The nursing profession represents qualities of both leadership and management. But what traits and skills distinguish a nurse leader and a nurse manager, and how do these roles work together?
Across the healthcare continuum, regardless of your role or practice setting, you embody qualities of both a nurse leader and manager. As a nurse, you've been taught to lead and guide colleagues from other groups, oversee care teams, and be accountable for patient care outcomes. In addition, you're responsible for managing your own goals, professional growth, and personal performance.
"Every single nurse, no matter how long they have been in the field, has the opportunity to be a leader," said Cara Lunsford, RN and Vice President of Community at Relias. Adding that leaders are also individuals who motivate and inspire their colleagues, creating a comfortable work environment.
With these skills in tow, some nurses go on to lead in an informal capacity, while others take on formal management and leadership roles. But all leadership roles are not the same, and although the titles are often used interchangeably, they're not synonymous.
The nurse manager
Whether managing a unit, division, or service line, at its core, a nurse manager's role is to ensure that day-to-day operations function smoothly. They are involved in myriad daily tasks and details related to patient care planning, quality improvement, and goal setting.
They also oversee staff schedules and assignments, performance, professional growth, and the ongoing provision of educational and career enhancement opportunities. The manager is also responsible for ensuring that staff carries out all assignments and is held accountable if they're not.
According to the Agency for Healthcare Research and Quality (AHRQ), nurse managers have two major functions -- providing clinical care and administrative leadership. Nurse managers must not only oversee the administrative aspects of their position (e.g., budgeting and record maintenance) but also their staff. However, managing nursing staff requires much more than supervising schedules, training, and overseeing patient care.
Being a team player
Staff members -- nurses, certified nursing assistants (CNAs), technicians, etc. -- are integral to a nurse manager's functions, and their manager should be a voice of support and encouragement. With that, staff will have certain expectations for their supervisors, looking for clear communication, direction, and support. They also want them to be available, open, and honest.
Nurse managers are most closely tied to bedside nursing, and in these positions, it's important for them to ensure the needs of their staff are being met. A study on relationships between nurse managers and nurses' job satisfaction suggested that nurse managers' should manage and organize staff's work in a way that makes them feel supported, motivated, and secure. Nurses want -- and deserve -- encouragement, clear expectations, directions, and mentoring from management. And most of all, they want to be included in decision-making, recognized for their contributions, and considered important to the team.
In addition, it's beneficial for nurse managers to support their staff by helping them manage patient care. "The number one trait that great nurse managers have is their willingness to jump in and provide care when their staff needs help," said Lunsford. "Nurses will always be willing to help their managers when they're in times of need if they feel like it is reciprocated."
The role of the nurse manager is powerful in that they have a more hands-on and direct influence on their staff, patients, and the organization. Seeing both the highlights and the challenges day to day, nurse managers hold a pivotal place in the nursing profession.
The nurse leader
Nursing leadership roles are not one size fits all. With variations in job titles like nurse administrator and chief nursing officer, nurse leaders, depending on their role, have differences in their responsibilities. For instance, a director of nursing manages the budget for their department and implements new policies and practices, including training, for nursing staff, while a chief nursing officer explores and integrates new healthcare technology, manages additional financial assets, and reports on collected data to enhance the function of the organization.
However, in most instances, upper-level nurse leaders have fewer day-to-day operational tasks to manage than their nurse manager counterpart. While nurse leaders may appear less hands on, they're focused on setting and maintaining standards, spearheading transformation, and inspiring and influencing their teams. They're charged with fulfilling the organization's mission, vision, and strategic long-range plans.
Lunsford added that through their roles, nurse leaders have the benefit of sharing their leadership principles with a larger audience. "These are nurses who are advocating for major issues facing nurses everyday such as healthcare reform, safe working conditions, and violence in the workplace," she said.
Their role involves policy setting, overseeing quality measures, dealing with regulatory compliance, taking on fiscal responsibilities, and more. They have responsibility and accountability for the overall quality of patient care delivery, patient and staff satisfaction, and organizational outcomes. Both staff and management look to them for their knowledge, experience, and guidance. Their role is an expansive one that touches the entire organization.
Strong collaborations
Nurse managers and leaders complement each other. Together, they aim to meet ethical and regulatory compliance standards, improve the quality of patient care, and enhance the job satisfaction of their nurses. Managers function best in the company of good leaders, and both roles should be filled by individuals who earn the respect and admiration of their staff, are passionate about their work, and instill that passion into others.
While each role comes with different responsibilities, they share similar skill sets to get their job done. Both nurse managers and leaders:
- Must be motivators who positively influence and mentor their staff, while fostering passion and commitment
- Must have excellent decision-making skills and be able to coordinate teams and delegate duties
- Must be committed to the organization and those they lead
- Must think innovatively and critically regarding patient care outcomes, organizational procedures and processes, and staff satisfaction, retention, and engagement
- Must have strong communication and interpersonal skills with all nursing staff, patients and families, and other interdisciplinary teams
Nurse leaders are taking the reins with components such as the development of treatment plans and strategies to improve patient care, while nurse managers are supporting front-line staff and ensuring patient safety and satisfaction. The division of these responsibilities not only promotes stability within the organization but creates a strong and cohesive working relationship.
A call to leadership
Leadership in nursing can move you to a higher plane of responsibility and accountability, with or without a management or leadership title. And this call is inherent in all nursing positions -- from a staff nurse to the CEO. No matter your nursing role, you share similar goals and responsibilities for patient care.
With all the changes that continue to occur in health care and the nursing profession, it's important to emulate the hallmarks of good management and leadership and never stop working on professional growth. It's also imperative to stay informed, be politically savvy, know what professional journals and nursing organizations are saying, and understand the ways to advance your education.
"The best working environments are the ones where the senior nurses are embracing and practicing great leadership because it creates an amazing culture of safety and learning for all the new nurses who are entering the profession," added Lunsford, reinforcing the leadership qualities seen in all nurses.
In the end, every nurse can lead, and every day you demonstrate that you're visionaries, critical thinkers, skilled communicators, and educators. You apply and build your skills with every shift, patient, and task, showing nurse leadership can be achieved without a formal title.
Editor's Note: This blog was originally published in May 2017 and has been updated with new content.
Learn more about nurse leadership through these courses:
How to Develop Your Leadership Potential (1.25 contact hours)
The goal of this course is to provide nurses with practical strategies to help them establish customized plans for developing their leadership potential.
Transformational Leadership: Transforming from a Manager to a Leader (1 contact hour)
The goal of the Charge Nurse Focused CE Series is to provide nurses with information and skills to be a successful charge nurse.
Transitioning to Charge Nurse: The Basics (1 contact hour)
All nurses are leaders when they care for patients. Nurses lead by working autonomously to support patients when they are unable to care for themselves. They also plan, organize, and manage patient care to help them attain better health. When a nurse steps into a charge nurse role, their responsibility grows significantly. New nurse leaders need to understand leadership and management principles that are critical for transitioning into a charge nurse role and the impact of culture on unit dynamics.
