What kind of health professional possesses the ‘inside knowledge’ needed to advise prospective nurses on the skills and qualities they will be required to maintain upon embarking on their careers? There may be more than one answer to this question, of course, but the one that we’ll focus on here is unique. This is a nursing role that rarely receives the attention of TV medical dramas, but without it, nursing would grind to a halt.
Enough with the parlor games: the senior nursing role that we have in mind – the one that gets little of the limelight enjoyed by patient-facing clinicians in popular entertainment, at least – is the nursing administrator.
You would be mistaken to imagine that this refers to someone who spends each day working to ensure that there are enough paper clips and printer ink, surgical face masks and scrubs, etc., for each clinical nurse in a hospital or district. This is not to imply that ‘office supplies’ are unimportant, of course, but merely to highlight another dimension to the term ‘administrator’ when used in conjunction with the word ‘nurse’.
To anticipate in abbreviated form what follows, let’s begin with a succinct introductory statement of what nurse administrators do: “We picture nurses as the hands-on health care providers who juggle multiple tasks to keep us well. That’s definitely true. But in the field of nursing, it’s the nurse administrator who, you might say, juggles the nurses.”
This definition of what these senior nursing roles about come from Chicago’s prestigious Elmhurst University, which offers the requisite Master of Science in Nursing (MSN) degree for entering this unique specialism. Upon reading what follows, those who think that it may be a worthwhile career move for them might do well to get themselves credentialed with such a qualification (it can be studied on a part-time basis at universities such as Elmhurst).
Let’s turn to the topic of what role nurse administrators play in the profession, what responsibilities they hold, and what qualities they exemplify to execute this complex and vital managerial work.
‘Juggling the nurses who juggle patient care’ – what nurse administrators are and do
Far from being an administrator in the conventional sense of the term, a nurse administrator is typically a fully qualified and experienced registered nurse who knows, inside out and from the ground up, what day-to-day nursing care entails. Their role may be relatively circumscribed, as in shift supervisors who oversee and provide clinical supervision to a relatively small number of nurses. However, it can also be decidedly expansive, as in the case of chief nursing officers, who take responsibility for running the entire nursing staff for huge healthcare corporations.
Let’s take a brief detour into one example of a highly imaginative nurse administrator’s work.
Nurse administrators and creative innovation
One rather vivid example of a nurse administrator’s sense of initiative took the form of a ‘kindness challenge’ developed by Dr. Carolyn Booker, a chief nursing officer based in Georgia.
Concerned about the unwelcome increase in violence she had noticed creeping into places she had always considered sacred (such as churches, schools, and hospitals), she began developing a method of using acts of kindness to counteract (and preemptively disarm) the cruelty of physical violence.
As reported in the Daily Nurse, the aim was to cultivate an atmosphere of considerate generosity to defuse the aggression preceding a violent act. Booker encouraged her nurses to model these acts of kindness, often in the form of small gestures such as regular and frequent eye contact with patients and coworkers, speaking more frequently to one another, and coming to the aid of coworkers without having to be asked.
Through this, she noticeably changed the culture in her local environments to minimize the trigger – or flashpoints – for irruptions of violence. Morale, needless to say, was significantly enhanced.
The point of a story like this is to underscore the creativity and intelligence of nurse administrators, whose daily work is about as far away from the provision of paperclips as possible.
‘Juggling nurses’ to ensure that they’re able to serve the daily demands of patient care safely and effectively requires ingenuity and innovation that the conventional meanings attached to the word ‘administrator’ tend, implicitly at least, to exclude. And yet in nursing, deep technical knowledge and creative initiatives of this sort are more the norm than the exception for talented nurse administrators.
Let’s now drill down a little deeper into what nurse administrators do (and the qualities that make this possible).
Where in healthcare systems are nurse administrators found?
The short answer to this question is ‘everywhere’. These unique professionals occupy managerial/leadership positions in every healthcare industry sector, from small clinics to large hospitals to community-wide home care.
