Sources of influence : nursing service administrators in Montana
by Avis Ruth Peterson
A thesis submitted in partial fulfillment of the requirements for the degree of Master of Nursing
Montana State University
© Copyright by Avis Ruth Peterson (1984)
Abstract:
This exploratory descriptive study identifies the personal and professional profile of nurse
administrators today. These nurse administrators function in nongovernmental acute care hospitals. The
conceptual framework of this study was organized around the sources of influence through formal and
functional power as identified in the publications of Stevens (1980a; 1980b) and Mersey and Blanchard
(1982). Dimensions of the organizational position were derived from national standards.
Responsibility, authority, and personal and professional characteristics which contribute to
administrative role were studied. Mentor-network relations which contribute to role development were
identified.
The study population was 35 nurse administrators in acute care hospitals in Montana. A questionnaire
was mailed to nurse administrators in order to identify- the personal and professional characteristics
which define the administrative role. All returns were found acceptable for data analyses. Descriptive
statistics were used to develop a group profile. Findings were compared with nationwide studies
conducted by the American Society of Nursing Service Administrators and the American Hospital
Association. The rural nature of Montana hospitals was identified as an extraneous variable in
comparisons.
Findings of this study included similarities and differences between the national profile and the profile
in Montana. Montana nurse administrators are following the nationwide trend for higher credentialling.
There is increased educational preparation in nursing administration, greater participation in corporate
affairs, and major responsibility for the department of nursing. Influence within the corporation is equal
to, or greater than, the responsibility held by Montana nurse administrators. Professional mentor and
network relationships are important concepts for administrative role development. SOURCES OF INFLUENCE:
NURSING SERVICE
ADMINISTRATORS IN MONTANA
by
Avis Ruth Peterson
A thesis submitted in p a r t ia l f u l f i l l m e n t
of the requirements f o r the degree
of
Master of Nursing
' MONTANA STATE UNIVERSITY
Bozeman, Montana
August 1984
APPROVAL
of a thesis submitted by
Avis Ruth Peterson
This thesis has been read by each member of the the s is committee
and has been found to be s a tis fa c to r y regarding content, English usage,
form at, c i t a t i o n s , b ib lio g ra p h ic s ty le , and consistency, and is ready
f o r submission to the College of Graduate Studies.
Cl; /irpe^sbn, Graduate7 Committee
Date
Approved f o r the Major Department
/,
Head, Major Department
Approved f o r the College of Graduate Studies
Date
Graduate Dean
STATEMENT OF PERMISSION TO USE
In presenting th is thesis in p a r t ia l f u l f i l l m e n t of the re q u ire ­
ments fo r a m aster's degree at Montana State U n iv e rs ity , I agree th a t
the L ib ra ry shall make i t ava ila b le to borrowers under ru le s of the
L ib ra ry .
B rie f quotations from th is the s is are allowable w ithout spe­
c ia l permission, provided th a t accurate acknowledgement of source is
made.
Permission f o r extensive quotation from or reproduction of th is
the sis may be granted by my major professor, or in h is /h e r absence, by
the D ire cto r of L ib ra rie s when, in the opinion of e it h e r , the proposed
use of the material is f o r s c h o la rly purposes.
Any copying or use of
the m a te ria l in th is the sis f o r fin a n c ia l gain shall not be allowed
w ithout my w ritte n permission.
Signature
iv
ACKNOWLEDGEMENTS
I wish to express thanks and appreciation to the f a c u lt y members on
my committee f o r t h e ir support and guidance, Cheryl Olson, R.N., M.S.,
Kathleen Chafey, R.N., M.S. , and e s p e c ia lly to Dr. Jacqueline Taylor,
R.N., Ph.D., my committee chairperson.
the leadership kind.
Dr. Taylor is a tru e mentor of
She spent many hours in providing advice,
encouragement, and d ire c tio n during th is study.
My appreciation is fo r the 35 nurse adm inistrators in Montana who
p a rtic ip a te d in t h is research study.
I g r a t e f u lly acknowledge the
American Society of Nursing Service Adm inistrators and the American
Hospital Association f o r allowing me to use much of t h e i r instrument
and the fin d in g s of t h e i r studies.
I also wish to express my
appreciation f o r the expertise and knowledge th a t Dr. Barbara Rogers,
R.N., Ph.D., so w i l l i n g l y shared.
F in a lly , I wish to give special thanks to my fa m ily .
They provided
continual support, encouragement, and understanding throughout my study.
V
■ TABLE OF CONTENTS
Page
TITLE PAGE.................................................................................................
i
APPROVAL PAGE..........................................................
ii
STATEMENT OF PERMISSION TO USE........... .................................................
ACKNOWLEDGEMENTS.................. ......................................................................
TABLE OF CONTENTS....................................................................................... •
LIST OF TABLES...................................................................
LIST OF FIGURES.......................................................
ABSTRACT.......................................
lit
'
iv
v
v iii
ix
x
Chapter
1.
INTRODUCTION
Purpose of the Study.........................................................
Statement of the Problem.......... ..............................................
D e fin itio n of Terms.........................................
Conceptual Framework...............................................................
The. Model...............................
Discussion of the V a ria b le s ..............................................
Conclusion.........................................
2.
REVIEW OF SELECTED LITERATURE
A d m in is tra tiv e In flu e n c e .......................................................
A d m in is tra tiv e R e s p o n s ib ilitie s ..........................................
National P r o f i l e .............................
National P r o f ile in 1982....................................................
A d m in istra tive Preparation.......................................
Women in Management....................
Mentor Connections...................................................................
Professional Networks...........................
Conclusion...................................................................................
I
3
4
4
6
6
8
10
11
12
14
17
19
20
23
27
32
35
Vl
TABLE OF CONTENTS-Continued
Chapter
3.
4.
Page
METHODOLOGY............................................
37
P o p u la tio n ..................................................................................
P rotection of Human R ights.....................................................
Data C o lle c tio n and Instrument Design................................
R e l i a b i l i t y and V a l i d i t y ............................................... ; ___
Analysis of Data.........................................................................
37
38
38
40
42
FINDINGS.............................................................................................
43
Population................ ............................................... .....................
A dm in istra tive P ra c tic e ........................... ....... ......................
Reporting R elatio nsh ip s...................................................
A dm in istrative Hospital Coverage..................................
Span of C o n tro l..................................................................
Hospital Bed Size................................................ ....... .......
Budget S etting and Planning................................'...........
Time A llo c a tio n ...................................................................
Corporate P a r tic ip a tio n ........................................... -___
I n s t it u t io n a l Committee P a r tic ip a tio n ........................
Nursing Theory fo r Professional P ra c tic e .....................
Level of R e s p o n s ib ility f o r the Department
of Nursing.................................................................
A dm in istrative Support S ervices....................................
Personnel Management....................................................
C o lle c tiv e Bargaining...................................
Nurses With Other Reporting Levels...................
Personnel R e s p o n s ib ility ..............................
Mentor-Network R e la tio n s h ip s ............. ........... ■....................
Mentor R e la tio n s .................................................................
Nurse Adm inistrators as Mentors...................
Network R elatio nsh ip s.......................................................
Demographic Inform a tion.................................................
A dm in istrative T i t l e ......................... ..............................
Employment, Recuitment, Time in P o s i t i o n . . . ...............
Years of Experience, C e r t if ic a t io n ,
Special iz a t i o n .................................................................
Education Preparation and Continuing
Education.....................................
Professional and Community A c t i v i t i e s . ......................
Age, Sex, and Marital S tatu s...............................
Salaries and B e n e fits ................................................. —
Success Defined...........................................
A dditional Comments...........................................................
Summary...........................................................................................
■ 43
44
45
46
46
47
48
49
50
53
54
55
57
57
57
59
59
61
61
63
64
66
66
66
68
70
71
75
75
77
79
80
vii
TABLE OF CONTENTS-Continued
Chapter
5.
Page
DISCUSSION....................................................... ............................
81
Summary and Discussion...........................................
Montana Nurse A dm inistrator P r o f i l e ............................
Conclusion..............................................................
L im ita tio n s .....................................................
Recommendations...................................................................
Im p lica tion s fo r Nursing.................................................
81
84
88
89
90
90
REFERENCES CITED..................................
91
APPENDICES.................................
98
Appendix A - Cover L e tte r to Nursing Adm inistrators
99
Appendix B - Mailed Questionnaire................................
101
Appendix C - L e tte r of Response to Use ANSA
Questionnaire...............................................
112
viii
LIST OF TABLES
t o oo
C T i oi 4 = > C j o r o i —•
Table
10.
11.
12.
Page
Percentage of Time Spent in Normal Workweek....................
P a rtic ip a tio n on Corporate Committees or Boards............
P a rtic ip a tio n on Hospital Committees..................................
Level of R e s p o n s ib ility in the Nursing Department........
A dm in istrative Support Services.......... .................................
Comparison of Number of Employees with Hospital
Bed Size.....................................................
Assistance Provided by Mentor.................................................
Recruitment and Promotion of Nurse A d m in is tra to rs ........
Years of Experience in P rio r P o s itio n s ..............................
Comparison of Percentages of Respondents
Reporting Highest Degree Earned............. ■........................
Professional A c t i v i t i e s ................ ...........................................
Comparison of Salary Ranges.................. ................................
51
52
54
56
58
.60
63
68
69
70
74
76
ix
LIST OF FIGURES
Figure
I.
Page
Conceptual Model.........................................................................
7
X
ABSTRACT
This ex p lo ra to ry d e s c rip tiv e study id e n t i f i e s the personal and
professional p r o f i l e of nurse adm inistrators today. These nurse
ad m inistra tors fu n c tio n in nongovernmental acute care h o s p ita ls . The
conceptual framework of th is study was organized around the sources of
influence through formal and fu n c tio n a l power as i d e n t if ie d in the
p u b lic a tio n s of Stevens (1980a; 1980b) and Mersey and Blanchard (1982).
Dimensions of the organizational p o s itio n were derived from national
standards. R e s p o n s ib ility , a u th o rity , and personal and professional
c h a ra c te ris tic s which c o n trib u te to a d m in is tra tiv e ro le were studied.
Mentor-network re la tio n s which c o n trib u te to ro le development were
id e n tifie d .
The study population was 35 nurse adm inistrators in acute care
ho s p ita ls in Montana. A questionnaire was mailed to nurse
ad m inistra tors in order to id e n tify - the personal and professional
c h a ra c te ris tic s which define the a d m in is tra tiv e r o le . Al I returns were
found acceptable f o r data analyses. D escriptive s t a t i s t i c s were used
to develop a group p r o f i l e . Findings were compared w ith nationwide
studies conducted by the American Society of Nursing Service
A dm inistrators and the American Hospital Association. The ru ra l nature
of Montana ho s p ita ls was id e n tifie d as an extraneous v a ria b le in
comparisons.
Findings of t h is study included s i m i l a r i t i e s and differences
between the national p r o f i l e and the p r o f i l e in Montana. Montana nurse
ad m inistrators are fo llo w in g the nationwide trend fo r higher
c re den tial l ing. There is increased educational preparation in nursing
a d m in is tra tio n , greater p a r tic ip a tio n in corporate a f f a i r s , and major
r e s p o n s ib ilit y f o r the department of nursing. Influence w ith in the
corporation is equal to , or greater than, the r e s p o n s ib ilit y held by
Montana nurse a d m in is tra to rs . Professional mentor and network
re la tio n s h ip s are important concepts f o r a d m in is tra tiv e ro le
development.
I
CHAPTER I
INTRODUCTION
Experience as a nurse executive in a ru ra l Montana h o s p it a l,has
provided the basis of in te r e s t fo r th is statewide research study.
Professional mentor-network re la tio n s h ip s in the pra ctice s e ttin g were
a powerful influence in career development fo r th is researcher..
Personal experience has increased in te r e s t in the influence held by
nurse adm inistrators and in mentor-network re la tio n s h ip s of nurse ad­
m in is tra to rs in Montana.
In order to c l a r i f y the s e ttin g in which nursing adm inistrators
in Montana fu n c tio n , the ru ra l nature of Montana and of the acute care
h o spitals are id e n t if ie d .
Federal rules and re g u la tio n s , a ccredita tion
standards, national nursing and hospital organization standards and
gu ideline s, provide a basis f o r comparison between roles and respon­
s i b i l i t i e s of nurse adm inistrators in Montana and nurse adm inistrators
nationwide.
Deviation between national standards and Montana standards
may be a ttr ib u te d to the sparse population and the r e la t iv e is o la tio n
of some h o spitals and nurse ad m inistra tors.
Data re la te d to the extent
and impact of mentor-network re la tio n s h ip s on po sition a c q u is itio n and
career success v a lid a te the concepts as sources of influence fo r
Montana nurse ad m inistra tors.
The nurse a d m in is tra to r, responsible f o r the department of nursing,
also holds r e s p o n s ib ilit y f o r the major po rtion of the in s t i t u t i o n a l
2
budget and the la rg e s t number of organ ization al employees (Stevens,
1978b).
The nursing a d m inistra tor is a nursing leader fun ctio n in g
w ith in a p o s itio n which requires both c l i n i c a l nursing s k i l l s and admi­
n i s t r a t i v e e xp ertise .
Increased complexity of health care, exploding
medical technology, and the expanding ro le of the. nurse are axiomatic
of the dual ro le of the nurse executive
(Stevens, 1980a).
The ru ra l nature of the health care d e liv e ry system serves to is o ­
la te most of the nursing adm inistrators in Montana. "There is a wide
d iv e r s it y in size and services offered by Montana h o s p ita ls .
Climatic
conditions and distance to other acute care f a c i l i t i e s serve to magni­
f y health care d e liv e ry problems in rural, h o s p ita ls .
To understand
the ro le and r e s p o n s ib ilit ie s of nurse adm inistrators in Montana, some
perspective of the c h a ra c te ris tic s of the s ta te , population, hospital
size, and management require c l a r i f i c a t i o n .
Montana, the fo u rth la rg e s t state in the nation, is ric h in
natural resources, beauty, and land.
Montana is also t h i n l y populated.
In the s ta te 's 145,392 square mile area there are only 5.4 persons per
square m ile.
Over 47 percent of the population is considered ru ral
(Census, 1980).
Areas of Montana are designated as m edically under­
served due to a m a ld is trib u tio n of health care providers.
Coordinated
e f f o r t s have been made in recent years fo r upgrading of emergency medi­
cal services and the rapid tra nspo rt of p a tie n t from primary to t e r ­
t i a r y health centers.
N a tio n a lly there are over 7,000 acute care hospitals (AHA, 1981).
Approximately 1.2 m illio n professional nurses are employed in the
United States, tw o -th ird s are employed in ho spitals (The American
3
Nurse, 1983).
In the 56 counties of Montana there are 60 nongovern­
mental acute care h o s p ita ls .
The la rg e s t acute care ho spital has 282
beds, f i v e hospitals, have from 200-282 beds, and six ho s p ita ls have
100-200 beds.
(MSDHES, 1983).
Of the remaining 49 ho s p ita ls the average is 28 beds
Approximately one-half of a l l acute care hospitals in
Montana are combined w ith long-term f a c i l i t i e s or have allocated acute
care beds as swing beds (AHA, 1981).
Services vary g re a tly in hos­
p i t a l s in Montana and are t o t a l l y dependent upon physician population.
Financial v i a b i l i t y is incre a s in g ly d i f f i c u l t fo r n o n p ro fit hos­
p ita ls .
Many of Montana's 60 acute care hospitals have entered in to
management contracts or some other contractual agreement w ith hospital
corporations.
Six h o spitals operate under church ownership, fou r are
county owned, two have corporate ownership, and the 48 remaining hos­
p i t a l s are n o n p ro fit corporations, d i s t r i c t s , or a u t h o r it ie s .,
Only 19
of the 60 h o spitals are accredited by the J o in t Commission on
A c c re d ita tio n of Hospitals (MSDHES, 1983).
Despite the continual increase of men in the profession, nursing
remains a profession dominated by women.
are in the m a jo rity .
Women in management positions
The ro le of women in executive p o s itio n s w i l l
a ffe c t any research on aspects of nursing adm inistration at th is time.
I t is recognized th a t a focus on women's roles is beyond the scope of
t h is research study.
Purpose of the Study
■ The purpose of t h is e xp lora tory d e s c rip tiv e study is the develop­
ment of a professional p r o f i l e of nursing service adm inistrators in
4
acute care ho spitals in Montana.
The professional p r o f i l e includes
personal and professional c h a ra c te ris tic s and current ro le s , respon­
s i b i l i t i e s , and influ ence s.
Comparison of s i m i l a r i t i e s and differences
between Montana nurse adm inistrators and nurse adm inistrators nation­
wide was made possible, since the instrument used was an adaptation of
the 1977 t o t a l universe survey of nursing adm inistrators in hospitals
by the American Society of Nursing Service Adm inistrators of the
American Hospital Association (ASNSA, 1980b).
Mentor-network r e la ­
tio n s h ip s , as a fa c e t of career development and advancement, was a part
o f the information requested in order to complete the p r o f i l e .
National guidelines provided the framework fo r considering ro le enact­
ment w ith in one c ru c ia l dimension of a d m in is tra tio n , th a t of influence.
Statement of the Problem
The problem was to develop a p r o f i l e of nurses in nursing admin­
i s t r a t i v e po s itio n s which provide inform ation s a lie n t to the ro le of
nursing ad m inistration in acute care ho s p ita ls in Montana.
The data
obtained w i l l aid in answering questions re lated to level of respon­
s i b i l i t i e s , sources of influence through power bases, educational pre­
p a ratio n, employment con dition s, and the importance of mentor-network
re la tio n s h ip s in p o s itio n a c q u is itio n and ro le development.
D e fin itio n of Terms
For the purpose of th is study, the d e f in it io n of terms is a com­
posite from the review of l i t e r a t u r e .
5
.Niirse_a d m in is tra to r:
The highest ranking nurse in the organizational
s tru c tu re of an acute care hospital and an active member- of
executive management.
I n f l uence:
Possession of sources of power which a ffe c t compliance,
m o tiv a tio n , and the behavior of others.
Professional Network:
Mutual in te ra c tio n with professional contacts
■who provide in fo rm a tion, advice, and moral support f o r career
development and advancement.
Professional Mentor:
An experienced professional who acts as a guide
f o r a less experienced professional to aid in the development of
professional expertise and fo r career advancement.
Sources of Influ en ces:
The formal power granted by the corporate posi­
tio n and the fu n c tio n a l power which combines p e rs o n a lity , behav­
i o r , and perceived expertise and p o s itio n .
Organizational P o s itio n :
The h ie ra rc h ic a l po sition occupied by the
nurse a d m inistra tor in the acute care h o s p ita l ad m in is tra tiv e
s tru c tu re .
Career Success:
The se lf-p e rc e p tio n of achievement of professional
p o s itio n and goals, as evidenced by a c q u is itio n of both formal
and fu n c tio n a l power.
Formal Power:
Power derived from delegated a u th o rity and
r e s p o n s ib ilit y based on organizational fa c to rs .
Functional Power:
Power based on the in d iv id u a l c h a ra c te ris tic s of
the leader.
Professional Role:
The achieved ro le of nurse executive which is a
synthesis of nursing and management.
6
Conceptual Framework
The conceptual framework f o r th is study is organized around the
concept of influence and is drawn from the p u blicatio ns of Stevens
(1980a; 1980b) and Mersey and Blanchard (1982).
Major complex
variables examined in th is study are sources of influ ence , organiza­
tio n a l p o s itio n , and career success.
Career success w i l l be considered
only in r e la tio n to achievement of the roles and r e s p o n s ib ilitie s as
indicated in national gu ideline s.
Network and mentorship linkages are
concomitant variables id e n t if ie d to v a lid a te th e ir e ff e c t on ro le devel­
opment and p o s itio n a c q u is itio n .
The Model
The conceptual model in Figure I I l l u s t r a t e s the constructs, con­
cepts, v a ria b le s , measures, and t h e ir proposed d ire c tio n a l r e la ­
tio n s h ip s .
Each arrow represents the d ire c tio n of the re la tio n s h ip
assumed by th is researcher to e x is t.
A broken lin e ind ica tes th a t a
d ir e c t e ff e c t was postulated, however, i t was beyond the scope of th is
study to v a lid a te e f f e c t .
No e f f o r t was made fo r antecedent ordering
o f the variables thought by th is researcher to influence success in
nursing a d m in is tra tio n .
The model was developed from n a rra tiv e descriptions by Stevens
(1980a; 1980b) and Mersey and Blanchard (1982).
The model is an
in te r p r e ta tio n of concepts of formal and fu n ction al power defined in
t h e i r p u b lic a tio n s .
Organizational p o s itio n encompasses the r o le , func­
tio n s , and q u a lific a tio n s of the nurse ad m inistrator as designated by
the Health Financing A dm in istratio n, Department of Health and Human
Sources of
Organizational
Career
I n f l uence
Position
Success
Formal Power
I . Reward
system
control
2. Sanction
control
3. Resource
control
4. Decision­
making
a u th o rity
Functional Power
Expertise:
a) nursing
b) management
c) public
re la tio n s
A b i l i t y to
set and
communicate
professional
goal s
Network ref­
la tio n s and
linkages in
and out of
the
organization
Sources of Organizational Power:
Stevens
_____Hersey and Blanchard______
Figure I .
Conceptual Model
. Professional Role
D ivision management and control
Formal and informal organizational
decision-making
Membership on physician committees
Membership on tru stee committees/
boards
Status symbols/support systems
Environment r e fle c tin g a u th o rity
T i t l e of a u th o rity
C lin ic a l and management preparation
A c t i v i t y in professional organizations
P o lit ic a l activity/com m unity v i s i b i l i t y
ASNSA Questionnaire
Peterson Questionnaire
8
Services (1982), J o in t Commission f o r A ccre d ita tio n of Hospitals
(1983), American Nurses' Association (1982), National League fo r
Nursing (1980), American Society of Nursing Adm inistrators of the
American Hospital Association (1979; 1980a), and the American Hospital
Association (1979).
categories.
