Nurse Manager Observation Paper

Nurse Manager Observation Paper

Nurse managers play a significant role in cultivating a healthy working environment, supporting organizational outcomes, and promoting quality care. Besides participating in interdisciplinary care delivery processes, nurse managers are responsible for overseeing daily activities and various managerial and leadership roles. According to Nene (2022), managerial roles for nurse managers include planning, organizing, directing, coordinating, and controlling activities aimed to improve health. Similarly, leadership roles and responsibilities include motivating employees, mentoring staff members, and inspiring and empowering employees. Amidst the unprecedented challenges that face healthcare organizations, nurse leaders should understand and effectively execute their roles and responsibilities. Consequently, this observational paper focuses on the leadership style and underlying management philosophy, issues, concerns, and activities of a nurse manager, as well as the type of communication applied when carrying out managerial functions.

Leadership and Management Query Items

  1. What are your dominant management dominant style and the rationale for using that style?

The nurse manager prefers the transformational leadership style over other leadership or managerial approaches. The rationale for using this leadership style depends massively upon the style’s association with positive outcomes, including employee motivation, empowerment, inspiration, and influence. According to Ree & Wiig (2018), transformational leadership correlates with patient safety culture because it entails leaders’ broadened and elevated interests in the employees. By implementing this leadership style, employees generate awareness and accept the organizational purpose, mission, vision, and objectives.

  1. What patient care delivery methods do you use and what rationale for using that style?

Team-based and patient-centered care (PCC) is the primary care delivery method implemented at the organizational level. These models result in improved care quality, process accuracy, patient safety, and client satisfaction. Team-based nursing has two fundamental principles; leadership in the planning and evaluation of care delivery to each patient; and effective communication to ensure care continuity (Parreira et al., 2021). On the other hand, patient-centered care is an advanced care delivery model that entails providing Health services that are responsive to and consistent with patient needs, preferences, values, and autonomy (Kuipers et al., 2019). This model has various aspects, including emotional support, improved access to care, patient education and information access, care coordination, continuity and transition, and involvement of family and friends.

  1. Mission and philosophy of the organization and does it coincide with nursing philosophy?

The organization’s mission and philosophy reflect an all-concerted commitment to providing quality, responsive, timely, and patient-centered care. The organization operates under the mission and philosophy of becoming the leading provider of quality, convenient, evidence-based, and population-centered care by incorporating the best available evidence and technologies into nursing practices and decisions. The mission and philosophy align with nursing philosophy. According to Green (2018), the nursing profession entails caring for and improving people’s well-being, preventing illness, restoring health, and alleviating suffering. As a result, the organizational mission and philosophy coincide with the nursing philosophy because they focus on the aspects of people’s health, alleviation of health threats, and restoring health.

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  1. How are goals, objectives, policies, and procedures developed for your agency?

The process of developing goals, objectives, policies, and procedures should align with the organizational mission, vision, and philosophy, as well as short-and-long term commitments. When creating goals and objectives, it is essential to establish measurable outcomes, develop benchmarks, and create a clear action plan. Action plans for achieving these goals and objectives represent the organizational policies and procedures. When developing policies and procedures, it is vital to establish the desired outcomes and actual implementation guidelines, allocate and delegate work to interdisciplinary teams, develop a comprehensive budget plan, and define evaluation plans.

  1. What external and internal forces affect the operation of your agency?

Internal and external environments significantly affect and influence operations, decisions, and practices for healthcare organizations. Internal factors are organizational aspects, including infrastructure, leadership and management styles, employees’ competencies, organizational structure, and culture. On the other hand, external factors that influence and affect organizational practices are demographic changes, regulatory and policy landscapes, legal and financing environments, people’s sociocultural contexts, technology, inter-organizational networks, and physical environment, including location issues (Ziemann et al., 2019). The organizational awareness of these factors can improve decisions and allow the agency to thrive in the ever-dynamic healthcare sector.

  1. How do you prioritize management concerns for your urgency?

The agency’s management concerns revolve around priority issues such as workload management, staffing, project management, resource utilization, scheduling, and tracking Projects. Therefore, the process of prioritizing management concerns involves understanding the agency’s objectives, aligning team goals with organizational goals and objectives, understanding and addressing employees’ concerns, setting achievable goals, organizing tasks and ensuring timely delegation of roles, and empowering employees to complete tasks within the set deadlines. Further, flexibility is vital to effective prioritization in organizational management.

