mid-level competencies for nurse and midwife managers
TRANSCRIPT
MID-LEVEL COMPETENCIES > FOR NURSE AND MIDWIFE MANAGERS
CONTENTS >
1 Empowering and enabling leadership style2 Setting and monitoring performance standards3 Negotiation skills4 Proactive approach to planning5 Effective co-ordination of resources
The work of nurses in mid-level nursing and midwiferymanagement positions covers a broad spectrum withconsiderable variations in core tasks and areas ofresponsibility. Nonetheless, this role is becoming pivotalto effective service co-ordination and is increasinglyinvolved in quality assurance.
Specifically in relation to mid-level nursing and midwiferymanagement the Commission on Nursing recommendsthat the responsibilities should include the following:
> have a defined management role and not merelyretain a ‘gate-keeping’ administrative function
> have defined management responsibility with explicitdelegation of authority from directors of nursing andchief nursing officers
> have definite functional roles either in managing unitsof care or in the management of functionalresponsibilities such as in bed management andpractice development co-ordination
> have the authority to manage their area ofresponsibility without constant reference to moresenior management. However, as in all management,there should be effective communication with front-line and senior management. (7.29, page 16)
The primary purpose of the role in mid-levelmanagement is to co-ordinate the development anddelivery of nursing services across a significant servicesector (geographical sub-regions, a hospital divisionetc).
Scope of the role
> to lead in the professional planning andcommissioning of new services and new ways ofdelivering effective services (e.g. skill mix, nursingattendants etc)
> to ensure co-ordination of resource deployment (staffprimarily) across service units/wards etc to meetfluctuations in demand
> to ensure that all nursing services are managed tooptimise effectiveness, quality and efficiency
> to ensure co-ordination of scheduling across differentactivity areas (departments, theatres and wards, dayand residential services)
> to take a lead role in functional areas such aspersonnel, health and safety, activity analysis etc
> to play a lead role in staff recruitment and induction
> to lead the implementation of performance reviewand staff counselling
> to develop a coherent nursing identity and a clearmanagement style for the division/service area
> may have a managerial role in addressing complaints,discipline or grievance issues
> takes a lead role in facilitating interdisciplinary andinter-service issue co-ordination and resolution
> budget planning for nursing resources.
Timescale of impact One month to one year plus ideally, although staffingissues and resource planning can have a much shortertimeframe in terms of problem solving and short-termresponse planning.
Changes, trends and challenges The trends
> growing emphasis on value for money
> growing emphasis on formalised protocols andprocesses for service evaluation, audit and qualityassurance
> increasing specialisation within the delivery ofservices
> public health nursing becoming a primary healthservice hub
> community nursing fulfilling a skills transmission andfacilitation role with other providers of care
> the urgent issue of staff shortages and the need toreview core and peripheral tasks in role allocation
> evolving models of nursing practice not all of whichare consistent with each other
> the need to develop new approaches to skill mix, togiving away skills and to being more innovative inmodels of service delivery.
The challenge
The challenge is to take up an ‘integrator role’ involving
> at service delivery level integrating the resourcing andquality assurance activities across service units
> at service delivery level integrating the deploymentand contribution of specialist/expert nurses within theoverall service system
> at service development level integrating the learningon the practice level and the impact of newtechnologies etc with the requirement to delivercontinuity and quality of service within a resourceefficient paradigm
> at service development level integrating theleadership and learning and practice at front-lineservice level with the values and policies beingdeveloped at corporate or organisational levels
> at service management level, integrating the servicequality imperative with the need for efficiencies inresource deployment
> at service management level the need to championevidence-based nursing management practices whileretaining a primary patient advocate role
> to act as the ‘knowledge integrators’ by bridgingcurrent realities and practice at delivery level and thestrategic direction for the service (see diagram).
Empowering and enabling
leadership style
Proactive approachto planning
Effectiveco-ordinationof resources
Setting and monitoring
performance standards
Negotiation Skills
Practioner competenceand professional
credibility
Promotion of evidence-based decision-making
Building and
maintaining
relationships
Communicationand influencing
skills
Service initiationand innovation
Resilienceand composure
Integrity andethical stance
Sustainedpersonal
commitment
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Middle Managers
Strategic/Corporate View (What ought to be)
Solving contradictions/integrating knowledge forthe future
Reality at the front-line delivery level (What is)
Middle-manager competency map We have identified five critical competencies for this level of nursing management.
