HPWSs, the health care industry appears to be catching on to the

potential benefits and many hospitals are placing a greater importance on the management

of their people (Townsend and Wilkinson 2010). There are various definitions of HPWSs,

but in most of them the role of first-line managers is seen as crucial in the successful

implementation of HPWS. Further, a critical component of the implementation of

successful HR policies and practices is the person who is most responsible for the delivery

of these policies and practices – the first-line managers whom we focus on in this article.

This article draws on research on nurses, and, in particular, moves of nurses into

managerial positions. Nursing has typically been viewed as a vocation, which was a career

in itself. However, there has been limited scholarly consideration given to career paths of

those people who choose a nursing career. A ‘traditional’ career is one which ‘is

characterised by linearity and path dependency’ (Valcour and Ladge 2008). As the nursing

workforce is female dominated, the ‘traditional’ career path does not provide an adequate

picture of what tends to happen with nurses’ careers. Career development can typically be

affected by pregnancy, childbirth, family commitments and consequentially time away

from the workplace and the perception of reduced commitment (Epstein, Soren, Oglensky

and Saute 1998). Furthermore, in a hospital context, the changing role of nurse managers

becomes an important consideration in the successful implementation of HPWS.

The formal education of nurses has changed dramatically in recent decades with the

shift to university-based undergraduate and postgraduate nursing and speciality courses

(Duckett 2005). Concurrently with the improved clinical education, there has been a

changing role of senior nurses. Senior nurses have long undertaken line-management

responsibilities, for example, supervising and organising the work of junior nurses, and

ward-level training of staff (Bolton 2003; White and Bray 2005). Furthermore, senior

nurses have long been recognised as playing a mediating role between strategic and

operational levels of management (Loan-Clarke 1996; Bolton 2003). Thus, nurse

management is a ‘profession of its own with special training and skills’ (Sellgren, Ekvall

and Thomson 2006, p. 349). Managers should understand the system in which they

manage and tasks that must be performed by themselves and those they manage. The role

of managers in hospitals and other contexts can be considered in terms of the difference

between ‘professional/vocational’ and ‘managerial’ work (Dalton 1966; Pahl and Pahle

1971; Moss-Kanter 1977; Scase and Goffee 1989; Smith 1990; Watson 1994). However,

detailed discussions of this are outside the scope of this article as here we focus on how

hospitals utilise training and development (T&D) to prepare staff for the new roles.

In the United Kingdom (UK)’s National Health Service (NHS), the role of senior

nurses has been changing. A UK Department of Health report (1999) described the ward

manager as ‘the backbone of the NHS and the hub of the wider clinical team’ (DoH 1999)

The International Journal of Human Resource Management 205

Dow

nloa

ded

by [

Gri

ffith

Uni

vers

ity]

at 1

6:52

28

Dec

embe

r 20

11

although Doherty notes that there is ‘perhaps . . . little clarity of what this means in

practice’ (Doherty 2003, p. 35). An Audit Report in 1991 (cited in Willmot 1998)

suggested that charge nurses spend more time developing and managing ward staff rather

than having a direct role in patient care. Indeed, the continuing restructuring of acute

hospitals in recent decades means that there are significant demands on the role of nurse

managers in the areas of day-to-day functions and the ability to see both the ‘big picture’

while building interpersonal relationships with subordinate nurses (Wallick 2002).

There has been much research indicating a changing role for the nurse unit manager or

ward manager to the point that ward managers have become the key ‘people managers’ in

hospitals (Carpenter 1977; Mark 1994). To what extent has the senior management in

hospitals managed the career development of nurses identified as potential ward

managers? In this industry, managerial staff ‘must do’ items such as improving outcomes

according to such key performance indicators as reducing waiting times and meeting

financial targets are often in the public eye. This tends to mean that, apart from a focus on

staff recruitment and retention, other workforce issues rarely appear high on managerial

agendas (Finlayson, Dixon, Meadows and Blair 2002).

Aikin, Smith and Lake (1994), Aikin, Havens and Sloane (2000), and Aikin, Clarke

and Sloane (2002) have attempted to link the HR function to patient mortality in acute

hospitals. By attracting and retaining good nurses through their HR practices ‘Magnet’

hospitals have lower patient mortality rates. Goode et al. (2005) list ‘14 Forces of

Magnetism’, five of which have direct relevance to the administrative and people-

management function of the ward manager: quality of nursing leadership, participative

managerial style, personnel policies that are supportive of nursing, adequate consultation

and resources and professional development. To what extent have hospitals developed

their skilled clinicians to perform the administrative and HR manager role of the ward

manager?

We consider this research question in this article through an analysis of one hospital,

simply referred to as ‘The Hospital’ – where the executive team is aiming to introduce

HPWS and to shift to a high-performance form of HRM. The HPWS places emphasis on

line managers (in our research site, they were known as ward managers), so we might

expect to see such staff fully equipped to carry out their roles with support provided from

the hospital’s administration and executive. This Australian hospital is probably

prototypical in so far as it is close to the leading edge in Australia in developing initiatives

to address the line managers’ role. For example, it created a new role – Executive

Director, People and Learning – to help to generate change and initiatives to enhance the

improved use of human resources (HR) as well as to promote learning and development.

The Hospital also launched a Leaders Program and a Managers Program; both were

designed to focus on the development of managers and leaders. Further, the hospital

improved its performance development support and the availability of a variety of

manager-targeted development opportunities, including a ‘Manager as Coach’ program.

All of these initiatives have been designed to support the career paths of managers,

including current and future ward managers.

The literature

T&D has been of much interest to researchers for decades (McGeehee and Thayer 1961;

Moore and Robie 1978; Goldstein and Gessner 1988; Ford and Kraiger 1995; Aguinis and

Kraiger 2009). It is important for employers who wish to ensure that employees meet and

continue to meet the competencies required in their field, the efficiencies and effectiveness

K. Townsend et al.206

Dow

nloa

ded

by [

Gri

ffith

Uni

vers

ity]

at 1

6:52

28

Dec

embe

r 20

11

of employees in meeting organisational goals (Tharenou 2010) and, in some cases, to meet

legislated requirements. T&D is important to employees as, if it is done well, it can have a

positive impact on employment duration, continuity of employment, pay and career

advancement (Tharenou 1997; Aguinis and Kraiger 2009). In general, however, the

training and career development of nurses into the role of ward managers has not always

been done well in the acute hospital sector, but to what extent has the introduction of

HPWS to lead to such T&D gaps being closed?

In the various models of the HPWS paradigms, the T&D of employees plays a critical

role (Wright, Gardner, Moynihan and Allen 2005; Marchington and Wilkinson 2008).

Furthermore, the recent focus of research on HPHR places a great importance of

understanding the ‘black box’ of firm performance. Specifically, the black box refers to

the intervening variables that mediate the link between HRM and performance. That is, the

way actual policies are implemented and perceived and the worker attitudes and

behavioural responses are essential to understand any causality between HR policies (seen

as independent variables) and performance outcomes (dependent variables).

