NURSING MANAGEMENT AND PATIENT SAFETY AMONG NURSES

The Relationship of Nursing Management and Patient Safety among Nurses:

Its Implications and Impact on the Future of Advanced Health Care
Chelsea-Nicole K. Poligratis
Kapiolani Community College

Abstract

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Nursing has a history of poor workplace contexts in which the focus has been on performing and
completing tasks, rather than engaging fully with patients (Henderson, Schoonbeek, & Auditore,
2013). This paper will first address the reality that nursing practice is increasingly driven by
bureaucratic demands and service requirements, which can result in neglect of the workplace
needs of the staff (Henderson et al., 2013). Essentially, this means that nurse management plays
a strategic role in patient safety. Behaviors that nurse leaders role model and reinforce are
especially instrumental in creating effective work practices that deliver optimum care
(Henderson et al., 2013). Further, this discussion will describe how nurse unit managers can
improve poor working environments by implementing transformational leadership techniques to
accompany procedural practices, and mobilize and direct staff in reaching shared values,
objectives, and outcomes (Henderson et al., 2013). Nurse leaders within a professional nursing
organization should provide a means for obtaining continuing education, establish standards of
practice and ethical values of patient safety, and provide a culture that promotes leadership
among the nursing staff (Henderson et al., 2013). Ultimately, the dedication and commitment to
personal growth is important to the future of nursing in order to enable nurses to lead change and
advance health care (Henderson et al., 2013).
Keywords: nursing management, patient safety, transformational leadership, ethical
values

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The Relationship of Nursing Management and Patient Safety among Nurses:
Its Implications and Impact on the Future of Advanced Health Care
Patient safety has grown to be the key driver in health care (Kangasniemi, Vaismoradi,
Jasper, & Turunen 2013). This means ensuring that the patient does not experience preventable
harm during the process of the implemented nursing plan (Kangasniemi et al., 2013). Just as
important, it is not only preventing the underlying disease but also any medical errors or adverse
effects from happening during the provision of care (Kangasniemi et al., 2013). Since the
1990s, the focus of patient safety has been about having adequate healthcare facilities along with
ethical and knowledge-based foundations from healthcare providers (Kangasniemi et al., 2013).
Further, the demand and main priority to improve optimum care through patient safety has been
primarily centered on the role of nurse management (Kangasniemi et al., 2013). In order to
create safe patient care environments, it relies on the responsibility of nurse managers to ensure
the competence of their staff (Kangasniemi et al., 2013). It becomes an unethical problem if a
nurse believes that they are not able to provide patient care safely (Kangasniemi et al., 2013).
Therefore, it is important for nurse managers to recognize any deficits in knowledge and skills
that may threaten the patient (Kangasniemi et al., 2013). Subsequently, it is important to offer
training and education to remediate these problems and improve patient-centered care
(Kangasniemi et al., 2013).
When there is close collaboration between healthcare provision and nursing education,
efficiency in nursing competence and preserving patient safety is ensured (Kangasniemi et al.,
2013). With this proactive approach, nurse managers can educate their staff to focus on
prevention rather than just learning from events (Kangasniemi et al., 2013). Therefore
fundamentally, nurse managers act as role models for their staff and promoting justice and

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integrity in clinical nursing supervision with their staff are key to ethical decision-making, and
crucial in leading by example (Kangasniemi et al., 2013). Nurse managers who understand the
needs of their staff, employ empowerment processes, and encourage nurses to follow ethical
safety protocols, are more likely to be effective in promoting cultural change (Kangasniemi et al.,
2013). Consequently, increased evidence-based practice along with standard protocols and
guidelines is essential in order to facilitate safe nursing practice and prevent moral distress
(Kangasniemi et al., 2013).
Discussion
Common to these frameworks is a culture of democracy and innovation, with an
emphasis on transformational leadership and support for staff to explore good practice and
initiate change (Henderson et al., 2013). Positive work relationships, team building, recognition
of achievements and being heard are desired characteristics that should accompany a productive
and efficiently safe workplace environment (Henderson et al., 2013). However, along the years
nursing work has increasingly been driven by simply getting the job done and completing tasks
rather than fully encompassing these qualities (Henderson et al., 2013). Another aspect of this
issue has been documented extensively and raised concerns of nurses just interacting with
patients to perform specific tasks, rather than engaging with them to perform a broad range of
activities to support patients overall wellbeing (Henderson et al., 2013). This way of working
does not support understanding patients as individuals and, ultimately, limits nurses job
satisfaction, as they perform repetitive tasks with minimal understanding of patients and their
nursing care (Henderson et al., 2013).
Nursing Culture

