Nurse managers – Nurses or Managers?
Paper to the 30th International Labour ProcessConference, March 27th – 29th 2012 Stockholm, Sweden
Associate professor Jörg W. Kirchhoff Østfold University College,
Faculty of Health and Social Services 1757 Halden, Norway
jorg.kirchhoff@hiof.no
Professor Jan Ch Karlsson Østfold University College,
Faculty of Business, Languages and Social Sciences ,1757 Halden, Norway
Background
•
Trends toward ‘professional management’
– New Public Management– Organisational ‘Fads’ – (‘flat’ organisations)
– Legislation regarding public services (eg. clients rights and employees obligations in Norway)
•
Result – An increased bureaucracy in public
services
•
However – Nurse managers and nurses
(professional employees) are reluctant to
embrace the concept of professional
management (Ackroyd et al 2007, Bolton
2000)
•
How interpret nurse managers in health care
enterprises (in Norway) their role as manager?
•
Do nurse managers interfere within or manage
3
Data Compilation
Method Respondent Participating observation In – depth interviews Focus group interviews Number of informantsManagers 4 interviews 4 informants
Coordinators 1 interview 3 interviews 10 informants
Registered nurses
4 field notes 1 interview 3 interviews 15 informants
Auxiliary nurses 4 field notes 4 informants
Care workers 4 field notes 4 informants
Home helpers 4 field notes 4 informants
Empirical data 16 interviews 6 interviews 6 interviews
41 inf. 28 int..
Modes of Management – Two ‘Ideal Types’
Professional Administration Professional Management
Managements main purpose
• Provide services in accordance with professional standards
• Provide services in accordance with financial resources
Rationales of power
• Formal position in a social structure
• Professional knowledge and standards
• Credibility among colleagues
• Formal position in a social structure
• Skills divorced from productive expertise
• Rational and objective personality
Means or
How to manage employees?
• Providing resources in order to gain professional quality
• Support staff on professional issues
• Involvement in operational matters
• Professional discretion
(Decentralized responsibility)
• Formal standards / procedures • Control of the Labour process • Decentralized responsibility
The Cases – Providers of Public Services
Case 1
Case 2
Case 3
Case 4
Employees
ca.100
ca. 125
ca. 50
ca. 50
‘Units’
3
4
4
2
Coordinators
2
4
4 (3+1)
1
Manager (Registered nurse)
Coordinator(s) – ‘Management in disguise’
(Assigned to coordinate and assign tasks to employees)
Operating core (four occupational groups)
Case 1
Mode of management Professional Management Main Purpose of management• Provide services in accordance with financial resources
“From now on our services are based on financial registrations in our system. I think that’s very good. It’s like taking a car to a garage – what you pay for is what you get”
Main Rationales of Power
• Formal position in a social structure and supervisors credibility:
“My role as a manager is clearly defined in my job prescription. I know what I have to do and what I’m accountable for. It’s quit clear to me what my supervisors are expecting from me.”
Management
mainly through …
• Decentralized responsibility (coordinators, teams of employees and nurses)
“My coordinators must pay attention to the service contract and the services provided to clients. I really don’t care whether a contract is to demanding or not, that’s nothing I waste my time on. I spend my time on how my coordinators are performing their job.”
Interaction with employees
• Lack of participation in employees’ work or difficulties encountered by them.
Case 2
Mode ofmanagement
The Professional Administrator
Main Purpose of management
• Provide services in accordance with financial resources, but most in accordance with professional standards:
“Some times, occasionally, we can be flexible if there is a need for something, although it isn’t approved by the service contract.” Main Rationales of
Power
• Formal position in a social structure and supporting subordinates (coordinators):
“I’m very little involved in what people are doing, but try to point out
direction and encourage my coordinators and make people work together.” (manager)
“When there is trouble ahead we go to her (manager) and she is taking over and helps us out” (Coordinator)
Management mainly through …
• Decentralized responsibility and coordinators:
“I like our organisational model. Especially that all employees are
accountable and obliged to involve in their own work, and thereby they can influence their working conditions.”
Interactions with employees
• Size and managerial obligations make it impossible to engage in employees’ work.
Case 3
Mode of
management
The Hybrid Manager
Main Purpose of
management
•
Provide services in accordance with clients’ needs and within
financial resources available:
“I would rather have framework financing and more educated
employees, so they can provide services that meet clients’
needs.”
Main Rationales of
Power
•
Formal position in a social structure, credibility from supervisor,
coordinators and employees:
“Fortunately my door is always open and colleagues can come to
me and let out their frustration, and then I try to solve the
problem.”
Management
mainly through …
•
Decentralized responsibility and coordinators
“My concern is that every employee is accountable for the job and
for every decision taken in relation to their clients.”
Interactions with
employees
•
Frequent formal and informal encounters through discussions and
meetings among employees
Case 4
Mode ofmanagement
The Petrified Manager – Lack of Management
Main Purpose of management
• Provide services in accordance with professional standards:
“Service contracts are a point of departure. Our services are based on a professional judgment of our clients’ needs.””
Main Rationales of Power
• Formal (isolated) position in a social structure:
“There are too many projects going on and I have no one to help me out. I struggle to cope.”
Management mainly through …
• Decentralized responsibility and ‘The Coordinator’:
“Every employees is in charge of a group of clients and responsible for the coordination of services to their clients.”
“ T. (coordinator) has taken over these meetings, so I’m not
participating anymore, since she is more up to date on the information about clients.”
“S. is the manager, but occasionally do I take care of practical issues. After all I’m also a union representative.” (The Coordinator)
Interactions with employees