In the black box: the line manager

One of the central components of the black box is the role of middle managers. Research

suggests that they have faced an increased level of devolved responsibility (Guest 1987;

Legge 1989; Hyde et al. 2006). There is an extensive range of empirical studies that

compare the roles of different ‘levels’ of managers (c.f. Hales 2005) including definitional

debates around terminology used, for example, middle managers, front-line managers and

supervisors (Lowe 1992). These definitions are important for our study as we will discuss

later. Some studies refer to ‘middle managers’ as all those who hold positions between ‘top

strategic management’ and ‘first-level supervisors’ (Dopson and Stewart 1992). However,

we do not view this as particularly helpful in the context of our hospital study.

In deciding whether ward managers are more appropriately defined as a supervisor or a

line manager, we refer to Child and Partridge (1982). These authors compare a line

manager and a supervisor, suggesting that line managers are more likely to have the

following:

. Have had higher education (modern nurses have).

. Undergone management training (some ward managers have, but no means all).

. Been recruited directly into management rather than from the ‘shopfloor’ (ward

managers are recruited mostly from the pool of clinicians on a ward floor).

. Have opportunities for advancement into ‘middle management’ (some ward

managers do advance).

Hence, Child and Partridge argue that line managers have ‘management’ status and

attitudes and orientations more closely aligned with other managers. As our data will

suggest, the ward manager in hospitals does not fit well with these definitional criteria. Our

observations are that ward managers are supervisors and they are also first-line managers.

Since the era of Florence Nightingale, the role of senior nurses has changed a great

deal. The list of tasks performed by nurses at all levels has been developed substantially,

from the ‘Nightingale’ model where the nurses’ role ‘straddled both the scientific and

non-scientific worlds’ (Carpenter 1977, p. 167). However, there was a distinct transference

of professional power to the ‘Matron’ who was often recruited from more elevated social

backgrounds (Dingwall, Rafferty and Webster 1988). The proliferation of allied health

professionals (e.g. physiotherapy and occupational therapy) diminished the role of the

The International Journal of Human Resource Management 207

Dow

nloa

ded

by [

Gri

ffith

Uni

vers

ity]

at 1

6:52

28

Dec

embe

r 20

11

senior nurses1 Southall (1959). Between the hospital management, ward staff, patients and

families and allied health professionals, the senior nurse became the central coordinator

and decision-maker in a complex network of communications (Runciman 1983).

Administrative support staff were introduced to assist the senior nurse. Further, hospitals

removed catering services, cleaning and so on from being the direct responsibility of the

senior nurse (Bell 1998).

While ‘middle-level managers’ were subject to delayering in many industries in the

1980s and 1990s (Balogun and Johnson 2004) hospitals were undergoing rather different

changes as there was an expansion in the numbers of managerial personnel, with the

development of ward manager positions (Willmot 1998; Bolton 2003; Perry and Kulik

2008). The senior nurse manager roles have been transformed from the experienced

clinician to the ‘ward manager’ who has been promoted to take responsibilities for

managing the personnel in the ward, and a range of additional resource management

responsibilities (Willmot 1998; Townsend and Wilkinson 2010). The problematic nature

of management arises in this industry as in others when skilled clinicians are promoted to a

ward manager role and away from the bedside – the precise area where they are experts.

The position of influence line managers hold is important. Earlier research suggests

that to be successful a range of factors are important for line managers, including

unambiguous processes and practices (Currie and Procter 2005), adequacy of training

(Cunningham and Hyman 1999) and support from the HR department (Whittaker and

Marchington 2003). We also know that employees’ experiences of HR will be

significantly influenced by their direct manager, hence, the importance of studying the

employee–line manager relationship (Hyde et al. 2006). Moreover, line managers are an

essential link in attempts to elicit more discretionary effort that is essential in HPWS

(Purcell and Hutchinson 2007).

In the 1990s, there were three related debates about the changing role of the ‘front-line

manager’. First, there was debate about the process and extent to which the functions of the

HRM department was ‘returning to line managers’. Second, there was research examining

the job enlargement of line managers in adding further people-management

responsibilities to their traditional supervisory duties. Third, there was a stream of

research comparing the distinction between the espoused and the enacted HR practices

with the gap explained by the lack of training, interest and motivation of line managers, as

well as work overload, conflicting priorities and self-serving behaviours (for more on these

three debates, see Purcell and Hutchinson 2007, p. 5). All of these issues are relevant to the

expanded role of hospital ward managers.

Storey (1992, p. 26) suggests that the people-management decisions that are made in

organisations must not be treated as ‘incidental operational matters’ or to be left to an HR

department. Rather, line managers should understand their role as the link between the

strategic direction of the organisation and the management of front-line staff members.

As such, they have a ‘responsibility’ to act accordingly in the way they manage people

(Thornhill and Saunders 1998). However, senior nurses in one study have been reported to

‘enthusiastically embrace’ some aspects of a managerial role, while remaining suspicious

and ‘distancing themselves’ from other areas that might be at odds to their values as

‘caring professionals’ (Bolton 2003).

Typically, line managers have been directed to take on greater HRM responsibilities

because of tensions between the HR departments and the front-line managers, for

example, tensions because of policies that are ‘fine in theory but hard to put into effect’ or

because of the lack of immediacy by HR departments and the requirement of immediacy

on the front line. Therefore, it is argued that being given more explicit responsibility for

K. Townsend et al.208

Dow

nloa

ded

by [

Gri

ffith

Uni

vers

ity]

at 1

6:52

28

Dec

embe

r 20

11

HRM will increase the line managers’ ‘ownership’ over these issues, thus increasing their

commitment to integrating organisational ‘HR approaches’ with workplace ‘HR practices’

(Marchington and Wilkinson 2008).

Often there is an assumption that line managers will implement policies exactly in the

ways intended by HR specialists or, as Marchington and Grugulis (2000) describe, act as

‘robotic conformists’. As HRM is seen as a component of all managerial jobs, the line

manager generally has the responsibility for the delivery of HRM to the greatest number of

workers. Employees’ perceptions of HRM, then, are of those practices that are applied by

line managers (Purcell and Hutchinson 2007). Hence, line managers are critical

intermediaries in shaping enterprise performance (Currie and Procter 2005). Harney and

Jordan (2008) suggest that it is the line managers’ implementation of practices that directly

impact on the abilities, motivation and opportunity (AMO) performance rubric (Boxall

and Purcell 2008, p. 5).

However, HR policy and practice are different. Research needs to incorporate the HR

architecture and the role of line managers in delivering HRM (Becker and Huselid 2006;

Boxall and Purcell 2008). Although HR issues remain the purview of HR departments,

there are many shared responsibilities. Line managers seem to think that they are most

heavily involved in motivation and morale of staff, team briefings and communication,

health and safety, identifying training needs, employee selection and performance

appraisals (Watson, Maxwell and Farquharson 2007). Commonly, a lack of skills is touted

by senior managers and HR departments as one of the greatest problems for line managers.

