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FIONA CASSIE reports on KERRI-ANN HUGHES’ initial research findings into the support and barriers that help and hinder nurse managers in their work.

Wearing two hats can contribute to nurse burnout for nurse managers on the ward trying to balance their operational and professional roles.

Her survey of 78 members of the New Zealand Nurses Organisation (NZNO) nurse managers section – which includes charge nurse managers and duty managers – found that they were far more operationally focused than their DoN colleagues and were largely focused on their particular sphere of influence, be it operating theatres or a medical ward.

But what the managers surveyed did share with their other nurse manager colleagues were the same barriers (see box) hindering them from meeting their dual professional and operational role of influencing nursing quality.

"All the obvious things were barriers, inadequate resourcing and being time-poor etc and these all lead to nurse burnout … to someone feeling overwhelmed."

Just over 40 per cent of the nurse managers surveyed had to report operationally to a different person when wearing their operational hat or their professional hat, with just on half reporting to the same person for both 'hats'.

Seventy-two per cent of nurse managers' immediate bosses were registered nurses (RNs), with 30 per cent of them required to maintain a current annual practising certificate (APC), nearly a quarter not requiring an APC, and the remainder unknown. Hughes said this was important as the international research, particularly the Magnet Hospital findings, indicated where nurses reported to nurses both professionally and operationally, there was a "shared culture of professional practice and nurse leadership" that provided for more effective and safe patient outcomes.

The nurse managers surveyed had between three to 125 staff directly reporting to them, with the mean being 31 staff – most of whom were nurses. When asked how much they were able to influence the quality of nursing practice in their area, 46 per cent said "significantly", nearly 18 per cent said a "reasonable" amount, and a quarter said their influence was "variable".

Major blocks hindering managers were seen to be a lack of senior management support, poor consultation on change, management not listening, and a "perceived lack of interest by managers of what was happening at the coalface”.

Hughes said nurse managers also commented about the "constant push of new initiatives" from above, with little time given to bed them down. Being time-poor was the second most common barrier, with managers reporting that it was stressful and unsatisfactory not having the time to do the job properly – particularly because of being overloaded with paperwork, constant interruptions, and increased ward volume.

She said added to the reports of overloaded workloads, more than 50 per cent of managers’ responses noted inadequate resourcing, ranging from not enough staff, not replacing staff, and having the wrong skill mix.

"The combination of these, with the emotion and passion nurse managers put into their role, can sometimes lead to nurse burnout."

Hughes reported her research preliminary findings to the NZNO nurse managers conference in November and is to hold a second survey to capture responses from more South Island nurse managers. She is also following up her initial research with a literature review to find the best nursing strategies to break down the barriers managers experienced in trying to influence nursing quality in their workplace.