MID-LEVEL COMPETENCY 1 > EMPOWERING AND ENABLING LEADERSHIP STYLE
Definition Practices an enabling management stylewith the front-line management team andother contributing professionals.
AREAS OF APPLICATION
> Operating a consultative decision-making process on service issues > Pushing down responsibility and accountability to front-line management
levels > Proactively involving staff in managing change > Joint development of care standards, operating protocols etc > Encouragement of service proposals from the front line
MID-LEVEL COMPETENCIES
>1 Empowering and enabling leadership style
> Uses a consultative approach, isapproachable and keeps channels ofcommunication open with staff/trusts themto keep leader informed and ensures teammembers are informed at all times
> Uses a democratic style and encouragesstaff to make decisions about theirenvironment. Delegates tasks effectively
> Gives time to staff development/teammeetings and allows staff time to plan anddevelop their work and assists in makingtime and resources available to do so
> Fully involves other service providers indeciding upon service needs anddevelopments
> Encourages all team members toparticipate and contribute views on serviceissues
> confident and comfortable about owncapabilities and level of accountabilitywhen inviting contributions from others
> Works to create a team ethos andcollaboration across units at front-line
> Encourages synergies and sharing of ideasand learning from projects
> Leads enthusiastically on change. Presentsthe benefits case, influences staffpositively and gets ‘buy in’
> Deliberately delegates stretching tasks tojunior managers and supports theirlearning and delivery. Coaches juniormanagers to improve reflection andpractices
> Leads emotionally as well as rationally.Understands team members needs welland responds empathetically. Has astrong positive influence in teamsituations
> Establishes ad hoc management teamsto develop service proposals
> Encourages front-line contributions.
Indicators of MORE effective performance
Indicators of MOREeffective performance
MID-LEVEL COMPETENCIES
>1 Empowering and enabling leadership style
> Tends to remain distant and does not askfor views or opinions. Uses a top downstyle of communication
> Uses an autocratic style and makes owndecisions and communicates these tostaff as ‘fait accompli’. Tries to doeverything. Does not delegate
> Tends to hold few and short meetingswith a strong emphasis on routine andmaintenance of status quo
> Does not involve other providers orprofessionals in decisions regardingservice needs or developments
> Selectively involves team members indiscussions on service issues
> Is anxious or less confident about ownrole when engaged in consultativedecision-making processes
> Tends to manage subordinates on a moreindividualistic basis. Everyone works ontheir own project without sharing. Doesn’tcreate a common view or ethos
> Is reluctant to change, focuses on thedifficulties. Looks to compromise andminimises changes in practice or routines
> Is overly cautious and plays too safe indelegating tasks to others. Tends not tofully trust the capability of subordinates
> Tends to be more formal in style andtreats all individuals in the same way. Can be wooden or uninspiring in team settings
> Relies on the formal management chainto develop new proposals or services.
Indicators of LESS effective performance
Indicators of LESS effective performance
MID-LEVEL COMPETENCY 2 > SETTING AND MONITORING PERFORMANCESTANDARDS
Definition Establishes clear objectives and definescore standards of performance and clearexpectations for his/her unit managers.Regularly reviews performance againststandards.
AREAS OF APPLICATION
> Defining service level expectations > Tracking service quality and intervening as appropriate > Conducting staff appraisals and reviewing performance > Giving staff a clear sense of priority > Establishing project management protocols
MID-LEVEL COMPETENCIES
>2 Setting and monitoring performance standards
> Establishes project teams with clearterms of reference, reporting protocolsand review processes
> Regularly reviews progress on workprojects in relation to set targets
> Encourages team to set and achieveshort-term and medium-term goals
> Conducts formal appraisals orperformance reviews with staff and setsagreed targets and goals
> Uses tangible measures as outcomes toevaluate service or performance levelsand collects these regularly
> Intervenes decisively where service levelsor quality are below standard andestablishes a remedial process
> Will be assertive in addressing staffperformance problems. Will intervene in atimely and positive way
> Will be prepared to make tough decisionsor invoke sanctions for poor performanceas needed
> Coaches and mentors staff to improvetheir performance
> Strongly encourages junior managers andsupervisors to set specific performancegoals and standards
> Encourages and supports assertiveperformance management by juniormanagers
> Encourages staff development andsharing of best practice. Links staffdevelopment and training to the priorityservice needs.