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Simultaneously, some elements within the nursing culture may also affect nurses who are
new to either an organization or the nursing profession when they encounter experienced
clinicians they think are not being supportive (Cusack et al. 2010). This includes nurses who do
not like to teach, nurses who expect a high level of competency that only experience provides,
and nurses who are too stressed or too busy to provide extra support to nurses who are new or are
struggling with the expectations and demands of the workplace (Cusack et al. 2010). A couple of
major concerns this issue brings rise to is first the concern about bullying within the workplace
by nurses, and the second is the issue of retention of new nurses in the profession. A shortage of
nurses has also been identified as a significant problem in health care worldwide (Cusack et al.
2010). Further, if nursing management is not effective, it could contribute to workplace bullying
targeted at new nurses and highlights a possible reason why nurses may leave the profession,
especially if they feel isolated and bullied and discouraged (Cusack et al. 2010).
Negligence of nursing staff and workplace. In reality, nurse managers have a greater
responsibility to maintain high quality patient care, so they often just make sure their staff is
focused on particular service requirements. However, such an approach often neglects the
workplace needs of the staff (Henderson, Schoonbeek, & Auditore 2013). When leadership is
ineffective and meeting administrative targets become the focus, too often the staff does not feel
a sense of purpose or worth, are less likely to engage in work, and are more likely to provide
essential rather than optimum care (Henderson et al. 2013). Thus, nurse managers need to
initiate constructive relationships in order to improve the workplace environment and,
essentially, increase staff satisfaction (Henderson et al. 2013). In short, transformational
management styles that incorporate respect and value staff would also be more likely to
empower staff to create safer patient care than drive-through styles (Henderson et al. 2013).

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Transformational nursing leadership. Henderson et al. (2013) stated that a
transformational nurse leader can motivate and improve morale, encourage best practice by
inspiring others, listen and have confidence to challenge bureaucratic demands, and make
changes when necessary. By adopting transformation principles, nurse managers can motivate
and engage staff to improve patient-centered practice (Henderson et al. 2013). The objective
goal of transformational leadership is to integrate staff members to perform competent skills and
embrace accompanying behaviors and raising the quality of standards of practice at the same
time (Henderson et al. 2013).
This form of leadership essentially focuses on feedback, learning and improving quality,
rather than on simply performing duties (Cusack et al., 2010). Unfortunately, nurses may have
become complacent, feel powerless or think that practice cannot be improved. But with
considerable time and resources, in order to develop competency standards, Cusack & Smith
(2010) suggest incorporating a specific professional nursing interest group who help nurses in
clinical areas create optimum working practices through formal and informal staff development
opportunities.
A progressive plan. Transformational leadership can be developed to bring about
desired behaviors (Henderson et al., 2013). Creating a visionary goal demonstrated by nurse
managers and highly competent nurses for staff to follow is essential by engaging and
encouraging staff to share thoughts and ideas in decision making to improve care delivery
(Henderson et al., 2013). Subsequently, staff can be given more opportunities and accompanying
responsibilities (Henderson et al., 2013). They can also be encouraged to support their peers
when they voice concerns, which is important for nurse empowerment. Another element of this
competency assessment is to challenge existing behaviors, particularly negative interactions by