No nursing specialism is excluded from a nurse administrator’s purview, whether pediatrics or podiatry, enterology, or emergency medicine. This means that they hold responsibility for an enormous workforce.
What does that responsibility consist of? An enormous and diverse workforce could be a recipe for entropy, chaos, or discoordination. However, if a capable, knowledgeable and imaginatively agile authority figure exists who can consistently coordinate this workforce and ensure that its various members remain on task, then disorder can be averted.
And the nurse administrator is that authority (‘authority’ not in the crude sense of someone who commands other people to do what they require, but in the ‘earned’ understanding of an experienced and self-disciplined individual who has acquired valuable wisdom and thereby naturally evokes respect).
So, the nurse manager overseeing a huge workforce assumes a weighty responsibility for managing the schedules in each nursing workplace, contributing to policies and then setting them in motion, conducting performance reviews, managing and helping to resolve disputes, and coordinating the duties of each nurse.
Most organizations today recognize that nursing isn’t simply a generic profession but an assembly of intricate specialisms. As a result, nurses are better managed by a fellow professional who has acquired substantial knowledge of the day-to-day work of those professionals from the inside.
Hence the demand for qualified nurses to become nurse managers. Typical titles for nurse administrators include nurse manager, nurse supervisor, director of nursing, VP of nursing, and, as mentioned above, chief nursing officer.
The roles and responsibilities of nursing administrators
To begin with the more overarching roles, upon assuming such a leadership position, a capable nurse administrator will be expected to craft a vision for the nursing service they preside over. But that’s just the beginning.
To become tangible, that vision must be implemented in the real world, a process that calls for talent in fostering (and sustaining through the inevitable turbulences and conflicts ahead) collaborative relationships between staff and managers in different departmental divisions.
Such collaboration typically arises from and is perhaps strengthened by, the emergence of differences of viewpoint and perhaps abrasive confrontations between the assembled stakeholders. The role of nurse administrators under these conditions is to draw upon their repertoire of analytical problem-solving and dispute-resolution aptitudes on a day-by-day basis to keep the ship afloat and on course.
Nurse administrator jobs are generally organized into a three-tier hierarchy.
First-line nurse managers
First-line nurse managers constitute the widest tier, where most nurse administrators are to be found. Sometimes also named ‘nurse managers’ or ‘nurse supervisors’, these professionals oversee frontline nursing services wherein nurses are engaged in direct patient care. Quite often, the number of nurses managed by these professionals is relatively small – typically a couple of dozen ward-based nurses working on a shift basis.
Responsibilities include ensuring that the nurses they manage appear for their shifts punctually so that ward handovers are smooth (and allow nurses completing the preceding shift to leave for home without unnecessary delay).
They’re also responsible for ensuring that their nursing teams deliver optimal care of the highest standard to patients and comply with organizational policies. In addition, they manage their unit’s stock and inventory and regularly spend part of their time in direct patient care.
In this way, they remain intimately connected to the day-to-day challenges that the nurses they manage routinely contend with. These managers, in other words, are not averse to rolling up their sleeves and lending their shoulders to the nursing job itself.
Mid-level nurse managers
Mid-level nurse managers, who are sometimes titled ‘clinical nurse managers’ or ‘case managers’ (and other similar designations), take responsibility for several nursing units within a healthcare organization. These are the professionals who first-line managers report, a function that situates them as intermediaries between frontline nursing care services and the more senior tiers of management.
This entails receiving and managing the issues and concerns brought to them from below by the frontline managers, and receiving and interpreting new developments and policy changes from above from senior executives. They’re also required to coordinate care with other departments and their managers, and to manage hiring and budgetary issues within their own managerial purview.
Nurse executives inhabit the loftiest managerial tier of the organization and include chief nursing officers, executive VPs of nursing, and nursing directors. This tier effectively constitutes the highest level of responsibility within any given healthcare organization or service.