The standards were compressed in to ten broad
Organizational p o s itio n was measured using an adaptation
of the American Society of Nursing A dm in istrato rs' 1977 survey of
• ■
nursing service adm inistrators in acute care hospitals (1980b) and
supplemental items developed by the researcher.
Sources of influence
are assumed to p o s it iv e ly a ffe c t organizational p o s itio n and to
influence the dependent v a ria b le , career success.
Discussion o f the Variables
An acute care hospital is a complex social system with
in te r r e la te d subsystems.
In order f o r ad m inistration to control and
coordinate organizational a c t i v i t i e s , there is the assumption of a
hierarchal power system.
The h o s p ita l, considered a fu n c tio n a l
o r-g a n iz a tio n , has two lin e s of a u th o rity ; the a d m in is tra tiv e and
professional (E tz io n n i, 1964).
Stevens' (1980a) d e s c rip tiv e model of
nursing a d m inistra tion r e f le c t s th is m u l t i p l i c i t y .
synthesis of both nursing and management.
The model is a
Complex problems re lated to
m u ltip le roles in nursing w i l l be discussed in the review of
Iite ra tu re .
The nursing a d m inistra tor combines both formal and fu n c tio n a l
power in order to increase influence both w ith in and out of the organi
z a tio n .
Formal power may be inherent in the organizational p o s itio n .
9
p o s itio n on powerful committees, re p o rtin g re la tio n s h ip s , rewards, and
status th a t r e f l e c t p o s itio n a l a u th o rity .
Functional power is derived
from the p e rs o n a lity and behavior of the leader, perceived expertise,
p o s itio n , leadership, and the knowledge a leader possesses (Stevens,
1980b).
The importance of mentorship and networking is discussed by both
Stevens (1980a) and Mersey and Blanchard (1982).
They discuss i t in
terms of inform ation and connection power, and networks and linkages.
Coercive and reward power w i l l not be considered in t h is study.
The instrument was not designed to answer questions re la te d to
in d iv id u a l a d m in is tra tiv e p ra c tic e .
A formal p o s itio n in an organization does not guarantee entree
in to the informal organizational s tru c tu re .
Access by the nursing
ad m in is tra to r to both the formal and informal a d m in is tra tiv e stru cture
is necessary in order to influence organizational decision-making.
The
nurse a d m inistra tor is an active p a r tic ip a n t in the h ig h -le v e l
a d m in is tra tiv e s tru c tu re , has access to the o ff ic e of the c h ie f
executive o f f i c e r , and is a c tiv e ly involved in physician and trustee
decision-making committees and boards.
Organizational influence is
re fle c te d in rewards and status symbols of the p o s itio n .
These include
not only salary and b e n e fits , but also ad m in is tra tiv e support services,
o f f ic e , and t i t l e
th a t r e f l e c t a d m in is tra tiv e management (Stevens,
1980a).
Influence impacts not only on the d iv is io n of nursing w ith in the
o rg a n iz a tio n , but also on the nursing profession and the ov e ra ll d ire c ­
tio n of health care d e liv e ry .
Managerial control insures control of
10
the department of nursing, control of finances, and decision and
policy-making (Stevens, 1980a).
Access to a p o s itio n of a u th o rity does not insure access to bases
of power.
Formal sources of influence are d i r e c t l y re la te d to the
w illin g n e s s of the superior o f f ic e r to delegate a u th o rity and respon­
s ib ility .
The superior may also be in a po sition to withdraw
a u th o rity .
The most important sources of influence are the reward and
sanction systems.
Power is f i n i t e , th e re fo re , the nurse adm inistrator
e f f e c t i v e l y con trols organizational influence (Kersey & Blanchard,
1982).
Concl us ion
Sources of influence fo r the nursing adm inistrator are pro­
fe s s io n a l, o rg a n iz a tio n a l, and personal.
In order to develop
leadership and management p o te n tia l, sources of influence are u t i l i z e d .
Influence is dependent upon personal in te ra c tio n , is m u ltid ire c tio n a l
in nature, and is part of both the formal and fun c tio n a l s tru c tu re .
The assumption is th a t professional mentor-network r e la tio n s are an
important source of influence and necessary fo r professional career
success.
A c q u is itio n of ad m in is tra tiv e influence and r e s p o n s ib ilit y
is studied f o r i t s e ffe c t on professional achievement.
11
CHAPTER 2
REVIEW OF SELECTED LITERATURE
Barbara Stevens is a nursing leader, author, educator, and
consultant in nursing a d m in is tra tio n .
A ccording'to Stevens (1980a),
the ro le perceptions of nurse adm inistrators are re fle c te d in ro le
performance.
Typical roles assumed by nursing adm inistrators are those
of expert c l i n i c i a n , manager, educator, or expert in human r e la tio n s .
Successful nurse executives e x h ib it ro le f l e x i b i l i t y and adapt t h e ir
perceived ro le to meet organizational needs.
Robert Katz (1974), consultant in corporate s tra te g y , states th a t
the successful a d m inistra tor develops three basic in te rre la te d
managerial s k i l l s .
These s k i l l s are developed in order to d ire c t the
a c t i v i t i e s of others, and f o r assumption of r e s p o n s ib ilit y fo r
corporate o b je c tiv e s .
Required m a n a g e ria l.s k ills , as i d e n t if ie d by
Katz, are human, conceptual, and te c h n ic a l.
encompass departmental re la tio n s h ip s .
F i r s t , human s k i l l s
Second, conceptual s k i l l s , which
may be more innate than acquired, are necessary fo r development of an
ove ra ll organizational view re la ted to management p ra c tic e .
Third,
technical expertise is required in order to comprehend organizational
operations and d ir e c tio n , as well as, the a b i l i t y to prope rly i n i t i a t e
and analyze communication with subordinates and others.
12
Adm inistrative Influence
In reviewing l i t e r a t u r e , em pirical studies were found to be lacking
in the area of power, influ ence , and a u th o rity .
Much has been w ritte n
in nursing l i t e r a t u r e , however, confusion exis ts about concept d e f i n i ­
t io n .
In nursing and management l i t e r a t u r e influence and a u th o rity are
fre q u e n tly defined as a l l i e d concepts of power.
. one aspect of interpersonal re la tio n s h ip s .
Power may be viewed as
"Power is a dyadic r e la ­
tio n s h ip , based on both the strengths of the powerholder and the
dependencies of the fo llo w e rs " (Stevens, 1980a, p.183).
Kersey and
Blanchard (1982) describe power as a "le a d e r's influence p o t e n t ia l" (p.
177).
Paul Kersey and Kenneth J. Blanchard (1982), behavioral s c ie n tis ts
and s p e c ia lis ts in organizational management, state th a t formal and
fu n c tio n a l power combine to provide the power base which con stitute s
the in flu e n c e -in te ra c tio n system in a d m in is tra tio n .
There are many
c la s s if ic a t io n s of power noted in both management and nursing l i t e r a ­
tu re .
The most fre q u e n tly accepted are the fiv e bases of power as
defined by French and Raven (1959); coercive, le g itim a te , expert,
reward, and re fe re n t.
Raven and Kruglanski (1975) la te r introduced a
s ix th base of power; inform ation. , In 1979 Paul Kersey and Marshall
Goldsmith (Kersey & Blanchard, 1982) added connection power as a
seventh power base.
The seven power bases' defined by Kersey and
Blanchard (1982) are as fo llo w s :
I.
Coercive power implies a th re a t and is based on fe a r.
13
2.
Legitimate power is based on the lea der's p o s itio n , and
implies rig h ts of c o n tr o l.
3.
Expert power is based on the lea der's expertise and
knowledge.
4.
Reward power is based on the le a d e r's a b i l i t y to provide
p o s itiv e rewards f o r compliance.
5.
Referent power is based on the lea der's personal character.
6.
Information power is based on the a b i l i t y to gain access to ,
or possess, inform ation which is deemed valuable by others.
7.
Connection power denotes connections with in f l u e n t i a l or
important others, both w ith in and out of the organization.
Sources of power of the nursing a d m inistra tor proposed by Stevens
(1980b) are as fo llo w s :
1.
Knowledge includes expertise in nursing and ad m in is tra tio n .
2.
Network re la tio n s and linkages grant access to information
channels both in and out of the organization, and with access
to in f l u e n t i a l people.
3. • Control of resources ensures power and knowledge f o r resource
d i s t r ib u t i o n and a c q u is itio n .
4.
Decision-making or problem-solving a b i l i t y w ith a u th o rity fo r
problem diagnosis, re s o lu tio n , and decision-making.
5.
Vision and statesmanship in one's profession and the a b i l i t y
to id e n t i f y and communicate goals and practices to others.
The concept of mentorship is implied by Kersey and Blanchard's
(1982) d e f in it io n of information and connection powers.
According to
Stevens (1980a), i t is the r e s p o n s ib ilit y of p ra c tic in g nurse
14
ad m inistra tors to provide education and experience f o r nurses who
e x h ib it leadership p o te n tia l.
Future nursing leaders need the guidance
and d ire c tio n of an experienced nursing leader fo r development of
leadership p o te n tia l and f o r c o n tin u ity of management.
Organizational status is re fle c te d in status symbols.
Stevens
(1980a) c ite s as examples of executive status symbols, the physical
environment which r e fle c ts p o s itio n , t i t l e which denotes power, and
personal and departmental v i s i b i l i t y both in and out of the organiza­
t io n .
A dm in istra tive R e s p o n s ib ilitie s
R e s p o n s ib ilitie s , d u tie s , and t i t l e s of the nurse ad m inistrator .
have changed in the past 100 years.
The nurse executive is no longer
ca lle d the superintendent of nurses or nurse matron.
In the past the
superintendent of nurses held to t a l r e s p o n s ib ilit y fo r the hospital and
nursing department management.
added r e s p o n s ib ilit y .
Operation of a school of nursing was an
Duties included student t r a in in g , purchase of
supplies, f i s c a l management, establishment of rules and re g u la tio n s ,
supervision of a ll p a tie n t care, and some d ir e c t p a tie n t care
(Erickson, 1980).
Erickson postulates th a t c h a ra c te ris tic s of the
e a rly ro le remain in some h o s p ita ls .
This is, seen in the immaculate
uniform, professional comportment, d a ily p a tie n t rounds, and apparently
endless time fo r s o lu tio n .o f employee problems.
The provision of
d ir e c t p a tie n t care by the nurse a d m inistra tor may be a vestige of the
past in ru ra l h o s p ita ls , both expected and accepted by a d m in is tra tio n ,
tru s te e s , and the community.
15
Federal re gula tions f o r h o spitals provide minimal guidelines fo r
the department of nursing and f o r the, r e s p o n s ib ilitie s of the nurse '
a d m in is tra to r.
Delegated r e s p o n s ib ilit ie s re la te almost e x c lu s iv e ly to
nursing personnel and p a tie n t care.
Educational q u a lif ic a t io n s ,
experience, and demonstrated a b i l i t i e s o f the nurse ad m inistrator are
not, c le a r ly defined.
Hospital size apparently i d e n t if ie s the need fo r
increased q u a lific a tio n s (HCFA, 1982).
The im p lic a tio n is th a t the
la rg e r the h o s p ita l, the more q u a lifie d the nursing service administra­
to r is expected to be.
The J o in t Commission on A c c re d ita tio n of Hospitals ( JCAH), the
v olu ntary accre d itin g agency f o r health care i n s t i t u t i o n s , has
developed standards f o r hospital departments and i n s t i t u t i o n a l
organ ization s.
management.
Standards are s p e c ific f o r evaluation of hospital
The JCAH recognizes the nurse executive as a member of the
t o t a l hospital a d m inistra tion with a u th o rity and r e s p o n s ib ilit y .
R e s p o n s ib ilitie s include assessment, eva luatio n, in d iv id u a liz a tio n of
p a tie n t care, to t a l departmental management, and ove rall in s t i t u t i o n a l
planning.
Standards expand r e s p o n s ib ilit ie s and a u th o ritie s to include
formal lia is o n with the.medical s t a f f , hospital and tru s te e committees
and boards, and coordination with a ll hospital departments.
R e s p o n s ib ilitie s include the departmental budget and budget a llo c a ­
t io n .
I t is recommended by the JCAH th a t nurse adm inistrators have at
le a s t baccalaureate education.
A dditional standards include advanced
education, experience, and demonstrated a b i l i t y in nursing practice and
ad m inistra tion ( JCAH, 1983).
I'
16
The American Nurses' Association (ANA) and National League f o r
■
Nursing (NLN) have developed standards, p o lic y statements, or c r i t e r i a
f o r evaluation of nursing service departments and de lin e a tio n of ro le
and r e s p o n s ib ilit ie s of the nursing service a d m in is tra to r.
The
American Hospital Association (AHA) and the American Society of Nursing
Service A dm inistrators of the American Hospital Association (ASNSA)
have issued guidelines which also define the ro le and r e s p o n s ib ilit ie s
of the nursing a d m in is tra to r.
These guidelines p a ra lle l JCAH standards
(ANA, 1982; AHA, 1979; ASNSA, 1979; NLN, 1980).
The ASNSA, ANA, and
NLN are s p e c ific in recommendation of a master's degree in nursing .
ad m inistra tion as the required educational preparation.
In a d d itio n , .
both strong nursing and ad m in is tra tiv e preparation are considered
e s s e n tia l.
C r i t e r i a fo llo w JCAH standards in re cogn ition of the nurse
ad m in is tra to r as a member of the executive management team.
A u th o ri­
t ie s include re p o rtin g d i r e c t l y to the c h ie f executive o f f i c e r and
communication with the board of tru s te e s .
The nurse ad m inistrator
holds r e s p o n s ib ilit y f o r departmental f i s c a l and management control and
the planning and monitoring of p a tie n t care.
The three primary
fun ction s of the nursing a d m in is tra to r, as defined by the AHA, are
p a tie n t care, f i s c a l , and resource management (AHA, 1979).
The Montana Hospital Association (W. Leary, personal correspon­
dence, October 14, 1983) has developed no s p e c ific guidelines fo r
de fin in g the ro le and fun ction s of the nursing a d m in is tra to r.
The.
association is quick to point out th a t AHA has developed guidelines and
not a universal p o lic y statement.
Guidelines may be adopted at the
d is c re tio n of in d iv id u a l hospital members.
Each hospital assumes
17
r e s p o n s ib ilit y f o r development of p o s itio n descriptions d e fining roles
and r e s p o n s ib ilit ie s f o r the nurse a d m inistra tor which are fun c tio n a l
f o r the s p e c ific h o s p ita l.
The Montana Society of Nursing Service
A dm inistrators of the Montana Hospital Association (MSNSA) did develop
a p o s itio n statement in
(MSNSA, 1978).
1978 which was adapted from AHA guidelines
The p o s itio n statement serves as a guide f o r Montana
nurse ad m inistra tors.
National guidelines fu r th e r charge nursing adm inistrators with the
r e s p o n s ib ilit y of promoting nursing research and fo r providing educa­
tio n a l o p p o rtu n itie s w ith in the i n s t i t u t i o n .
The nursing administra­
to r is also expected to assume r e s p o n s ib ilit y fo r health care d ire c tio n
and promotion in areas w ith in and outside of the i n s t i t u t i o n
(ANA, 1982;
MSNSA, 1978; ASNSA, 1979; Stevens 1978b).
The fo llo w in g newspaper advertisement appeared in a major Montana
d a ily newspaper during July of 1983.
"D ire c to r of Nursing f o r small
Hospital-Nursing Home in Eastern Montana—Generous Salary and benefits
X-ray exper. h e lpful . . . "
p.
7-B).
("Professional P o s itio n s ", 1983,
The implied r e s p o n s ib ilit ie s provide added in te r e s t in
in v e s tig a tin g the question of how c lo s e ly the recommended ro le and
r e s p o n s ib ilit ie s of the nursing service ad m inistrator p a r a lle l the
r e a l i t y of the ro le in ru ra l MontanaNational P r o file
To obtain a p r o f i l e of the nursing ad m in is tra to r, the ASNSA con­
ducted a universal survey in 1977.
November of 1980.
The f i n a l summary was published in
Of the 7,084 nurse adm inistrators surveyed, 5,325
18
(75.2 percent) returns were completed (ASNSA, 1980b).
The seven page
survey provided data f o r the development of a general p r o f i l e of the
nursing ad m inistra tor nationwide.
The survey revealed th a t the average
nursing a d m inistra tor is female (94%), married, and between 40-49
years o ld .
f i v e years.
The nurse ad m inistrator has held the p o s itio n from one to
Upward m o b ility is a national trend.
The nurse admin­
i s t r a t o r previou sly worked from one to f i v e years in p o sitions ranging
from s t a f f nurse to ass is ta n t nursing a d m in is tra to r.
The nurse admin­
i s t r a t o r reports d i r e c t l y to the c h ie f executive o f f ic e r and par­
t ic ip a t e s in a d m in is tra tiv e coverage fo r ove rall hospital operation.
The nurse ad m inistra tor has held a f a c u lt y po sition and may have been
a c l i n i c a l s p e c ia lis t .
The exact ro le of c l i n i c a l s p e c ia lis t is not
defined in the questionnaire.
The nursing adm inistrator has a bac­
calaureate degree or higher, is pursuing formal education, and has .
obtained continuing educational units w ith in the previous f iv e years.
The nurse ad m inistrator is responsible f o r the departmental budget and
may be involved in hospital budget planning.
s i b i l i t y f o r the department of nursing.
There is t o t a l respon­
I f a bargaining u n it e x is ts ,
the nurse a d m inistra tor is a part of the negotiating team (ASNSA,
1980b).
,
.
Data analysis of the ASNSA 1977 survey has s ig n ific a n c e beyond the
general p r o f i l e .
in nursing.
The la rg e s t percentage (45.9 percent) hold a diploma
The major is u n id e n tifie d , but 27.5 percent hold master's
degrees, and only 0.5 percent are d o c to ra lIy prepared.
The budget is
established by 73.1 percent of the nursing ad m inistra tors, while only
56 percent have f u l l ad m in is tra tiv e r e s p o n s ib ilit y f o r th a t budget.
19
According to Stevens (1980b), a managerial t i t l e
p o s itio n .
denotes power and
The ASNSA (1980a) survey revealed th a t despite the
recognized a d m in is tra tiv e p o s itio n , 77.1 percent of the nurse admin­
is t r a t o r s s t i l l hold the t i t l e of d ir e c to r of nursing.
C orrelation of
data revealed th a t men in the p o s itio n achieved higher p o sitions
e a r l i e r in t h e ir careers and are more concentrated in la rg e r h o s p ita ls .
Never-married women are in larg e r h o s p ita ls , have higher s a la rie s , and
hold more advanced degrees.
Younger nurse adm inistrators generally
p ra c tic e in smaller h o s p ita ls .
pared w ith hospital size.
Twenty-six b e n e fit categories were com­
There appears to be l i t t l e commonality in
be nefits offered by in d iv id u a l h o s p ita ls .
The ASNSA survey reveals th a t many nursing adm inistrators work over
44 hours a week and some as many as s ix t y hours.
demands placed upon nursing ad m inistra tors.
This i l l u s t r a t e s the
There were no questions in
the survey re la te d to obtaining the p o s itio n by advancement w ith in the
organization or recruitm ent from outside of the agency.
The annual
sala ry range reported in 1977 was from less than $15,000 to $35,000 or
more per year.
National P r o file in 1982
In 1982 the ASNSAz again conducted a survey of nursing administra­
to rs in h o spitals (ASNSA, 1984).
The purpose was to obtain an update
of the p r o f i l e and to id e n t if y changes in the ro le s , fu n c tio n s , respon­
s i b i l i t i e s , and professional background.
sample.
This was not a universal
The population included only ASNSA members.
was 500 w ith 343 (68.6 %) responding.
The sample size
20
Some c h a ra c te ris tic s are unchanged from the 19.77 survey.
The
average nurse ad m in is tra to r is , or has been married, is a woman
between 40 and 49 years old , and has functioned in t h e i r present p o s itio n
from one to f i v e years.
Some changes noted are the upward movement fo r
higher c re d e n tia ls w ith in the o rgan ization .
ment in hospital a f f a i r s .
There is increased in v o lv e ­
Changes are noted also in t i t l e , corporate
r e s p o n s ib ilit y , and appointment to hospital governing boards.
The
nurse a d m inistra tor reports to the highest ad m in is tra tiv e o f f i c e r , par­
tic ip a te s in hospital budget planning and p r i o r i t y s e ttin g , and attends
meetings of the hospital governing board and medical executive commit­
tees (ASNSA, 1984).
The salary averages approximately $35,000 and be nefits have
increased.
The average nurse a d m inistra tor has a master's degree, has •
taken courses re la te d to a d m in is tra tio n , and .is active in community and
professional groups.
The 1982 survey re p o rt was received fo llo w in g re c e ip t of per­
mission to use the 1977 ASNSA questionnaire.
in progress.
This research study was
The 1982 survey, by in c lud ing only a sample population of
ASNSA members, may not be t o t a l l y representative of the average nurse
a d m in is tra to r.
The re s u lts of the survey are of value in in te rp r e ta ­
tio n of trends found in th is researcher's study.
A dm in istrative Preparation
I t is estimated th a t less than twenty percent of a l l nursing admin­
is t r a t o r s have a master's degree, many of which may be in f i e l d s other
than nursing.
Only 22 percent have baccalaureate degrees.
As a rule,.
21
the m a jo rity of nursing adm inistrators have advanced through the ranks
and have learned management s k i l l s on the jo b .
Power f o r the nurse
ad m in is tra to r is fre q u e n tly an unresolved issue,, and some nurses are
advanced because of the f a c t th a t they lack influence (Stevens, 1978b).
Ruth KronmiH e r (1979), assista nt professor at Yale U n iv e rs ity School
of Nursing, states th a t "promoting in d iv id u a ls from w ith in the ranks,
although thought to be one of the best ways to f i l l
supervisory posi­
tio n s and a le g itim a te incentive toward improving competencies has i t s
p itfa lls .
supervisor.
Being a good s t a f f nurse does not always mean being a good
Indeed, becoming a good s t a f f nurse does not ensure that
one w i l l be an e ff e c tiv e executive d ir e c to r e i t h e r ! " (p. 666).