Perhaps not surprisingly, line managers themselves less often identify their own lack of

skill as a problem (Watson et al. 2007). However, a study of ward managers demonstrated

a high level of dissatisfaction in the level of preparation they had before becoming a ward

manager (Willmot 1998). Our research looks at the senior managers’ and ward managers’

views on the development of ward managers in the context of a move towards HPWS.

Our study aims to draw conclusions about four overlapping research propositions:

Proposition 1: People who are working as ward managers did not have a managerial or

administrative career path in mind when they became nurses.

Proposition 2: Hospitals have developed career planning and training to take account

of the changing role of ward managers.

Proposition 3: The Hospital has provided organisational support for the nurses when

they have been promoted to ward managers.

Proposition 4: Ward manager selection criteria have taken account of people and

general management skills rather than clinical skills alone.

Research context and method

Hospitals are funded through a complex mix of sources in Australia. Public-sector

hospitals are financed and controlled by state and federal governments. There is political

rhetoric around the centralisation of the health system at the federal level. Nevertheless,

state governments currently fund and control their own public-sector hospitals (National

Health and Hospitals Reform Commission 2009). There are many private as well as public

hospitals and almost half of Australians (44.7%) are covered by private health insurance to

meet the costs of private hospital care and allied health services (PHIAC 2008). There are

two categories of private hospitals: first, not-for-profit private hospitals; these are typically

part of faith-based charities associated with a church denomination, and second, for-profit

The International Journal of Human Resource Management 209

Dow

nloa

ded

by [

Gri

ffith

Uni

vers

ity]

at 1

6:52

28

Dec

embe

r 20

11

private hospitals; these are typically part of health-industry companies, for example

Healthscope.

Hospitals have a predominantly feminised staff although upper management and

professional roles are dominated by men (Willis, Young and Stanton 2005). It is estimated

that almost 2,20,000 people are working as nurses in Australian hospitals (AHWI 2008).

This is a significant number of people. Hence, much research attention has been focused

on the largest occupational group: nurses. When we conducted the study, 80% of The

Hospital’s employees were nurses.

The Hospital is in Australia. It has a mix of private and public funding. The Hospital

comprises numerous separate hospitals on one campus – in some ways, they are fairly

autonomous. The ‘silo’ hospitals include separate hospitals for children, women and

adults. Some of the hospitals are not-for-profit private hospitals, part of a faith-based

charity associated with a church denomination; they receive most of their income from

private health insurers and patients. The other hospitals are public-sector ones funded

mainly by the state government. The Hospital currently employs more than 6,000 people

and has more than 500 beds across various different disciplines.

This study is part of a larger project investigating HRM and related matters in

Australian hospitals. In the hospitals where we conduct case studies, we interview upper

and middle managers as well as line managers and ward staff. The project was developed

to investigate several themes. At The Hospital, we established a research protocol that

helped us investigate HR issues generally, with a particular focus on the role of the ward

managers.

Interviews were the primary data collection method, which allowed us the opportunity

to understand contextual issues relevant to the hospital and the ward on which the

interviewees worked. In total, we conducted more than 80 interviews. This article draws

data from more than 40 of these interviews with senior and middle managers, ward

managers and Level 2 nurses – a senior level, immediately below the ward managers.

We interviewed 14 ward managers and a similar number of ‘Level 2s’ to investigate the

career development of ward managers. We included the Level 2 nurses in this study

because they have a higher level of expertise than registered nurses and are the nurses who,

based on their experience, are the people most likely to be next in line to become ward

managers. The interviews with the ward managers and nurses focused on a range of issues,

including the role and competencies of ward managers.

In addition, we interviewed more than ten middle and senior managers including

Executive Directors (EDs) of People and Learning (P&L), Organisational Development

and Mission Development as well as several Directors of Nursing, Directors of Human

Resources and Administrative Services. We also interviewed two HR business partners,

the Chief Executive Officer and the EDs of the various silo hospitals. Many of these

interviews focused mainly on the role of the ward manager in the HRM function of the

hospital. The interviews generally lasted about an hour and were recorded, transcribed and

analysed using NVivo. All interviews were conducted by one or more experienced

interviewers in the offices of the respondents or in other private areas available nearby.

The changing role of the ward manager

Let us consider several interrelated propositions. The context is a move towards HPWS

with an increasing emphasis on line/ward managers. First, we examine the issue of

whether people who are currently working as nurses had a career path in mind when they

became nurses. Second, we examine the extent to which hospitals have a career planning

K. Townsend et al.210

Dow

nloa

ded

by [

Gri

ffith

Uni

vers

ity]

at 1

6:52

28

Dec

embe

r 20

11

process for nurses that includes training for the new managerial roles. Third, we consider

to what extent The Hospital has provided support for ward managers when they are placed

in the managerial role. Fourth, we consider whether ward manager selection has much

attention to managerial skills. These issues will be addressed in the following sections.

Of the 14 ward managers we interviewed, only two said that the idea of becoming

a ward manager was part of a conscious career plan. The remainder mentioned a

combination of factors involved in them becoming a ward manager, ranging from luck, to

upper management saying they were appropriate for the role. Typical responses from ward

managers were that they fell into the role by accident:

I was the second in charge and I took over, my boss just couldn’t do it anymore, she had herown reasons so she left within two weeks and I took it on as a gatekeeper and no intention ofstaying in the role because I didn’t like what was going on either, but I did stay. (WardManager)

I got here accidentally [laughter]. I have no idea (how I became ward manager). I transferredfrom a surgical ward to this department at the request of my DoN (Director of Nursing), and Itransferred as a level two nurse, and the next day, and I was to assume a 2IC type role . . . Thenext day the nurse manager, well his wife had a baby and he went on paternity leave andbasically never came back so I got stuck here. (Ward Manager)

. . . the nurse manager at the time . . . she kept asking me to do her job for holiday relief, andthe last two previous times I had said ‘no I’m not quite there yet’, and she was about to go onfive week’s leave, but as she was handing over to me, she took a few days to hand over to mewhich I didn’t understand why, and she said ‘I’m actually resigning in my holidays’, and ohmy God, I’m stuck in this, this is me, and it was the first time I’d done it. (Ward Manager)

This experience is well known among upper management, for example, the Executive

Director, Organisational Development stated:

. . . that group of people, more often than not . . . probably . . . have the role imposed on thembecause somebody is about to leave or because they’ve opened up a new unit or they’vedecided to split into teams, whatever, they’ve acted in the role while someone has been onholidays, so when a position becomes available, a cursory . . . recruitment process takes place,if at all, and that person ends up sitting in the chair whether they genuinely wanted it or not.

