Conflicts of practice confronting second line nurse managers in an accident and emergency department. Part 2

Emergency nurses' perceptions of their role in responding to escalations of care for clinical deterioration

BACKGROUND

Clinical leadership is fundamental to patient safety. The Emergency Department (ED) nurse-in-charge is a key leadership role; however, few studies have explored the management of clinical deterioration from the ED nurse-in-charge perspective. The aim of this study was to explore ED nurses-in-charge' perceptions of their role in responding to episodes of escalation of care for clinical deterioration of ED patients.

METHODS

A prospective exploratory descriptive design was used to address the study aims. The study was conducted in an urban ED in Melbourne, Australia. Senior emergency nurses who fulfilled the role of being in charge of the ED were invited to participate. In-depth semi-structured interviews were conducted between December 2015 and March 2016. Interview transcripts were analysed using thematic analysis.

RESULTS

Two major themes, each with two subthemes were identified. The first major theme of Clinical Risk Management comprised sub-themes of Clinical Skills and Confidence. The second major theme of Resource Management comprised sub-themes of Human Resource Management and Logistical Resource Management.

CONCLUSIONS

Strong collaboration, logistical and clinical risk management roles were perceived as fundamental to the nurse-in-charge's capacity to respond to escalations of care for clinical deterioration within in a complex team environment such as the ED.

From caring to managing and beyond: an examination of the head nurse's role

AIM

The aim of this study was to depict the essence of what head nurses do, and how they perform their managerial role.

METHODS

To achieve this, the work behaviour of 48 head nurses was examined by a semi-structured observation technique for 6 hours each.

RESULTS

Results demonstrated that head nurses spent a large proportion of their time in clinical practice, followed by co-ordinating care, operating the unit's functions, and leading staff. Personnel management and quality improvement occupied only a marginal share of head nurses' time.

CONCLUSIONS

These results implied that head nurses exhibited a management style orientated to maintenance rather than to re-creation, focusing more on the 'doing' and the 'here and now' aspects of the job than on leading, planning, and proactive problem solving.

Performance of first-line management functions on productivity of hospital unit personnel

Eight management functions influence the productivity of unit personnel differently. Although leadership of the first-line manager is the primary driving force, time and effort expended in operations detract from this unit output. Better use of second-line managers is a choice strategy to enhance productivity. Benner's model of professional development, in combination with the creation of a first-second line shared leadership operational framework, is recommended, with follow-up evaluations on unit productivity effect.