Acob, Nurse Managers’ Utilization of Fayol’s Theory in Nursing

Nurse Managers’ Utilization of Fayol’s Theory in Nursing


Joel Rey Ugsang Acob

Visayas State University, Philippines

joel.acob@vsu.edu.ph

Abstract


The main aim of this paper is to appreciate and evaluate human resource management practice of nurse managers utilizing Henri Fayol’s theory. The study being conducted to health facilities in Southern Leyte purposively employed sixteen respondents qualified based on the inclusion criteria such as having supervisory experience of at least five years, either male or female and with permanent employment status. The study utilized descriptive-evaluative research design in order to collect information without manipulating or changing study subjects and its environment. Demographic data were tabulated using simple percentage. Weighted mean was also used to establish different management practice delivered and implemented by nurse managers. Based from the findings, most of the nurse managers are female (87%), aging 40-47 years old, with an average gross individual monthly income of 17,000 to 25,000 thousand pesos. All of them did not have units of graduate degrees, however underwent trainings parallel to nursing practice. Education and supervisory-related trainings were acquired through shadowing and peer-coaching. Nurse Managers identified that the fast turnover of staff nurses is the leading factor affecting human resource management due to low salary rate of staff nurses. On the other hand, planning and controlling were the least among the five managerial roles delivered by nurse managers. The study recommends enhancement of these management components to effectively deliver care among clientele.

Keywords: nurse managers, nursing management, human resource, theory utilization

Introduction

The American Nurses Association defined nursing practice as the promotion, prevention, optimization of patient’s abilities, alleviation of suffering through diagnosis and proper treatment and advocating in the care of different clienteles across lifespan (1). A nurse, as a professional performer of the nursing discipline is called to deliver what is expected of his/her profession to satisfy the acceptable level of care for the sick and well to individuals, families, communities and the population in general. As a nurse emerges over the changing practice in health care, he/she is also expected to assume roles as communicator, as client advocate, change agent, leaders and managers and research consumers. A nurse manager on the other hand must recognize the need for growth within, which then translates into improvement of one’s practice. Practicing nurse managers illustrate role perceptions; cite decision making and problem solving as major roles for which maintaining objectivity is a special challenge.

Rapid changes in today’s health care industry are reshaping the nurse’s role. The emergence of new health care systems, the shift from service orientation to business orientation, and an extensive redesign of the workplace directly affect where and how nursing care is delivered as well as those who deliver the care. To manage well, nurses must understand the health care system, the organizations they work and resources as well. They need to recognize what external factors affect their work and how to influence those forces. Nurse Managers must equip oneself to address the different situations concerning their roles. In the Philippines, Health Care System is in the midst of significant and dramatic development as it continues to rapidly evolve - the devolution of hospitals to the Local Government Unit; free health care for the senior citizens; and the no-balance billing policy for the indigents. These resulted to increase number of patients in the hospital which in turn increased the workload of staff nurses and nurse to patient ratio adding more burdens to the nurse managers. The impact of these changes greatly affects the role of nurse managers in their practice. They are tasked with a wider range of playing both the key to ensuring quality patient care and excellent workplace for staff nurses. The roles of managers have expanded in response to changing health care delivery, practice and the philosophical shift. In exploring the concept of management in practice, all nurses are managers (2). They direct the work of professionals and non-professionals in order to achieve expected outcomes of care. Sullivan and Decker mentioned that nurse managers in the health care setting is responsible and accountable for the goals of the organization (3).

In the Philippines, as stated in the Philippine Nursing Law, a person occupying managerial positions requiring knowledge of nursing must be a registered nurse in the Philippines, have at least two (2) years experiences in general nursing service administration; possess a degree of Bachelors of Science in Nursing, with at least nine (9) units in management and administration courses at the graduate level; and be a member of good standing of the accredited professional organization of nurses. During the literature review, no study has been made to document how the nurse managers utilized Fayol’s theory of management in human resource of the nursing practice with dynamism to the changing health care practice. This study will deeply appreciate and evaluate human resource management practice of nurse managers utilizing Henri Fayol’s theory in the changing health care practice which must be looked into for possible enhancement of these management components to effectively deliver care among clientele.

Methods and Materials

The study utilized descriptive-evaluative research design to collect information without manipulating or changing study subjects and its environment. Therefore, the researcher cannot in anyway interact with the environment to avoid changes related to the study. The descriptive technique permits the statement about the identified management functions of nurse managers utilizing Fayol’s theory. The study has conducted to selected health care facilities in Southern Leyte. It is the only tertiary and government-owned hospital having 100 bed-capacities with an average of 85 to 95 patients and admissions daily. The hospital is divided into different wards and departments. As the catchment hospital in Southern Leyte and its neighboring provinces in the region, it also houses special areas such as operating room, Intensive care unit, emergency and delivery rooms and the office of the Integrated Provincial Health Offices (IPHO) where all community health services in the Rural Health Units (RHU) are being facilitated.

