Running head: ANALYZING A MANAGER
Analyzing a Nursing Unit Manager
Jonathon Rospierski
Ferris State University
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ANALYZING A MANAGER
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Analyzing a Nursing Unit Manager
Anita Baggiani is the unit manager on the cardiac/telemetry floor of Lakeland Regional
Hospital in St. Joseph, MI. She began her career as a nursing assistant in the critical care unit at
that hospital before attending nursing school. She obtained a Bachelor of Science in Nursing
(BSN) degree from Ferris State University that led to a position as a registered nurse (RN) on the
cardiac/telemetry floor. Ten years of hard work led to warranting a position that became
available as the manager of that unit. The qualifications of that position required a BSN, at least
five years of practicing as a RN, and at least three years working in the cardiac specialty area of
nursing. With hard work, determination, a willingness to lead and advance, and experience,
Baggiani earned the position of leading the staff working on the cardiac/telemetry unit. This
paper is going to analyze her role within the hospital system, the different issues that arise for a
nursing manager in her position, and how she approaches those issues (A. Baggiani, personal
communication, March 15, 2014).
Job Duties
Main Duties
As manager on the unit, Baggiani’s main duty deals with the daily operations of
maintaining a safe and caring environment for her staff to offer the best service for the patients
that are under her care. She is the leader for the RNs and nursing assistants on the floor and also
oversees the technicians that cover the centralized telemetry and video monitoring of patients
throughout the health system. Staffing, in terms of hiring, scheduling, and orienting, are duties
that she analyzes weekly. Issues that arise from the staff allow for her to use corrective action
procedures, while problems with patients utilize her customer service skills. Business skills such
as financing and payroll are covered for floor operatives. Baggiani leads educational initiatives
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and works with other disciplines while focusing on the policies and procedures that exemplify
the mission and philosophy of the hospital so as to best serve its patients.
Organizational Chart
In maintaining the consistency and fluidity of the unit, Baggiani is held accountable for
her actions and decisions just as the staff she leads. As middle-management, she works directly
under the Director of the medical-surgical units. The Director reports to the Executive Director
of nursing who works with the Vice-President. They participate under the direction of the
President of Lakeland Regional Health system. Each level of management works together for the
patients’ interests.
Collaboration Roles
In order to best lead the floor, Baggiana must work with others. She has admitted that she
could not do it alone, and that she needs everyone working together for her to succeed (A.
Baggiani, personal communication, March 15, 2014). Yoder-White (2014, p. 63) agrees that,
“Collaboration requires one to be flexible and broad-minded and to have a strong self-concept.”
Every unit manager works together with her on the Joint Management Team and meets monthly
to ensure that consistency exists throughout the health system. There is a monthly meeting with
the Director to assure inter-departmental unity for a caring environment to exist. There is work in
collaboration with the leaders of the nutrition department, laboratory, housekeeping, and
transport on a weekly basis to ensure the floor has its services. Finance is an important issue that
includes those that help with scheduling and billing so as to maintain a fiscally responsibility that
ensures patient safety by providing an adequate and qualified staff. Baggiani cannot be present
all of the time, so she works with the floor’s resource nurse and the charge nurses regularly for
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updates, suggestions, and other important exchanges. Collaboration is utilized on a daily basis as
a leadership strategy.
Legal and Ethical Issues
Currently there is a patient on the unit whose family does not want him to have a code
status of do not resuscitate (DNR). They are determined that the patient will get better, even
though doctors have insisted otherwise. As the manager of the floor, Baggiani must incorporate
skills as a customer service representative to the family and as an ethical adviser to the staff for
the true process. Doctors are mentioning the use of a “slow code” if the patient requires
cardiopulmonary resuscitation (CPR). Baggiani has implored the staff to perform CPR as they
would any other patient. In the meantime, she has consulted the Ethics Committee to clarify the
discrepancies that are causing confusion. Lantos and Meadows (2011) state that a slow code
should be used when CPR is not effective, the decision of the right code status for the patient is
not enacted, and those family members cannot agree to a DNR status for which the doctors
believe is the right choice. The American College of Physicians ethics manual says to consult an
ethics committee since they cannot come to an agreement with the family (Snyder, 2012).
Baggiani has counseled the family about the process the hospital wishes to take with the Ethics
Committee. The family and the staff have been insured that the wishes are to be served as the
present order. Collaboration with the family, the staff, and the hospital on taking the correct
measures to ensure the ethical responsibility of the patient’s life, code status, and best interest
have been taken into account.