A review of l i t e r a t u r e leaves no doubt th a t the pra ctice of
nursing service ad m inistra tion must be based on c l i n i c a l competence and
sound managerial s k i l l s .
What is not agreed upon by some authors, is
whether an advanced c l i n i c a l component in p a tie n t care should be a
r e q u is ite in educational programs f o r nurse a d m inistra tors.
Dorothy •
Jones, associate professor at Boston U n iv e rs ity School of Nursing, and
Murial Poulin, professor in a d m inistra tion at Boston U n iv e rs ity School
of Nursing and associate a d m in is tra to r at Beth Israel Hospital (1983),
advocate a curriculum w ith a strong c l i e n t component in order to remain
curren t in advanced technology today.
Nurse adm inistrators require
c l i n i c a l competency in' order to address problems re la te d to a changing
population p r o f i l e and f o r the development of nursing as a science.
Other authors state th a t as the second ranking o f f i c e r in the
health care i n s t i t u t i o n , the r e s p o n s ib ilit ie s of the nursing admin­
i s t r a t o r are to administer nursing care and no longer to provide the
22
d ir e c t p a tie n t care (Stevens, 1978a; R otkovitchs 1979).
to the need f o r " c l i n i c a l con ceptualization" (p. 6 ).
Stevens re fe rs
Rachel
R otkovitch, vic e -p re s id e n t fo r nursing at Yale-New Haven H ospital,
advocates th a t the c l i n i c a l component involve a preceptorship with a
p ra c tic in g nurse a d m in is tra to r.
The nurse ad m inistrator must be pre­
pared with managerial s k i l l s th a t provide power and the a u th o rity of
leadership in order to adequately i n s t i t u t e both departmental and
organizational planning.
Rotkovitch (1979) fu r th e r states th a t the nurse ad m inistrator must
be ed uc a tio n a lly prepared to communicate nursing to others.
They must
be prepared to communicate with the a d m in is tra to r, tru s te e s , physicians,
and the community at large.
In order to enact the executive ro le , the
nurse a d m inistra tor must learn to be p o l i t i c l y astute and v is ib le .
According to Stevens (1978b), the nurse executive must be able to. view
management re la ted to the to ta l system.
The nurse ad m inistra tor must
also be e d u c a tio n a lly prepared in the management s k i l l s of the chie f
executive o f f i c e r in order to fun ctio n in times of h is /h e r absence.
The numbers of students in advanced c l i n i c a l p ra c tic e increased
from 1968-1977.
As fu n c tio n a l s p e c ia lty options in schools of nursing
decreased, the numbers of students e n rolled in a d m in is tra tiv e programs
also declined.
( F itz p a tr ic k & H e lle r, 1980).
Only re c e n tly has there
been an increase in master's programs in nursing a d m in is tra tio n .
Inc re a s in g ly , programs have been developed by corporate h o s p ita ls , pro­
fessional organizations, and u n iv e rs itie s fo r the p ra c tic in g nurse
a d m in is tra to r.
The ANA and ASNSA re cogn ition programs are examples of
encouragement fo r professional growth by nurse a d m inistra tors.
23
According to Stevens (1978b), the increase in organizations fo r nursing
adm inistrators and the s o p h is tic a tio n o f professional jo u rn a ls is e v i­
dence of the awareness of a need fo r change by nurse a d m inistra tors.
Of the 111 graduate programs in nursing lis t e d by the NLN in the
1982-1983 p u b lic a tio n of master's programs in nursing, there are only
39 programs th a t o ff e r a major in a d m in is tra tio n .
However, many of the
programs do o ff e r fu n c tio n a l concentration in th a t area (NLN, 1983).
The NLN Nursing Data Book 1982 l i s t s 142 master's programs, 93 of which
are accredited by NLN.
Of the 5,026 graduates in the 1980-1981 academ­
ic year, only 5.2 percent are lis t e d as graduating in the fun ction al
area of a d m inistra tion (NLN, 1982).
Women in Management
According to an a n a ly s is 'o f a survey of registered nurses by the
D ivision of Health Professionals, nursing remains a predominantly
female occupation.
Men in nursing increased from 1.9 percent in 1977
to only 2.7 percent in 1980 (AJN, 1982).
By con trast, nurse managers
fu n c tio n in an a d m in is tra tiv e s tru c tu re dominated by men.
Physicians
and hospital adm inistrators are p r im a r ily men who have t r a d i t i o n a l l y
c o n tro lle d p o lic y and decision-making in health care systems (Ashley,
1976; Meisenhelder, 1982).
A ttitu d e s are changing, but there remain
dis p ro p o rtio n a l employment o p p o rtu n itie s f o r Women in the work force
(Ro
ds
, 1981; Kanter, 1977; Roberts, 1982).
The ro le of women in
nursing is viewed from the standpoint of social concepts re la ted to the
ro le of women both in the past and present (Ashley, 1976).
24
A recent survey (AJN, 1983) reveals th a t the median salary fo r
hospital nursing adm inistrators is $36,727.
Of the to p , 45 hospital
management personnel, nursing a d m in is tra to rs ' sala ries rank only s ix th .
Salaries are f i v e percent less than f o r men in a d m in is tra tiv e positions
which are o rg a n iz a tio n a lI y equal.
The" 171 nursing adm inistrators in
th is sample supervise an average of 497 employees and have worked an
average of nine years w ith t h e i r current employer.
The adm inistrators
had held t h e i r p o s itio n an average of three years.
Nurse admini­
s tra to rs receive approximately one-half the salary of the top
a d m in is tra tiv e o f f i c e r , despite t h e ir supervisory r e s p o n s ib ilit ie s .
The survey revealed they have, on the average, seventeen years of
education and hold an average of two academic degrees.
Lucie Young K e lly (1981), professor of nursing at Columbia
U n iv e rs ity , posits th a t nurses in ad m inistra tion are working through
and solving problems re la te d to a p r io r lack of management tra in in g and
the d i f f i c u l t y of fu n c tio n in g in power s itu a tio n s t r a d i t i o n a l l y domi­
nated by men.
A major source of c o n f l i c t fo r the nurse ad m inistrator
is the dual ro le of nurse and a d m in is tra to r.
■
The combined power
inherent in both roles provides strength fo r the successful nurse
a d m in is tra to r.
A major b a rrie r to management p o te n tia l is powerlessness w ith in the
c orporation .
Powerlessness re s u lts from lack of organizational oppor­
t u n i t i e s , a u th o rity w ithout formal power, and a c c o u n ta b ility f o r others
w ithout informal p o l i t i c a l influence (Kanter, 1977).
According to
Mirides and Cote (1980), b a rrie rs f o r women in management are organiza­
tio n a l w ith t r a d it io n a l male-oriented p o lic ie s and procedures.
25
B arriers are corporate w ith the s o c ia liz a tio n and rapport accorded men.
There is also the b a r r ie r created by centuries of a c c u ltu ra tio n and
and con dition ing of women.
Rosen and Jerdee, in 1974, stated that
greater support and concern given men in the corporation had a d e t r i ­
mental a ffe c t on the self-image and career progress of women (1974).
With increasing numbers of women in management positions', th is trend
may today be viewed from a d if f e r e n t perspective.
There has been a plethora of research studies and authors who
have a ttr ib u te d success or f a i l u r e . o f women in management positions to
sex-role stereotyping.
The l i s t of differences is interm inable.
To
men are a ttrib u te d the t r a i t s of the "corporate man" w ith a u th o ri­
ta ria n is m , task o r ie n ta tio n , and competitiveness.
Women are associated
w ith the "queen bee syndrome", viewing other women as competitors.
Women are viewed as cooperative, team o rie nte d, compassionate, passive,
accommodating, and less goal directed (Bunker & Bender, 1980; Hennig &
Jardim, 1977; Sargent, 1978; Moore & R ic k e l, 1980).
Social and economic fa c to rs have effected change in employment and
the ro le of women in management.
The women's movement and related
organizations have a ll collaborated in creating change.
C iv il rig h ts
le g is l a t i o n , a ffir m a tiv e action programs, and the changing p r o f i l e of
the.workforce have a ll contributed to change.
Women now c o n s titu te 43
percent of the workforce and are entering what have been considered
n o n tra d itio n a l f i e l d s .
tio n s .
This includes organizational executive posi­
There is an increased need in both industry and business fo r
competent managers (Mirides & Cote, 1980).
26
According to Marilyn Ferguson (1980), author of numerous publica­
tio n s on social change, increasing numbers of women are impacting and
changing p o lic y making and government.
Rather than b u ild in g on the
past male oriented s tru c tu re , social change must be created by both
women and men.
Not a ll authors agree th a t sex differences a ffe c t women in manage­
ment today.
A more androgynous management model which combines both
male and female behaviors has been suggested.
In the fu tu re tra in in g
programs, recruitm ent, and performance appraisals w i l l be generic in
nature.(Sargent, 1978; Mirides & Cote, 1980).
Candace West (1982), at the U n iv e rs ity of C a lifo r n ia , Stevens
College, states th a t success in a man's world is , at le a s t p a r tly ,
a ttr ib u te d to learning the unspoken rules of men's games.
In i n t e r - .
action between men and women the im p lic a tio n of actions change with
gender.
West states th a t even i f a woman "does learn the rules of the
game, she may not be treated as a c re d ib le player" (p. 20).
The question th a t West (1982) presents, is why women should be
singled out fo r management and assertiveness tr a in in g , ra th e r than
addressing the real issues.
These issues include not only changing the
work s tru c tu re , but a change in interpersonal in te ra c tio n patterns as
w e ll.
There is a d iffe re n c e in communication and influence styles be­
tween men and women (West, 1982; Wiley & Eskelson, 1982).
Rather than a focus on an androgenous management model, the
research studies of Carol G illig a n (1982), associate professor at
Harvard U n iv e rs ity , a ffirm s th a t q u a litie s associated with weakness in
women are in r e a l i t y t h e i r strengths.
Differences in developmental
27
o r ie n ta tio n is re fle c te d in the differences of thought and in te rp r e ta ­
t io n .
Social sta tu s , power, and reproductive biology, shape e xp eri­
ences and the re la tio n s h ip s between men and women.
The e a rly social
environment d i f f e r s , and re la tio n s h ip s and issues of dependency are
experienced d i f f e r e n t l y .
As a r e s u lt , women become more re la tio n s h ip
oriented and f o r men, in d iv id u a liz a tio n and achievement are important.
There are differences in perspective, modes of language, and thought;
a l l of which have im p lic a tio n s fo r women developing t h e i r own s ty le of
management e xp ertise .
Mentor Connections
Professional mentor and network re la tio n s h ip s are r e l a t i v e l y new
concepts f o r women in management.
The assumption is th a t mentor con­
nections and professional networks are mutual concepts which have a
d ir e c t re la tio n s h ip to success fo r the nurse adm inistrator in a ru ra l
s ta te .
Kersey and Blanchard (1982) re fe r to the 'tra in in g and development
of young leaders p r io r to advancement as "a n ti-P e te r P rin c ip le vaccine"
(p. 146).
The primary purpose of a mentor re la tio n s h ip is in s o c i a l i ­
zation of a younger person in to the profession.
insured c o n tin u ity and q u a lity of leadership.
In t h is way there is
Professional development
is achieved by access to i n f l u e n t i a l persons, entree in to inner
c i r c l e s , and s o c ia liz a tio n in to the system (Vance, 1982).
Henry Mitzenberg (1975), associate professor at McGill U n iv e rs ity ,
conducted an indepth study o f the a c t i v i t i e s of f iv e American c hie f
executives.
Mitzenberg found th a t the emphasis of the manager is on
28
verbal media.
The manager spends 78 percent of his time in verbal
communication.
Telephone access is e s s e n tia l, and inform ation seeking
behavior is by word-of-mouth.
Managers r e ly on s o ft communication such
as gossip, speculation, and heresay.
Mitzenberg states th a t "today's
gossip may be tomorrow's f a c t " (p. 52).
With v i t a l verbal communi­
cation stored in the minds of managers, the support f o r mentorship
necessary to pass on leadership knowledge appears to be e s s e n tia l.
Abraham Zaleznik (1977), professor of social psychology of manage­
ment at Harvard, c ite s the one-to-one re la tio n s h ip in mentoring.
This
re la tio n s h ip requires time and emotional expenditure, and may be a
major reason fo r reluctance of executives to enter in to mentor r e la ­
tio n s h ip s .
Mentorship o ffe rs firs th a n d experience in the use of power
to influence the actions of others.
Equally important is to learn what
Zaleznik (1977) c a lls "the important antidotes to the power disease
ca lle d h u b ris --performance and i n t e g r i t y " (p. 78).
The concept of mentorship is not new.
mythology (Atwood, 1979).
The term o rig in a te d in Greek
The most widely reviewed nursing study is
Connie Vance's 1977 doctoral research at Teachers College, Columbia
U n iv e rs ity .
The mentor connections of 71 id e n tifie d leaders in nursing
were determined.
Vance defines a mentor as "someone who serves as a
career ro le model and who a c tiv e ly advises, guides, and promotes
another's career and t r a in in g " (p. 10).
Vance found th a t 83 percent of
the i n f l u e n t i a l nurse p a rtic ip a n ts reported one or more mentors.
Mentors were predominantly women; 79 percent were women, and 21 percent
were men.
Ninety percent of the mentors had acted as mentors to younger
nurses (1982).
P h y llis Owens (1982), in a master's research study at
29
the U n iv e rs ity of Colorado, found th a t 65 percent of the 55 nurse admin
i s t r a t o r p a rtic ip a n ts had been mentees, and seve nty-five percent were
mentors to others in nursing.
In non-nursing studies, Margaret Hennig and Anne Jardim (1977)
re p o rtin g on Hennig1s doctoral d is s e rta tio n at Harvard Business School,
found th a t of the 25 successful women in management under study, a ll
reported having mentors.
The successful women developed close r e la ­
tio n s w ith a male boss, ju s t as they had w ith t h e i r fa th e rs e a rly in
life .
Fathers influenced t h e i r development, encouraged r is k - t a k in g ,
independence, and com petition.
fir m a tio n , and rewards.
The fa th e r also provided approval, con­
Successful women found acceptance la te r in
l i f e from a male sup erio r.
Women equated advancement and acceptance
with a b i l i t y and in te llig e n c e .
According to Hennig and Jardim women
f a i l to assume a mentorship ro le because they fea r loss of organiza­
tio n a l p o s itio n .
Later women f a i l to promote subordinates because of
unwillingness to share t h e ir unique p o s itio n w ith in the organization.
Daniel Levinson (Levinson, Darrow, K le in , Levinson & McKee, 1978),
of Yale U n iv e rs ity , conducted a lo n g itu d in a l study of the career
h is to r y of f o r t y men. Levinson states th a t a mentor e a rly in a man's
career is instrumental in achievement of career success, and the r e la ­
tio n s h ip term ination is a pa inful experience.
Levinson reported l i t t l e
mentoring is found among women and postulates there is a lack of
q u a lifie d women to fu n c tio n in the r o le .
Women are involved in sur­
v iv a l in a male work-oriented world, according to Levinson.
Levinson
did not include women in the study, and assumptions re la te d to mentor
re la tio n s h ip s f o r women are not valid a te d .
30
In a study of 1,250 new executives by Gerald Roche (1979), i n t e r ­
national -management con sultan t, only a small, unspecified percent were
women.
Two-thirds of a ll executives included in the study reported
having mentors, and o n e -th ird had two or more mentors.
Contrary to
Levinson's study, men did not view mentors as c o n trib u tin g to career
success, and mentors and mentees ended t h e ir re la tio n s h ip as frie n d s .
Women executives a ll reported having mentors.
mentors were men.
Seven out of ten of the
A male sponsor was viewed by women p a rtic ip a n ts as
being essential f o r career success.
Nursing l i t e r a t u r e reveals a general concern th a t nurses have been
u n w illin g to support professional growth in others.
The lack of
support is a ttrib u te d to the s o c ia liz a tio n of women, power struggles in
nursing, competitiveness, and a poor self-im age.
The decreased numbers
of women in leadership po s itio n s who also have less power and influence
have contributed to the small numbers of nurses in mentorship ro le s .
Mentor re la tio n s are seen as being m utually b e n e fic ia l f o r both mentor
and mentee.
Authors agree th a t as more nurses gain po s itio n s of
influence and confidence, not only leaders in nursing, but also a ll
nurses w i l l develop m utually s a tis fy in g mentor relationships- ( P ile t t e ,
1980; Shoor, 1978; Cameron, 1982).
Not a ll authors agree th a t mentorship re la tio n s are essential fo r
professional growth (Cameron, 1982; P i le t t e , 1980).
In Vance's (1981)
study, 17 percent of the nurse i n f l u e n t i a l had no mentors, and there
were 35 percent in Owen's (1982) study who were successful without
mentorship re la tio n s .
31
Jeanne Speizer (1981), research associate at W ellesly College,
reports weaknesses in recent studies which attempt to v a lid a te the con­
cept of mentorship.
Speizer asserts th a t research studies have been
re tro s p e c tiv e in nature.
Research has p r im a r ily been conducted with
business groups and men in management.
c o n tra d ic to ry and varied.
support data.
Findings of the studies are
Assumptions are presented w ithout necessary
While women have generally viewed a mentor as a fa c to r
in career success, men have not always agreed.
One consistent fin d in g in research studies has been the prevalence
of men who fu n c tio n in the ro le of mentor f o r women in management p o s i­
tio n s .
Ruiz (1982) states th a t the power struggle w ith in nursing and
the c r i t i c a l a ttitu d e women have of each other has been a c o n trib u tin g
fa c to r in women seeking men ra ther than women as mentors.
According to
Vance (1981), as more women move in to i n f l u e n t i a l po s itio n s there w i l l
be confidence in a b i l i t i e s and personal value.
With more women in
management, supportive re la tio n s with other women w i l l be available and
found equally as e ff e c tiv e as men in mentorship ro le s .
Robert Katz (1974) may have serend ipitou sIy provided the major
reason fo r women sele c tin g men as mentors.
Katz states th a t the higher
the manager ris e s in the corporate hierarchy; the more important are
conceptual s k i l l s .
The top executive needs a confidante w ith in the
organization with the same conceptual s k i l l s , knowledge of corporate
operations, key personnel, and corporate change.
Only w ith a confidant
w ith in the corporation is there a w ell-inform e d, o b je c tiv e , and
supportive person w ith whom to f r e e ly discuss fe a rs, doubts, and
32
a s p ira tio n s .
Subordinates are unable to provide .unanimous or continual
support.
The nurse ad m in is tra to r is dependent upon the hospital administra­
to r f o r reward and sanction powers.
In small ru ra l h o s p ita ls , most
nurse adm inistrators have male supervisors, but no peer w ith in the
in te rn a l environment on whom to depend f o r support and encouragement.
The c h ie f executive o f f i c e r becomes the in f l u e n t i a l mentor who provides
sources of organizational influence.
Professional Networks
Social anthropologist J. A. Barnes (1954) 'studying, social f i e l d s
in Bremnes, Norway during 1952-53,.f i r s t used the term web to explain
social phenomenon.
Barnes developed the image of a network which more
c le a r ly id e n t if ie d the multidimensional concept of' social re la tio n s
found in his work.
People represented the knots, lin e s id e n t if ie d per­
sonal in te ra c tio n s .
Claude Fischer, (Fischer et a l . , 1977) author of
studies in social r e la tio n s , more s u c c in c tly defines a social network
by saying, "We are each a center of a web of social bonds th a t radiates
outward to the people whom we know in tim a te ly , those whom we know w e ll,
those whom we know ca su a lly, and the wider society beyond.
These are
our personal social networks" (p. v i i ) .
According to Marilyn Ferguson (1980), the recent p r o lif e r a t io n of
networks is a powerful force in social and personal transform ation of
modern so c ie ty .
Ferguson describes a network as the modern version of
an ancient fa m ily system.
Today's fa m ily are those persons with bonds
of commonly held values, assumptions, and goals.
Everyone w ith in the
33
network is perceived as the center of a f l e x i b l e , open network system.
Ferguson also states th a t a network is a grass roots phenomena.
Not
only is a network s e lf-g e n e ra tin g , but i t also may be s e lf- d e s tr u c tin g ;
Each network has i t s own i d e n t i t y depending upon the need.
"Just as a
bureaucracy is less than the sum of i t s pa rts, a network is many times
greater than the sum of i t s parts" (pp. 216-217).
According to Stevens (1978b), there are increasing numbers of
nursing adm inistrators who are jo in in g in fo rm a lly to provide education
and problem-solving assistance.
An u n o f f ic ia l survey by the ASNSA
li s t e d 42 such organizations f o r nurse ad m inistra tors.
Sue DeWine, associate professor in the School of Interpersonal
Communications at Ohio U n iv e rs ity , and Diane CaSbolt, in management
t r a in in g at Ross Laboratories (1983), conducted a research of network
a c t i v i t i e s of 158 professional women.
Although the subjects were p r i ­
m a rily in middle and lower management p o s itio n s , some fin d in g s are
applicable to any social network.
DeWine and Casbolt found th a t men
t r a d i t i o n a l l y used informal social networks as a source of professional
advancement.
Good old boy networks have t r a d i t i o n a l l y been available
but good old g i r l networks have been nonexistent fo r women.
As more
women obtain managerial p o s itio n s , networks are proving to be the lin k
to peers who are able to aid in professional advancement.
Networking
f o r men has provided fo r establishment of contacts fo r self-prom otion.
Relationships are a part of the social as well as business m ilie u .
c o n tra s t, women e sta blish network re la tio n s h ip s fo r s p e c ific goals
re la te d to development of professional contacts,
By
34
Women executives have previously been excluded from the informal
corporate network which extends beyond the walls of the i n s t i t u t i o n .
The informal network influences corporate p o lic y making and provides
promotional op p o rtu n itie s (Puetz, 1983; Warihay, 1980).
Janice Meisenhelder (1982), in s tr u c to r at Boston U n iv e rs ity School
of Nursing, states th a t women in business are "a lie n s in a male,
corporate world" (p. 77).
