The nurse manager is an "individual employed by an organisation who is responsible for efficiently accomplishing the goals of the organisation," according to Eleanor Sullivan and Phillip Decker, authors of "Effective Leadership and Management in Nursing," This means that a nurse manager must strike a balance between administrative and patient-care aspects of the position. The most effective nurse manager "possesses a combination of qualities: leadership, clinical expertise, and business sense," according to Ruth Tappen, Sally Weiss and Diane Whitehead in "Essentials of Nursing Leadership and Management."
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The "autocratic" manager assumes individuals are motivated by external forces or authority, according to Sullivan and Decker. This manager makes all of the decisions and directs all of the behaviours of the subordinate nurses. Therefore, this manager creates a centralised authority system in which everyone knows her function and what is expected. However, problems may arise if a nurse must wait for the manager's decision or direction before taking action regarding a patient.
The "democratic" manager assumes that individuals are motivated by internal forces or personal integrity, according to Sullivan and Decker. This manager relies on participation from the nursing staff. Decisions are based on a consensus or majority opinion. While this type of management style values the input of the entire staff, there may not always be time to form a majority opinion when a patient's health, or life, depends on fast action.
The "laissez-faire" manager assumes individuals are motivated by internal forces or personal responsibility, according to Sullivan and Decker. This manager leaves the staff alone to do their work. The laissez-faire manager offers little direction or facilitation to the nursing staff, instead relying on the expertise of the staff. However, in patient care, circumstances often arise in which administrative direction or approval is needed and this "hands-off" style offers little help to the nurse in these situations.
The "bureaucratic" manager assumes individuals are motivated by external forces, or organizational authority, according to Sullivan and Decker. This manager does not trust herself in decision-making and relies completely on the organisation policies and rules. This type of management is called "deontological," and it provides a clear starting point for actions. However, it offers little help when rules or procedures do not precisely apply to current circumstances.
The "structure initiating" manager assumes individuals are motivated by external forces, particularly clearly organised and defined goals, according to Sullivan and Decker. This manager is called "teleological" because of the emphasis on goals. This manager creates work patterns and methods, channels of communication, and defines the roles of the nursing staff. While this manager works toward excellent patient care, the focus on the creation and defining of patterns and methods may cause this manager to lose sight of traditional, and proven, models of care.
The "consideration" manager assumes individuals are motivated by external forces, or relationships, according to Sullivan and Decker. This manager takes an employee-centred approach. The manager engenders trust, warmth, respect, friendship and rapport among the staff. Decision-making involves the entire staff. The manager addresses the needs of the work group as a whole. While this style creates a favourable morale and work environment, most experts would argue that nursing should be patient-centred.
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