Current Level 2 nurses concur that while they might act as ward manager occasionally, it is

with reduced responsibilities and great reticence:

Yeah, I did her relief about four weeks ago, yeah it was interesting. I’ve studied healthmanagement at uni, I’m just deciding what to do next, so a possible career for me. It’s not mygoal, but I could do it for awhile, give it a go. I found it quite interesting, being off the floor, offthe clinical side for a while . . . I don’t know I’ll see how it goes. (Level 2 Clinical Nurse)

I don’t want the responsibility that goes with it as well . . . It’s changed dramatically in thetime that I’ve been nursing, the ward managers’ role, and even the name of it has changed.It has become a lot more managerial, a lot more HRish than what it used to be. It used to have ahigher clinical aspect, but now it is all about rostering, staff satisfaction, patient satisfaction,complaints that sort of stuff. (Level 2 Clinical Nurse)

Such interview data are reinforced by our empirical observations. These complementary

sources of data lend support to our first proposition. (People who are currently working as

nurses did not have a managerial or administrative career path in mind when they became

nurses.) Many current ward managers arrived in their managerial positions accidently.

Furthermore, many future ward managers do not appear to have an increased level of

career development planned prior to their ward manager appointment.

The data we present here is based on one study. Hence, we cannot generalise about

what can be found in all hospitals. Yet, we can infer from interviewees who have worked

The International Journal of Human Resource Management 211

Dow

nloa

ded

by [

Gri

ffith

Uni

vers

ity]

at 1

6:52

28

Dec

embe

r 20

11

at other hospitals, and from our data collected from other hospitals that there are many

similarities between our case and other hospitals in Australia (references to be included

post-refereeing). This is most relevant when we explore our second proposition: that

hospitals have developed career planning and training to cope with the changing role of

ward managers.

Our ward managers and upper managerial staff agree that the role of ward manager has

changed a great deal over the years, a phenomenon that has been documented elsewhere

(Willmot 1998; Bolton 2003, 2005; Perry and Kulik 2008). However, with the changing

role and responsibility as a starting point, we did not find evidence to support the

proposition that ward managers were ready for the role. By contrast, the following

vignettes indicate that ward managers tend to find themselves ‘unprepared’ for the role

they were required to perform.

I am a clinician, when I entered this role I had no preparation whatsoever. (Ward Manager)

. . . I don’t know if there has been anything particularly structured (training and

development). I guess the only structured things have been when new systems have come inplace, like new computer systems and I did some training for that. There has certainly been no

financial training, they have done some, over the years done leadership courses, but I wasalready well into a job by that stage, so there is no sort of formal process . . . There is noformalised process. (Ward Manager)

. . . There is nothing in the educational programs here, there used to be, but nothing at the

moment, to mentor those girls, to transition them from being an expert clinician into a manger.There’s nothing here like that. (Ward Manager)

. . . it has changed a lot, but no there was no orientation, no real mentoring (when I started)

. . . so it is fly by the seat of your pants stuff. (Ward Manager)

I had no prep or training, but I’m a doer, like you just, you just, there wasn’t, I guess just in myupbringing and training, you just do what you’ve got to do, like you don’t think I can’t do this,

I don’t think I can’t do this, I haven’t had the training, I think the training would be nice, butyou just do what you’ve got to do . . . (but) I don’t think anything would have made the first

twelve months easier. (Ward Manager)

We infer from these complementary sources of data, including the above sample of typical

quotes that such data do not support our second proposition. Combined with our reading of

earlier studies on the role of the ward manager, it is clear that while the span of

responsibilities has expanded in recent decades to encompass more managerial duties,

hospitals, including The Hospital, have not yet developed career planning and training for

ward managers accordingly. Furthermore, there is evidence (supported in Table 1) that in

years past, nurses have often been left to develop their own ‘unstructured’ career

Table 1. Qualifications for ward managers at the hospital.

Essential qualifications Professional T&D Hospital T&D Individual T&D

† Current registration with NursingCouncil

U U

Desirable qualifications† Tertiary qualification in relevant

specialtyU U

† Minimum 5 years cumulativeexperience in clinical speciality

U U

† Tertiary management qualifications U

K. Townsend et al.212

Dow

nloa

ded

by [

Gri

ffith

Uni

vers

ity]

at 1

6:52

28

Dec

embe

r 20

11

development path through a variety of higher education providers (Foster 2000). Such an

approach tends to leave many ward managers to ‘sink or swim’.

Our third proposition is that The Hospital has provided good organisational support for

nurses when they have been promoted to ward managers. Some staff arrange their own

career development if they feel that their organisation does not provide enough (Parker,

Arthur, and Inkson 2004). This has been apparent at The Hospital. The various levels of

organisational or self-driven career development have led to mixed outcomes for upper

management and ward-level employees. This has important implications for many day-to-

day issues within the hospital including employee satisfaction, delivery of care and

employee retention/turnover. Certain nurses may seem to be talented managers who easily

take to the role and acquire the skills quickly without much formal support. However,

others may be left floundering with a new managers’ role.

There is a body of research, which considers employees’ perceptions of organisational

support (Eisenberger, Huntington, Hutchinson and Sowa 1998; Shore and Tetrick 1991;

Yoon and Lim 1999). According to Furnham and Taylor (2004) people will join an

organisation, however, the reasons they leave will be more likely related to the

relationship with their boss. Empirical studies have linked the supervisor into studies of

perceived support (Eisenberger, Stinghambler, Vandenberghe, Sucharski and Rhoades

2002; Stinghambler and Vandenberghe 2004; Cole, Bruch and Vogel 2006; Rhoades,

Shanock and Eisenberger 2006). In hospitals, the ward managers’ role appears to be a key

factor, which determines if nurses maintain their employment or intend to leave. With this

in mind, it is essential that the hospital employee’s ‘boss’ – most usually ward managers,

have the appropriate skills and competencies for managing their subordinates. The HPWS

literature identifies the line manager as the critical interface between the organisation and

the employee and the person who delivers HRM. HPWS also emphasises the importance

of developing skills. However, in our case we find mixed picture, as before:

. . . (training and support) is rarely very structured, so you don’t go to university to do a degree

in ‘Ward Manager-ship’, you don’t have that opportunity. Every institution is different, so the

systems are different, so you tend to be self taught. (Ward Manager)

. . . you have to be good at the operational stuff, before you can be visionary . . . ..

. . . I virtually do everything just by failing at one thing or another. You are not taught abouthours per patient day which is one of the budgetary things; you are not taught about how to

manage budgets; you are not taught about how to talk to people, what to say, how to analyse.

