Analyzing a Leader or Manager Role

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Analyzing a Leader or Manager Role

Charlie Dietrich

Ferris State University

Analyzing a Leader or Manager Role

Nurses take on many roles during their careers. Nurses can be bedside caregivers, instructors, independent clinicians, and leaders in management roles. There are many titles that nurses can obtain throughout their personal career experiences especially as you move up the ladder into management. . This paper presents a nurse who has chosen to expand her career in nursing by taking on the role of Emergency Department/Acute Care Manager in a small community hospital in Kalkaska, Michigan.

Liz Birgy began her career in healthcare education with a BSN from Grand Valley State University. She said that she was able to obtain a lifelong dream of being a nurse with the help of a scholarship from Kalkaska Memorial Health Center. On top of her school education she created a foundation in patient care by working during the off semesters at Kalkaska Long Term Care. She said that she enjoyed her time with the residents finding out activities they were interested in like bingo and coming up with new ones to make their days more interesting. She also found extra time to learn how to become a CENA so that she could develop some of the skills necessary later on in patient care. After graduating from Grand Valley she states that she had considered staying down in the Grand Rapids area and getting a job at a local hospital with jobs already on the table. Even with the temptation of good jobs at a big hospital she had two factors that made her come back to Kalkaska to work, family and scholarship commitment. She took a job in the emergency department and because of the close connection there is the acute care section with IV therapy. During the past few years the hospital has grown and individuals have retired opening up opportunities for individuals to advance. The door opened up when the former emergency manager, Christine, took on a higher position of Service Line Director responsible for more hospital wide departments. There were up and coming healthcare changes with CMS and implementation of policies to stay compliant. Christine had saw this ahead of time and looked for anyone willing to take the lead in these changes. Liz stepped forward and took on the leadership role by establishing current hospital practice like POE/POM(physician order entry), First Net and to my surprise she took the lead on initiating Powerchart and Kalkaska Hospital before Musnon Hospital brought it in. Not only did she take on the leadership role on these programs she took on the responsibility and the complexity of building the hospitals vision for the future. She said that initially it was a difficult decision because she enjoyed patient care but looked forward to the new challenge of being a manager. While transitioning into the role of emergency manager she is also taking on the responsibility or orientating new staff to the department. “Staff nurses at the bedside 24 hours a day, seven days a week are on the front lines and have a distinct power to influence sustainable outcomes and productivity” (Valentine, 2002). Pursuing advanced degrees in nursing contributes to the autonomy and professionalism of nurses. She realizes she has a long ways to go before she becomes the manager she wants to be. She has made several moves towards those goals by attending conferences on business management, networking with other managers and when the time is right going for a dual program at Saginaw Valley State University. She would like to take the program that combines both management and education.

The interview was conducted in an informal, face to face, question and answer style. The questions were written based on the objectives of the assignment. The focus of the interview was to gain a better understanding of nurses in manager roles. An analysis of the information obtained, provides evidence for the effectiveness of this manager and her role as a leader. Exploring nursing leadership theories and standards practiced support the managing style of this leader are identified. The importance of effective leaders and their influence on healthcare, as a whole, contributes to positive patient outcomes. It is important that leaders and managers be competent in their leadership positions. This competency should be based on an evidence based practice which involves the application of nursing theories. Their decisions affect patients, staff, and organizations as a whole.

Roles and Responsibilities

Liz role right now is a combination of ER nurse and ER manager. She is currently training other nurses while being trained herself into the role of manager. The field of nursing management involves supervision of various personnel who directly provide nursing care to patients (Yoder-Wise, 2011, p. 75). As the nursing manager, Liz is responsible for approximately 8 ER nurses and 2 Acute Care nurses and making sure there is a balance between the two departments. Liz stated that “Creating a balance between staff members who have clinical experience and those who have recently entered the critical care unit is challenging, it is easy to get pulled into one department and forget about the other” (personal communication, Oct 6, 2014). There are also 4 nurse aides that work between the two departments she is responsible for. While doing all this from the manager’s position she has been involved in the hiring process of new staff. A couple of very important manager duties she has had to take on are updating job descriptions and coming up with a strategic plan for the future of inpatient population in acute care. She feels that this is important because down the road she’ll have the right people in place so that she can focus on her job as a manager. Managers must be a role model and offer support to not only those that directly report to them but also to peers and health care executives. On the organizational chart she reports to the former ER manager, Christine who reports to the COO, Sheila. Liz is also co-developing a manager’s survival guide for other would be future managers looking to benefit from extra resources.

Communication and Relationship Building

Liz spoke of how the former ER manager practiced an open door policy and would continue to use this method with staff to keep them aware of future events. Liz states (personal communication, Oct 6, 2014), that consulting the managers regarding their past experiences can provide an avenue for new managers to achieve certain goals related to management issues.