Managers use s o c ia l, professional networks
f o r support, assistance, social contacts, and advancement.
The
professional network increases self-esteem fo r the nurse who functions
in is o la t io n and promotes understanding and support from other nurse .
executives.
Nurse adm inistrators are drawn together by mutual
fr u s t r a t io n s and problems.
According to Meisenhelder, lack of
cohesiveness in national nursing associations indicates a need fo r
informal ra th e r than formal network associations.
This indicates a
need f o r informal networks fo r a ll professional nurses.
One of the inconsistencies found in network studies is the actual
amount of support perceived as given and received by women in manage­
ment p o s itio n s .
Philomena Warihay (1980), management development con­
s u lta n t, conducted a national cross-sectional study of 500 women in
management p o s itio n s .
T h ir ty percent of the women in top level admin­
i s t r a t i v e positions reported no woman superior on whom to depend fo r
support.
Women in a ll positions perceived th a t they did provide needed
support fo r others.
However, approximately one-half of the women in
lower management leve ls experienced l i t t l e ,
■in superior p o s itio n s .
i f any, support from women
35
Networking f o r nurses is an old concept with a new name according
to Andrea O'Connor, associate professor at Columbia U n iv e rs ity School
of Nursing (1982), and Lucie Young K e lly (1980).
Nurses have always
used professional contacts and have valued knowing who to know.
Contacts are viewed as necessary f o r communication of v i t a l
and in in flu e n c in g change.
d i r t y word; i t ' s
a re a lity .
information
K e lly (1980) states th a t "contacts i s n ' t a
U n til nurses use i t b e tte r, they w i l l
lin g e r on the frin g e s of power" (p. 396).
Professional networks fo r nurse executives provide access to
info rm a tio n , advice, ideas, and moral support.
The r e fe r r a l system
inherent in a network insures contact not only on a one-to-one basis,
but also access to the e n tire network system.
A network f o r nurse
executives is re c ip ro c a l, every person in the network is a ffected .
requires i n i t i a t i v e to reach out to others.
It
I t also involves an
exchange of ta le n ts (O'Connor, 1982).
For a network to be successful, O'Connor (1982) presents several
caveats.
There must be a r e a liz a tio n of an in v e s titu re of time.
U t i l i z a t i o n of telephone contact is e s s e n tia l, as is fa c e -to -fa c e con­
ta c t at p ro fe s s io n a l, form al, and social meetings.
and c re d e n tia ls of a ll members must be known.
Areas of expertise
Every person must be an
expert in some area, and be able to share th a t expertise with others.
Conclusion
A need f o r th is study is demonstrated by a review of lit e r a t u r e
which reveals few studies s p e c ific to nursing a d m in is tra tio n .
studies are re tro s p e c tiv e in nature.
Many
Knowledge of personal and
I
36
professional c h a ra c te ris tic s of nursing adm inistrators in Montana is
unknown.
There are m u ltip le fa c to rs which co n trib u te to power and influence
of those in management p o s itio n s , and p a r t i c u l a r l y f o r women.
Many
fa c to rs have not been considered in studies of nurses which are
in te g ra l to the ro le of the nurse in management.
In th is study, there
is inclu sio n of mentor connections, professional networks, and some
consideration given to the ro le of women in management.
This re fle c ts
an e f f o r t to gain a r e a l i s t i c perspective of the m u lt ip l e x i t y of sources
o f influence in nursing a d m in is tra tio n .
37
CHAPTER 3
METHODOLOGY
An ex p lo ra to ry d e s c rip tiv e study was designed to develop a p r o f i l e
of Montana nursing service a d m in is tra to rs , fu n c tio n in g in acute care
h o spitals today.
The method was selected to i d e n t i f y the ro le s ,
r e s p o n s i b i l i t i e s , a u th o r itie s , and demographic variables which deter­
mine sources of influence of Montana nurse ad m inistra tors.
There was a
lack of published research s p e c ific to nurse adm inistrators fun ction in g
in ru ra l areas.
The design allowed f o r a comparison study between
Montana nurse adm inistrators and w ith nurse adm inistrators nationwide.
No attempt was made to prove a r e la tio n s h ip between sources of
influence and success in the ro le of nursing a d m in is tra tio n .
Population
The ta rg e t population f o r t h is study consisted of the to t a l popu­
la tio n of nursing adm inistrators employed by the 60 nongovernmental
ho s p ita ls in Montana.
A l i s t of a ll acute care h o spitals and hospital
bed size was f i r s t obtained from the Montana State Department of Health
and Environmental Sciences (MSDHES, 1983).
S p e c ific a lly excluded from
the study were the nursing service adm inistrators employed by long-term
f a c i l i t i e s , special treatment centers, hospice, mental h e a lth , or chem­
ic a l dependency centers.
Warm Springs State H ospital, the U. S.
Public Health Service Indian H ospitals, Veteran Adm inistration Medical
38
Centers, and the LI. S. A ir Force Hospital at Malmstrom A ir Force Base
were also excluded.
A dm in istrative s tru c tu re , employment, advancement
p o lic ie s , admission, and p a tie n t populations in these f a c i l i t i e s
d i f f e r from general, short-term , acute care f a c i l i t i e s .
Population
sele c tio n was made in an e f f o r t to control fo r homogeneity in order to
elim in ate a possible source of bias.
s id e ra tio n in population size.
A response rate was a con­
A f i f t y percent response rate would
e lim in ate the r is k of response bias and would allow f o r comparison
w ith the nationwide survey ( P o lit & Hungler, 1978).
P rotection of Human Rights
The Human Rights Committee approved the study, and a l l human
rig h ts requirements of Montana State U n iv e rs ity were met.
In the cover
l e t t e r accompanying the questionnaire, a ll nursing adm inistrators were
in v ite d to p a r tic ip a te .
No formal consent form was used.
Consent to
p a r tic ip a te was implied by p a r tic ip a tio n in the study and return of the
questionnaire..
C o n fid e n tia lity was assured in the cover l e t t e r and
maintained throughout the study.
Data C o lle c tio n and Instrument Design
The instrument was designed to examine three major variables in
t h is study; formal and fu n c tio n a l power and professional r o le .
Data
were c o lle c te d by the use of a mailed questionnaire to each of the 60
nursing adm inistrators in s pe cified acute care h o s p ita ls .
A mailed questionnaire was selected fo r th is study because i t
offere d anonymity, elim inated possible response bias, and because of the
39
time and distance considerations ( P o lit & Hungler, 1978).
The
questionnaire cover l e t t e r explained the study ob je c tiv e s .
Questionnaires were mailed on March 16, 1984 with a request fo r return
by A p ril 6, 1984.
was enclosed.
A postage-paid envelope addressed to the researcher
Questionnaires were not coded and id e n t i f i c a t i o n could
only be made through hospital size.
Al I returns were received by A p ril
17.
The instrument was developed from items obtained from the 1977
Survey of Nursing Service Administrators in Hospitals.
The survey was
developed by the American Society of Nursing Service Administrators of
the American Hospital Association (ASNSA,1980b).
The 1977 survey was a
universal study used to develop a national p r o f i l e of nursing admin­
is t r a t o r s .
The survey was used to analyze the fu n c tio n s , ro le s ,
r e s p o n s i b i l i t i e s , and a u th o ritie s of nurse ad m inistra tors.
Additions to
the questionnaire were made by the researcher to obtain data fo r
variables in the study not included in the ASNSA survey.
questionnaire is not under copyright.
The ASNSA
W ritten permission to
z
use the instrument was obtained p r io r to instrument development.
The 1977 ASNSA questionnaire was used in order to make comparisons
between Montana nurse adm inistrators and nurse adm inistrators n a tion­
wide.
Items in the ASNSA survey reformulated to conform to current
trends, or by suggestions generated during p re te s t, may a ffe c t some
comparisons.
The instrument was divided in to three pa rts.
to i d e n t i f y a d m in is tra tiv e p ra c tic e .
Part I was designed
The ro le s , fu n c tio n s , a u th o ritie s ,
and r e s p o n s ib ilit ie s were id e n tifie d by items re la ted to re porting
40
le v e l, a d m in is tra tiv e coverage, nursing department and corporate
r e s p o n s ib ilit y , and span of c o n tro l.
Drawn from the ASNSA survey were
items I , 2, 3, 4, 5, 6, 7, 9, 10, 14, 18, and 19.
Deletions or addi­
tio n s were made in questions 3, 10, 14, 18, and 19 to obtain i n f o r ­
mation on current a d m in is tra tiv e p ra c tic e .
(See Appendix B .)
Part I I of the instrument Was designed to include items to study
the variables of mentorship and networking.
explored in the ASNSA survey.
These concepts were not
Items were developed by the researcher.
Part I I I of the instrument contained items to examine personal and
professional variables included in the study.
Included in Part I I I are
items to id e n t i f y age, sex, and m a rita l sta tu s ; professional and com­
munity a c t i v i t i e s ; educational preparation and route to the top nursing
p o s itio n ; s a la rie s and b e n e fits .
Drawn from the ASNSA survey were
items 23, 24, 28, 30, 31, 32, 35, 36, 37, 38, and 39.
The additions to
questions 23, 28, 30, 32, 37, and 38 were made in order to conform to
current p ra c tic e .
Items on promotion from w ith in the i n s t i t u t i o n or
Montana residency were included to id e n t i f y the c h a ra c te ris tic s of
p ra c tic e in a ru ra l state f o r a possible re la tio n s h ip to variables in
the study.
The instrument contains open-ended and f ix e d - a lte r n a tiv e
items.
R e l i a b i l i t y and V a lid it y
The ASNSA (1980b) instrument is a survey fo r the stated purpose of
obtaining inform ation on the personal and professional background,
scope of r e s p o n s ib ilit ie s , s k i l l le v e ls , educational preparation, func­
tio n s , and roles of nurse ad m inistra tors.
There is no information
41
re la te d to r e l i a b i l i t y or v a l i d i t y of the ASNSA national survey
questionnaire.
The 1977 survey was universal and not r e s tr ic te d to
members of ASNSA.
The survey included only the top nursing service
ad m inistrators in 7,084 acute care h o s p ita ls .
response ra te .
There was a 75.2 percent
A previous study had been done in 1973.
Some in s t r u ­
ment lim ita tio n s and comparisons in the 1977 survey were ava ila ble in
published reports of analysis of data.
Items drawn from the ASNSA
questionnaire were evaluated to determine r e l i a b i l i t y in measurement of
variables included in t h is study ( P o l i t & Bungler, 1978).
P rio r to beginning the research study, three key informants con­
sidered experts in nursing a d m inistra tion in Montana were consulted.
The key informants i d e n t if ie d components in the ro le of the nurse
ad m inistra tor in Montana, mentor-network re la tio n s h ip s , and administra­
t iv e p ra c tic e .
development.
I d e n tifie d components were used to guide instrument
Questions were also developed from review of l i t e r a t u r e
and added to the questionnaire.
Approximately two months p r io r to ad m inistra tion of the question­
n a ire , the researcher met w ith f i v e graduate nursing students and four
nursing f a c u lt y members in the graduate nursing program of Montana
State U n iv e rs ity to p re te s t the instrument.
based on f a c u lt y and student evaluation.
The instrument was revised
The instrument was again
pretested by one former nurse ad m in is tra to r working in an admin­
i s t r a t i v e p o s itio n and one nurse ad m in is tra to r who fun ction s in a
Veterans Adm inistration Medical Center in Montana.
f u r th e r re fin e d in accord with recommended changes.
The instrument was
The small
42
population of nurse adm inistrators in Montana precluded pre te stin g the
instrument with the population under study.
Analysis of Data
Due to. the e xp lora tory d e s c rip tiv e nature of the study, descrip­
t iv e analysis was used to order and c l a r i f y data th a t were obtained.
Data summary was done by r e la t iv e frequency d i s t r ib u t i o n , and measures
of central tendency.
items.
Content analysis was done on all"open-ended
C ro s s -c la s s ific a tio n was done f o r some data to determine
possible re la tio n s h ip s .
Comparison of data from the 1977 ASNSA (1980b)
survey, was done when appropriate.
In order to perform comparisons with
nationwide studies, analyses of data were done by rounding to the
nearest tenth using s t a t i s t i c a l convention (Kviz & K n a fl, 1980).
43
CHAPTER 4
FINDINGS
Results of data analyses from the Montana nurse a d m inistra tor study
are presented in th is chapter.
s e c tio n s :
The re s u lts are presented in three
a d m in is tra tiv e p ra c tic e , mentor-network r e la tio n s , and
demographic inform ation.
This corresponds w ith the organization of the
questionnaire and the summary of fin d in g s from the study used fo r com­
parison.
Data obtained in th is study are used to i d e n t i f y a p r o f i l e of
nursing adm inistrators fu n c tio n in g in Montana today.
The data were
analyzed to answer questions re la ted to the major complex variables
found in the conceptual framework.
These variables are sources of
in flu e n c e , organizational p o s itio n , and the concomitant variables of
mentor-network r e la tio n s .
Data generated from the study fu r th e r de ter­
mine the formal and fu n c tio n a l powers and a d m in is tra tiv e ro le of the
,
nurse a d m in is tra to r.
Population
The ta rg e t population f o r t h is study were the 60 nurse adm inistrators
c u r r e n tly holding the top ad m in is tra tiv e p o s itio n in nongovernmental,
acute care hospitals in Montana.
cluded from the study.
Special treatment centers were also ex­
The hospital may, or may not, contain extended
care term or swing beds. There were 35 (58.3%) who returned question­
na ires, and 25 (41.7%) who did not.
Only one respondent was male.
44
This elim inated any p o s s i b i l i t y f o r comparison between the p r o file s of
male and female nurse ad m inistra tors.
Al I questionnaires were returned
completed and were usable f o r t h is study.
Nd questionnaire was
returned undelivered.
Comparisons of some data were made using the American Society of
Nursing Service Adm inistrators of the American Hospital Association
(ASNSA) 1977 survey of nursing service adm inistrators in acute care
ho s p ita ls (1980b).
Selected comparisons were made with some find ings
of the ASNSA 1982 survey (1984).
Consideration must be made fo r the
large numbers of returns in the 1977 survey.
One return changed the
data analysis in the Montana study, one return has l i t t l e
analysis in the ASNSA survey.
e ffe c t on
The 1977 ASNSA nationwide universal
study included a l l acute care h o s p ita ls .
7,084, w ith a return of 5,326 (75.2%).
The population numbered
There were 66 ho s p ita ls in
Montana included in the 1977 ASNSA study with a 63.6 percent re tu rn .
The 1982 ASNSA sample population included only nurse adm inistrators in
acute care hospitals who are members of the ASNSA.
The sample size was
500 w ith a return of 343 (68.6%).
/
A dm in istrative Practice
Of in te r e s t and concern fo r nurse adm inistrators and other leaders,
has been the a d m in is tra tiv e ro le and span of control of nurse admin­
is tra to rs .
Of fu r th e r concern is the possible lack of allocated
a u th o rity f o r the increasing r e s p o n s ib ilit y in acute care h o s p ita ls .
In th is section the ro le s , a u th o r itie s , r e s p o n s ib ilit ie s , and
45
a c c o u n ta b ilitie s of the nursing a d m inistra tor are covered.
Also
included are the re p o rtin g re la tio n s h ip s , and level of p a r tic ip a tio n in
o v e ra ll organizational a f f a i r s .
Reporting Relationships
T h i r t y - f i v e nurse adm inistrators responded to item one which asked
i f the nursing a d m inistra tor reports d i r e c t l y to the top ad m inistra tive
o ffic e r.
T h irty -th re e (94.3%) respondents re port to the
top a d m in is tra tiv e o f f i c e r in the i n s t i t u t i o n .
There were 5.7 percent
who re port to the second level in the hospital a d m in is tra tiv e hierarchy.
There is an apparent trend f o r nurse adm inistrators in la rg e r medical
centers to re port to an ad m in is tra tiv e o f f i c e r at the second level
of the a d m in is tra tiv e s tru c tu re .
The o f f i c e r may hold the t i t l e of
executive vice-p resid ent or c h ie f operating o f f i c e r .
Some nurse
ad m inistrators f i r s t indicated a re p o rtin g re la tio n s h ip to the top
a d m in is tra tiv e o f f i c e r .
The indicated person was then li s t e d in a
second or t h i r d level of a u th o rity with no other o f f ic e r lis t e d as a
superior.
In assessing hospital size, i t can only be concluded that
the respondent considered the governing board to be the top level of
a u th o rity .
In comparison with the 1977 ASNSA survey, 84.9 percent of the
nurse adm inistrators nationwide re port to the top ad m in is tra tiv e
o ffic e r.
There are s i g n if ic a n t l y greater numbers of nurse
adm inistrators in large hospitals in the ASNSA survey with reporting
re la tio n s h ip s to lower levels in the organization.
46
A d m in is tra tiv e Hospital Coverage
Item two asked i f the nurse ad m in is tra to r personally p a rtic ip a te d
in hospital coverage.
Thirty-one (88.6%) of the 35 respondents par­
t i c i p a t e in a d m in is tra tiv e coverage of the h o s p ita l.
not a s s is t in a d m in is tra tiv e coverage.
Four (11.4%) did
In the 1977 ASNSA study, 67.3
percent of the a d m in is tra tiv e coverage was provided by the nurse admin­
i s t r a t o r or the nursing s t a f f .
Span of Control
There were 27 u n its or special departments lis t e d in item three.
The item requested inform ation on the span of control w ith in the
in s titu tio n .
item.
There were 34 nurse adm inistrators who responded to th is
One questionnaire contained a response unusable f o r analysis.
Of the 27 units or departments l i s t e d , not a ll ho spitals re port having
a l l u n its or departments in t h e ir f a c i l i t y .
There were three of the
special services fo r which no nurse a d m inistra tor reported
r e s p o n s ib ilit y the la b o ra to ry , ra d io lo g y , or school of nursing.
An analysis was made of the numbers of hospital u n its or depart­
ments under the span of control of the nurse ad m in is tra to r.
There were
17.6 percent who stated r e s p o n s ib ilit y f o r 1-4 departments, 55.9 percent
were responsible fo r 5-8 departments, 17.6 percent held r e s p o n s ib ility
f o r 9-12 departments, and 8.9 percent were responsible f o r 13-14 special
departments or u n its .
Information on the span of control w ith in the hospital indicates
the extensive control held by nurse adm inistrators in Montana.
Responses also ind ica te the extent of i n s t i t u t i o n a l a c c o u n ta b ility .b y
.
47
control of such diverse departments' as the d ie ta ry , housekeeping,
laundry, social work, pharmacy, ambulance service, or occupational,
physical and speech therapy.
The 1977 ASNSA survey data are analyzed f o r nurse administrators
who re port to the top three a d m in is tra tiv e le v e ls .
An average of 22
percent reported r e s p o n s ib ilit y fo r 1-4 departments, 51.2 percent were
responsible f o r 5-8 departments, 23.7 were responsible f o r 9-12
departments, 1.5 percent were responsible f o r 13-16 departments, and "
0.1 percent reported r e s p o n s ib ilit y f o r 17-20 departments.
comparison cannot be made with the ASNSA survey.
A v a lid
Some nurse
ad m inistrators in the 1977 survey re p o rt to lower leve ls of a u th o rity .
Span of control is somewhat less fo r nurse adm inistrators in the
Montana study, but is comparable with nurse adm inistrators nationwide.
Hospital Bed Size
Item number fou r requested inform ation bn the numbers of acute care
beds in the i n s t i t u t i o n .
The 35 ho s p ita ls were c la s s ifie d by bed size,
6-24, 25-49, 50-99, 100-199 or 200-299 acute care.beds. Of.the
re p o rtin g h o s p ita ls , 14 (40%) were between 6-24 beds, 9 (25.7%) had
between 25-49 beds, 3 (8.6%) had between 50-99 beds, 4 (11.4%) were
between 100-199 beds, and 5 (14.3%) were between 200-299 acute care
beds.
The ru ra l nature of Montana h o spitals is apparent when comparing
hospital size to the national survey. ..Only 29.2 percent of the
re p o rtin g hospitals, in the 1977 ASNSA survey had less than 50 acute
care beds, and 32.8 percent were over 299 beds.
48
A large number o f nurse adm inistrators (14 Or 40%) in th is study
held added r e s p o n s ib ilit y fo r extended care beds.
Three of the 14
(21.4%) stated a swing bed concept was used fo r extended care.
Data
analysis excluded ho s p ita ls with designated acute care beds as swing
beds.
The range of extended care beds was from 13-55 w ith a mean of
approximately 27.
Budget S etting and Planning
1
There is increased concentration in hospitals today on cost con­
tainment and f is c a l r e s p o n s ib ilit y .
Maintaining q u a lity p a tie n t care
with careful fin a n c ia l con trols is a major national concern,.
R e s p o n s ib ility fo r f i s c a l management is a designated a u th o rity fo r
nurse adm inistrators in accord with national standards.
resources is also a recognized formal power.
Control of
A dm in istra tive respon­
s i b i l i t y f o r departmental and fo r ove ra ll organizational budget
planning and p r i o r i t y - s e t t i n g is an important facet of nurse admin­
i s t r a t i v e a u th o rity .
Items 5-8 in the instrument were designed to obtain information on
budget c o n tro l.
T h i r t y - f i v e nurse adm inistrators responded to the
questions on p a r tic ip a tio n in planning f o r the ove rall hospital budget.
There were 26 (74.3%) who do p a rtic ip a te and 9 (25.7%) who stated they
do not p a rtic ip a te in hospital planning.
T h ir ty - fo u r nurse adm inistra­
to rs answered the question on p r i o r i t y - s e t t i n g fo r the in s t i t u t i o n a l
budget.
There were 28 (82.4%) who responded they do p a r tic ip a te in
i n s t i t u t i o n a l p r i o r i t y - s e t t i n g and only 6 (17.6%) who do not have th is
a u th o rity .
49
There were 34 nurse adm inistrators who responded to the item con­
cerning establishment of the nursing budget.
Twenty-six (76.5%) have
a u th o rity to e s ta b lis h the budget f o r the department of nursing, and 8
(23.5%) stated they do not plan the departmental budget.