Power and Influence
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Baggiani is not always present on the floor. She must rely on different staff members as a
representative of herself when she is not physically present. A son of a patient was concerned
because they had to move to semi-private room in the middle of the night due to the
unavailability of a private room for an isolation patient. The charge nurse came into the room
and used skills learned from his manager by providing a listening ear for the son, and giving the
customer service and reasoning that they deserved. He told the family the health of the patients
could be compromised if patients did not move. In the morning, Baggiani became aware of the
situation and spoke with the son. The same skills that were taught to the charge nurse were used,
and notified the son of her willingness to relinquish power in the absence. This power enabled
the charge nurse to deliver leadership care during her absence.
Empowerment for nurses may consist of three components: a workplace that has the
requisite structures to promote empowerment; a psychological belief in one’s ability to be
empowered; and acknowledgement that there is power in the relationships and caring that
nurses provide. (Manojlovich, 2007, p. 1)
The manager used her power to delegate the control that was needed allowing the unit to
function effectively in her absence. It also showed the patient’s family the type of influence the
manager has on her staff and other patients, resulting in a better understanding and experience.
Decision Making and Problem Solving
Falls had been occurring frequently over the past year on the unit. As a result, Baggiani
held a Joint Management meeting to discuss the issue and presented the use of a centralized
monitoring system to observe patients who would rather require a 1:1 observer. She also
instituted new policies to identify high-risk fall patients as new protocol (A. Baggiani, personal
communication, March 15, 2014). Yoder-Wise (2014, p. 101) notes that, “The hallmark of
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decision making is the identification and selection of options or alternatives.” The video
monitoring is used throughout the hospital system under her departmental lead. Jeffers et al
(2012, p. 298) showed that falls become reduced and, “The Centralized Video Monitoring
program reallocated the underutilized talents of Certified Nursing Aide sitters as video
monitoring technicians to meet the challenge of delivering high-quality, cost-effective patient
care.” Through decision making skills and problem solving ability, the hospital has saved money,
staff has not been limited by the focus of a single patient, and that patient has been remaining
safe from a fall through the monitoring from a centralized location. The decision making abilities
has made her an effective member of the leadership team.
Management and Conflict Resolution
Conflict exists. The manager must, “Engage in conflict-management strategies to prevent
or resolve conflict within nursing environments to ensure quality and safety” (Yoder-White,
2014, p. 475). It has also been noted that conflict coaching is an effective method to improve
interaction communication and interaction skills (Brinkert, 2011). A patient and a nurse were
having an argument one day over fluid restrictions that almost grew to a poor outcome. Baggiani
intervened with the nurse to identify ways to handle the situation and the patient’s persistency.
Information was provided that through calm listening and professional approach, the nurse could
identify the patient’s strengths and weaknesses. The nurse then could collect ways to better
identify with the patient’s situation and involve the family to resolve the situation (A. Baggiani,
personal communication, March 15, 2014). The nurse and patient came to an agreement that the
patient could apply to his life. The patient changed his attitude through the help of the nurse and
his family, and the nurse learned a lesson in resolving conflict by the advice given by the
manager.
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Conclusion
Baggiani has demonstrated the ability to effectively lead and manage the
cardiac/telemetry unit. Examples of evidenced-based research and theory have been
demonstrated in her practice. These examples have provided the safe and effective care that
patients deserve, the guidance that the staff heeds, and the respect and security that the hospital
has in her as a leader. Attitude and leadership are an educational example for the staff.
Communication with patients and their families are commendable, and the hospital has benefited
from the leadership.
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References
Brinkert, R. (2011). Conflict coaching training for nurse managers: a case study of a two‐hospital
health system. Journal of Nursing Management, 19(1), 80-91.
Jeffers, S., Searcey, P., Boyle, K., Herring, C., Lester, K., Goetz-Smith, H., & Nelson, P. (2012).
Centralized video monitoring for patient safety: a Denver Health Lean journey. Nursing
Economic$, 31(6), 298-306.
Lantos, J. D., & Meadow, W. L. (2011). Should the “slow code” be resuscitated?. The American
Journal of Bioethics, 11(11), 8-12.
Manojlovich, M. (2007). Power and empowerment in nursing: Looking backward to inform the
future. The Online Journal of Issues in Nursing, 12(1), Manuscript 1.
Snyder, L. (2012). American College of Physicians Ethics Manual Sixth Edition. Annals of
Internal Medicine, 156(1_Part_2), 73-104.
Yoder-Wise, P. S. (2014). Leading & Managing in Nursing (5th ed, Rev). St. Louis, MO:
Saunders.