I’ve been to about three study days, all of which at varying levels were not very good, butotherwise, nothing. (Ward Manager)

. . . finance, logistics management, people management, HR, it has all just been about . . .

going to somebody that has been doing it for longer than me and saying I can’t work out why

I am so spent, you know, go back and have a look at this, this and this, okay where do you findthat? So you go to the computer and look for an hour, this is the report that I have to look at,

profit/loss, account summaries, many, many pages, I’ve never had a lesson on how to do this,

never, never. Over the last four years, I have learnt by a process of elimination, about how toread it. How to interpret, what it all means, what influences it, and stuff like that, very, very

poor higher education study explanation of the job once you get up this high. Once you hit . . .

clinical nurse, the amount of resources that are available to you from this organisation . . . toteach you how to do your job, higher than just being a nurse, is very poor, there isn’t anything,

there is no money. (Ward Manager)

The Executive Director, Organisational Development had also identified that there had not

been adequate support for ward managers in the past. Therefore, when we were conducting

The International Journal of Human Resource Management 213

Dow

nloa

ded

by [

Gri

ffith

Uni

vers

ity]

at 1

6:52

28

Dec

embe

r 20

11

the study, she was already developing improved processes and systems to address the kind

of gaps that are identified here:

We have already made quite a few inroads . . . most of us are non health (and) perceive this tobe a terribly slow moving environment, but because of the complexity of the workenvironment, the history and culture that has existed before it is about building relationshipwith the Exec. level, particularly with the nursing cohort . . . So rather than picking off thingsand saying ‘well the loudest person that jumps up and down and says we need a course inbudget management right now’, we are actually at a point in . . . this organisation where weare able to see there is a much bigger picture we do know that . . . if we do that first, we mightmiss the boat on a whole bunch of other stuff, if we do it embedded in a broader programappropriately, we will actually get it to stick . . . (this) means there is a long lead in time to alot of (training and development). There is the Exec leader’s program that has started to filterdown so those people that are participating in it are actually filtering down some of theprocesses, theories and ideas, so some of the people at management level are already seeingthe models we will be teaching them . . . We’ve also learnt to pilot things extensively and testworkshops and test case studies, that takes a long time, so mid next year, we will probablyhave the first series of offerings as part of the broader management development program.

Some people come to supervisory positions better prepared than others. Furthermore,

there has been a long debate among practitioners (also see the many ‘self-help’ books)

whether ‘managing people’ is a skill that can be learned or rather, is simply something

which people are born with (Torrington, Weightman and Johns 1989; Torrington 1991).

Nevertheless, since ward managers are the conveyors of HRM, if ward managers in a

hospital interpret their role in very different ways, this could be a problem for ward staff,

patients and senior management (Willmot 1998; Townsend, Wilkinson, Bamber and Allan

2011). Numerous senior managers showed us that it is the role of the ward manager who

can really ‘make or break’ any initiative from the executive team through ward managers’

capacity (and indeed willingness) to adequately convey and implement their managerial

duties.

Our fourth proposition suggests that henceforth the selection criteria for ward

managers will give greater weight to people and general management skills rather than

clinical skills alone. This change is appropriate for clinicians to perform as ward managers

in an HPWS. The ward nurse who has been ‘around the longest’ and is clinically skilled

has typically been provided with first opportunity to take a vacant ward manager position.

While this has been the custom and practice for many years, it has also long been a

problem. Without exception, senior managers agree that this has been a problem for the

years they have been involved in the industry, for example, a Director of Nursing states:

I basically worked on the wards for a couple of years, then became a clinical nurse, so was incharge of shifts and whatever, at the time the manager that walked on the ward went into theback and there was no one else to step up so I went from being a clinical person to suddenlymanaging a ward, and unfortunately in nursing school they don’t teach you how to do that,they teach you how to be a nurse, but they don’t teach you about budgets, about peoplemanagement, about anything, so that’s been a real deficit . . . I think I was probably luckybecause I had a good mentor, that helped me identify what I needed to work on and withoutthat mentor I wouldn’t have gotten to where I am. (Director of Nursing)

The Director of Administrative Services had worked in many hospitals in the last 30 years

and states:

Having worked around the hospital and in health for as long as I have, I have friends who havebeen those ward managers and have been thrown into that role, who are great people, greattraditions, but absolutely crappy ‘people’ people. They don’t like the whinging, but mostpeople whinge about something, but it is how you deal with that whinging, that is what makesthem a manager or a clinician sort of thing. Even from an admin. point of view, just because

K. Townsend et al.214

Dow

nloa

ded

by [

Gri

ffith

Uni

vers

ity]

at 1

6:52

28

Dec

embe

r 20

11

you’ve been in the department, say outpatients for a long time and you know every process,that doesn’t make you the best person to do that management role. (Director, AdministrativeServices)

While there is an acknowledgement that more needs to be done and that the move towards

HPWS has highlighted these gaps, progress to remedy the problem seems to be

frustratingly slow. The Executive Director, P&L recognises that the relationships at the

ward level are vital, and have typically not been developed well in this, or other hospitals:

They say nurses eat their young and that is absolutely right, they have no training, you chuckthem in there with no expertise . . . People treat each other appallingly, the behavioural thingis appalling and the managers do nothing about that, there [are] . . . commercial skills orbusiness skills, pretty lacking they are all level-one problem solvers, so they all dive in andsolve their problem today, and then there will be the same problem next week and the weekafter, and they just keep solving it, or they design their own solution that is totally irrelevant tothe organisation, so there’s no sort of whole-organisation systems-wide attempt to deal withanything. . . . I have spent a lot of time researching this, and I have spent a lot of time talkingto people who understand this stuff right across the world, and basically in England, America,Australia, New Zealand, this is Health and how they all behave. So I say it is not our fault, it isthe way they have been trained really, and nobody has done anything about it. (ExecutiveDirector, People and Learning)

The HR Business Partner adds that:

. . . what happens is they (the level 2s) may have relieved as a nurse unit manager when theyare a Level 2, which is a clinical nurse, midwife, and then they relieve holidays and things, butthere isn’t a lot of program support to actually help them be really good at doing that, which isa very stressful way of becoming good at something.

And:

. . . there is a gap (in training), we don’t have a Manager’s Program which gives (ward)managers that round of skills across strategy, finance and managing your people andmanaging the mission, so at the moment they get it from on the job experience . . .

The Hospital has a committed team of HR personnel who are all came from outside the

health care industry. Such HR personnel have had much to learn about the peculiarities of

health care. This has led to some misunderstandings with medically trained staff.

Nevertheless, the The Hospital recent practice has been to recruit HR personnel externally.

The rationale was that they bring a new perspective to the hospital, which can help it

identify HR solutions that may be novel in this industry, an approach which is proving

successful albeit in a long journey of developing HPWS and manager training.

. . . in other industries I’ve worked in it is very much about succession planning and quiteoften managers had KPIs around the person who was about to step into the senior role, it is abit of a phenomenon that is lacking in health. Succession planning is a major part of what wedo now. It has been substantially missing. (HR Business Partner)

Table 1 outlines The Hospital’s expected qualifications for ward managers. As indicated,

the only essential qualification is current registration with the Nursing Council. This

registration is typical of professional body registration, where qualifications are required

(in this case, a bachelor’s degree), professional competencies (documented by the Nursing

Council and publicly available) and fitness for practice (including health, good

standing/reputation and English language competency). Such qualifications are

determined and met by the individual and the professional body, the hospital’s T&D

has no explicit role in gaining registration.