  1. What decision-making tools do you use for managing resources?

Organizational resource management should be consistent with goals, objectives, mission, and vision. Effective decision-making in the context of resource utilization is crucial for safe healthcare practice, as well as for promoting organizational sustainability (Baynouna Al Ketbi, 2021). Therefore, the agency implements various tools to guide decisions and ensure sustainable resource utilization. Examples of these tools include cost-benefit analysis, SWOT Analysis, Pareto analysis, feasibility studies, and fishbone diagrams for root-causes analysis.

  1. How are ethical dilemmas addressed?

Ethical dilemmas are inevitable due to the challenges associated with the four bioethical principles; autonomy, beneficence, non-maleficence, and justice. Other factors that can trigger ethical dilemmas are ineffective communication, limited resources, and time constraints (Giannetta et al., 2021). To address ethical dilemmas that compromise care quality and patient safety, the organization enacts a Code of Ethics and embeds them in the institutional culture. Equally, employee education, counseling, and empowerment can enable them to address ethical dilemmas, including emotional distress. Thirdly, cultivating a culture of openness and effective communication can enable healthcare professionals to report incidences of ethical dilemmas and obtain insights into appropriate response interventions.

  1. How are workloads, time, meetings, etc., managed by the manager?

Workload, time, and meetings management is one of the traditional roles for nurse managers. Heavy workloads and time constraints reduce employee satisfaction and performance by contributing to burnout and emotional distress. Strategies for managing workload include delegating tasks, collaborating with the human resource department to ensure merited and timely staffing, and advancing the role of technology in nursing practice (Miller & Hemberg, 2022). Further, the nurse manager ensures time and meetings management by setting deadlines, ensuring proper scheduling, and empowering employees to meet these deadlines.

  1. Discuss budgetary processes and decisions

The budget process enables the organization to forecast, plan, and prepare the budget for all projects and practices within the stipulated time. The process entails various steps and decisions, including reviewing past budgets, forecasting revenues for the coming period, and allocating resources based on budgetary decisions. The agency’s budget process and decision-making process align with various steps of the “budget cycle,” which includes budget requests, reviews, submissions, approvals, execution, accounting, auditing, and feedback on the next budgeting (Yamamoto, 2018). These steps enable the organization to ensure effective and sustainable financial resource utilization.

  1. What does the organizational structure look like?

The organizational structure represents the hierarchical order of job responsibilities and layers of accountability. In the agency, the top governing body is the hospital board of directors which represents the highest helm on the hospital chain of command and comprises experts in respective fields. Secondly, executives form the second helm and are responsible for managing the organization, making financial decisions, and overseeing operations. Department administrators are third-in-command and manage daily operations at the departmental level. Patient care managers, like nurse managers, are responsible for ensuring quality care delivery, the fulfillment of duties for employees, and compliance with legal requirements. Finally, service providers like doctors, nurses, and assistant nurses are responsible for quality care delivery, maintenance of clinical records, and other hospital functions consistent with the organization’s mission and vision. They have a hierarchical structure that determines delegation decisions.

  1. Staffing, power, and empowerment issues

Like other healthcare organizations, the agency faces various staffing, power, and empowerment issues. Nursing staff shortages, a top-down hierarchical power structure, and transition issues for new employees are among the challenges facing the organization. Nursing staff shortages contribute to delayed care, burnout, emotional distress, and heavy workloads for other healthcare professionals. On the other hand, a top-down hierarchical power structure can lead to delays in decision-making and limited involvement of employees at the bottom of the structure in decisions. Equally, it can compromise the application of the transformational leadership style. Finally, empowerment issues like problems facing new nurses during their transitions prompt the organization to implement ongoing mentorship, preceptorship, and training programs.


  1. How is conflict managed?

Interpersonal disagreements, dissimilar goals among employees, improper communication, personal issues, and organizational incivility are among the causes of conflicts in the organization (Piryani & Piryani, 2019). To address conflicts, the organization has a functional conflict resolution policy that requires healthcare managers to accommodate other people’s perspectives when solving conflicts and practice active listening, emotional intelligence, and collaborative interventions for solving interpersonal conflicts. Besides these elements of conflict management, the other elements of conflict resolution include conflict identification, resolution through negotiation and mediation, conflict feedback, and prevention.

  1. How are evaluations for staff handled?

Staff evaluation through performance appraisals is an effective strategy for motivating employees, improving their performance, and identifying and addressing issues that affect their performance and job satisfaction. However, not all performance appraisal tools can guarantee positive employee outcomes. To ensure effective staff evaluations, the organization implements strengths-based performance appraisal as a strategy for improving their performance and motivating them (von Woerkom & Kroom, 2020). This approach focuses on identifying, appreciating, and developing employees’ skills consistent with the organizational mission. By identifying employees’ strengths and skill deficiencies, it is possible to implement career development and empowerment initiatives.

