Nurse managers Nurses or Managers?

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Arlene Wade
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1 Nurse managers Nurses or Managers? Paper to the 30 th International Labour Process Conference, March 27th 29th 2012 Stockholm, Sweden Associate professor Jörg W. Kirchhoff Østfold University College, Faculty of Health and Social Services 1757 Halden, Norway Professor Jan Ch Karlsson Østfold University College, Faculty of Business, Languages and Social Sciences,1757 Halden, Norway

2 Background Trends toward professional New Public Management Organisational Fads ( flat organisations) Legislation regarding public services (eg. clients rights and employees obligations in Norway) Result An increased bureaucracy in public services However Nurse managers and nurses (professional employees) are reluctant to embrace the concept of professional (Ackroyd et al 2007, Bolton 2000) How interpret nurse managers in health care enterprises (in Norway) their role as manager? Do nurse managers interfere within or manage the labour process of professional work?

(professional employees) are reluctant to embrace the concept of professional (Ackroyd et al 2007, Bolton 2000) How interpret nurse managers

3 Data Compilation Respondent Method Participating observation In depth interviews Focus group interviews Number of informants Managers 4 interviews 4 informants Coordinators 1 interview 3 interviews 10 informants Registered nurses 4 field notes 1 interview 3 interviews 15 informants Auxiliary nurses 4 field notes 4 informants Care workers 4 field notes 4 informants Home helpers 4 field notes 4 informants Empirical data 16 interviews 6 interviews 6 interviews 28 int.. 41 inf. 3

field notes 1 interview 3 interviews 15 informants Auxiliary nurses 4 field notes 4 informants Care workers 4 field

4 Modes of Management Two Ideal Types Managements main purpose Professional Administration Provide services in accordance with professional standards Professional Management Provide services in accordance with financial resources Rationales of power Formal position in a social structure Professional knowledge and standards Credibility among colleagues Formal position in a social structure Skills divorced from productive expertise Rational and objective personality Means or How to manage employees? Providing resources in order to gain professional quality Support staff on professional issues Involvement in operational matters Professional discretion (Decentralized responsibility) Formal standards / procedures Control of the Labour process Decentralized responsibility

structure Skills divorced from productive expertise Rational and objective personality Means or How to manage employees?

5 The Cases Providers of Public Services Manager (Registered nurse) Coordinator(s) Management in disguise (Assigned to coordinate and assign tasks to employees) Operating core (four occupational groups) Providing social and health care services, based on standardized service contracts. Case 1 Case 2 Case 3 Case 4 Employees ca.100 ca. 125 ca. 50 ca. 50 Units Coordinators (3+1) 1

groups) Providing social and health care services, based on standardized service contracts.

6 Case 1 Mode of Main Purpose of Main Rationales of Power Management mainly through Interaction with employees Professional Management Provide services in accordance with financial resources From now on our services are based on financial registrations in our system. I think that s very good. It s like taking a car to a garage what you pay for is what you get Formal position in a social structure and supervisors credibility: My role as a manager is clearly defined in my job prescription. I know what I have to do and what I m accountable for. It s quit clear to me what my supervisors are expecting from me. Decentralized responsibility (coordinators, teams of employees and nurses) My coordinators must pay attention to the service contract and the services provided to clients. I really don t care whether a contract is to demanding or not, that s nothing I waste my time on. I spend my time on how my coordinators are performing their job. Lack of participation in employees work or difficulties encountered by them.

It s like taking a car to a garage what you pay for is what you get Formal position in a social structure and supervisors credibility: My role as a manager is clearly defined in my job prescription.

7 Case 2 Mode of Main Purpose of Main Rationales of Power Management mainly through Interactions with employees The Professional Administrator Provide services in accordance with financial resources, but most in accordance with professional standards: Some times, occasionally, we can be flexible if there is a need for something, although it isn t approved by the service contract. Formal position in a social structure and supporting subordinates (coordinators): I m very little involved in what people are doing, but try to point out direction and encourage my coordinators and make people work together. (manager) When there is trouble ahead we go to her (manager) and she is taking over and helps us out (Coordinator) Decentralized responsibility and coordinators: I like our organisational model. Especially that all employees are accountable and obliged to involve in their own work, and thereby they can influence their working conditions. Size and managerial obligations make it impossible to engage in employees work.

Formal position in a social structure and supporting subordinates (coordinators): I m very little involved in what people are doing, but try to point out direction and encourage my coordinators and

8 Case 3 Mode of Main Purpose of Main Rationales of Power Management mainly through Interactions with employees The Hybrid Manager Provide services in accordance with clients needs and within financial resources available: I would rather have framework financing and more educated employees, so they can provide services that meet clients needs. Formal position in a social structure, credibility from supervisor, coordinators and employees: Fortunately my door is always open and colleagues can come to me and let out their frustration, and then I try to solve the problem. Decentralized responsibility and coordinators My concern is that every employee is accountable for the job and for every decision taken in relation to their clients. Frequent formal and informal encounters through discussions and meetings among employees

Formal position in a social structure, credibility from supervisor, coordinators and employees: Fortunately my door is always open and colleagues can come to me and let out their frustration, and

9 Case 4 Mode of Main Purpose of Main Rationales of Power Management mainly through Interactions with employees The Petrified Manager Lack of Management Provide services in accordance with professional standards: Service contracts are a point of departure. Our services are based on a professional judgment of our clients needs. Formal (isolated) position in a social structure: There are too many projects going on and I have no one to help me out. I struggle to cope. Decentralized responsibility and The Coordinator : Every employees is in charge of a group of clients and responsible for the coordination of services to their clients. T. (coordinator) has taken over these meetings, so I m not participating anymore, since she is more up to date on the information about clients. S. is the manager, but occasionally do I take care of practical issues. After all I m also a union representative. (The Coordinator) Occasional interaction with employees but primarily with nurses.

Formal (isolated) position in a social structure: There are too many projects going on and I have no one to help me out. I struggle to cope.

10 Preliminary Conclusions A formal position with increased financial accountability and steered activities projects initiated from above Similar condition, but different outcomes variety in style Management s style depending on their rationales for power Credibility through membership with supervisors / peer groups Credibility through leadership of those that have received managerial power (coordinators) Credibility through participating in employees work (e.g. counseling) Decentralized responsibility Two reasons Management means to manage employees My employees must take the consequences of their decisions. Inherent in the services provided All employees, both professionals and the other occupations are accountable for the content and quality of services.

managerial power (coordinators) Credibility through participating in employees work (e.g. counseling) Decentralized responsibility Two reasons Management means to manage employees My employees must take the consequences of their decisions.

Regional Social Work Co-ordinator. Interpersonal Skills Physical Effort Concentration Complexity

Job Class Profile: Regional Social Work Co-ordinator Pay Level: CG-46 Point Band: 1190-1253 Accountability & Decision Making Development and Leadership Environmental Working Conditions Factor Knowledge