Qualifications also reflect an individual’s drive for further career development. As

indicated in Table 1, higher educational qualifications in the relevant speciality are

The International Journal of Human Resource Management 215

Dow

nloa

ded

by [

Gri

ffith

Uni

vers

ity]

at 1

6:52

28

Dec

embe

r 20

11

developed in conjunction with the professional body, and the cumulative experience is

provided through organisational opportunities. Yet, both of these require an active level of

professional development by the individual employee. In addition, higher-education

management qualifications are also driven mostly by the individual’s initiative to seek

professional development. This should not be a surprise. Employees who are more

experienced and motivated to go beyond the minimum requirement would be better placed

to attain higher-level positions. However, when we consider the qualifications in

conjunction with the selection criteria documented at The Hospital another aspect of this

story unfolds.

The Executive Director, P&L of The Hospital acknowledges that there are selection

criteria in place, but says that they are not being used, at least ‘not seriously’ and that

subjective judgements continue to be used in judging an applicant’s capacity for selection.

In the P&L (HR) division, steps are being taken to develop a solution to this failing in the

field of career development for potential ward managers. Currently, there is internal

managerial education in the form of training programmes for senior managers. An

extension of this, at the time of this research, is being developed for ward managers.

In addition to management education programmes, the P&L division at The Hospital is

working to develop improved performance development processes and procedures. These

include an intranet-based system for developing, recording and tracking performance

development conversations for all employees including managers at all levels. The aims of

this program include ensuring a consistency of performance development measures across

the organisation, and identifying clinicians with the skills required to be successful ward

managers, regardless of their current position in the hierarchy. The end goal is that when

identified as a potential ward manager, these nurses can then be provided with adequate

T&D to increase their likelihood of success in the role.

We present only an initial part of the story here as The Hospital is, by the admission of

several senior managers, in the early stages of working towards an HPWS model. Hence,

they are recognising the areas where their systems are failing and flawed and working to

initiate high-performance processes that are currently not typical in Australian hospitals.

In relation to recruitment, selection and career development of ward managers, the P&L

managers are aware of what they require to meet an HPWS model of operation. But this

confronts reality – there is a chronic undersupply of nurses in the labour market. It is a

major challenge for The Hospital and most other hospitals to recruit and retain enough

people with the competencies that it requires. Hence, senior managers are developing

simultaneous policies to address the challenge. There is a dual focus on both the external

and the internal labour markets – bring in skilled and competent ward managers from

outside The Hospital, and for internal candidates, develop selection criteria and internal

T&D that is measurable, linked to performance, and rewarded accordingly.

Nevertheless, as long as skilled Level 2 clinicians find themselves as ward managers

‘accidently’, ‘unprepared’ and relatively ‘unsupported’, all levels of staff at this hospital

and others may tend to suffer from the failings of a system to train and develop adequately

the right people to have the appropriate skills for the positions they are asked to perform.

HPWSs are not simple to develop and our evidence suggests that the skills of the line

manager are critical in developing successful HPWSs. Senior managers should invest in

developing the careers the people before their appointment as ward managers. By selecting

and appropriately developing the skills of nurses before they become ward managers,

hospitals should be better able to capitalise more significantly on the potential benefits of

HPWS.

K. Townsend et al.216

Dow

nloa

ded

by [

Gri

ffith

Uni

vers

ity]

at 1

6:52

28

Dec

embe

r 20

11

Conclusions

Hospitals are different from most organisations in that their effectiveness is often

measured by their success in treating illness, avoiding deaths or in the case of palliative

care units, making the death as humane as possible. While increasing pressures face

hospitals in Australia and other countries, one important area of opportunity for hospitals

is to improve and better manage the HR function. While many performance measures in

hospitals are unique, there has been an increasing interest in and recognition of the

potentially valuable role of HR policies and practices in this industry

This article has presented a study of a group of hospitals, which is moving to

implement an HPWS model. This article has explored a number of areas of the ‘black box’

in the causal link: the recruitment, then the T&D and the organisational support of ward

managers who are already in the role. However, we infer from our data that ward managers

almost without exception find themselves in such a line manager role accidently and are

unprepared for what is required of them. Although The Hospital is noted through

accreditation processes as an industry leader, at the time of the research, it was still

developing and implementing the T&D programmes to provide all the skills required to

manage a hospital ward. Consequently, like organisations throughout the industry,

generally, The Hospital has as yet failed to harness the benefits of ward managers as a

pivotal part of the HR system. They are the missing link.

There has long been a failure of hospitals and other employing organisations fully to

develop the skills required by employees before they become line managers. Line

managers are a critical link in the high-performance chain of causality and this study

illustrates that, despite much rhetoric, hospitals may still have much potential for

implementing schemes further to develop nurses to prepare them for line-manager

positions.

Acknowledgements

Thanks to the executive, mangers and staff at The Hospital for allowing us to conduct research thereand for commenting on an earlier version of this article. Thanks also to this journals’ editor andreferees for helpful comments, which have helped us improve an earlier version. This research hasbeen supported through the Australian Research Council’s Discovery Projects funding scheme(DP0772163).

Note

1. We use the term ‘senior nurse’ to encapsulate all roles that have seniority and primarymanagerial responsibility in hospital wards. This could be called the Matron, Charge Nurse,Ward Sister or Nurse Unit Manager, depending on the custom.

References

Aguinis, H., and Kraiger, K. (2009), ‘Benefits of Training and Development for Individuals andTeams, Organisations and Society,’ Annual Review of Psychology, 60, 451–474.

Aikin, L.H., Clarke, S.P., and Sloane, D.M. (2002), ‘Hospital Staffing, Organisation, and Quality ofCare: Cross-National Findings,’ International Journal for Quality in Health Care, 14, 5–13.

Aikin, L.H., Havens, D.S., and Sloane, D.M. (2000), ‘The Magnet Nursing Services RecognitionProgram: A Comparison of Two Groups of Magnet Hospitals,’ American Journal of Nursing,100, 26–35.

Aikin, L.H., Smith, H.L., and Lake, E.T. (1994), ‘Lower Medical Mortality Among a Set ofHospitals Known for Good Nursing Care,’ Medical Care, 32, 771–787.

Australian Health Workforce Institute (2008), Australian Nursing Workforce Research, Melbourne:Australian Health Workforce Institute.

The International Journal of Human Resource Management 217

Dow

nloa

ded

by [

Gri

ffith

Uni

vers

ity]

at 1

6:52

28

Dec

embe

r 20

11

Balogun, J., and Johnson, G. (2004), ‘Organizational Restructuring and Middle ManagerSensemaking,’ Academy of Management Journal, 47, 523–549.

Becker, B., and Huselid, M. (2006), ‘Strategic Human Resources Management: Where Do We GoFrom Here?’ Journal of Management, 32, 6, 898–925.

Bell, J. (1998), ‘From Ward Sister to Ward Manager,’ in Ward Management in Practice, ed.J. Mackenzie, London: Churchill Livingstone, pp. 33–58.

Bolton, S. (2003), ‘Multiple Roles? Nurses as Managers in the NHS,’ The International Journal ofPublic Sector Management, 16, 122–130.