Indicators of MORE effective performance
Indicators of MORE effective performance
MID-LEVEL COMPETENCIES
>2 Setting and monitoring performance standards
> Establishes project teams without clearenough guidelines or objectives. Fails toput in place systems for tracking andreview of progress or may not set specificenough targets
> Tends to focus on day-to-day operationsand does not set medium-term targets
> Does not conduct formal appraisals norreview performance systematically, doesnot set specific goals or measures
> Doesn’t use tangible data to evaluateprogress or service levels or does so onan inconsistent or irregular basis
> Collects data but doesn’t use it toaddress shortfalls in performance, slow torespond to failing standards
> Will tend to let performance issues festeror intervene in a negative way when theyhave gone too far
> Will tend to let difficult decisions slip orput off confronting the issue
> Lets staff perform as they can withoutpositive guidance
> Lets subordinate managers concentrateon the day-to-day without giving enoughattention to leading on standardsassurance
> Lets junior managers refer difficulties withstaff performance upwards
> Reactive to staff development needs anddoes not link training and development toservice priorities.
Indicators of LESS effective performance
Indicators of LESS effective performance
MID-LEVEL COMPETENCY 3 > NEGOTIATION SKILLS
Definition Skilful in the handling and positiveresolution of conflict, building commonground and seeking to achieve mutuallyacceptable outcomes. Can be skilfullyassertive to achieve desired outcomes,puts a case across well.
AREAS OF APPLICATION
> Negotiating with senior management and external agencies to obtainresources
> Introducing new ways of working and selling the benefits of change > Resolving employee relations issues > Adjudicating or mediating in inter-professional disputes or client issues > Negotiating to redeploy staff
MID-LEVEL COMPETENCIES
>3 Negotiation skills
> Always investigates background to issuesthoroughly and investigates all possibleoptions, senses when there is a morecomplex or sensitive underlying issue
> Shows a balanced approach in disputesand listens to both sides. Is open minded
> Able to use high level of communicationskills to convince or argue the needs ofstaff and of service
> Able to see others’ viewpoints and buildsa win/win case and bridges the interestsof both parties
> Able to put forward alternativesuggestions in problem solving
> Retains composure under pressure andstays calm, is assertive but not aggressive
> Skilful in getting both parties to exchangepositions and check their relativeunderstanding
> Can win concessions by offering someground and doesn’t let the issue destroythe relationship
> Judges the timing of interventions tomaximise effect
> Anticipates objections and preparesground. Gets into consultation early
> Knows how to get things done boththrough formal channels and the informal network.
> Will go into sensitive meetings poorlyprepared or with only half the facts andtends to jump to a solution
> Shows bias and may get emotionallyinvolved, takes sides in disputes orprejudges issues
> Poor communication skills, doesn’tpresent effective arguments
> Tends to see things only from ownperspective and doesn’t sell benefits tothe other party
> Does not put forward suggestions. Onlyprovides one proposal and then waits forsolution
> Tends to react emotionally and shows thestrain, can become aggressive in style
> Allows both parties to concentrate onlyon their own concerns, doesn’tencourage position clarification
> Wins concessions at too high a cost tothe working relationship. Only wants to getand doesn’t offer to give or reciprocate
> Misjudges situations and has a ‘bull in achina shop’ effect, overreacts too early
> Doesn’t read the environment well,doesn’t get key players on side earlyenough
> Is overly rigid or naive in only goingthrough formal channels to get things done.
Indicators of MORE effective performance
Indicators of LESS effective performance
MID-LEVEL COMPETENCY 4 > PROACTIVE APPROACH TO PLANNING
Definition Looks ahead and forward plans forservice developments. Anticipates trendsand identifies opportunities. Ensures thatthe learning from new service models andpractices influences service planning.