Following
formal approval of the nursing budget, 22 (62..9%) stated they do have
f u l l r e s p o n s ib ilit y f o r development of the departmental budget and 13
(37.1%) stated they do not have f u l l r e s p o n s ib ilit y .
Comparison with the 1977 ASNSA survey revealed th a t only 50.8 p e r-'
cent of the nurse adm inistrators nationwide were involved in planning
the o v e ra ll hospital budget, and 48 percent were involved in hospital
p r io r i t y - s e t t i n g . .
The nursing budget was established by 73.1 percent
of the nurse ad m in is tra to rs , and 56.1 percent had f u l l ad m inistra tive
r e s p o n s ib ilit y fo llo w in g budget approval.
The 1982 ASNSA survey shows a
trend fo r greater p a r tic ip a tio n by nurse adm inistrators in both i n s t i ­
tu tio n a l and nursing department p a r tic ip a tio n in budget c o n tro l.
Mon­
tana nurse adm inistrators appear to be fo llo w in g the national trend fo r
greater p a r tic ip a tio n in i n s t i t u t i o n a l and departmental budget c o n tro l.
Time A llo c a tio n
Six categories were established fo r analysis of hours in the normal
workweek of the nurse ad m inistrator (item 9).
Three respondents stated
they worked more than the indicated hours, and one reported extra
o n -c a ll hours.
These returns were calcu la ted as even hours worked fo r
data an alysis.
T h i r t y - f i v e nurse adm inistrators responded to th is
item.
Only one (2.9%) reported working less than 35 hours, 13
(37.1%) worked from 40-44 hours, 7 (20%) reported working 45-49 hours.
50
9 (25.7%) worked 50-59 hours, 4 (11.4%) worked 60 hours, and I (2.9%)
re p o rte d ly worked over 60 hours each week.
For the nurse a d m inistra tor to work more than 40 hours in an
average workweek follo w s the trend nationwide.
demands of the p o s itio n .
This r e f le c t s the
There is also a need fo r reward mechariisms,
s ta tu s , and formal and fu n c tio n a l powers to meet indicated
r e s p o n s ib ilit ie s .
Nurse adm inistrators were requested in item 10 to in d ic a te the
percentage of time in the workweek allocated to various fu n c tio n s .
percentage of a llo c a tio n of time is i d e n t if ie d in Table I .
The
Analysis of
data revealed th a t over 33 percent of the nurse adm inistrators spend no
time in d ir e c t p a tie n t care a c t i v i t i e s (n=33).
Forty-two percent of
the nurse adm inistrators spend greater than 70 percent of t h e i r work­
week in a d m in is tra tiv e a c t i v i t i e s .
Considering the span of control of
most nurse adm inistrators in Montana, the 24 percent who indicated
research a c t i v i t i e s appears to r e f l e c t an upward trend in professional
in te r e s t.
An item-by-item comparison with the 1977 nationwide survey was not
possible because of item re v is io n .
In the nationwide survey, 69.4
percent of the nurse adm inistrators re p o rt spending 76 to 100 percent
of t h e ir workweek in ad m in is tra tiv e fu n c tio n s .
Consideration must be
made f o r the increased numbers of large hospitals in th is study.
Corporate P a rtic ip a tio n
The aggregate analysis of p a r tic ip a tio n on corporate committees and
boards by nurse adm inistrators is presented in Table 2.
T h ir ty - fo u r
51
Table I .
Percentage of time spent in normal workweek.
Percentage of time
Function
Community
0
1-4
5-25
15.2
33.3
51.5
A dm inistration
D irect p a tie n t
care
26-50
51-75
3.0
18.2
42.4
6.1
3.0
30.3
9.1
51.5
Patients
51.5
9.1
39.4
S ta ff
18.2
12.1
63.6
Students
87.9
Outside
72.7
18.2
9.1
Research
75.7
18.2
6.1
Outside
consult
69.7
24.2
6.1
Professional
51.5
21.2
27.3
Other
97.0
Teaching:
Total n=33
12.1
3.0
6.1
76-100
36.4
52
nurse adm inistrators responded to item 11.
Only 3 (8.8%) stated they
had no p a r tic ip a tio n on any corporate committee or board.
Of equal
importance is the f a c t th a t no nurse a d m inistra tor stated they hold
voting p r iv ile g e s on the governing board.
There are a m a jo rity of the
nurse adm inistrators in th is survey who had some p a r tic ip a tio n in
corporate a c t i v i t i e s .
p r iv ile g e s
Over 50 percent had membership or voting
on the a c c re d ita tio n or I i censure (57.2%), ad m inistra tive
s t a f f (84.9%), governing board (53.8%), corporate planning and
development (78.2%), and executive medical s t a f f (67.9%) committees.
Table 2. ' P a rtic ip a tio n on corporate committees or boards.
Percentage p a r tic ip a tin g
,
ji
None
Occasional Iy
Member
Voting
,member
A c c re d ita tio n /
Licensure
28
32.1
10.7
39.3
17.9
A dm in istrative
S ta ff
33
9.1
6.0
27.3
57.6
Board of
Trustees •
26
30.8
15.4
53.8
Corporate
Planning
32
15.6
6.2
46.9
31.3
Executive
Medical
28
17.8
14.3
64.3
3.6
Interdepartmental
Research
17
52.9
11.9
17.6
17.6
Committee/
Board
Total
n=34
•
53
Items re la ted to corporate a c t i v i t i e s were not included in the
1977 nationwide survey.
The 1982 ASNSA survey contains some items
re la te d to p a r tic ip a tio n in corporate a c t i v i t i e s .
Data analysis
revealed th a t 21.6 percent of nurse adm inistrators re p o rt membership on
the hospital governing board and 3.9 percent were voting members.
Greater p a r tic ip a tio n is in a c t i v i t i e s of governing board committees,
than on the governing board i t s e l f .
I n s t it u t i o n a l Committee P a rtic ip a tio n
Active p a r tic ip a tio n on i n s t i t u t i o n a l committees increases the
influence of nurse adm inistrators w ith in the organization.
Item 12 was
included to analyze a u th o ritie s id e n t if ie d in national standards fo r
nursing service ad m in is tra to rs . . T h i r t y - f i v e nurse adm inistrators
responded to t h is item.
Al I respondents stated they p a rtic ip a te d on at
le a s t 30 percent of the id e n t if ie d hospital committees.
Not a ll
committees included in th is item are o p e ra tio n a li zed in the reporting
h o s p ita ls .
Over 51 percent of the nursing adm inistrators stated active
p a r tic ip a tio n on a ll of the hospital committees included in th is item.
I
Data were analyzed fo r committee p a r tic ip a tio n .
analysis is presented in Table 3.
Aggregate data
Two (5.7%) nurse adm inistrators
p a rtic ip a te d on from 1-3 committees, 8 (22.9%) p a rtic ip a te d on 4-6
committees, 7 (20%) p a rtic ip a te d on 7-9 committees, and 18 (51.4%)
a c tiv e ly p a rtic ip a te d on greater than 10 committees w ith in the
h o s p ita l.
54
Table 3.
P a rtic ip a tio n on hospital committees.
Percentage p a r tic ip a tin g
I n s t it u t i o n a l
committee
n
Emergency Care
34
In fe c tio n Control
34
Disaster Planning
35
Medical Records
31
Pharmacy and
Therapeutics
No hospital
committee
No
p a r tic ip a tio n
Active
p a rtic ip a tio n
14.7
85.3
100.0
2.9
97.1
9.7
22.6
67.7
33
3.0
6.1
90.9 .
Professional
L ib ra ry
31
51.6
9.7
38.7
Q u a lity Assurance
35
14.3
5.7
80.0
Safety
32
12.5
9.4
78.1
Special Care Unit
33
21.2
3.0
75.8
Standing Medical
S ta ff
32
3.1
6.3
90.6
Risk Management
32
25.0
12.5
62.5
Total n=35
Nursing Theory f o r Professional Practice
Nursing adm inistrators were asked in item 13 to id e n t i f y a
nursing theory which had been developed or adopted by the department
of nursing.
Of the nurse adm inistrators who responded to th is item
(N=32), only I (3.1%) had a f u l l y developed nursing theory fo r
professional p ra c tic e .
A nursing theory had been developed by a
55
c o lla b o ra tiv e e f f o r t of the nursing s t a f f fo llo w in g an indepth study of
e x is tin g nursing th e o rie s .
There were 3 (9.4%) who stated th a t the
nursing departments was in the process of adopting a theory fo r nursing
p ra c tic e .
One department had selected Dorthea E. Orem's theory fo r
nursing p ra c tic e , one department selected Martha E. Rogers' theory fo r
nursing p ra c tic e , and one respondent indicated no s p e c ific nursing
theory.
This may r e f l e c t a growing trend f o r departments of nursing in
Montana.
Level of R e s p o n s ib ility fo r the Department of Nursing
Information was requested to determine the level of r e s p o n s ib ilit y
the nurse a d m inistra tor in Montana holds fo r nursing p ra c tic e in the
department of nursing (item 14).
Analysis of data is shown in Table 4.
The 1977 ASNSA survey item was changed to include r e s p o n s ib ilitie s
i d e n t if ie d in national standards.
Data analysis indicates a trend fo r
increased r e s p o n s ib ilit y in some areas.
Montana nurse adm inistrators
had greater r e s p o n s ib ility , f o r changing nursing p o lic ie s and
procedures, development of nursing research, implementing new nursing
ro le s , and increasing or decreasing nursing s t a f f .
,
Montana nurse
adm inistrators had less r e s p o n s ib ilit y fo r the e lim in a tio n of
non-nursing duties from nursing service than did the nurse
adm inistrators included in the 1977 nationwide study.
There are only 33.3 percent of the nurse adm inistrators in Montana
who hold r e s p o n s ib ilit y fo r contractual agreements with nursing
schools.
I t must be noted th a t the low response r e fle c ts few hospitals
in Montana with nursing school a f f i l i a t i o n .
56
Table 4.
Level of r e s p o n s ib ilit y in the nursing department.
Percentage of r e s p o n s ib ility
Function
n
Contractual agreement
with nursing school
33
Changing basic organi­
zation of nursing care
on units
Full
P arti aI
None
. 15.1
18.2
66.7
35
85.7
8.6
5.7
Changing nursing
procedure and
p o lic ie s
35
91.4
8.6
Developing and/or
implementing nursing
research projects
35
68.6
14.3 ■
Development of de part­
mental educational
programs
35
62.9
37.1
E lim inatin g non-nursing
duties
34
■ 29.4
' 61.8
8.8
E stablishing in d iv id u a l
pra ctice workload
35
71.4
25.7
2.9
Implementing new
nursing roles as they
develop
34
91.1
Increasing or de­
creasing nursing
s ta ff
34
79.4
Total n=35
5.9 .
'20.6
17.1
3.0
57
A dm in istra tive Support Services
.
Span of control and levels of r e s p o n s ib ilitie s inherent in the
p o s itio n of nursing a d m inistra tor increases the need f o r support
services f o r nurse ad m in is tra to rs .
The a v a i l a b i l i t y of adequate
support services has been an increasing concern fo r nurses in
a d m in is tra tiv e p ra c tic e .
Support services available f o r nurse
adm inistrators are a r e f le c t io n of working conditions and of formal and
fu n c tio n a l powers of the a d m in is tra tiv e p o s itio n .
requested information re la te d to support services.
Items 15 and 18
Only 16 (45.7%) of
the to t a l re p o rtin g ho s p ita ls have i n s t i t u t i o n a l computer services.
The discrepancy in reported data in a. supplemental item is apparently
due to contractual computer services when no in-house service is
a v a ila b le .
Analysis of data fo r support services through use of
computer programs and other support services are presented in Table 5.
Nurse adm inistrators in t h is study state th a t major support services
are ava ila b le in to t a l or in p a rt.
A dditional computer assisted data
c o lle c tio n and analysis included word processing, data f i l i n g ,
p r o d u c tiv ity re p o rts , p o lic ie s and procedures, and emergency room
a c u ity p r o f ile s . .
Personnel Management
C o lle c tiv e bargaining.
Only 7 (20%) of the 35 nurse adm inistrators
stated there is c o lle c t iv e bargaining f o r professional nurses in th e ir
hospital ( item 17).
Of the hospitals who reported c o lle c t iv e
bargaining u n its , 5 (71.4%) of the nurse adm inistrators p a rtic ip a te d as
58
members of the management ne gotiating team.
Two (28.6%) served in an
advisory capacity fo r the negotiating team.
Table 5.
A dm in istrative support services.
Support services
' n
Percent available
6
21
27.3
95.5
9
I
6
18
40.9
4.5
27.3
81.8
14'
4
63.6
18.2
29
18
26
26
25
14
22 ..
85.3
52.9
76.5
76.5
73.5
41.2
64.7
30
6
88.2
17.6
Computer Services
Audit
Fiscal data
P atient and s t a f f in s tr u c tio n
Manpower data
Nursing diagnosis
P atient p r o f i l e
Payroll
Scheduling
S t a t i s t i c a l Analysis
Other
Total jn reporting=22
Access to other support services
Access to data from other
departments
Computer
M aterials management
Record keeping
S ecre taria l
S ta ff coordinator
Q u a lity reports
Cost center fin a n c ia l
reports
Other
Total 2 re p o rtin g = 34
In the 1977 ASNSA nationwide survey only 15.6 percent of reporting
ho s p ita ls had c o lle c t iv e bargaining u n its fo r professional nurses.
There were re p o rte d ly 53.5 percent of nurse adm inistrators who served
59
on the ne gotia ting team, and-33.1' percent served in an advisory
capacity.
Nurses With Other Reporting Levels.
adm inistrators who responded to item 16.
There were t h i r t y - f i v e , nurse
Twenty-one (60%) stated there
were professional nurses fu n c tio n in g in the hospital who reported
d i r e c t l y to an a d m in is tra tiv e o f f ic e r other than the nursing admin­
is tra to r.
The a d m in is tra tiv e o f f ic e r may be the top a d m inistra tive
o f f i c e r , vic e -p re s id e n t of technical services, a member of the medical
s t a f f , or some other ad m in is tra tiv e o f f i c e r .
Practice areas may
include oncology, cardio-pulmonary, cardiac r e h a b ilit a t io n or cathe­
t e r i z a t i o n , q u a lity assurance, surgery, anesthesia, education,
emergency service, diagnosis re lated groupings, or r is k management.
One c e r t i f i e d nurse p r a c titio n e r was reported as fu n c tio n in g with a
re p o rtin g re la tio n s h ip other than to the nurse ad m in istra to r.
Personnel R e s p o n s ib ility .
There were 35 nurse adm inistrators who
responded to item 19 requesting inform ation on f u l l - t i m e and part-tim e
employees fo r whom the nurse a d m inistra tor was delegated
r e s p o n s ib ilit y .
A g e neralization only was made in analysis of data
generated, due to the methods used in re p o rtin g numbers of employees.
Employees were reported by numbers of employees, by f u l l - t i m e
equivalents, and by approximations.
Analysis of data comparing
personnel to bed size is included in Table 6.
f i v e categories as fo llo w s :
beds, and 200-299 beds.
not done.
Bed size is lis t e d in
6-24 beds, 25-49 beds, 5 0 -9 9 'beds, 100-199
Comparison w ith the 1977 nationwide study was
60
Table 6.
Comparison of number of employees with hospital bed size.
Employees
Hospital bed size
n
Percent re porting
Mean
Range
6-24
14
40.0
29
13-52
25-49
9
25.7
49
33-78
50-99
3
8.6
130
32-209
100-199
4
11.4
218
128-285
200-299
5
14.3
415
265-556
Total n=35
Nurse adm inistrators were requested to provide inform ation on
percentage of to t a l hospital employees f o r which they hold delegated
r e s p o n s ib ilit y .
Percentages of employees were analyzed by categories
of less than 24 percent, 25-49 percent, 50-74 percent, 75-80 percent,
and over 80 percent of a l l hospital employees.
One (3%) nurse admin­
i s t r a t o r held r e s p o n s ib ilit y fo r less than 24 percent of the totalhospital employees, 9 (27.4%) of the nurse adm inistrators were respon­
s ib le f o r 25-49 percent of a ll hospital employees, 21 (63.6%) of the
nurse adm inistrators were responsible f o r 50-74 percent of a l l hospital
employees, one nurse ad m inistrator (3%) reported r e s p o n s ib ilit y fo r
75-80 percent o f a ll employees, and one nurse a d m inistra tor (3%) held
r e s p o n s ib ilit y fo r over 80 percent of aI employees.
The larg e r the
h o s p ita l, the greater are the numbers of employees fo r which the nurse
ad m in is tra to r is held accountable.
In hospitals with greater than 50
61
beds, no general pattern emerges of numbers of employees re porting to
the nurse a d m in is tra to r, and f o r whom they hold a c c o u n ta b ility .
Rela­
t i v e l y small hospitals re port percentages of ove rall ho spital employees
f o r whom the nurse a d m inistra tor is accountable are as great, or
greate r, than in the la rg e r h o s p ita ls .
Actual numbers of employees are
understandably sm aller. .
Mentor-Network Relationships
I t is suggested th a t mentor and network re la tio n s h ip s are
c o n trib u tin g fa c to rs in ro le development and success in an administra­
t iv e p o s itio n .
Items were selected to measure the importance of
mentor-network re la tio n s fo r nurse adm inistrators in Montana.
analyses were used to i d e n t i f y categories of responses.
Content
Analysis of
data included the occupation and sex of the mentor or mentee, and the
assistance received from a mentor or provided to a mentee.
These items
were requested fo llo w in g search of l i t e r a t u r e to id e n t i f y key factors
in mentor and network re la tio n s h ip s .
Content analyses were also used
to id e n t i f y categories of management expertise shared through
networking by nurse a d m inistra tors.
I t should be noted in th is study,
mentor and network re la tio n s h ip s were used almost e x c lu s iv e ly fo r
development of management expertise and ro le development.
The
a c q u is itio n of a d m in is tra tiv e expertise was considered to be the
primary fa c e t of mentor-network re la tio n s h ip s .
Mentor Relations
T h irty -th re e nurse adm inistrators responded to item 20 requesting
inform ation on the presence of mentors who had aided in development of
62
professional expertise and career ro le development.
There were 20
(60.6%) who stated there had been mentor re la tio n s h ip s e a r l i e r in t h e ir
careers.
Thirteen (39.4%) stated they had not had a professional with
whom they had developed a mentor re la tio n s h ip .
Summary analysis of data revealed th a t 25 (59.5%) of the mentors
were female and 17 (40.5%) were male.
Approximately tw o -th ird s of the
mentors fo r both male and female nurse adm inistrators were female.
Five (25%) of the nurse adm inistrators had one mentor, 11 (55%) re p o rt­
edly had two mentors, and 3 (15%) reported having three mentors.
The
greatest number of mentors was s ix , reported by one, respondent (5%).
Research indicated th a t fathers and men in a d m in is tra tiv e positions
fre q u e n tly fu n c tio n as mentors for- women in management p o s itio n s .
Men
fu n c tio n in g as mentors in th is study included one ex e c u tiv e /fa th e r
(5.9%), six hospital adm inistrators (35.3%), one associate administra­
to r (5.9%), six physicians (35.3%), and three other health pro­
fe ssio n a ls (17.6%).
Mentors fo r nurse adm inistrators in t h is study were almost
e x c lu s iv e ly professionals in health occupations.
Twenty-two (52.4%)
were nurse p rofessio nals, 19 (45.2%) were health professionals other
than nurses, and I (2.4%) was i d e n t if ie d only as an executive.
Professional nurses who had functioned as mentors were nurse super­
visors (19%), nursing service adm inistrators (16.7%), professional
nurse peers (16.7%), and one dean of a school of nursing (2.4%).
Other
health professionals who had provided mentorship were ho spital admin­
is t r a t o r s (16.7%), physicians (7.1%) and others (21.4%).
Health pro­
fessio nals li s t e d as other were associate a d m in is tra to r, pharmacist.
63
m aterials manager, c o n t r o lle r , physical th e ra p is t, hospital d i e t i t i a n ,
and consultant.
The assistance provided by the mentor was id e n tifie d as management
exp e rtis e , goal setting/guidance, psychosocial support, employment,
ro le m o d e l/in s p ira tio n , arid feedback.
presented in Table 7.
The analysis of data are
Psychosocial support was provided by o ffe rin g
encouragement, support, self-c o n fid e n c e , "s tro k e s ", and fin a n c ia l
assi stance.
Table 7.
Assistance provided by mentor.
Category of assistance
H
Percentage
Management expertise
20
40.8
Goal setting/guidance
13.
26.5
Psychosocial support
10
20.4
Employment
2■
4.1
Role M o de l/in s p ira tio n
2
•4.1
Feedback
2
4.1
Total nj=49 ,
Nurse Adm inistrators as Mentors
T h ir ty - fo u r nurse adm inistrators responded to item 21 requesting
inform ation re la ted to mentorship by the nurse a d m in is tra to r.
percent stated th a t they had been, or were, mentors to others.
i d e n t if ie d were a ll nurse professionals.
Only 50
Mentees
The greatest numbers were
s t a f f nurses (61.5%), supervisors (15.4%), or other nurse adm inistrators
64
(12.8%).
Students (7.7%) and one assista nt nurse ad m inistrator
(2.6%) were also l i s t e d .
Analysis of data showed th a t 74.4 percent of the mentees were
female and 25.6 percent were male.
One (5.9%) respondent reported men­
t o r re la tio n s h ip s w ith 10 other professions, 2 (11.8%) had been mentors
f o r three other professio nals.
The m a jo rity stated they had functioned
as mentor to two other professionals (52.9%) or to one other pro­
fessional (29.4%).
Approximately tw o -th ird s (65.2%) o f a ll assistance
provided the mentee had been a d m in is tra tiv e assistance or pro­
fessional development.
support (34.8%).
Other assistance was id e n t if ie d as psychosocial
Psychosocial support was provided by encouragement,
lis t e n in g , advice, counsel, and "s e lf-m o tiv a tio n through autonomy".
