Running head: ANALYZING A LEADER
Analyzing a Leader or Manager Role
Adetunji O Ojo
Ferris State University
ANALYZING A LEADER
Introduction
This paper is the analyzed interview with Sam Mignoni, the Chief Nursing Officer
(CNO) of Great Lakes Specialty Hospital (GLSH), Grand Rapids Michigan. Sam, as he would
like to be called, joined Select Medical Group in May 2012, as the CNO at the Saginaw location.
On November 22, 2013, he transferred to the Grand Rapids location as the third CNO. Before he
joined Select hospital group, he was a nurse manager at McLaren hospital in Flint, Michigan.
This facility is a 36-bed progressive cardiac care unit. Sam attended Boston University where he
obtained his Bachelor of Science in Nursing (BSN) in 1979, he was certified Advance Cardiac
Life Support (ACLS), and Basic Life Support (BLS), with both expiring in 2014. In 2013, he
completed the course study for Master of Science in administration (MSA) from Central
Michigan University, Mount Pleasant, Michigan.
Sam has been a nurse for more than 35 years, and his wealth of experience made him
suitable for his role as the CNO of GLSH. Other functions in his previous roles over the years
include Clinical Care Coordinator, Assistant Director of Nursing, and staff nurse. These roles
coupled with accompanied experience have equipped him with first hand expectations of staff
nurse to and from a nurse manager, thus allowing him to switch roles with his staff members
either when resolving conflict or providing education on standard of care.
Chief Nursing Officer Responsibilities
As the CNO, Sam is responsible for day-to-day management of the nursing department
and personnel; including the Charge Nurses, Wound Care Nurse, Registered Nurses, Certified
Nursing Assistants, Rehabilitation personnel, Telemetry Monitors, and Unit Secretaries, staffing
the unit to acuity of care and budget, maintaining quality standard to TJC/state laws/CMS
guidelines. He provides supervision of care in compliance with Evidence Based-Practice, CNOs
ANALYZING A LEADER
also educate staff members to new practice standards and foster development of frontline staff to
unit based policy and protocol. He also strives to maintain a positive work environment and
problem-solving to achieve organizational goals and objectives. The CNO reports directly to the
Chief Executive Officer (CEO), and he is considered second in command according to the
hospital’s organizational chart.
Collaboration
The CNO works in collaboration with the Chief Executive Officer (CEO) of the hospital
in the administration of the hospital’s most important department (Nursing). He also
collaborates with the leadership team including Director of Quality (DQM), Physicians,
Materials Manager, Medical Records, Business development, and Physicians. He also
coordinates care with contract agencies like Radiology, Laboratory Services, Staffing Agencies,
Dietary Services, Davita (hemodialysis), and Advantage Health medical group. The CNO
coordinates admission process by reviewing all potential candidates, and determines if the
hospital can provide the kind of care required. He also confirms with the admission coordinator
if the patient meets criteria to be admitted into the hospital level of care.
The charge nurses on the unit report directly to the CNO, and they also refer to him when
they need guidance about hospital policy or protocol. All clinical decisions are made by the
CNO, with qualitative care as the common goal of the leadership team. Findings or incidences
are discussed with the Director of Quality Management (DQM) and addressed appropriately
following the hospital rules and regulations in conjunction with conditions of participation with
The Joint Commission (TJC)
Legal and Ethical Issues:
Sam makes sure that staff members display professionalism at all times. The most
ANALYZING A LEADER
common ethical issue in nursing is verbal outbursts from staff members to patients, due to
ineffective stress management. This usually leads to a low patient satisfaction score and the risk
of lawsuit for the hospital. To address this, alarm fatigue was addressed by the CNO to eliminate
excessive alarms on the floor, thus reducing the stress on the staff members. The insensitive
probe used by the Respiratory Department was discontinued, and replaced by more sensitive one;
this reduced unnecessary alarm by more than 30% on the unit. This is consistent with the ethical
decision-making framework of weighing available options and arriving at the desired goal or
outcomes (Yoder-Wise, 2014, Pg. 93)
Power:
I asked Sam if the power of his office is adequate for effective running of the unit, and he
answered “yes, the CNOs power is adequate, it must be used carefully, respectfully, and
honestly”. He also said the CNO need to be consistent with the application of rules and be fair
across the board. Staff members must be dependable, and this is the reason why the CNO must
make sure staff members licenses are renewed when due, and failure to renew a license or keep it
current will lead to the staff member’s removal from the schedule until license is valid for
practice. This is consistent with nurse’s control in three domains: control over the content of their
practice, control over the context of their practice, and control over their competence
(Manojlovich, 2007). Some examples are RN license, ACLS, and BLS certificates, all must be
current for staff member to perform their duties on the unit. Power of office came from the
ability to enforce the rules and regulations as set up by the hospital, and when patients complain
about staff members, it is the CNO that will address the issues with the staff involved, while
providing feedback and re-assurance to the patient. The CNO sometimes delegates staff
education to the DQM as needed. Sam loves to develop staff to be reliable and therefore
ANALYZING A LEADER
requiring less supervision. This is the case with Charge Nurses who are in charge of the unit in
the absence of the CNO and this follows the Functional Model of nursing care delivery (YoderWise, 2014, Pg. 254).