  1. How is care delegated in the agency?

Care delegation is a vital strategy for workload management and preventing burnout among healthcare professionals. Barrow & Sharma (2022) explain delegation as the process by a nurse to “direct another person to perform nursing tasks and activities.” The urgency complies with the five rights of delegation; right task, person, supervision, circumstances, and direction/communication. When delegating tasks and activities, delegators maintain accountability for the task’s completion and are responsible for effective supervision and communication with delegates. Proper delegation enables the organization to address the challenges of financial constraints, nursing shortages, and the demands associated with increased patient care complexities and intricacies.


Based on the nurse manager’s observation, it is valid to argue that he understands and effectively executes his executive roles and responsibilities. By implementing transformational leadership as his dominant management style, the nurse leader can motivate, inspire, empower, and influence employees to pursue the organization’s mission, vision, goals, and objectives. The manager is aware of decision-making tools, internal and external environments, budgetary processes, elements of organizational structures, and strategies for addressing ethical dilemmas and conflicts. Also, he provides insights into strategies for workload and time management, performance appraisal, and care delegation.



Barrow, J. M., & Sharma, S. (2022). Five rights of nursing delegation. StatPearls Publishing.

Baynouna Al Ketbi, L. M. (2021). Meta-Decision in healthcare. Frontiers in Public Health, 9.

Giannetta, N., Villa, G., Pennestrì, F., Sala, R., Mordacci, R., & Manara, D. F. (2021). Ethical problems and moral distress in primary care: A scoping review. International Journal of Environmental Research and Public Health, 18(14), 7565.

Green, C. (2018). A philosophical model of the nature of nursing. Nursing Research, 67(2), 93–98.

Kuipers, S. J., Cramm, J. M., & Nieboer, A. P. (2019). The importance of patient-centered care and co-creation of care for satisfaction with care and physical and social well-being of patients with multi-morbidity in the primary care setting. BMC Health Services Research, 19(1), 1–9.

Miller, M., & Hemberg, J. (2022). Nurse leaders’ perceptions of workload and task distribution in public healthcare: A qualitative explorative study. Journal of Clinical Nursing.

Nene, S. E. (2022). Nurse managers’ leadership roles in mining primary healthcare settings in Gauteng. Health SA Gesondheid, 27.

Parreira, P., Santos-Costa, P., Neri, M., Marques, A., Queirós, P., & Salgueiro-Oliveira, A. (2021). Work methods for nursing care delivery. International Journal of Environmental Research and Public Health, 18(4), 2088.

Piryani, R. M., & Piryani, S. (2019). Conflict management in healthcare. Journal of Nepal Health Research Council, 16(41), 481–482.

Ree, E., & Wiig, S. (2019). Linking transformational leadership, patient safety culture and work engagement in-home care services. Nursing Open, 7(1).

von Woerkom, M., & Kroon, B. (2020). The effect of strengths-based performance appraisal on perceived supervisor support and the motivation to improve performance. Frontiers in Psychology, 11.

Yamamoto, K. (2018). Budgeting and Decision-Making. In: Farazmand, A. (eds) Global Encyclopedia of Public Administration, Public Policy, and Governance. Springer, Cham.

Ziemann, A., Brown, L., Sadler, E., Ocloo, J., Boaz, A., & Sandall, J. (2019). Influence of external contextual factors on the implementation of health and social care interventions into practice within or across countries—a protocol for a “best fit” framework synthesis. Systematic Reviews, 8(1).


Observe the nurse manager for


1. Leadership style and underlying management philosophy; issues, concerns, and activities that occupy the majority of his/her day.


2. Types of communication used. How the manager carries out the 5 traditional functions of management.


Suggested Leadership/Management Query items


1. What is your dominant management style and rationale for using that style? Transformational


2. What patient care delivery methods do you use and rationale for using that style?


3. Mission and philosophy of the organization and does it coincide with nursing philosophy?


4. How are goals, objectives, and policies and procedures developed for your agency?


5. What external and internal forces affect the operation of your agency?


6. How do you prioritize management concerns for your agency?


7. What decision-making tools do you use for managing resources?


8. How are ethical dilemmas addressed?


9. How are workloads, time, meetings, etc., managed by the manager?


10. Discuss budgetary processes and decisions


11. What does the organizational structure look like?


12. Staffing issues, power, and empowerment issues.


13. How is conflict managed?


14. How are evaluations for staff handled?


15. How is care delegated in the agency?


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