Network Relationships
T h ir ty - fo u r nurse adm inistrators responded to item 22 which
requested inform ation on the network re la tio n s h ip s of nurse administra­
to rs in Montana.
Support.and assistance through network re la tio n s is
apparent in responses to th is item.
T h ir ty nurse adm inistrators
(88.2%) re p o rte d ly do p a rtic ip a te in a network system w ith other nurse
ad m inistra tors.
tic ip a tio n .
Only 4 (11.8%) stated they had no network par­
Networking is a c r i t i c a l fa c e t of influence f o r th is group
of nurse administrators..
There were 72 separate areas of expertise re p o rte d ly shared with
other p rofessio nals.
Shared expertise included management s k i l l s
(43%), professional development (26.4%), s t a f f development (18.1%),
p a tie n t care management (8.3%), and psychological or emotional support
65
(4.2%).
The small amount of emotional support provided may r e f l e c t the
increasing autonomy of nurse ad m in is tra to rs .
This may also be a t t r i ­
buted to distance to other nurse adm inistrators in Montana which would
preclude u t i l i z a t i o n of other nurse adm inistrators fo r emotional sup­
p o rt.
Areas of expertise shared most fre q u e n tly by nurse adm inistra­
to rs are management ski 11s/career development, s ta f fin g patterns, p o l i ­
cies and procedures, and development of new servicesV Other areas of
expertise re p o rte d ly shared are in areas of problem so lv in g , accredita­
tio n standards, f is c a l management, s t a f f m o tivation , s t a f f education,
and re te n tio n and recruitm ent of personnel.
Emotional support and
advice were considered by only three of the respondents.
T h ir t y - s ix areas of expertise were id e n t if ie d as having been
requested from other network members.
included management s k i l l s
A dm inistrative assistance
(36%), professional development (22.2%),
s t a f f development (22.2%), p a tie n t care management (14%), and emotional
support (5.6%).
Only two nurse adm inistrators re p o rte d ly had requested any type of
emotional support or advice.
One nurse adm inistrator stated there had
been network advice requested, but not received.
The, numbers of nurse
adm inistrators in th is study a c tiv e ly p a r tic ip a tin g in a network does
v a lid a te th a t one or more networks e x is t in Montana.
general w illin g n e ss to share a d m in is tra tiv e expertise.
There is a
The most f r e ­
quently requested s k i l l s were in areas of problem s o lv in g , s t a f fin g '
patterns and acu ity systems, p o lic ie s and procedures, and fis c a l
management.
66
Demographic Information
In order to complete the p r o f i l e of nurse adm inistrators in
Montana's acute care h o s p ita ls , personal and professional information
was requested.
Data requested included demographic inform ation.
A d m in is tra tiv e T i t l e
The response to item 23 requesting information; on a d m inistra tive
title
(n=35) indicated the most common t i t l e
nursing.
is s t i l l - d ir e c to r of
Twenty-three (65.7%) stated they hold th is t i t l e .
The next
most common t i t l e s are nursing ad m inistrator (8.6%), vice-p resid ent of
nursing (8.6%), and ass is ta n t ad m inistrator (2.8%). • T it le s lis t e d as
other (14.3%) included d ire c to r of nursing services, assista nt
a d m in is tra to r /d ire c to r of nursing, and d ire c to r of professional
services.
Data corresponds with t i t l e designation determined by the 1977
nationwide survey.
However, nationwide the second greatest percentage
l i s t e d c h ie f of nursing as professional t i t l e .
I t should be noted th a t
governmental h o spitals which use the t i t l e of c h ie f nurse are not
included in th is research study.
A dm in istrative t i t l e has remained
r e l a t i v e l y unchanged since the 1977 nationwide study was completed.
Nurse adm inistrators who fun ction in h o spitals with greater numbers of
beds, generally hold t i t l e s r e f le c t iv e of status w ith in the cor­
po ration.
Employment, Recruitment, Time in Position
T h i r t y - f i v e nurse adm inistrators responded to item 24 requesting
67
inform ation on years in current p o s itio n .
are reported by fiv e -y e a r segments.
13 years.
Years in present p o sition
The range was from three days to
The greatest percentage of nurse adm inistrators reported
holding t h e i r present p o s itio n from 1-5 years.
Time indicated in
months was calculated by rounding months to years' fo r data analysis.
In increasing order, time in present p o s itio n
was 11-15 years (2.9%),
less than one year (20%), 6-10 years' (22.8%),
1-5 years (54.3%).
Comparison with the 1977 nationwide survey corresponds with these
fin d in g s .
In the ASNSA study there are greater numbers who have held
t h e i r p o s itio n over 10 years.
Data analysis re la ted to recruitm ent and promotion from w ith in the
i n s t i t u t i o n is found in Table 8.
Of 35 respondents, 6 0 ,percent stated
they had been promoted from w ith in t h e i r present place of employment.
Most of the nurse adm inistrators (51.4%) are native of Montana, and
■most (68.2%) are not natives of the area in which they now reside.
.A
breakdown of the 12 respondents who l i s t e d state of o r ig in other than
Montana is as fo llo w s :
66.7 percent are from the Midwest, 16.7 percent
are from Eastern states, 8.3 percent are from
cent are from the fa r West.
the South,
Nurse adm inistrators
provide information on areas of residency (n=8).
and 8.3per­
were requested to
F i f t y percent were
from ru ra l areas, 25 percent were from areas considered suburban, and
25 percent from urban areas.
The m a jo rity of those re porting (n=34), stated they were not
re c ru ite d f o r t h e ir present po sition from another area of Montana
(61.8%).
Some nurse adm inistrators stated they had applied f o r the
p o s itio n , ra th e r than being re c ru ite d f o r t h e ir p o s itio n .
68
C l a r i f i c a t i o n in these items would be essential in f u r th e r studies.
Table 8.
Recruitment and promotion of nurse a d m inistra tors.
Total n_
re p o rtin g
Category
Percentage ■ Percentage
yes
no
Native of Montana
35
51.4
48.6
Promoted from w ith in
the organization
35
60.0
40.0
Native of present residence
22
31.8
68.2
Recruitment from w ith in
Montana
34
38.2
61.8
Years of Experience, C e r t if ic a t i o n , S p e c ia liz a tio n
Analysis of data in response to item 28 requesting information on
experience by the nurse a d m inistra tor in other professional positions
is presented in Table 9.
There were 100 percent of those responding
(n=35) w ith experience as a s t a f f nurse.
There was some discrepancy in
re p o rtin g p r io r years of experience as a nurse a d m in is tra to r.
There
were 56.5 percent who reported years which did not correspond to years
in present p o s itio n , and 43.5 percent did correspond to the stated
years in present p o s itio n .
f o r fu r th e r s tu d ie s .
Some re v is io n of t h is item would be needed
P rio r experience l i s t e d as other included
experience in physicians' o ff ic e s , in -s e rv ic e education, assistant
nursing a d m in is tra tio n , emergency room. Professional Standards Review
Organization, in d u s tr ia l nursing, nursing home a d m in is tra tio n , and
anesthesia.
69
Table 9.
Years of experience in p r io r p o s itio n s .
Years
Percentage re porting
n
P osition category
experience
Range
Mode
S ta ff nurse
35
100.0
1-20
2
Head nurse
19
54.3
1-20
2
Nursing supervisor
11
31.4
1-7
3
C lin ic a l s p e c ia lis t
2
5.7
2-3
I
Nurse p r a c titio n e r
I
2.9
5
I
Nurse adm inistrator
23
65.7
1-10
2
7
2.0
1-4
2
10
28.6
1-5
I
Faculty
Other
Total
re p o rtin g = 35
Data corresponds with the experience of nurse . adm inistrators
reported in the 1977 survey.
One exception noted in the 1977 survey is
the greater numbers of nurse adm inistrators who had functioned as
ass is ta n t nursing a d m inistra tors.
,
In response to item 29, only fo u r nurse adm inistrators stated they
were nurse c lin ic ia n s or s p e c ia lis ts .
Two reported a master of nursing
major, one had a one year u n iv e rs ity c e r t i f i c a t e , and one lis te d
" o n - th e - jo b - tr a in in g " .
Questions re la te d to c l i n i c a l s p e c ia liz a tio n in
both the 1977 and 1982 ASNSA surveys obtained questionable data.
This item again needs careful evaluation f o r c l a r i f i c a t i o n .
Nurse adm inistrators were asked in item 29 to i d e n t i f y national
c e r t i f i c a t i o n in nursing a d m in is tra tio n .
Only fo u r of the nurse
70
adm inistrators (n=35) stated they were c e r t i f i e d in nursing service
a d m in is tra tio n .
C e r t if ic a t io n f o r two nurse adm inistrators is through
ANA, and two did not in d ic a te the c e r t i f y i n g organization.
Educational Preparation and Continuing Education
Analysis of data in item 30 re la te d to highest degree earned is
shown in Table 10.
The data are compared with the 1977 and 1982 ASNSA
studies (ASNSA, 1984, p. 11).
Major f i e l d of study from national sur­
veys is not indicated in the table due to the great numbers of pro­
fessional f i e l d s reported in both nationwide studies.
Table 10.
Comparison of percentages of respondents re p o rtin g highest
degree atta in e d .
Montana
nurse adm inistrators
a1984
Percentage
Degree attained
_n Percentage
Associate Degree
6
17.1
128
2.5
10
28.6
2,345
45.9
1,204
Diploma
Baccal aureate
B.S.
B.S.N.
Master1s
M.A.
M.N./M.S.N.
Doctorate
Other
aJi=
35
bjT=5,104
cn= 250
I
13
'
2
3
1982 ASNSA
csurvey
1977 ‘ASNSA
^survey •
Ji
jj
Percentage
. I
0.4
23.6
63
25.2
1,402
27.5
154
61.6
25
0.5
5
2.0
27
10.8
2.9
37.1
5.7
8.6
71
In Montana, master's or baccalaureate degrees earned in fie ld s
other than nursing have a l l been earned in health care a d m inistra tion .
One nurse ad m inistrator reported current enrollment in a master's '
program in health care a d m in is tra tio n .
The area of education
fo llo w in g basic nursing preparation r e fle c ts the upward trend na tion­
wide fo r advanced preparation in ad m in is tra tiv e p ra c tic e .
Despite f u l l - t i m e employment, increased r e s p o n s ib ilit ie s , and
distance to educational centers, th is study indicates an awareness of
need f o r continuing education.
Continuing educational c re d its earned
are considerably less than the numbers of continuing educational hours
earned w ith in the la s t f i v e years.
This appears to fo llo w the trend of
the nationwide ASNSA survey.
Sixteen (48.5%) of the respondents reported earning no academic
c re d its w ith in the past f i v e years, 8 (24.2%) have earned over 12,
and some re port 30-50 academic c re d its earned w ith in the past f iv e
years.
Of the 17 who stated they have earned academic c r e d its , 11
reported almost a ll were d i r e c t l y re la te d to nursing a d m inistra tion .
There were 75.8 ,percent of the nurse adm inistrators who re p o rt earning
over 30 continuing education hours in the past f iv e years.
was from 30-114.
The range
Only three of the nurse adm inistrators reported th a t
some education hours were in nursing areas other than a d m inistra tion .
Professional and Community A c t i v i t i e s
There were 33 nurse adm inistrators who responded to item 32 re ­
questing inform ation re la te d to professional a c t i v i t i e s .
The m a jo rity
(78.8%) held membership in some professional nursing organization.
72
By c o n tra s t, only 14.7 percent held an o f f ic e in these nursing organi­
z a tio n s , and 85.3 percent held no o f f ic e .
Of the 26 nurse administra­
to rs who indicated membership in a professional nursing organization
(n=67), the greatest percentage of membership is in ASNSA (28.4%) and
13.4 percent in the Montana Society of Nursing Service Administrators
(MSNSA).
This item requires c l a r i f i c a t i o n and may not have provided
v a lid inform ation re la te d to ASNSA membership.
ASNSA membership does
not include membership in the Montana Society as does the American
Nurses' Association (ANA) or National League fo r Nursing (NLN).
MSNSA
membership has h i s t o r i c a l l y been greater in Montana than in the
national organization ASNSA.
In other professional organizations, 16.4 percent of the to ta l mem­
bership was in ANA, 4.4 percent in NLN, and 3.1 percent in Sigma Theta
Tau.
The remaining 34.3 percent of organizational p a rtic ip a tio n : was
designated as membership in state or local organizations of ANA and
NLN.
There was less p a r tic ip a tio n in other professional organizations by
the nurse adm inistrators in t h is study.
There were 34 persons who
responded to these items, 61.8 percent belong to no other professional
organizations.
I f membership was id e n t if ie d , the numbers of organiza­
tio n s ranged from one to fo u r, with a mode of one.
Over 85 percent of
the nurse adm inistrators stated they held no o ff ic e in the organization
of which they are a member.
Analysis of data re la te d to community a c t i v i t i e s from 34 respond­
ents, showed th a t only 50 percent are presently active in community
a ffa irs .
There were 41.2 percent of the respondents who reported
73
previous community a c t i v i t y .
The numbers of community organizations
li s t e d by responding nurse adm inistrators covers a broad spectrum of
community a c t i v i t i e s .
There were 41 separate organizations lis t e d , and
only 15 were indicated more than one time.
The greatest number of
responses id e n t if ie d the Emergency Medical Services Council (n=5),
women's church organizations (n=7), and advisory boards fo r educational
i n s t i t u t i o n s (n=5).
Community a c t i v i t i e s are lis t e d as fo llo w s :
advisory committees
f o r educational i n s t i t u t i o n s , health re la te d social service and '
w elfa re, nonhealth re la te d social service and welfare, nonservice
re la te d , and re lig io u s organizations.
organizations i d e n t if ie d .
There were 22 health re la ted
Only the American Red Cross, City-County '
Health, Emergency Medical Services Council, hospital a u x ilia r y , ambu­
lance services, C h ild b irth -P re n a ta l Education CounciI , and American
Heart Association were s p e cified more than one time.
There were 23 nonhealth re lated social and welfare organizations
id e n t i f i e d .
The Soroptomis t , City-County Planning Council, G irl
Scouts, Chamber of Commerce, and l io n e t t e s were s p e cified more than one
time.
Of in te r e s t, is the membership' by nurse adm inistrators in the
Academy of P o l i t i c a l Science, National Organization of Women, and the
League of Women Voters.
nonservice.
Only three organizations were c la s s ifie d as
Two separate r e lig io u s organizations were s p e c ifie d .
Of
a l l organizations i d e n t if ie d , 92.7 percent were service or health
re la te d .
Data were not a v a ila ble fo r comparison with the 1977 ASNSA survey.
The great numbers of community organizations lis te d by Montana nursing
74
adm inistrators made comparison with the 1982 ASNSA survey d i f f i c u l t .
Analysis of responses to items requesting information on the
research a c t i v i t i e s of nurse adm inistrators in Montana is shown in
Table 11.
Involvement has been greatest in areas of p a r tic ip a tio n at
symposia or conferences.
Two respondents stated they have published
te x ts , one is s p e c ific f o r a Montana health care agency.
Table 11.
Professional A c t i v i t i e s .
Professional A c t i v i t y
H
Percentage of
P a rtic ip a tio n
Research A c t i v i t i e s
P rin c ip le in v e s tig a to r
h=24
5 •
C o-in vestiga tor
ri=23
2
8.7
Research assista nt
£=23
3
13.0
16
59.3
Journal a r t i c l e
n=29
I
3.4
Media p u b lic a tio n
£=28
3
10.7
11
39.3
2
6.3
P a rtic ip a n t
p=27
20.8
Contributions, to professional
a c tiv itie s
Symposi um/conference
presentation
£-28
Other
n=32
..
75
Age, Sex, and M a rital Status
Age, sex, and m a rita l status are included in items 35 and 36.
Montana nurse adm inistrators who p a rtic ip a te d in th is research study
are overwhelmingly female.
T h irty -th re e nurse adm inistrators responded
to the item re la ted to sex, 97 percent are female and 3 percent male.
Age was reported as less than 30 years of age, 30-39 years of age,
40-49 years of age, 50-59 years of age.
14.3
Analysis of data showed that
percent were less than 30 years o f age, ;37.1 percent between
30-39, 28.6 percent between 40-49,, and 20' percent between 50-59 years
of age.
T h i r t y - f i v e nurse adm inistrators responded to the item requesting
inform ation on current m arital sta tu s . ■Categories were never-married,
married, widow/widower, separated, or divorced.
The m a jo rity of nurse
adm inistrators reported they are married (65.7%), divorced (22.9%), or
never-married (11.4%).
Comparison w ith the 1977 ASNSA nationwide survey reveals th a t the
greatest sing le re p o rtin g age was between 40-49 years (36.4%).
The
sin g le greatest percentages are married (60.8%), and only 9,7 percent
ove ra ll reported being divorced.
Comparison indicates th a t Montana
nurse adm inistrators who p a rtic ip a te d in t h is study are younger and a
greater percentage are divorced.
Salaries and Benefits
Items 37 and 38 requested information on sala ries and benefits of
nurse ad m in is tra to rs .
A comparison with both the 1977 and 1982 ASNSA
surveys (ASNSA, 1984, p. 20) is shown in Table 12.
Reporting increments
76
are the same, however, the range in each survey d i f f e r s .
Increased s a l­
aries f o r Montana nurse adm inistrators fo llo w s the national trend fo r
increased s a la rie s f o r nurse ad m in is tra to rs , despite the ru ra l nature
of Montana h o s p ita ls .
Analysis of data in th is study shows th a t
increased sala ry does correspond with increased hospital size and also
w ith r e s p o n s ib ilit ie s fo r greater numbers.of nursing service employees.
Table 12.
Comparison of sala ry ranges.
aMontana study
^1977 Survey
Percentage
Percentage
Less than $15,000
6.2
26.4
$15,000 - $19,999
9.4
32.7
0.6
$20,000 - $24,999
25.0
23.4
6.7 .
$25,000 - $29,999
31.3
11.6
12.1
$30,000 - $34,999
12.5
4.4
28.2
$35,000 - $39,999
3.1
$40,000 - $44,999
9.4
Salary range
in d o lla rs
Percentage
7.6
20.6
13.3
$45,000 - $49,999
$50,000 - $54,999
1.5 ■
c1982 Survey
3.1
5.2
$55,000 - $59,999
2.4
$60,000 - $64,999
0.6
Over $65, 999
2.7
aTotal nj=
32
I3Total n=5,224
cTotal n= 330
Range = Under $15,000 - Over $50,000
Range = Under $15,000 - Over $35,000
Range = Under $15,000 - Over $65,000
77
There were 33 nurse adm inistrators who reported be nefits provided
by the i n s t i t u t i o n .
item.
T h ir ty b e n e fit categories are l i s t e d in th is
Some nurse adm inistrators indicated the b e n e fit was " p a r t i a l l y "
a b e n e fit provided by the employer.
were considered to be b e n e fits .
P a rtia l benefits f o r data analysis
Professional meeting expenses and
major medical plans were reported by 75-85 percent of those responding.
Pension/retirem ent plans, l i f e
insurance, greater than 10 annual sick
leave days, and greater than 7 paid holidays were sp e c ifie d by 63-73
percent of the respondents.
Payment of professional organization
dues, t u i t i o n reimbursement, social s e c u rity , gas mileage, fre e or
reduced parking, professional journal expense, and greater than three
weeks vacation were included as benefits fo r 45-60 percent of nurse
a d m in s itra to rs .
Meals, d i s a b i l i t y plans, tax sheltered
an nuity/deferred compensation, and moving expenses upon h ir in g were
provided f o r 30-43 percent of nurse adm inistrators in Montana.
No
housing allowance was granted to nursing adm inistrators in the Montana
study.
Al I other be nefits were reported by lesser numbers of nurse
adm inistrators and correspond with increased hospital bed size.
Items in th is question were analyzed d i f f e r e n t l y than in the 1977 .
ASNSA nationwide survey.
There is some correspondence w ith those bene­
f i t s which are also received by the la rg e s t percentage of nurse admin­
is t r a t o r s in Montana.
Success Defined
.
The concept of success was explored in th is research study by
requesting nurse adm inistrators to define t h is concept re la te d to
78
professional p ra c tic e .
responded to item 34.
sponses.
Twenty-eight (80%) of the nurse adm inistrators
There were 54 items generated by t h e i r re ­
Obviously, success is a d i f f i c u l t concept to define.
One
response not included in analysis was "ambiguous question unable to
answer".
The researcher was unable to categorize two responses,
"improved" and "above average".
There were only three responses con­
sidered negative by th is researcher.
Negative responses were
" s u r v i v a l ", "I'm not sure there is such a t h i n g ! " , and "avoiding
bu rno ut".
I t is worth noting th a t only one nurse a d m inistra tor stated
p a r tic ip a tio n in a professional network, and none reported mentor
re la tio n s h ip s .
Major themes in responses were c la s s if ie d as a d m in is tra tiv e
re c o g n itio n and support, professional q u a lit y care f o r p a tie n ts , s t a f f
support and s t a f f development, and goal achievement and recognized
r e s p o n s ib ilit y .
A dm in istra tive re cogn ition as a member of organiza­
tio n a l management was defined in numbers of ways.
Some of the re ­
sponses were "respect by s t a f f , physicians, and a d m in is tra to r", "being
involved in a l l a c t i v i t i e s of hospital management", "decisions sup­
ported by ad m inistra tor and. nursing s t a f f " , "re cogn ition as a u th o rity ",
"keeping open communication with a d m inistra tion and other departments",
and "to have peer status with other a d m in is tra tiv e s t a f f " .
Q u a lity p a tie n t care was the most frequent item i d e n t if ie d with
success by nurse adm inistrators in th is study.
Thirteen (46.4%) of the
nurse adm inistrators a ttr ib u te d success to provision of excellence in
p a tie n t care under t h e i r leadership.
The nurse adm inistrators stated
success was "a fe e lin g of accomplishment in d e liv e rin g the best
79
possible care to p a t ie n t s , 11 "high q u a lit y c a r e ," and "to provide
leadership to allow f o r q u a lit y p a tie n t care in a cost e ffe c tiv e
manner."