Decision-making and problem solving:
Sam stated that his decisions are guided by consensus from research findings, EBP, and
hospital policy. He loves to gather information and analyze that data before making the final
decision. “No snap decision” he said.
He starts by investigating the problem/issue to understand the reason why the problem
exists in the first place, then offers solutions to fix the problem and prevent future occurrences. A
good example was a time when an RN, who was on anti-psychotic medication, was thought to be
under the influence of narcotics on the job because her medication was being adjusted. The staff
member was allowed to take some time off and she resumed working when she was competent to
work again. This leadership quality is evident of management Sam’s education and experience,
and therefore he is more effective as a manager than managers without experience or
management education. According to Manag, “managers with management education and
experience are usually more effective as managers when compared with managers with no
experience or management education”. (www.ncbi.nlm.nih.gov).
Management Style:
Sam is firm, stern, open, honest, and respectful. When he schedules staff members for
private coaching for performance issues, there must be a witness, preferably the human resource
coordinator, to address issues with non-compliant staff. The reason for this is to document each
occurrence, in case of employee termination; it protects the hospital from frivolous lawsuits from
disgruntled ex-employees.
ANALYZING A LEADER
Sam also prefers direct communication when addressing issues with staff members. Even
though e-mail is good for meetings and contact information, direct communication or physical
interaction is the best way to engage the staff members. Nothing works better than direct contact,
this is important for building trust and accessibility. You cannot ignore people and expect to get
anything done. According to Sam, “A good example was when I received an email from a staff
member; I called the people involved to my office, and worked through it.”. Sam also tries hard
to avoid the leadership trap, which is when managers do not get back to staff members or follow
up on issues, and the manager has the tendency to become less effective.
Conflict Resolution:
Sam defines conflict, gathers the necessary information, and then finds ways or means to
resolve the issue. According to Yoder-Wise “some staff can be difficult to work with, so
managers must remain focused on the problem and not the personalities of the team members”
(Yoder-Wise, 2014, Pg. 475). Common core issues are usually related to respect. He expects
staff members to treat each other with respect. This promotes harmony and positive patient
outcome. Sam does not schedule unreliable per diem staff, but full time employees must work a
certain number of hours every pay period to maintain employment with GLSH. After a period of
non-schedule of per-diem staff, the hospital has the legal right to terminate their employment,
thus opening positions for potentially reliable candidates.
Conclusion
Sam has succeeded as the CNO of Great Lakes Specialty Hospital, Grand Rapids because
of his leadership qualities, honesty, and ability to carry his staff members along when making
major decisions. He also utilizes the 16 standards of nursing practice and 9 provisions of
professional ethics to get the best care for his patients by ensuring the nursing staff members are
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responsible, competent to do their jobs, and accountable for own actions, and delegated care.
(ANA, 2010)
ANALYZING A LEADER
References
American Nurses Association. (2010). Nursing: Scope and standards of practice (2nd ed.).
Silver Spring, MD: American Nurses Association.
Manojlovich, M. (January 31, 2007). "Power and Empowerment in Nursing: Looking Backward
to Inform the Future". OJIN: The Online Journal of Issues in Nursing. Vol. 12 No. 1,
Manuscript 1. DOI: 10.3912/OJIN.Vol12No01Man01
The perceived problem-solving ability of nurse managers. Retrieved on March 27, 2014 from:
http://www.ncbi.nlm.nih.gov/pubmed/16787468
Yoder-Wise, P. S. (2014). Leading and managing in nursing: Revised reprint (5th ed.). St. Louis,
MO: Elsevier Inc.