Human resource management activities on the front line: A nursing perspective :
Deanna Michelle O Donnell
Nurse Unit Manager, Neurology Box Hill Hospital, MBA, La Trobe University
Patricia M Livingston
Faculty of Health, Medicine, Nursing and Behavioural Sciences, Deakin University, Burwood, VIC
Timothy Bartram
School of Business, Faculty of Law and Management, La Trobe University
PP: 199 - 206
Abstract
Objective: To identify the practical human resource management issues that may impact on job satisfaction, nurse retention and ultimately quality of patient care of the Nurse Unit Manager's (NUM) role.
Background: NUMs are in the unique position within the healthcare industry to impact upon and effect large numbers of people, including nurses, doctors, patients and their families, and processes on a daily basis. More effective human resource management practices could improve performance in terms of staff satisfaction, positive patient outcomes and the cost effectiveness of staff retention.
Method: Two focus groups, one group of nine NUMs and one group of five staff nurses, were conducted at an Australia public hospital. A descriptive phenomenological approach informed data generation and data analysis.
Results: The NUMs reported that they were not adequately trained in the skills required to effectively manage staff conflict such as manipulation and bitterness, requiring disciplinary intervention on an ongoing basis. The consequences included reduced staff morale, decreased staff satisfaction, increased stress to the NUM and ultimately retention issues for both the NUM and Unit staff.
Conclusion: This study highlights the potential impact of inadequate implementation and understanding of HRM policy and practice by NUMS on the front line. Further research is required to understand why this phenomenon exists and how it can be remedied.
Keywords
nursing; human resource management; discipline; front line management; nurse unit manager; conflict management
Article Text
Nurse Unit Managers (NUMs) are credited with the responsibility of front line leadership and management (Lee & Cummings, 2008). They are in a unique position within the healthcare industry to have an impact on large numbers of people (staff, patients and the general public) and processes on a daily basis, with both short and long term consequences for the individual, organization and industry (Lee & Cummings, 2008). Whilst the NUM job varies across the Australian State of Victoria, each NUM will supervise both nursing and non-nursing personnel. The effectiveness of the NUMs' human resource management (HRM) practices has been linked to health care costs, retention and quality of patient care (Dwyer & Leggat, 2002; Stanton, 2002; Bach, 2000). In times of dynamic change within the health care environment, strong purposeful leadership and management of day-to-day operational activities is essential for nurse managers to be effective (Anderson et al, 2010). NUM's must be able to navigate the health care environment successfully (Allen, 1998), adapt to and manage change (Collins and Holton, 2004), as well as, be able to anticipate the future, challenge the present, take risks, innovate and motivate staff toward goal achievement (Manfredi, 1996).
Faced with the need to deliver world class standards of health care by highly trained and motivated professional staff there is an emerging awareness that more HRM strategies could improve performance both in terms of staff satisfaction, staff retention, positive patient outcomes and cost effectiveness (Dwyer & Leggat, 2002; Stanton, 2002; Bach, 2000). HRM consists of a set of functions and activities that when engaged in their totality are designed to achieve the key objectives of attracting, retaining and motivating employees (Kramar, Bartram & DeCieri, 2011). NUMs' are responsible for the delivery of most HRM functions and activities. They take a lead role in recruitment, selection, performance management and appraisal, and training and development. NUMs' are challenged daily by the rising issues of work family balance, workplace stress, bullying and harassment and issues of workload and intensification of work (Shirey, 2004).
The HRM discipline offers a wide range of strategies to assist managers at all levels when dealing with the complexity and challenges of effectively managing people. Theoretically, HRM is the integrated use of the above mentioned HR functions with organizational strategic objectives that are designed to shape employee attitudes and behaviours and ultimately their performance (Boxall, Ang & Bartram, 2010; Bartram, et al, 2007). More specifically, the relationship between HR systems and organisational outcomes is transmitted through the way they influence individual employee abilities, motivations and job opportunities (the 'AMO' framework) (Boxall & Purcell, 2008). Some of these strategies include job rotation, job redesign, creative recruitment methods, reward programs, methods of empowering and engaging staff and a wide range of motivation techniques.
From an organizational perspective, HRM involving strategies to retain staff and provide a stable workforce reduces the costs associated with ongoing recruitment, orientation, and training (Lee & Cummings, 2008). These costs can also be measured by rates of absenteeism and its consequences in relation to patient care (Duffield et al, 2009). In this context a more strategic role for human resource development, particularly in relation to the training and development of NUMs may be critical to improving quality of service delivery and cost effectiveness (Brinkert, 2010; Creegan, Duffield & Forrester, 2003; Dwyer & Leggatt, 2002; Fitzgerald & Ferlie, 2002).
Greater investment in people within the public healthcare sector is recognized as a national priority (Duffield et al, 2009; VDHS, 2001; Swerissen & Tilgner, 2000). In Australia, the labour force is the largest component of health care costs, accounting for greater than 70% of total costs (Duckett, 2000). HRM is therefore critical to the provision of high quality, cost effective health care (Kabene et al, 2006). Previous research has highlighted that continual professional development of managers and clinicians can be related to improved change management (Courtney, 2002), perceived employee empowerment (Duffield et al, 2009), improved individual performance (Aiken et al, 2001; Fleming, Parker & Oldenburg, 2000) and retention and attraction of employees (Duffield et al, 2009; Upnieks, 2003). However, the NUM is not required to undertake HRM education and yet, as is the case in Victoria, can be responsible for the supervision and management of over 100 front line staff in units/departments such as intensive care and emergency.
The aim of this study is to explore the HRM activities performed by the NUM and identify their impact on job satisfaction, nurse retention and quality of patient care.
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