S ta ff development was id e n t if ie d as "job s a tis fa c tio n f o r s t a f f , "
"to observe the growth and level of expertise among subordinates,"
" d ir e c tin g a hospital th a t has an e x c e lle n t reputa tion f o r good nursing
c a re ," and "maintaining competent nursing s t a f f . "
Other respondents
re la te d success to "the a b i l i t y to meet s ta f fin g needs of the f a c i l i t y
plus the needs of the s t a f f in order to provide q u a lit y p a tie n t care"
and " a b i l i t y to advance a nursing department with changing health trends
by working through subordinates."
Goal achievement and re cogn ition of r e s p o n s ib ilit ie s were described
in numbers of ways.
Success was "to lis t e n before making decisions and
to be responsible f o r making f i n a l d e c is io n s ," " f is c a l s t a b i l i t y in the
nursing department," "a continuing education process whereby goals aredeveloped and achieved," "being an en a b le r," "achieving g o a ls ," and
"productive reaching of most annual goals, development of new r e la ­
tio n s h ip s in f i e l d of endeavor."
Responses to t h is item, i d e n t if y the complexity of the concept of
success in the ro le of nursing a d m in is tra to r.
Nurse adm inistrators
have id e n t if ie d the importance of influence w ith in the i n s t i t u t i o n and
the r e s p o n s ib ilit ie s inherent in the ad m in is tra tiv e r o le .
A dditio n a l Comments
An op p o rtu n ity was provided fo r ad ditio n a l comments fo llo w in g
completion of the instrument used to develop a p r o f i l e of nurse
80
a d m inistra tors in Montana.
Three of the respondents made addition al
comments on the questionnaire.
One nurse ad m inistrator stated the
questionnaire was very time consuming and fu r th e r stated th a t " I hope
i t is worth my time not l i k e many I have p a rtic ip a te d in and never had
any feedback" (emphasis by respondent) " I s t i l l
love my job as DNS
(d ir e c to r of nursing service) a fte r 10 y e a rs ," and "very thought pro­
voking process".
Summary
The fin d in g s of th is research study were used to i d e n t i f y a p r o f i l e
of nurse ad m inistrators who fun ctio n in ru ra l ho spitals in Montana
today.
Comparison w ith nationwide- surveys of nurse adm inistrators by
the American Society of Nursing Service Administrators of the American
Hospital Association (ASNSA, 1980b; ASNSA, 1984) provided a base fo r
comparisons with hospital nursing adm inistrators nationwide.
Sources
of influence both w ith in and out of the hospital and the scope of the
organizational p o s itio n were explored.
81
CHAPTER 5
DISCUSSION
Summary and Discussion
The purpose of t h is study was to develop a p r o f i l e of the personal
and professional c h a ra c te ris tic s of the nurse ad m in is tra to r in acute
care ho s p ita ls in Montana.
The conceptual framework f o r th is study was
organized around the concept of sources of influence through formal
/
and fu n c tio n a l power and included the dimensions of the organizational
r o le .
The r e s p o n s i b i l i t i e s , a u th o r itie s , and personal c h a ra c te ris tic s
which c o n trib u te to a d m in is tra tiv e ro le development were studied'..
These three domains c o n s titu te the a d m in is tra tiv e r o le .
The ru ra l c h a ra c te ris tic s of the acute care ho s p ita ls were iden­
t i f i e d in order to include th is extraneous variable in comparison of
data w ith nationwide stud ies.
Rural c h a ra c te ris tic s were a con­
s id e ra tio n in t h e ir e ff e c t on a d m in is tra tiv e practice of nurse admin­
i s t r a t o r s in Montana.
P rio r to t h is study, the researcher assumed there was l i t t l e
admin­
i s t r a t i v e support w ith in the organization f o r nurse adm inistrators in
Montana.
She also assumed th a t mentor-network re la tio n s were a c r i t i ­
cal face t of ro le development.
One f u r th e r assumption made, was that
nurse ad m inistrators in a ru ra l state had expanded r e s p o n s ib ility
w ithout delegated a u th o rity .
The preparation fo r a d m in is tra tiv e prac­
t i c e and the concepts. of mentor and network re la tio n s were studied
82
because they are important in development of the a d m in is tra tiv e ro le
w ith in the organ ization .
The route to top management has generally been
through upward m o b ility w ith in nursing with l i t t l e
p ra c tic e or educational preparation.
p r io r a d m inistra tive
These considerations and the
review of l i t e r a t u r e formed the background of th is study.
A review of l i t e r a t u r e suggested th a t management s k i l l s are
m u ltip le and m u ltifa c e te d .
Educational preparation is suggested by
n a tio n a lly recognized nursing leaders and national standards fo r nurse
ad m inistra tors.
Without a d m in is tra tiv e preparation, the nurse admin­
i s t r a t o r is unable to assume r e s p o n s ib ilit y fo r f i s c a l , resource, and
p a tie n t care management.
In order to fu n c tio n e f f e c t i v e l y , the nurse
a d m inistra tor possesses both formal and fu n c tio n a l power.
of influence are c r i t i c a l
These sources
in order to a ffe c t decision-making, to assume
delegated r e s p o n s ib ilit y w ith in the organ ization , to d ir e c t the organi­
z a tio n , and to d e liv e r health care.
National rules and re g u la tio n s , standards, and guidelines define the
a d m in is tra tiv e r o le .
These standards c l a r i f y the professional and
a d m in is tra tiv e aspects of the dual ro le in nursing adm inistration..' The
numbers of women in a d m in is tra tiv e po s itio n s in nursing are s i g n i f i ­
c a n tly higher than men.
By c o n tra s t, there, is a predominance of men in
a d m in is tra tiv e po sitions w ith in the ho spital hierarchy.
Social and
economic fa c to rs have, in the past* been a ttrib u te d to lack of manage­
ment p o te n tia l fo r women in management.
A dm inistrative support
services, organizational sta tu s , and ac tiv e p a r tic ip a tio n in corporate
decision-making are important sources of influence and are considered
essential fo r success in nursing management.
83
Nursing adm inistrators are leaders in nursing.
The acknowledged
influence held by the nurse a d m inistra tor a c tiv e ly a ffe c ts change in
health care del iv e ry and insures increasing professional ism w ith in
nursing.
The v i s i b i l i t y of the nurse a d m inistra tor is a po te n tia l
source of influence and insures the r i g h t to address the issues in
nursing today.
This researcher was interested in exploring the span of control and
the ove ra ll r e s p o n s ib ilit y and power of nurse adm inistrators in a ru ra l
s ta te .
A comparison population was e s s e n tia l, so th a t id e n tifie d
c h a ra c te ris tic s were a ttrib u te d to nurse adm inistrators fun c tio n in g in
acute care hospitals in general.
Comparison was also necessary to
i d e n t i f y those variables unique to h o spitals and nursing practice in a
ru ra l s ta te .
The variables id e n t if ie d in the conceptual framework of
the study provided the structure, fo r instrument development.
Differences between th is study and the two ASNSA studies must be
considered.
A ll studies included only nurses in the top ad m inistra tive
p o s itio n in acute care h o s p ita ls .
The population in t h is research
study included only those 60 acute care hospitals which were nongovern­
mental or were not special treatment centers.
There were 35 returns
(58.3%) which were a ll found to be acceptable fo r data analysis.
Comparability with the 1977 study was possible since most items were
retained f o r use from the tool developed by the ASNSA.
Because of d i f ­
ferences in the 1982 study in both sampling and changes in the
questionnaire, com parability was lim ite d .
84
Montana Nurse A dm inistrator P r o file
A p r o f i l e of the Montana nursing service ad m inistrator was devel­
oped from an analysis of the personal and professional c h a ra c te ris tic s
found in th is research study.
The comparisons with nationwide studies
found many s i m i l a r i t i e s and some differences between Montana nurse
adm inistrators and nurse adm inistrators n a tio n a lly .
The current trends
in a changing a d m in is tra tiv e ro le fo r Montana nurse adm inistrators
appears to fo llo w the national trend f o r change.
The p r o f i l e developed
can only be generalized fo r the to t a l population studied and; may not be
v a lid i f data were a v a ila ble from the to t a l population.
Based on analysis of data from th is research study, the average
nurse ad m inistra tor was female (97%), between 30 to 39 years of age
(37.1%), and was married (65.7%).
The nurse a d m inistra tor received a
sala ry of between $30,000 and $34,999 (31.3%), or possibly between
$25,000 and $29,999 (25%).
Increased salary was d i r e c t l y related: to
r e s p o n s ib ilit y f o r greater numbers of nursing personnel and increased
hospital size.
The nurse a d m inistra tor achieved the p o s itio n through upward
m o b ility , f i r s t as a s t a f f nurse (100%) and then as a head nurse or
supervisor (85.7%).
C e r t if ic a t io n in nursing ad m inistra tion (11.4%)
may in d ic a te a trend in Montana.
The greatest percentage of nurse
adm inistrators earned a baccalaureate degree (40%).
percent was a diploma in nursing (28.6%).
(14.3%).
The next highest .
A few hold master's degrees
A baccalaureate or master's degree other than in nursing was
in the f i e l d of health care a d m in is tra tio n .
The trend toward higher
85
education f o r nurse adm inistrators in Montana r e fle c ts the national
trend.
S l ig h t l y over h a lf of the nurse adm inistrators (51.5%) had earned
academic c re d its w ith in the la s t f iv e years.
The focus of continual-
preparation fo r the a d m in is tra tiv e ro le has been greater in continuing
education hours earned (97%) than in academic c re d its .
Most nurse
adm inistrators (75.8%) earned well over 30 continuing education hours
which are almost t o t a l l y applicable to nursing adm inistration (87.9%).
Most nurse adm inistrators belonged to a professional nursing
organization (78.8%), but did not hold an o f f ic e in th a t organization
(85.3%).
Professional organizations in which the nurse adm inistrator
was a member, included the ASNSA (28.4%), MSNSA (13.4%), or the ANA .
(16.4%).
Most nurse adm inistrators belonged to no other professional
organization (61.8%), and those who did , held no o f f ic e in th a t organize
tio n (85.3%).
The nurse a d m inistra tor was active in community a ff a ir s
(50%), and i f so, they were overwhelmingly health or welfare and
service re la ted organizations (92.7%).
Some nurse adm inistrators were involved in research a c t i v i t i e s
(24.3%).
The major involvement in other professional a c t i v i t i e s was
in presentations at conferences or symposia (39.3%) or f o r media
p u b lic a tio n (10.7%).
professional te x ts .
Two nurse adm inistrators have published
The nursing departments were fo llo w in g a trend in
planning f o r development o f, or adopting, a nursing theory fo r
professional p ra c tic e .
While these nursing adm inistrators were few in
number, they ind ica te a trend which may be much more evident in the
next decade.
86
Professional development fo r the nurse ad m inistrator was aided by a
mentor in 60.6 percent of the cases.
There probably has not been a
mentor re la tio n s h ip w ith greater than two experienced professionals
(55%).
The mentor was usually a woman in a professional ro le (59.5%).
Occupation of mentors included nursing supervisor (19%), nurse
ad m in is tra to r (16.7%), or hospital ad m inistrator (16.7%).
Although the
nurse adm inistrators had a mentor f o r professional development, there
was a f i f t y percent chance they had not functioned in the ro le of
mentor to others.
I f the nurse a d m inistra tor had functioned as a
mentor to another p ro fe s s io n a l, the mentee was a female (74.4%).
The
assistance given was generally re la te d to ad m inistra tive s k i l l s
(65.2%).
The mentee was usually a s t a f f nurse (61.5%) but was
sometimes a nursing supervisor (15.4%) or another nurse adm inistrator
( 12. 8%).
The nurse a d m inistra tor was a c tiv e ly p a r tic ip a tin g in a
professional network fo r support, advice, and development o f
professional expertise (88.2%).
The advice and support shared with
other network members was almost t o t a l l y re la te d to development of
management expertise (95.8%).
Support requested from professional
network members was also re la te d to development of management s k i l l s
and problem-solving (94.4%).
Nursing service adm inistrators in Montana viewed success from the
perspective of organizational ro le , p a tie n t, nursing s t a f f , and
professional r o le .
Success in the ro le of adm inistrator was d ir e c t ly
re la te d to re cogn ition as a member of organizational management, p r o v i­
sion of q u a lit y p a tie n t care by the department of nursing, development
87
of s k i l l s and expertise by the nursing s t a f f , and personal goal
achievement and re cogn ition of professional r e s p o n s ib ilit y .
Nurse adm inistrators reported d i r e c t l y to the top executive o f f ic e r
(94.3%), unless they functioned in a large medical center.
There was .
shared a d m in is tra tiv e coverage of the o v e ra ll i n s t i t u t i o n (88.6%).
The
span of control included r e s p o n s ib ilit y and designated a u th o rity fo r
special u n its or other departments w ith in the h o s p ita l.
The a u th o rity
included f i v e to e ig h t special units or departments (55.9%).
The
departments were as diverse as d ie ta ry , social work, pharmacy,
ambulance service, laundry, and occupational, physical, re s p ira to ry , or
speech therapy.
There was active p a r tic ip a tio n in planning of the hospital budget
.
(74.3%) and f o r p r i o r i t y - s e t t i n g fo r the hospital budget (82.4%).
There was control of the establishment of the nursing department
budget (76.5%) and in some cases there was to t a l control of th a t budget
(62.9%).
The nurse a d m inistra tor a c tiv e ly p a rtic ip a te d on a l l corporate
committees or boards.
The nurse a d m inistra tor was not a voting member
of the governing board but was often a member (53.8%).
Active
p a r tic ip a tio n on the ad m in is tra tiv e s t a f f committee was frequent
(84.9%), as were corporate planning and development (78.2%), and the
executive medical s t a f f committee (67.9%).
Active p a r tic ip a tio n in a ll i n s t i t u t i o n a l committees was frequent
(51.4%).
The nurse a d m inistra tor was a c tiv e ly involved in over fou r of
the committees which guided the d ire c tio n of care w ith in the ho spital
.
88
(94.3%).
The nurse ad m in is tra to r generally had major con trol over
decision-making and management of the department of nursing (66.1%).
A d m in is tra tiv e support services were ge nerally ava ila b le f o r the
nurse a d m in is tra to r.
The m a jo rity of th a t support was ava ila b le fo r
data access, m aterials management, record keeping, and fin a n c ia l
re p o rts .
When computer services were a v a ila b le , computer access was
p r im a r ily f o r f i n a n c i a l , s t a t i s t i c a l , and audit analysis and fo r per­
sonnel p a y r o ll.
I f there was a bargaining u n it fo r professional
nurses, the nurse ad m in is tra to r usu ally p a rtic ip a te d as a member of the
bargaining team (71.4%) or as an advisor (28.6%) to the bargaining
committee.
The nurse ad m in is tra to r generally functioned in a ho spital with
less than 50 acute care beds (65.7%), which included an average of 27
extended care beds.
The nurse a d m inistra tor was responsible f o r 50 to
74 percent of the t o t a l number of i n s t i t u t i o n a l employees.
R e s p o n s ib ilitie s of the p o s itio n as nursing a d m inistra tor required th a t
the workweek included greater than 40 hours and sometimes 60 or more
hours (14.3%).
A dm in istra tive r e s p o n s ib ilit ie s required the major por­
tio n of the nurse a d m in is tra to r's time.
Greater than 70 percent of the
time was spent on a d m in is tra tiv e r e s p o n s ib ilit ie s (55%).
little ,
There was
i f any, time allocated f o r d ir e c t p a tie n t care.
Conclusion
This research study indicated a s h i f t toward more p ro fe s s io n a lism
and more a u th o rity f o r the nurse a d m inistra tor over the department of
nursing.
Nurse adm inistrators in Montana followed the nationwide trend
89
f o r increased c re den tial lin g w ith in the corporation.
There was, on the
average, active p a r tic ip a tio n in the planning and d ire c tio n of the c o r­
poration as well as control of the department of nursing.
R e s p o n s ib ility w ith in the i n s t i t u t i o n was extensive, but sources of
organizational influence were guaranteed by the organizational p o s itio n .
Mentor and network re la tio n s h ip s proved to be v a lid concepts, in
development of expertise in nursing ad m in istra tio n .
There was also
v a lid a tio n th a t serving as a mentor was a ro le not usu ally assumed.
However, having a mentor was an important influence in ro le develop­
ment.
The importance of a professional network f o r nurse adm inistra­
to rs was evident.
Sharing and receiving ad m inistra tive assistance and
support from others was also an important aspect of ro le development.
The use of the network fo r professional needs, rather than emotional
support, validated the assumptions proposed in the review of previous
studies.
In th is study population the ro le of nurse a d m inistra tor in
Montana did meet the requirement fo r a u th o rity and r e s p o n s ib ilit y of
th a t r o le .
L im ita tio n s
The nurse adm inistrators who p a rtic ip a te d in th is research study
could be those nurse adm inistrators who had an established place in
a d m in is tra tiv e management.
They also could have been the population
involved in change, who were active in professional organizations, and
who developed a network of peers fo r support and guidance.
One l i m i t a ­
tio n is th a t the small sample of nurse adm inistrators in th is study may
90
not be representative of the to t a l population of nurse adm inistrators
in Montana.
Another lim i t a t i o n is th a t the population selected to insure
homogeneity made comparison with the selected nationwide study
d iffic u lt.
In the case of the 1982 ASNSA (1984) study, com parability
is questionable. The use of a mailed questionnaire imposed some
l i m i t a t i o n by l i m i t i n g response ra te .
\
Recommendations
Recommendations f o r fu r th e r study include the fo llo w in g :
1.
Repeat the study using a .la rg e r population to fu r th e r valida te
the id e n t if ie d concepts in other ru ra l states.
2.
Refine the instrument in order to elim inate or c l a r i f y
questionable items f o r greater precision in comparison with
other studies.
3.
Narrow the focus of the study to provide a more indepth v a lid a ­
tio n of major concepts in th is study.
Im plications f o r Nursing
The re s u lts of th is study c le a r ly have im plica tions f o r nurse admin­
is t r a t o r s in any ru ra l s ta te .
L i t t l e has been known of a d m inistra tive
p ra c tic e , the ro le , r e s p o n s ib ilit y , and a u th o rity .
Influence through
both formal and fu n c tio n a l power insures the a u th o rity to meet admin­
i s t r a t i v e r e s p o n s ib ilit y .
re la tio n s h ip s .
Equally important are mentor and network
These re la tio n s h ip s provide support fo r a d m inistra tive
ro le development and f o r nurse adm inistrators with T i t t l e or no peer
support w ith in the organization.
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92
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APPENDICES
APPENDIX A
COVER LETTER TO NURSING ADMINISTRATORS
I
100
525 So. 5th East , A pt . SG
Mi ss oul a, Montana 59801
March 15, 1984
Dear Nursing Ser vi ce A d m i n i s t r a t o r :
I am w r i t i n g t o i n v i t e you t o p a r t i c i p a t e i n a study of sources of
IpfIiiBiiiliE:
t a t i n n sL - ^ 0rs ^
6 Amf l c a ? H o s pi t al A s s o c i a t i o n , a r e p l i c a t i o n or ah adaosome q ues t i on s from the Survey of Nursing Service Administrators in'
may be I ade
ln thlS questionnaire.
In t h i s way, comparison st udi es
c i h n ^ L c UeSti 0nn?ur e - ! 5 1n - hree Parts.
P ar t I explores t he roles, respon­
s i b i l i t i e s , and a u t h o r i t i e s or the n ur s i ng a d m i n i s t r a t o r .
Par t I I expl ores
mentorship and network r e l a t i o n s h i p s , and Part I I I i s f o r the d e v e l o p m e n t ^ a
personal p r o f e s s i o n a l p r o f i l e o f a l l nurse a d m i n i s t r a t o r s .
. , THis s tudy i s fo r my master's t h e s i s a t Montana State U n i v e r s i t y .
My
i n t e r e s t i n t h e t o p i c i s d e ri v e d from wor ki ng as a nurse a d m i n i s t r a t o r in a
r u r a l h o s p i t a l i n Montana.
I t i s hoped t h a t the f i n d i n g s of t h i s st udy w i l l
or value t o the h o s p i t a l n u rs i n g a d m i n i s t r a t o r s p r a c t i c i n g in Montana today
Of0uU s e ,Sm lnlU atotL r L 0U
U U " " '
be
devs' op" ent of ="
t h e s i s w i l l be a v a i l I b l e Ut h m u g h ^ h e M S n t a n a ^ t l t r U n ^ r s i ' t y " I i b r l r y ^ j f ^ o u
-WW ^"Terest ed i n r e c e i v i n g an a b s t r a c t o f t he r e s u l t s , please send a s e l f -
l y ' h a v l d u r in ^ q u e s u l^ a ir e c o m p ? e tIo n '^ % ]; f ! I / f r %
you cnoose to p a r t i c i p a t e ,
tr c Z a c ^ e i^ l/^
I a pp r e c i a t e y o ur time and a s s i s t a nc e.
Sincerely,
A v i s Peterson, R.N.
Montana St at e U n i v e r s i t y
Mi ssoul a Extended Campus
(406) 721-5673
Enclosure
APPENDIX -B
MAILED QUESTIONNAIRE
102
HOSPITAL NURSING SERVICE ADMINISTRATOR QUESTIONNAIRE
DIRECTIONS FOR COMPLETING THE QUESTIONNAIRE:
I n o r der f o r your answers t o be a c c u r a t e l y analyzed please:
(1) p r i n t numbers or l e t t e r s c l e a r l y
(2) pl ac e a w e l l - d e f i n e d check mark i n the box beside t he most
a p p r o p r i a t e answer
(3) i f a w r i t t e n answer i s r equest ed, ver y b r i e f answers are
expected i n the space provi ded
P ar t I .
A dm inistrative Practice
We are i n t e r e s t e d i n a d m i n i s t r a t i v e f u n c t i o n s which w i l l hel p to
d e f i n e your r o l e , r e s p o n s i b i l i t i e s , and a c c o u n t a b i l i t i e s as a nur si ng
service ad m in istra to r.
la.