Bolton, S. (2005), ‘Making Up Managers: The Case of NHS Nurses,’ Work, Employment andSociety, 19, 5–23.

Boxall, J., and Purcell, J. (2008), Strategy and Human Resource Management, Basingstoke: PalgraveMacmillan.

Buchan, J. (2004), ‘What Difference Does (‘Good’) HRM Make?’ Human Resources for Health, 2.Carpenter, M. (1977), ‘The New Managerialism and Professionalism in Nursing,’ in Health and the

Division of Labour, eds. M. Stacey, M. Reid, C. Heath and R. Dingwall, London: Croom, Helmand Prodist, pp. 165–194.

Child, J., and Partridge, B. (1982), The Lost Managers: Supervisors in Industry and Society,Cambridge: Cambridge University Press.

Cole, M.S., Bruch, H., and Vogel, B. (2006), ‘Emotion as Mediators of the Relations BetweenPerceived Supervisor Support and Psychological Hardiness on Employee Cynicism,’ Journal ofOrganisational Behaviour, 27, 463–484.

Cunningham, I., and Hyman, J. (1999), ‘Developing Human Resource Responsibilities to the Line:Beginning of the End or a New Beginning for Personnel?’ Personnel Review, 28, 9–27.

Currie, G., and Procter, S. (2005), ‘The Antecedents of Middle Managers’ Strategic Contribution:The Case of Professional Bureaucracy,’ Journal of Management Studies, 42, 1325–1356.

Dalton, M. (1966), Men Who Manage, New York: Wiley.Degeling, P., Meaxwell, S., Kennedy, J., and Coyle, B. (2003), ‘Medicine, Management, and

Modernisation: A “Danse Macabre”?’ British Medical Journal, 326, 649–652.Department of Health (1999), Making a Difference: Strengthening the Nursing, Midwifery and

Health Visiting Contribution to Health and Health Care, London: Department of Health.Dingwall, R., Rafferty, A.M., and Webster, C. (1988), An Introduction to the Social History of

Nursing, London: Routledge.Doherty, C. (2003), ‘Modernisation: The Role of Ward Sisters and Charge Nurses,’ Nursing

Standard, 17, 33–35.Dopson, S., and Stewart, R. (1992), ‘What is Happening to Middle Management?’ British Journal of

Management, 1, 3–16.Duckett, S. (2005), ‘The Australian Healthcare Workforce,’ in Workplace Reform in the Healthcare

Industry: The Australian Experience, eds. P. Stanton, E. Willis and S. Young, Houndsmill:Palgrave Macmillan, pp. 30–59.

Eisenberger, R., Huntington, R., Hutchinson, S., and Sowa, D. (1998), ‘Perceived OrganizationalSupport,’ Journal of Applied Psychology, 71, 500–507.

Eisenberger, R., Stinghambler, F., Vandenberghe, C., Sucharski, I.L., and Rhoades, L. (2002),‘Perceived Supervisor Support: Contributions to Perceived Organizational Support andEmployee Retention,’ Journal of Applied Psychology, 87, 565–573.

Epstein, C., Soren, C., Oglensky, B., and Saute, R. (1998), The Part-Time Paradox: Time Norms,Professional Life, Family and Gender, New York: Routledge.

Finlayson, B., Dixon, J., Meadows, S., and Blair, G. (2002), ‘Mind the Gap: The Policy Response tothe NHS Nursing Shortage,’ British Medical Journal, 325, 541–544.

Ford, J., and Kraiger, K. (1995), ‘The Application of Cognitive Constructs and Principles to theInstruction System Model of Training,’ in International Review of Industrial and OrganisationalPsychology, eds. C. Cooper and I. Robinson, New York: Wiley, pp. 1–48.

Foster, D. (2000), ‘The Development of Nurses as Managers: The Prevalence of the Self-Development Route,’ Journal of Nursing Management, 8, 193–199.

Furnham, A., and Taylor, J. (2004), The Dark Side of Behaviour at Work, London: PalgraveMacmillan.

Godard, J. (2004), ‘A Critical Assessment of the High-Performance Paradigm,’ British Journal ofIndustrial Relations, 42, 349–378.

K. Townsend et al.218

Dow

nloa

ded

by [

Gri

ffith

Uni

vers

ity]

at 1

6:52

28

Dec

embe

r 20

11

Goldstein, I., and Gessner, M. (1988), ‘Training and Development in Work Organizations,’in International Review of Industrial and Organizational Psychology, eds. C. Cooper andI. Robertson, New York: Wiley, pp. 43–72.

Goode, C., Krugman, M., Smith, K., Diaz, J., Edmonds, S., and Mulder, J. (2005), ‘The Pull ofMagnetism: A Look at the Standards and the Experience of a Western Academic Medical CentreHospital in Achieving and Sustaining Magnet Status,’ Nursing Administration Quarterly, 29, 3,202–213.

Guest, D. (1987), ‘Human Resource Management and Industrial Relations,’ Journal of ManagementStudies, 24, 503–521.

Hales, C. (2005), ‘Rooted in Supervision, Branching Into Management: Continuity and Change inthe Role of First-Line Manager,’ Journal of Management Studies, 42, 471–506.

Harney, B., and Jordan, C. (2008), ‘Unlocking the Black Box: Line Managers and HRM-Performance in a Call Centre Context,’ International Journal of Productivity and PerformanceManagement, 57, 4, 275–296.

Hyde, P., Boaden, R., Cortvriend, P., Harris, C., Marchington, M., Pass, S., Sparrow, P., and Sibbald, B.(2006), Improving Health Through Human ResourceManagement:Mapping the Territor, London:The Chartered Institute of Personnel and Development.

Legge, K. (1989), ‘Human Resource Management: A Critical Analysis,’ in New Perspectives inHuman resource management, ed. J. Storey, London: Routledge.

Loan-Clarke, J. (1996), ‘Healthcare Professionals and Management Development,’ Journal ofManagement in Medicine, 10, 24–35.

Lowe, J. (1992), ‘Locating the Line: The Front-Line Supervisor and Human Resource Management,’in Reassessing Human Resource Management, eds. P. Blyton and P. Turnbull, London: Sage,pp. 148–169.

Marchington, M., and Grugulis, I. (2000), ‘Best Practice HRM: Perfect Opportunity or DangerousIllusion,’ International Journal of Human Resource Management, 11, 905–925.

Marchington, M., and Wilkinson, A. (2008), Human Resource Management at Work: PeopleManagement andDevelopment, London: The Chartered Institute for Personnel and Development.

Mark, B. (1994), ‘The Emerging Role of the Nurse Manager: Implications of EducationalPreparation,’ Journal of Nursing Administration, 24, 48–55.

McGeehee, W., and Thayer, P. (1961), Training in Business and Industry, New York: Wiley.Moore, M., and Robie, C. (1978), ‘Training Needs Analysis: Review and Critique,’ Academy of

Management Review, 3, 531–545.Moss-Kanter, R. (1977), Men and Women of the Corporation, New York: Basic Books.National Health and Hospitals Reform Commission (2009), A Healthier Future for All Australians:

Final Report of the National Health and Hospital Reforms Commission June 2009, Barton:National Health and Hospitals Reform Commission.