One saying that she says she learned from a past conference and believes in is “if you permit it then you promote it”. This is a saying that she has had to reference because of her new leadership role and some of the substandard work she saw from other staff while working on the floor. Even though no one else stepped up to take on this role of future manger there are nurses working in the department that feel she doesn’t deserve it. Liz says that she is hoping to create job descriptions that have expectations so that everyone is treated fairly and there is less complaining while maintaining great patient care. According to Yoder-Wise (2011), “a critical factor in being an excellent nurse manager is to understand how to ensure optimal patient outcomes, involve families or significant others in the plan of care, and allocate resources and technology in a fair and ethical manner” (p. 59).

Knowledge of Health System

Liz stated she never realized how much goes on behind the scenes in healthcare once you get off the floor. She states that she has learned a lot from networking with other individuals in the same position. She has taken it upon herself by contacting the staff at the Munson Hospital ER to answer questions or bounce ideas off them in regards to new policies and coordinate care between the two hospitals. One area of the health system she knows she is lacking is in budgeting in the healthcare system along with the changes in Medicare/Medicaid. She realizes that she will have to develop the skills necessary to prepare and justify a detailed budget that reflects the needs of the department. Again she knows she has a great back up in the former manager who would like to make sure the transition is less stressful.


In Yoder-Wise she states that the manager is a position and leadership is moving a group of people toward a vision (Yoder-Wise,2012). In Liz’s case she took on the role of leader before she was given the position of manager. Liz has taken it upon herself to make sure that the public’s needs are addressed and goals are set. She expects the nurses in the department to work at their highest level and tries to set an example by making sure that the departments staffing needs are met and patient care isn’t suffering. She use evidence based practice skills in her nursing while promoting critical thinking and problems solving with other nurse. She tries to be a great resource to other nurses and serve as a role model for the new nurses. A statement by Porter-O’Grady (1999) “managers can develop staff self-direction rather than giving direction" (p. 41).


When I asked Liz about professionalism she was very adamant about her thoughts on this topic. Some of her expectations of new nurses she was looking for in a professional way were their knowledge of nursing and their delivery, critical thinking skills and a passion for their job. Deep clinical reasoning and decision making is a function of reflection and self-correction that requires a critical self-awareness and is more about how nurses think than what they think. Novice nurses rely heavily on others in their decision making in order to ensure they were making the right decision. Hence, their relationships with other staff members influenced their ability to engage in clinical reasoning and decision making. To become proficient in clinical reasoning, practice is necessary (Sedgwick, 2014). She stated as a professional manager just as the previous manager did, that her job will encompass every aspect of the department requiring her to interact with staff and listen to their needs while managing the needs of the patients and families. Liz also knows that she will be accountable for the standards of nursing care practiced and knows she will have to develop a “thick skin” to the negativity of certain staff members.

Business Skills

One area of the health system she knows she is lacking is in budgeting. She realizes that she will have to develop the skills necessary to prepare and justify a detailed budget that reflects the needs of the department. Again she knows she has a great back up in the former manager. Because of all the new hires, orientation and changes in the ED she knows that this will be a big learning curve for her by coming up with future budgets. Liz’s long term goal is to dual enroll into a nursing program that concentrates on both business and education so that she is more comfortable in her position as manager.


I believe that Liz has put in the effort to become the leader that other hospital staff can count on. As a new manager one of the things she had brought up was about balance. A manager in any organization is responsible for a multitude of different functions that relate to the day to day operations of a department in an organization. According to Stalbaum & Valadez (2011) a nurse manager “must be able to balance three sources of demand: upper management requests, consumer demands, and staff needs” (p. 59). Not only balancing hospital duties but making sure she has time for her family. After interviewing Liz it made me again realize that I shouldn’t take someone’s job for granted and that there is more to the story than what is just seen. I believe her open door policy will continue to offer a positive work environment that fosters trust and civility. With her goals on standards and policies in place as an effective manager Liz hopes for increased employee job satisfaction, reduced turnover, and employee ownership within the organization and achieve the ultimate goal of exceptional patient care with positive outcomes. She would like nurses to want to stay working at Kalkaska Hospital and not jump to Munson Hospital after putting time in them. She told me at the end of the interview as far as being a nurse or a manager what she never loses sight on is that good patient outcomes come first.


Birgy, Liz, personal communication October 6, 2014

Porter-O’Grady, T. (1997). Quantum Mechanics and the Future of Healthcare Leadership. Journal of Nursing Administration, 27(1), 15-20.

Porter-O’Grady, T. (1999). Quantum Leadership: New Roles for a New Age. Journal of Nursing Administration, 29(10), 37-42.

Sedgwick, M. G., Grigg, L. L., & Dersch, S. S. (2014). ORIGINAL RESEARCH. Deepening the quality of clinical reasoning and decision-making in rural hospital nursing practice. Rural & Remote Health, 14(3), 1-12.

Stalbaum, A. L., Valadez, A. M. (2011). Developing the role of manager. In P.S. Yoder-Wise (5th ed.), Leading and managing in nursing (pp. 53-67). St Louis, MO: Mosby.

Valentine, S. (2002). Nursing Leadership and the New Nurse. Journal of Undergraduate Nursing Scholarhip, 4(1). Retrieved from

Yoder-Wise, P. S. (2011). Leading and managing in nursing (5th ed.). St. Louis, MO: Mosby.


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