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effectively listening to others and acknowledging any concerns (Henderson et al., 2013). This
also promotes team cohesion and gradually increases respect within the nursing staff (Henderson
et al., 2013).
Establishing a learning environment. This leadership role by the nurse manager is
critical in continuing education purposes as well as implementing workplace reform, change, and
performance management, to increase workplace productivity and control practice (Cusack et al.,
2010, p. 410). With support to access clinical knowledge and individual skills development,
nurse managers can bring more interactive education to the bedside, such as demonstrating and
role playing everyday and procedural skills, from intravenous therapy management to complex
wound dressings (Cusack et al., 2010, p. 410). Providing a learning environment reassures nurse
managers that staff are actually involved and understand the needs of the organization (Cusack et
al., 2010, p. 410). Although the process is labor-intensive, it is considered to be worth the
investment (Cusack et al., 2010, p. 410). An emphasis on education is often the most
empowering approach (Cusack et al., 2010, p. 410). Ultimately, learning in the workplace
should involve extending, enriching, enhancing, and developing a new collection of skills and
knowledge (Cusack et al., 2010, p. 410). It promotes staff proficiency and confidence, and as
staff competency improves, nurses are able to teach their less experienced colleagues (Cusack et
al., 2010, p. 410). This leads to sustaining these desired behaviors and efforts by recognizing and
rewarding positive performance (Cusack et al., 2010, p. 410).
Conclusion
A program of unit activities, led by a nurse educator, can focus on improving team
behaviors by having nurse unit managers role model preferred behaviors and being readily
available if staff needed assistance or clarification on clinical or administrative matters

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(Henderson et al., 2013). Nurse managers can also routinely circulate around the unit and
confirm with individual members of the team during the shift that they were effectively
managing patient care (Henderson et al., 2013). But overall, this intensive series of interactive
activities can encourage nurse managers input to help staff explore and practice how to challenge
members of the team who exhibit poor behaviors and practice giving feedback to colleagues and
having difficult conversations in a non-threatening environment away from the clinical unit
(Henderson et al., 2013). Reward and recognition and praising staff are viewed as important to
encourage the continuation of the desired behaviors practiced (Henderson et al., 2013).
Consequently, nursing practice can exceed the minimum regulatory healthcare standards,
improving staff performance, and increasing morale and motivation (Henderson et al., 2013).

References
Cusack, L., & Smith, M. (2010). Power inequalities in the assessment of nursing competency
within the workplace: implications for nursing management. Journal Of
Continuing

Education In Nursing, 41(9), 408-412.

Henderson, A., Schoonbeek, S., & Auditore, A. (2013). Processes to engage and motivate staff.
Nursing Management - UK, 20(8), 18-25.

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Kangasniemi, M., Vaismoradi, M., Jasper, M., & Turunen, H. (2013). Ethical issues in patient
safety: Implications for nursing management. Nursing Ethics, 20(8), 904-916.

Criteria
Defined issues and
discussed
relationship to
nursing care &

0
Did not state and define the
topic as it relates to nursing
care/health care

1-2
3-4
Minimally stated and defined Clearly defined and related
the topic. Mentioned one
the topic to nursing care/ &
aspect as it relates to nursing health care. Gave at least 2
aspects of how it relates to

Content provided
insight on how it
impacts current
nursing care and
health care
Organization of the
ideas to the topic.
Progression of ideas
throughout the
paper.

Did not address/ describe

aspects of the topic as it
relates to nursing

Described/addressed 1-2
aspects of how the topic
impacts nursing care/health
care

Describes/addresses 3 or
more aspects of how the
topic impacts nursing
care/health care

Discussion is not organized,

difficult to follow. Goes off
track

Written in an organized
manner; easy to follow
sequence/progression of the
topic for most of the paper

Written in an organized
manner and easy to follow
the sequence/progression of
the topic throughout the
entire paper. Stays on topic.

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Topic's impact on the
future of nursing
care and health care
Grammar, spelling
Punctuation.
Complete sentences

No discussion regarding the

topic's impact on the future of
nursing care/health care
Many grammar and spelling
errors; Punctuation errors,
paragraph errors

APA format. Exactly

Double spacing,
Headings are
correct. Title page,
running head, page
numbers
Reference page w/ 2
ref
Sources cited and
correctly
Rubric pasted to last
page of the paper =

Missing topic page, reference Minimal APA formatting

page, many APA errors in
errors throughout the paper.
format
Reference and topic page
with minimal errors

Discussed impact of the topic

on nursing care/health care
minimally
Minimal grammar,
punctuation and spelling
errors;

Gave insight and discussed

the topic's impact on future
nursing care/health care
No/minimal grammar and
spelling errors; correct
Punctuation
Paragraphs correctly
formatted
APA format correct
throughout the paper.
Reference and topic page
with no errors