Pahl, J.M., and Pahle, R.E. (1971), Managers and Their Wives, London: Allen Lane.Parker, P., Arthur, M.B., and Inkson, K. (2004), ‘Career Communities: A Preliminary Exploration of

Member-Defined Career Support Structures,’ Journal of Organizational Behaviour, 25,489–514.

Perry, E., and Kulik, C. (2008), ‘The Devolution of HR to the Line: Implications for Perceptions ofPeople Management Effectiveness,’ International Journal of Human Resource Management, 19,262–273.

Private Health Insurance Administration Council (2008), Operations of the Private Health InsurersAnnual Report 2007-08, Canberra: Private Health Insurance Administration Council, AustralianGovernment.

Purcell, J., and Hutchinson, S. (2007), ‘Front-Line Managers as Agents in the HRM-PerformanceCausal Chain: Theory,’ Analysis and Evidence, Human Resource Management Journal, 17,3–20.

Runciman, P. (1983), Ward Sister at Work, Edinburgh: Churchill Livingstone.Scase, R., and Goffee, R. (1989), Reluctant Managers: Their Work and Lifestyles, London: Unwin

Hyman.Sellgren, S., Ekvall, G., and Thomson, G. (2006), ‘Leadership Styles in Nursing Management:

Preferred and Perceived,’ Journal of Nursing Management, 14, 348–355.Shanock, L.R., and Eisenberger, R. (2006), ‘When Supervisors Feel Supported: Relationships With

Subordinates’ Perceived Supervisor Support, Perceived Organizational Support, andPerformance,’ Journal of Applied Psychology, 91, 689–695.

The International Journal of Human Resource Management 219

Dow

nloa

ded

by [

Gri

ffith

Uni

vers

ity]

at 1

6:52

28

Dec

embe

r 20

11

Shore, L., and Tetrick, L. (1991), ‘A Construct Validity Study of the Survey of PerceivedOrganisational Support,’ Journal of Applied Psychology, 76, 637–643.

Smith, V. (1990), Managing in the Corporate Interest: Control and Resistance in an American Bank,Berkley: University of California Press.

Southall, A. (1959), ‘An Operational Theory of Role,’ Human Relations, 12, 17–34.Stinghambler, F., and Vandenberghe, C. (2004), ‘Favourable Job Conditions and Perceived Support:

The Role of Organizations and Supervisors,’ Journal of Applied Social Psychology, 34,1470–1493.

Storey, J. (1992), Developments in the Management of Human Resources, Oxford: Blackwell.Tharenou, P. (1997), ‘Determinants of Participation in Training and Development,’ in Trends in

Organizational Behaviour, eds. C. Cooper and D. Rosseau, New York: Wiley, pp. 15–28.Tharenou, P. (2010), ‘Training and Development in Organizations,’ in The SAGE Handbook of

Human Resource Management, eds. A. Wilkinson, T. Redman, S. Snell and N. Bacon, London:Sage, pp. 155–172.

Thornhill, A., and Saunders, M. (1998), ‘What if Line Managers Don’t Realise They’re Responsiblefor HR? Lessons From an Organization Experiencing Rapid Change,’ Personnel Review, 27,460–476.

Torrington, D. (1991), Management: Face to Face, Hertfordshire: Prentice Hall International.Torrington, D., Weightman, J., and Johns, K. (1989), Effective Management: People and

Organisations, Hertfordshire: Prentice Hall.Townsend, K., Bartram, T., and Wilkinson, A. (2011), ‘Lifting the Standards of Practice and

Research: Hospitals and HRM in the Asia Pacific,’ Asia Pacific Journal of Human Resources,49, 2, 131–137.

Townsend, K., and Wilkinson, A. (2010), ‘Managing Under Pressure: HRM in Hospitals,’ HumanResource Management Journal, 20, 4, 332–338.

Townsend, K., Wilkinson, A., Bamber, G., and Allan, C. (2011), ‘Mixed Signals in HumanResources Management: The HRM Role of Hospital Line Managers,’ Human ResourceManagement Journal, forthcoming.

Valcour, M., and Ladge, J. (2008), ‘Family and Career Path Characteristics as Predictors offWomen’s Objective and Subjective Career Success: Integrating Traditional and Protean CareerExplanations,’ Journal of Vocational Behavior, 73, 300–309.

Wallick, W. (2002), ‘Healthcare Managers Roles, Competencies and Outputs in OrganisationalPerformance Improvement,’ Journal of Healthcare Management, 47, 390–401.

Watson, S., Maxwell, G., and Farquharson, L. (2007), ‘Line Managers’ Views on Adopting Humanresource Roles: The Case of the Hilton (UK) Hotels,’ Employee Relations, 29, 30–49.

Watson, T.J. (1994), In Search Management, London: Routledge.West, M., Borrill, C., Dawson, J., Scully, J., Carter, M., Anelay, S., Patterson, M., and Waring, J.

(2002), ‘The Link Between the Management of Employees and Patient Mortality in AcuteHospitals,’ International Journal of Human Resource Management, 13, 1299–1310.

West, M., Guthrie, J.P., Dawson, J.F., Borrill, C.S., and Carter, M. (2006), ‘Reducing PatientMortality in Hospitals: The Role of Human Resource Management,’ Journal of OrganisationalBehaviour, 27, 983–1002.

White, N., and Bray, M. (2005), ‘The Processes of Workplace Change for Nurses in NSW PublicHospitals,’ in Workplace Reform in the Healthcare Industry: The Australian Experience, eds.P. Stanton, E. Willis and S. Young, Houndsmill: Palgrave Macmillan, pp. 131–149.

Whittaker, S., and Marchington, M. (2003), ‘Devolving HR Responsibility to the Line: Threat,Opportunity or Partnership?’ Employee Relations, 25, 245–261.

Willis, E., Young, S., and Stanton, P. (2005), ‘Health Sector and Industrial Reform in Australia,’ inWorkplace Reform in the Healthcare Industry: The Australian Experience, eds. P. Stanton,E. Willis and S. Young, Hampshire: Palgrave Macmillan, pp. 13–29.

Willmot, M. (1998), ‘The New Ward Manager: An Evaluation of the Changing Role of the ChargeNurse,’ Journal of Advanced Nursing, 28, 419–427.

Wright, P., Gardner, T., Moynihan, L., and Allen, M. (2005), ‘The HR Performance Relationship:Examining Causal Direction,’ Personnel Psychology, 58, 409–446.

Yoon, J., and Lim, J. (1999), ‘Organisational Support in the Workplace: The Case of KoreanHospital Employees,’ Human Relations, 52, 923–945.

K. Townsend et al.220

Dow

nloa

ded

by [

Gri

ffith

Uni

vers

ity]

at 1

6:52

28

Dec

embe

r 20

11