Do you r e p o r t d i r e c t l y t o the top a d m i n i s t r a t i v e o f f i c e r o f the
hospital?
C ] YES [ ] NO
b.
I f NO, t o whom do you r e p o r t ?
(T itle)
c.
At what l e v e l o f t he o r g a n i z a t i o n a l s t r u c t u r e i s she/he?
[ ] 2nd [ ] 3rd - [ ] 4th • [ ] o t h e r (pl ease s p e c i f y )
2.
Do you . p e r s o n a l l y p a r t i c i p a t e i n a d m i n i s t r a t i v e coverage f o r the
o v e r a l l h o s p i t a l o p e r at i o n ?
[ ] YES [ ] NO
3a.
Which o f the f o l l o w i n g u n i t s or departments are in your h o s o i t a l
and which are you account abl e f o r ?
IN
ACCOUNTABLE
HOSPITAL
FOR
C]
[ ]
[ ].
[ ]
[ ]
C]
[ ]
C]
C]
C]
E]
E]
C]
C]
C, ]
.
E 3 Central Supply
E ] Chemical Dependency
E ] Dietary
E ] Emergency Department
E ] Extended Care
E ] Home Care
E ] Housekeeping
E ] Laundry
E I In te n sive/Coronary
Care
E ] Laboratory
E ] Occupational Therapy
E 3 Operating Room
E 3 Outpatient Surgery
E 3 Pharmacy
E 3 Physical Therapy
IN
ACCOUNTABLE
HOSPITAL
FOR
E3
E 3:
E3
E3
E3
E3
E3
E3
E3
E3
E3
E3
E3
E3
' E3
[ ] Rehabilitation
C ] Psychiatric
[
[
[
[
]
]
]
]
[
I
[
C
C
C
]
]
]
]
]
]
C]
[ ]
C I
Radiology
Recovery Room
Renal- d i a l y s i s
Respiratory
Theraoy
School o f Nursing
Self-care
Speech Therapy
Soci al Work
S t a f f Development
V o l un t ee r Servi ce
Other ( s p e c i f y )
103
4a.
What i s the number o f acute care beds in your h o s o i t a l ? _________
b.
I s an extended care f a c i l i t y a p a r t o f your r e s o o n s i b i T i t y ?
C ] YES [ ] NO
c.
I f YES, how many extended care beds do you have a d m i n i s t r a t i v e
r e s p o n s i b i l i t y f o r . __________________________
5.
Do you o a r t i c i o a t e i n the p l anni n g f o r the o v e r a l l h o s p i t a l
budget?
[ ] YES [ ] NO
6.
Do you p a r t i c i p a t e i n the p r i o r i t y - s e t t i n g f o r the o v e r a l l
h o s p i t a l budget?
C ] YES C ] NO
7.
Do you have major r e s o o n s i b i I i t y f o r the e s tabl i shm en t o f the
n u r s i n g s e r v i c e o p e r a t i o n a l budget?
- [ ] YES [ ] NO
8.
Once your nur si ng budoet i s aporoved, do you have f u l l resoons i b i l i t y f o r the budget?
[• ] YES [ ] NO
9.
How many hours are t h e r e i n your normal workweek?
10.
______________
Please es ti mat e the percentage of your time spent d u r i n g your
normal work week i n t he f o l l o w i n g areas:
______ J o b - r e l a t e d community a c t i v i t i e s
_______ % Admini s t r a t i v e - f u n c t i o n s
______ _% Gi vi ng d i r e c t p a t i e n t care
_______ % Teaching p a t i e n t s or f a m i l i e s w i t h i n the i n s t i t u t i o n
_______ % Teaching s t a f f w i t h i n t he i n s t i t u t i o n
_______ % Teaching student s w i t h i n the i n s t i t u t i o n
_______ % Teaching o u t s i d e of the o r g a n i z a t i o n
_______ %' Research
_______ % C o n s u l t a t i o n o u t s i d e o f the i n s t i t u t i o n .
_______ % St at e or n a t i o n a l p r o f e s s i o n a l a c t i v i t i e s
_______ % Other ( pl ease s o e c i f y ) __________________________________
100.0 %
11.
On which o f the f o l l o w i n g c o r p or a t e committees/boards do you
active ly participate?
VOTING
NONE
OCCASIONALLY
MEMBER
MEMBER
A c c r e d i t a t i o n / 1 i censure
Administrative Staff
Board o f Trustees
Corporat e Planning/Development
Execut i ve Medical S t a f f
I n t e r d e o a r t m e n t a l Research
Other ( pl ease S oe ci f v )
[
[
[
[
C
C
[
]
]
]
]
]
]
]
'
[
C
C
C
E
C
[
I
]
I
}
]
I
]
C
[
C
C
[
[
[
]
]
]
]
]
]
I
C
C
C
[
C
C
C
]
]
]
]
]
] '
]
104
12.
On which o f the f o l l o w i n g institutional committees do you or your
desi gnat ed r e p r e s e n t a t i v e p a r t i c i p a t e ?
PARTICIPATION
NO
COMMITTEE
NONE
ACTIVE
.Emergency care
In fe c tio n control
D i s a s t e r pl anni n g
Medical records
Pharmacy and t h e r a p e u t i c s
Professional l i b r a r y
Q u a l i t y assurance
S af et y
Special care u n i t
Standing medical s t a f f committees
Risk management
CI '
C]
[ I
CI
[ ]
[ I
[ ]
C]
C]
CI
[ ]
C]
C]
C]
C]
C]
. CI
C3
C3
C3
C3
C3
C3
C3
E3
E3
E3
E3
E3
E3
E3
E3
E3
13a. Has your n ur si ng deoar tment (s) developed/adopted a n u r s i n g t he or y
f o r p r o f e s s i o n a l p r a c t i c e ( ex c l u d i n g the departmental phi l os op hy
st at ement )?
[ ] YES C ] NO
b.
14.
I f YES, olease s p e c i f y ____________________________________________
Check the l e v e l o f r e s o o n s i b i l i t y t h a t the Department o f Nursing
a t ' y o u r h o s p i t a l has f o r the a c t i v i t i e s l i s t e d ' ' b e l o w .
FULL
RESPONSIBILITY
PARTIAL
NONE
C on tr a c t u al agreement
w i t h nur si ng school
E3
E3
E 3,
Changing basi c o r g a n i z a t i o n
of n ur si ng care on u n i t s
E3
E3
E3
Changing nur si ng
procedures and p o l i c i e s
E 3.
E3
E3
D e v el o oi ng and/or
i mplementing n u rs i n g
r esearch p r o j e c t s
E3
E3
E3
Develooment o f departmental
edu ca ti o na l programs
E3
E3
E3
E l i m i n a t i n g nonnursing
d u t i e s from n ur si ng dept .
E3
E3
E3
Establishing in d iv id u a l
p r a c t i c e work load
E3
E3
E3
105
RESPONSIBILITY
PARTIAL
FULL
15.
NONE
I mplementing new
n u r s i n g r o l e s as they
develop
C I
C ]
C J
I n c r e a s i n g or decreasing
nursing s t a f f
C ]
C ]
C ]
Please check a d m i n i s t r a t i v e support s e r v i ce s made a v a i l a b l e to you
[ ]
[ ]
C I
C ]
[ ]
C ]
C I
C ]
[ I
Access t o data from o t h e r departments
Computer
M a t e r i a l s management
Record keeping
Secretarial
S ta ffin g coordination
Q uality reports
Cost c e nt er f i n a n c i a l r e p o r t s
Other (please s p e c i f y ) ______________ ___________
C]
16a. Are any nurses not r e s p o n s i b l e to n u rs i n g s er vi ce?
b'. I f YES, t o whom do they r e p o r t ?
c.
[ ] YES
[ ] NO
(pl ease s p e c i f y ) _________________
What i s t h e i r p r o f e s s i o n a l r e s p o n s i b i l i t y ?
(please s p e c i f y )
17a. Are any nurses i n y our h o s p i t a l members o f a c o l l e c t i v e bar aai ni ng
u n i t ( s ) t h a t have c o n t r a c t ( s ) w i t h y o ur h o s p i t a l ? [ ] YES " [ ] NO
b. I f YES, as a nur si ng a d m i n i s t r a t o r , what i s your degree of
p a r t i c i p a t i o n w i t h the management n e g o t i a t i n g team f o r c o l l e c t i v e
bar gai ni n g?
[ ] P a r t i c i p a t i o n on the management n e g o t i a t i n g team
[ I Serve as an a d v i s o r t o the management n e g o t i a t i n g team
L J No invol vement w i t h the management n e g o t i a t i n g team
18a. Are computers used by your i n s t i t u t i o n ?
[ ] YES
[ ] NO
b. I f YES, please i n d i c a t e the nur si ng s e r v i c e f u n c t i o n s t h a t are
a s s i s t e d by computer s er v i c e s :
C ] Audit
C ] F i s c a l data
C
[
C
C
]
]
]
]
I n s t r u c t i o n ( p a t i e n t or s t a f f )
Manpower data
Nursing di aano si s
Patient p r o f ile
C
[
C
[
]
]
]
]
C]
Payroll .
Scheduling
S t a t i s t i c a l analysis
Other ( pl ease s p e c i f y )
106
19a. Please i n d i c a t e the number of f u l l - t i m e and p a r t - t i m e h o s p i t a l
employees i n each o f the f o l l o w i n g c a t e g o r i e s who are under your
d i r e c t / i n d i r e c t management:
NUMBER REPORTING
F u l l ti me
(35 hr/wk or more)
P ar t time
( l e ss than 35 hr/wk)
RN
LPN/LVN
Aide/O rderly
U n i t manager
Clerks/Secretary
Tech. (OR, OB, e t c . )
Other ( pl ease s p e c i f y )
b. What percentage of t o t a l h o s p i t a l personnel does the above person­
nel r epr es ent ? ___________ %
P ar t I I .
P r o f e s s i o n a l Mentor -Network R e l a t i o n s h i p
20a. I t has been suggested t h a t the presence of an experienced p r o ­
f e s s i o n a l who acts as a mentor ( g ui de) t o a less experienced pr o­
f e s s i o n a l , i s i m p o r t a n t i n development of p r o f e s s i o n a l e x p e r t i s e
and c ar e e r r o l e achievement.
In y o u r p r o f e s s i o n a l c ar e e r devel op­
ment, have t h er e been p r o f e s s i o n a l mentors?
[ ] YES [ ] NO
b. I f YES, pl ease l i s t :
OCCUPATION OF MENTOR
SEX
MENTOR’ S
RELATIONSHIP
TO YOU
ASSISTANCE
GIVEN BY
MENTOR
21a. Have you served as a mentor f o r o t h e r p r o f e s s i o n a l nurses i n the
development of t h e i r c ar eer goals?
[ ] YES [ ] NO
b. I f YES, pl ease l i s t :
MENTEE' S RELATIONSHIP.
TO YOU
SEX
SPECIFIC ASSISTANCE GIVEN
BY YOU
107
22a. I t i s g e n e r a l l y recogni zed t h a t a p r o f e s s i o n a l network p r o v i d e s
i n f o r m a t i o n , adv ic e, and moral suppor t f o r c ar eer development and
advancement. A s o c i a l network i s a mutual i n t e r a c t i o n w i t h p r o ­
f e s s i o n a l c ont ac t s ( p e e r s ) .
Do you c on si d e r t h a t you p a r t i c i p a t e i n a p r o f e s s i o n a l network
which i s e s s e n t i a l t o you i n your p r o f e s s i o n a l p r a c t i c e ?
C ] YES C ] NO
b. I f YES, what a d m i n i s t r a t i v e e x p e r t i s e do you share w i t h o t h e r n e t ­
work members? (pl ease be s p e c i f i c )
c . What a d m i n i s t r a t i v e e x p e r t i s e have you requested from o t h e r n e t ­
work members? (pl ease s p e c i f y )
i
P ar t I I I .
Demographic I n f o r m a t i o n
We are i n t e r e s t e d i n i n f o r m a t i o n about you and your p r o f e s s i o n a l
background.
23.
24.
Please i n d i c a t e your pr esent j o b t i t l e
(check one o n l y ) :
C ,1 Nursing A d m i n i s t r a t o r
I ] V i c e - P r e s i d e n t o f Nursing
C ] D i r e c t o r of Nursing
C ] Other (please s p e c i f y )
[ ] Ass oc iat e A d m i n i s t r a t o r
C ] Assistant Adm inistrator
[ 3
C3
How long have you been employed i n y our pr esent p o s i t i o n ?
25a. Are you a n a t i v e of Montana ( e . g . , born, r a i s e d ,
your l i f e i n ) ?
spent most of
[ 3 YES [ 3 NO
b. In NO,, what s t a t e are you a n a t i v e of?____________ __
26a. Were you promoted t o y our p o s i t i o n from w i t h i n your p r es en t place
of employment?
[ ] YES [ 3 NO
b. I f YES, are you a n a t i v e of t he area in which you are now l i v i n g
( e . g . , born, r a i s e d , spent most of your l i f e ) ?
[ 3 YES [ 3N0
27a. Were you r e c r u i t e d f o r your p r es ent p o s i t i o n from anot her p o s i t i o n
w i t h i n Montana?
[ ] YES [ ] NO
108
b. I f NO, were you r e c r u i t e d from an area in another s t a t e which
would be cons i der ed :
C ] Rural
C ] Suburban
[ ] Urban
28a. Please i n d i c a t e the years of experience you have had i n each of
t he f o l l o w i n g p o s i t i o n s :
YEARS
[
[
C
C
]
]
]
]
YEARS
S t a f f nurse
Head nurse
Nursing s u p e r v i s o r
C linical specialist
C
C
C
C
]
]
]
]
Nurse p r a c t i t i o n e r
Nursing a d m i n i s t r a t o r
F a c ul t y
Other (pl ease s p e c i f y )
[ ] _____________________;
b. I f you have f a c u l t y s t a t u s , what i s your t i t l e ? _________________
29a. I f you have had experi ence as a nurse c l i n i c i a n / s p e c i a l i s t ,
nurse p r a c t i t i o n e r , please i n d i c a t e your area of p r a c t i c e :
or
b. Please i n d i c a t e c e r t i f i c a t i o n or educati onal p r ep a r a ti o n f o r the
r o l e of nurse c l i n i c i a n / s p e c i a l i s t , or nurse p r a c t i t i o n e r :
c . Have you rec ei ved c e r t i f i c a t i o n or r e c o g n i t i o n by a n a t i o n a l p r o ­
f e s s i o n a l o r g a n i z a t i o n in nursing a d m i n i s t r a t i o n ( e . g . , ASNSA or
ANA)?
C ] YES C ] NO
d. I f YES, please s p e c i f y .
30.
Please i n d i c a t e a l l
diplomas and degrees earned:
[ ] LPN/LVN
[ ] Associated A r t s / A s s o c i a t e Degree
[ ] Diploma from H os pi t al School o f Nursing
MAJOR FIELD OF STUDY
[ ] B.S.N.
[ ] B.A.
C 3 M.A.
I
:
:
[ ] M.S.
C ] M.N. /M.S.N.
■ C 3 D.S.N.
C 3 Ed.D.
[ 3 Ph..D.
Other (please s p e c i f y )
C3
c 3 ________ ;______
MINOR FIELD OF STUDY
:
‘
;
~ ~ ~
^
;
:
;-----------------
109
31a. Please i n d i c a t e the academic c r e d i t s you have earned i n the l a s t
f i ve y ear s:
C30
C l 1-6
C ] 7-12
[ ] over 12
b. Please i n d i c a t e the number of c o n t i n u i n g education hours you have
accrued i n the l a s t f i v e y ear s:
c ] 0
C ] 1-10
c ] 11-20
C ] 21-30
C ] over 30
c . Of t he academic c r e d i t s or c o n t i n u i n g educati on hours, earned,
pl ease i n d i c a t e the number t h a t are d i r e c t l y r e l a t e d t o nursi ng
a d m i n i s t r a t i o n ( e . g . , f i s c a l , res our ce, p a t i e n t care management).
Academic c r e d i t s
C o n ti n u i n g education nours
Other (please s p e c i f y )
'
32a. In what p r o f e s s i o n a l o r g a n i z a t i o n s are you a member?
3 YES
I—
American Academy o f Nursing
American S oc iet y of Nursing Servi ce
A d mi n i s t r a t o r s
N at i o na l League f o r Nursing
Montana League f o r Nursing,
American Nurses' A s s o c i a t i o n
S t at e Nurses' A s s o c i a t i o n
D i s t r i c t Nurses' A s s o c i a t i o n
Sigma Theta Tau Honor Soc iet y
Other (pl ease s p e c i f y ) _ ______
I
NUMBER OF
OFFICES HELD
NO
C 3 YES
C 3 YES
C 3 NO
C 3 NO
[ I YES C 3 NO
C 3 YES C 3 NO
[ 3 YES [ 3 NO
C 3 YES C 3 NO
C 3 YES C 3 NO
[ 3 YES C 3 NO
C 3 YES • C 3 NO
b. In what nonnursing p r o f e s s i o n a l o r g a n i z a t i o n s are you a member?
ORGANIZATION
NUMBER OF OFFICES HELD
c . On what community programs or committees do you/have you served?
PRESENTLY SERVE
FORMERLY SERVED
HO
33a. P l e as e i n d i c a t e i n v o l v e m e n t you have had i n r e s e a r c h a c t i v i t i e s :
P rincipal
investigato r
[ ] YES
[ ] NO
C o-investigator
[ ] YES
C ] NO '
Research A s s i s t a n t
[ ] YES
C ] NO
P articipate
[ ] YES
C ] NO
b. What c o n t r i b u t i o n s have you made t o n u r s i n g l i t e r a t u r e , media
p u b l i c a t i o n s , o r p r e s e n t a t i o n s a t c o n f e r e n c e s o r symposiums:
NUMBER
Journal
a rtic le
■ C ] YES
[ ] NO
C ] YES
[ ] NO
' C ] YES
[ ] NO
Media p u b l i c a t i o n
Symposium o r c o n f e r e n c e
presentation
Other
(please s p e c i f y )
34.
How would y o u . d e s c r i b e " s u c c e s s " i n t he r o l e o f n u r s i n g
adm inistration?
35.
Pl eas e i n d i c a t e y o u r age group and sex:
36.
37.
C ]
under 30
[
Female
]
[ ] 30- 39
[ ] 40-49
[ ] 50-59
[ ] Male
Pl eas e i n d i c a t e y o u r c u r r e n t m a r i t a l
[
] Never m a r r i e d
[
] Married
[
] Separat ed
[ ] D i v o r c ed
status:
[ ] Widow/Widower
Pl eas e i n d i c a t e y o u r p r e s e n t s a l a r y range per y e a r :
[ ] under $15,000
C ] $15, 000 - $19,999
[ ] $20,000 $24,999 ■
C ]
$25, 000 $29, 999
[
]
$30,000 $34, 999
C ]
$35,000 $39, 999
'[
]
$40, 000 - $44, 999
[
]
$45, 000 $49, 999
[
]
$50,000 o r more
[ ] o v er 59
Ill
38.
Which o f the f o l l o w i n g b e n e f i t s are provi ded by your i n s t i t u t i o n ?
(check a l l t h a t a pp l y )
[ 3
Expense account
P r of e s s i o n a l o r g a n i z a t i o n
dues or membership fees
Nonnursing o r g a n i z a t i o n a l dues
Expenses f o r p r o f e s s i o n a l
meetings
T u i t i o n reimbursement
Meal s
Housing/home allowance
Major medical plan
D i s a b i l i t y plan
Soci al s e c u r i t y
P e n s i o n / r e t i r e m e n t plan
L i f e insurance
Stock o p t i o n / p r o f i t shari nq
T a x - s he l t er e d a n n u i t y def er r ed
compensation Club membership
39.
Are you a member o f a r e l i g i o u s order?
40.
A d d i t i o n a l comments:
C ]I
C ]I
[ I
C I
[]
C
[
[
C
C
[
C
[
C
I
]
]
I
I
]'
I
]
I
3 C r e d i t cards
3 Bonus i n c e n t i v e
3 C l o t hi n g allowance
3 Gas mileage
3 AutomobiIe
3 Free or reduced par ki ng
[ 3 Moving expenses ( a t h i r i n g )
C 3 P r of es s io na l j o u r n a l
subscriptions
[ 3 Sabbat i cal o p t i o n
[ 3 More than 10 annual paid
s i c k leave days
C 3 More than 7 pai d ho l i d a ys
C 3 M i l i t a r y leave
[ 3 More than 3 weeks v ac at i on
C 3 L o a n / f i n a n c i n g o pt i on
C 3 •Other (please s p e c i f y )
[ 3
C
C
C
[
[
C
[ 3 YES
[ 3 NO
THANK YOU FOR YOUR PARTICIPATION IN THIS RESEARCH STUDY
112
APPENDIX C
LETTER OF RESPONSE TO USE ASNSA QUESTIONNAIRE
113
A m e ric a n S o c ie ty fo r
N u rs in g S e rv ic e A d m in is tra to rs
o f rhc A m erican
H o sp ita l Association
fi4U N o rth Lake Shore D rive
C hicago, Illin o is A llfil I
Telephone j 12.2X11.64 IO
December'5, 1983
Avis Penerson
525 Souch Fifth St. East
Apartment C
Missoula, MT 59801
Dear Avis
•
■
Enclosed is a copy of the questionnaire.used for the 1977 Survey of Nursing
Service Administrators in Hospitals. The questionnaire is not copyrighted
so there is no: problem in your using the questions. May I suggest that
if you use the questions you indicate that they were adapted from the
ASNSA and AHA survey.
For the 1977 survey, questionnaires were sent to 7,084 hospitals and
5,326 responded. Questionnaires were sent to 66 hospitals in Montana.and
42 responded.
This was a 63.6 percent response.
Best of luck on your study of Montana nursing service administrators. We
would greatly appreciate knowing the results of your study when they are
available.
'
'
Janine A. Swent, R.N.
Director
ns
enc.
MONTANA STATE UNIVERSITY LIBRARIES
3 762 100
77 6
Y An
N378
P4403
cop. 2