Nursing Leadership &
Management
Patricia Kelly-Heidenthal
0-7668-2508-6
Delmar Learning
Copyright © 2003 Delmar Learning, a Thomson Learning company
Chapter 28
Your First Job
Delmar Learning
Copyright © 2003 Delmar Learning, a Thomson Learning company
Objectives

Upon completion of this chapter, the reader should be
able to:
• Identify key elements to consider in choosing a nursing
position.
• Describe typical components of health care orientation.
• Discuss types of performance feedback.
• Compare and contrast organizational responses to
performance.
• Discuss specific strategies to enhance the beginning nursing
manager role.
• Identify mechanisms to enhance professional growth.
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Choosing a Position

Patient types
• Best fit for the nurse in a patient care environment
• General versus specialty unit
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Work environment
• Smaller or larger setting

Available schedule
• Shift types
• Process for changing schedules
• Self-scheduling
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Choosing a Position
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Pay
• Salary policy
• Differentials
• Definition of pay week
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Orientation Considerations


Identify what the organization offers during orientation.
Organization-wide orientation
• Information and skills measurement
• Explanations of human resource policies
• Safety skills and procedures

Unit-specific orientation
• Specific competencies a new nurse needs to care for the
diagnoses and ages of patients typical to the assigned unit
• Technical skills as well as beginning mastery of unit-specific
processes
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Identifying Own Learning Needs, and
Socialization


It is important for the beginning nurse to assess his or
her own specific learning needs and to establish
learning priorities.
It is also important that the beginning nurse be
introduced to other members of the unit and to the
functions and roles of people who regularly interact
with the unit.
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Working with Others

Patients
• Nurses may be intimidated when patients look to them for
expertise and guidance.
• The nurse should work to put the patient at ease and should
demonstrate a sense of caring.

Doctors
• Nurses should establish rapport and introduce themselves to
the doctors with whom they work.
• It is important that nurses not be intimidated by doctors.
• Nurses should be assertive, yet respectful and considerate.
• Seeking clarification when orders are unclear is important.
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Learning Styles

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Understanding one’s own individual learning style
Understanding the learning styles of others
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Performance Feedback
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Self-evaluation
Preceptor assessment
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Formal Evaluation


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The individual and the nurse manager meet to review
progress.
The formal evaluation should be objective, based on
performance. A checklist may be used.
Both the manager and the staff member should have a
clear understanding of what needs to happen for the
nurse to grow.
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Formal Evaluation

The manager evaluation is used:
• To assure competence in the skills required for safe patient
care
• As an opportunity to recognize the nurse's accomplishment
in the evaluation period
• As an opportunity for the manager to coach, set goals, and
identify learning needs
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360-degree Feedback
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

360-degree feedback is a process in which an
individual is assessed by a variety of people in order
to provide a broader perspective.
It has the potential to provide the individual with a
broader, more balanced assessment.
Nurses who are asked to evaluate their peers need
orientation to the process and to the specific tool
being used.
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Setting Goals
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Performance appraisal provides the opportunity to set
goals for the coming year.
Goals should be measurable and clearly articulated.
Goals should be developed jointly between the nurse
being evaluated and the manager.
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Organizational Responses to
Performance


Many health care organizations have a merit-based
compensation structure that is tied to performance
evaluations.
Most health care organizations are looking for other
ways to create job satisfaction; e.g., employee
recognition programs formally recognize good
performance through reward or activity, and the
recognition is usually public.
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Organizational Responses to
Performance


Most health care organizations have a prescribed
corrective action program when appraisal feedback
indicates the need for significant performance
improvement.
Corrective action programs may involve:
• Determination of whether poor performance is
developmental or related to a failure to follow policies or
procedures
• Coaching or additional education/mentoring
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Disciplinary Corrective Action
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
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Employee receives feedback for failing to follow the
organization's policies.
Most organizations have a series of progressive steps
for corrective action, in cases where employee
performance does not improve.
In progressive discipline, the manager and employee
develop the mutual goal of taking steps to correct
performance in order to bring it back to an acceptable
level.
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Nurse as First-line Manager


The registered nurse who is responsible for the direct
care of a group of patients is functioning as a first-line
manager
Relating to Other Disciplines
• It is important for nurses to develop strong relationships
with representatives of the many other disciplines whose
practices interface with the nursing role.
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Delegation to Team Members

The registered nurse (RN) needs to refer to his or her
state's Nurse Practice Act, which limits or defines the
responsibilities that may be delegated. In addition, the
RN should:
• Consider the skills and knowledge of coworkers in order to
delegate well
• Be careful of over- or underdelegating
• Provide performance feedback to delegatees
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Levels of Authority

An agreement to the level of authority at the time the
task is delegated prevents each party from making
inaccurate assumptions about the other's
accountability for the delegated assignment.
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The Charge Role


The first-time charge nurse often has high
expectations for his or her own performance, and can
easily become stressed in the new role.
Success is a matter of perceiving and delegating
patient care needs from the perspective of the unit as a
whole rather than from that of an individual's
assignment.
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The Charge Role

The charge nurse should:
• Concentrate on staying organized
• Focus on what is best for the patients
• Recognize and utilize the available resources for problem
solving, such as coworkers and the facility supervisor
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Articulating Expectations
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As a first-time charge nurse, it is important to build
relationships with other staff members as well as
coworkers from other disciplines.
It is also important to share expectations, which may
involve discussing and agreeing to certain behaviors.
Some performance expectations may be more generic,
applying to relationships more than specific patient
care items.
The charge nurse should keep the doorway for clear
communication open.
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Strategies for Professional Growth
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
Use educational opportunities at the institution.
If no formal educational opportunities exist, look for
opportunities to learn from other staff.
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Strategies for Professional Growth
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Cross training
• While some organizations have strict guidelines to limit the
practice of floating nurses, other health care facilities expect
nurses to routinely float to either a related unit or an area
particularly in need of assistance.
• A nurse should not accept total responsibility for an area or
population in which he or she has not achieved
competency.
• One way to minimize the stress of being asked to float to a
different unit is to volunteer ahead of time to cross train to
the new area.
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Identifying a Mentor


Communicate a willingness to learn and grow.
Seek out a prospective mentor, rather than waiting to
be approached by one.
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Developing Professional Goals

Clinical ladder
• Clinical ladders are programs established by many health
care organizations to encourage nurses to earn promotion, to
gain recognition, and to increase their pay by meeting
specific requirements.

Specialty certification
• Nearly all nursing specialties now offer board certification
exams to validate expert knowledge of that particular
discipline.
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