NUR 7020 Module 1 Manager Competency Paper: Structural Empowerment, the AONL Domains and a New Manager's Development Plan Example

From Charge Nurse to Manager: Rating Myself Against the AONL Domains and Building Empowerment on a Union Medical Unit

Student Name

M.S. in Nursing, Nursing Administration, Thomas Edison State University

NUR-7020: Nursing Administration: Executive Managerial Process

Mentor Name

Month Day, Year

From Charge Nurse to Manager: Rating Myself Against the AONL Domains and Building Empowerment on a Union Medical Unit

The New Role

Nothing here describes a real hospital, unit or person. After nine years as a staff nurse and three as a charge nurse, I was promoted in March to manage a 36-bed adult medical unit at a community hospital in Union. Its staff includes 58 registered nurses, along with 14 technicians and two secretaries. Its previous manager left after eighteen months. Staff describe the unit as busy but loyal to each other, and they describe managers as people who come and go. Turnover among registered nurses last year was 19 percent, the highest of the hospital's medical-surgical units, and the unit's engagement scores sit in the bottom third.

I was a good charge nurse. I could run a shift, settle a conflict at the nurses' station and calm a family. Within two weeks as a manager I realized that those skills covered only part of the job. I had a budget to answer for, a staffing plan to defend, a director who expected monthly reports and a unit full of people who wanted to know whether I would stay. This paper uses a competency model to see where I stand and a theory of empowerment to decide what to build.

The Competency Model

The nurse manager competency set (American Organization of Nurse Executives, 2015), issued by the group now called the American Organization for Nursing Leadership, describes the competencies of nurse managers in five domains. Two concern people (communicating and building relationships, and leadership), one concerns the setting (knowing how health care is regulated, paid for and organized), and two concern the manager herself (professionalism and business skills). Each domain lists specific behaviors, such as managing conflict, understanding regulatory requirements, using systems thinking, holding oneself accountable and preparing a budget. The model is meant for self-assessment and development, not for ranking managers against each other.

I rated myself on each domain using a simple scale: strong, developing or new to me. I then asked my director and two charge nurses to rate me on the same domains, so that the assessment would not rest only on my own view.

Two domains stood out. Business skills, including budgeting, staffing productivity and reading a variance report, were entirely new. Leadership, in the sense of setting direction and developing others rather than solving problems myself, was developing. My director also pointed out that my relationships with physicians were thinner than my relationships with nurses, which matters on a medical unit where hospitalists make most admission and discharge decisions.

Structural Empowerment

Kanter (1977) argued that people's behavior at work is shaped less by their personalities than by the structure of their positions. In her account, a job empowers when it opens four doors: to information, to support, to resources and to chances to learn and advance. Those who lack such access tend to become rigid, controlling or disengaged, a result of the position more than of the person. Kanter also described formal power, which comes from jobs that are visible, flexible and central to the organization's goals, and informal power, which comes from relationships with sponsors, peers and subordinates.

Laschinger et al. (2004) tested Kanter's theory with staff nurses in Ontario hospitals over time. Nurses who reported greater structural empowerment at the start reported higher work satisfaction a year later, and changes in empowerment over the year were linked with changes in satisfaction. The study used nurses' own reports and could not rule out every alternative explanation, but its longitudinal design gave stronger support to the theory than a single survey could.

For a manager, the theory has two implications. The first concerns my own position: I need access to the same four things, especially information about the budget and support from my director, to do the job well. The second concerns my staff: their satisfaction and their decision to stay depend partly on whether the unit gives them information, support, resources and opportunity.

What the Unit Lacks

When I asked staff what would help them, their answers mapped closely onto Kanter's four structures. They did not know how the unit was performing, because results such as falls and patient experience were posted on a board nobody updated. They felt unsupported when they raised concerns about assignments, because nobody explained decisions. They lacked resources, especially lift equipment and a working bladder scanner. And they saw few chances to grow, because the unit had no clinical ladder participation and no one had been sent to a conference in three years.

My Development Plan

The plan has two parts, one for me and one for the unit, because Kanter's theory applies to both.

For my own development, I asked the director of nursing to assign a mentor, and an experienced manager of a surgical unit agreed to a standing hour with me on alternate Thursdays for the next year. I enrolled in the hospital's finance course for managers and asked the finance analyst assigned to our unit to walk me through the monthly variance report until I could explain it myself. I will attend the hospitalist group's monthly meeting, starting with a short presentation on how discharge timing affects our admissions, to build the physician relationships my director said were weak. Through this MSN program, I will complete a leadership project on the unit.

For the unit, I set up a practice council of eight staff nurses and two technicians that meets monthly and has authority over three decisions: the self-scheduling rules, the choice of a new lift device within the approved budget and the unit's annual education plan. I post unit results on a dashboard that the council updates each month and review them at every staff meeting. I created a professional development fund from the unit's education budget and committed to sending two nurses to a regional conference this year. And I meet with every registered nurse individually within my first six months to ask what they want from their work.

Measures

At the half-year mark and again at one year, my director, two charge nurses and I will redo the competency ratings together. The unit will track registered nurse turnover, engagement scores, participation in the practice council and clinical ladder applications. I will also ask staff a short set of questions drawn from Kanter's four structures each year.

Limits

The competency model describes what managers should be able to do but does not show which competencies matter most for outcomes. The empowerment study took place in another country and health system. My own ratings and those of people who know me well may share the same blind spots. And a manager's plan can be undone by forces outside the unit, such as a hiring freeze.

Conclusion

The competency model showed that business skills and leadership were my weakest areas and that my relationships with physicians needed work. Kanter's theory and the longitudinal study explained why my staff's satisfaction depends on the structures of their jobs and why my effectiveness depends on mine. The plan builds empowerment for both, with measures to show whether it is working.

References

American Organization of Nurse Executives. (2015). AONE nurse manager competencies. American Organization of Nurse Executives.

Kanter, R. M. (1977). Men and women of the corporation. Basic Books.

Laschinger, H. K. S., Finegan, J. E., Shamian, J., & Wilk, P. (2004). A longitudinal analysis of the impact of workplace empowerment on work satisfaction. Journal of Organizational Behavior, 25(4), 527-545. https://doi.org/10.1002/job.256