Most senior nurse managers shoulder responsibility for crafting patient care delivery systems and directing patient care across the entire organization or establishment. Mid-level nurse managers and other healthcare professionals report to these executive nurses.
At this level, nurse executives are required to possess a sound systemic overview and apply systemic and strategic thinking, which is hardly surprising when one realizes that they hold responsibility for the ways that massive budgets (often running into multiple millions of dollars) are converted into actual, real-world nursing policies and practices. These interventions will quite frequently affect hundreds of units and facilities within a regional healthcare system.
Let’s turn now to a quick exploration of the qualities that make for an exceptional nurse administrator.
Qualities that capable nurse administrators need to possess
It should be said at the outset that it’s often difficult to make clear distinctions in many of the following attributes between what has been acquired through formal training and what is perhaps more properly described as a personal predisposition. There is, however, an interplay, a kind of ongoing dialogue, between these two aspects.
Excellent communication skills
These have as much to do with careful listening as with speaking and writing (or making presentations) well. Especially when new policy initiatives are coming into effect, keeping teams ‘on board’ is essential, and listening, explaining clearly, and remaining attuned to staff anxieties (and, where possible, assuaging them) are indispensable characteristics of a competent nurse administrator.
It might seem superfluous to highlight this as we are, after all, discussing managerial roles. However, persuading teams of people, who may often be wary of change and even anxiously resistant to it, to implement new policy initiatives, for example, is a real art requiring considerable diplomacy.
It also requires a combined capacity to be both compassionate and authoritative (in the sense of reassuring and inspiring confidence at times of change or crisis). Change, for example, can’t simply be decreed from above. It has to be implemented from below. The ability to tactfully overcome preemptive staff resistance with assurance and understanding from the outset is crucial.
Combining an objective outlook with a subjective sensibility
There are occasions when a nurse administrator has to discharge duties that are unpleasant and awkward, yet necessary. Firing or formally disciplining a staff member who has consistently fallen below professional standards almost certainly falls into his category. While one can feel sympathy for such an individual, the deed must, from an objective point of view, be done.
Personal likes and dislikes, in other words, though present, must not be permitted to cloud judgment in these circumstances, especially when patient care is at stake. However, at times, an ability to ‘tune in’ compassionately to the concerns and anxieties of individual staff or teams is essential to making progress. Knowing when the distinction must be turned into a separation or a combination is key.
Motivating and mentoring
All teams pass through slumps in confidence and optimism. This may, for example, follow the loss of a loved and respected team colleague through, say, retirement or moving on to a new job, or it may become evident after a long period of minor accretions of discontent.
These are the moments when a nurse administrator is called upon to motivate a team or individual, conveying an ‘I believe you can do this/overcome this’ message with conviction, remaining attuned to the sense of despondency that may impede hope and optimism while also challenging it.
On other occasions, nurse administrators mentor their charges to encourage and bring out their best potential. This task becomes more successful when they routinely show kindness to employees and acknowledge that there will always be occasions when ‘external’ matters related to, say, nurses’ private lives may impact them at work. Compassionate mentoring through troubled times often generates gratitude and renewed commitment when the troubles ease.
The nurse administrator role isn’t for everyone. Many nurses enjoy working in direct patient care and are reluctant to relinquish this for managerial roles.
However, those capable of systemic thought, who can apply the insights (and compassion) honed during their training and subsequent patient care experiences, and who have gained advanced credentials (Master of Science in Nursing/MSN, or doctoral degrees such as a Ph.D. or Doctor of Nursing Practice/DNP) required for more senior, managerial positions, are likely to thrive in nurse administrator roles.
The nurse administrator role is challenging, yet it has become a crucial, if not critical, one for delivering effective healthcare systems and high-quality patient care, and it takes a special type of person to shoulder all the duties and responsibilities within it.
For those drawn to this unique role because they recognize the aptitudes described herein themselves, now may be the time to enroll in the advanced degree program that offers the key to entry.