AREAS OF APPLICATION
> Planning the development of new services and practices > Anticipating resourcing needs on a medium-term basis > Making a strong input to interdisciplinary policy and planning groups > Forward planning on complex service issues (e.g. new work practices, etc) > Integrating the learning from implementing new practices with future plans
MID-LEVEL COMPETENCIES
>4 Proactive approach to planning
> Sensing and keeping ear to the groundon corporate agenda. Leads ontranslating the corporate agenda intopractical service planning
> Shows strong trend anticipation andsensing skills and uses these toopportunistically develop services orpractices
> Shows awareness of service needs, ableto analyse and assess current systemsand demand levels to develop bestsystem, based on needs
> Constantly seeking to identify areas forpractice development, i.e. whereimprovement is necessary in terms ofstaff and service development, so thatbetter outcomes can be achieved
> Develops a proactive and positiveworking relationship with unions and staffassociations around change issues
> Collaborates with other disciplines andagencies in the development of serviceplans. Leads interdisciplinary planninggroups
> Acts as the conduit to ensure that thelearning from new service practicesactively shapes future service plans
> Takes responsibility for service policydevelopment.
> No awareness of ‘bigger picture’. Tendsto view service at micro or operationallevels only
> Misses opportunities to develop newservices due to short-term focus, or lackof awareness of developments within thewider health and social care system
> Does not analyse or assess serviceneeds, tends to be reactive in approachto service development
> Only examines need to improve serviceswhen there is a crisis
> Only relates to unions and staffassociations on a reactive basis and maybecome embroiled in difficult industrialrelations with unions
> Tends to be more comfortable planningfrom a single discipline perspective
> Continues to plan services in a top downway without consulting the staff on thelearning from current applications andpractices.
> Needs to be continuously reminded toengage in policy development.
Indicators of MORE effective performance
Indicators of LESS effective performance
MID-LEVEL COMPETENCY 5 > EFFECTIVE CO-ORDINATION OF RESOURCES
Definition Ensures that critical human and materialresources are allocated in an effectiveway, monitors activity levels andintervenes to align resources andmaximise efficiencies.
AREAS OF APPLICATION
> Ensuring an adequate supply of staff to meet service demands > Planning and monitoring the use of material resources > Setting budgets and tracking expenditure > Tracking service levels and reorganising staffing to meet contingencies > Continually reviewing how productively resources are being used to meet
service needs
MID-LEVEL COMPETENCIES
>5 Effective co-ordination of resources
> Shows system understanding and theability to balance multiple resourcingissues
> Consistently achieves efficiencies inresource usage by intelligent deployment,adjustments and monitoring
> Negotiates services and resource levelswith funding bodies and/or third parties
> Demonstrates the capability to accuratelymeasure resource usage against activitylevel for key areas (utilisation indices)
> Implements effective monitoring systemsfor all key resource deployments
> Can skilfully deploy and adjust humanresources to meet changes, demandsand contingencies
> Is resourceful in solving staff shortages orcrises. Reacts quickly and sources staffcreatively
> Shows a financial awareness as relevantto the service. Plans budgets and trackvariance
> Shows a sound appreciation and usageof IT systems for resource management
> Very mindful of wasting resources andencourages this attitude in staff andjunior managers. Cuts down appropriatelyon resources used and values costsaving as a way to free up resources forfurther service developments.
> Manages resource usage in a reactiveand historically informed way
> Is slow to intervene and lacks flexibility inreviewing and reallocating resources tomeet changing needs or demand levels
> Refers service and resourcing levelissues to the director without fullydeveloping them
> Lacks confidence in dealing with fundingagencies and third parties
> Monitors resource usage, mainly bysignificant exceptions or on an ad hocbasis
> Not aware of non-professional staffingand resources issues
> Operates standard rotas and schedulingwithout consideration of changing serviceneeds and opportunities
> Has difficulty coping with unexpectedstaffing problems. Slow to react and reliestoo much on conventional approaches
> Averse to financial monitoring, defers tofinance staff without making an informedcontribution
> Uses IT systems at a minimal level or notat all
> Tends to waste resources and downplaysthis issue with staff and other managers.Makes resource cuts in a reactive orpoorly thought through way. Lacks a rationale for where efficiency is needed.
Indicators of MORE effective performance
Indicators of LESSeffective performance
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