A purposive non-probability sampling was used in this study to acquire data that sufficed the research’s query. A purposive sampling selected the study participants based on personal judgment guided by the set inclusion criteria. They were nurse supervisors with permanent employment status, having five years of supervisory experience, either male or female, regardless of the age at the time of data collection. The study developed a researcher-made questionnaire based on Henri Fayol’s theory of management. The tool had two parts which includes demographic profile of the study participants such as age, gender, gross individual monthly income, number of years of supervisory experience, trainings, graduate or postgraduate programs earned and completed as of the date of the study. The second part of the instrument constitutes the five managerial functions in Henri Fayol’s theory of management. The five management components include planning, organizing, commanding, coordinating and controlling. Each management function has five statements and nursing situations commonly observed in the nursing practice and workplace which also describes the function. Literature readings and systematic integrative reviews were also utilized to enhance each description under each function. A total of twenty-five evaluative statements were pre-tested to nurse supervisors having the same inclusion criteria of the actual participants. The purpose of the tool pre-testing was to ensure validity and reliability of the instrument, appropriateness of the words used and comprehensiveness. The tool was Likert- scaled as follows: 5- very well delivered, 4- well delivered, 3- delivered, 2- least delivered, 1- not delivered, respectively.

The researcher communicated the heads of the nursing service where the study was conducted. Consent was signed and accomplished. Pilot test was done and incorporation of results was made prior to the actual conduct. The survey tool was distributed, then retrieved and tabulated thereafter. The researcher together with the statistician analyzed and interpreted the data. Data were assessed and tabulated using SPSS frequencies and percentages for the demographic profile of the study participants. Weighted arithmetic mean was used to determine the different management components adopted by the nurse managers of the hospital’s human resource.

Result

The demographic profile based on ages, gender, monthly salary and years of supervisory can be seen as table 1 and 2 below.


Table 1. Respondents age and gender

Age 40- 47 years old

Male

Female

Gender

2

14

Percentage

12.5%

87.5%


Table 2. Monthly Salary gross income and years of supervisory experience

Salary

17,000 – 24,000

Years of experience

5 years and 11 months

6 – 10 years


10 (62.5%)

6 (37.5%)


While the educational attainment and trainings of the respondents can be seen as table 3 below

Table 3. Educational attainment and trainings of the respondents

Educational attainment


  • BS degree in Nursing

  • MA/MS/MN/ MM in Nursing or its equivalent

  • PhD, DNS, DM in Nursing or its equivalent

16

0

0

Trainings

(e.g. peer coaching and shadowing, attendance to seminars, fora, convention and other scholarly gathering)


16


As for the result for nurse supervisor management function in the health care facility based on Fayol’s theory can be seen in the table 4.


Table 4. Management functions of nurse managers on human resource using Fayol’s theory

 

Function

Parameter interpretations

Planning

Organization

Coordinating

Commanding

Controlling

s1

2.93

3.96

4.09

4.785

2.5

1.01 - 1.49 not delivered

1.50 - 2.49 least delivered

2.50 - 3.49 delivered

3.50 - 4.49 well delivered

4.50 - 5.00 very well delivered

s2

2.5

3.89

4.57

4.945

2.5

s3

1.6

3.785

4.245

4.66

3

s4

1.93

3.375

4.66

4.715

2.5

s5

2.855

3.635

4.785

4.93

3.285

Total

4.726

7.458

8.94

9.614

5.514

Mean

2.363

3.729

4.47

4.807

2.757

.

Discussions

Based from the results of the study, most of the respondents ages 40-47 years old which are considered young adult as per Erikson’s classification of role development. This implies according to the study of Zwick that younger supervisors are frequently associated with technical skills and knowledge, innovation, creativity, flexible to work schedules and is open to new knowledge (4). Most of the nurse supervisors were female (87.5%), which supported by Wilson et al (2018) statement that the nursing profession is female-dominated work (5). The study by Wilson et al (2018) also documented findings that the nurse was viewed as a caring profession so as women fit for the job due to their motherly instinct (5). In the presense of this limelight, men were driven away to choose nursing as their profession.

Table 2 depicted the average monthly salary gross income of the nurse supervisors. This indicates that the respondents were well compensated as stipulated by Republic Act (RA) 7301 otherwise known as the Magna Carta of Public Health Workers. The RA mandated that public health workers should receive salary Grade 16 for supervisory function with increments every ten years including allowances and benefits, additional compensations and applicable incentives. On one hand, Rodolfo and Dacanay mentioned that in some private hospitals and health care institutions, employers can not provide higher salary since its revenue were dependent to economic viability of the hospital (6). Patient admissions were getting smaller every time because of the high cost appropriated to health services in private hospitals which in turn limit the capacity to increase compensation of health workers.

Most of the nurse managers (62.5%) had five years of experience in supervisory functions. This indicates that the respondents were in the expert level classification of Patricia Benner’s theory. The theory of Benner’s Novice to Expert model identified nurses with at least two years of managerial experience who are proficient enough and capable to see nursing situation as a whole and more than the sum of its parts. Proficient nurses were able to learn from their daily experience and typically adjust plans in accordance to the need of different life events. The result conformed to the requirement of Republic Act (RA) 9173 also known as the Philippine Nursing Act of 1991 that states nursing administrators should have at least two years of experience in general administration on nursing service.

However, on the basis educational attainment (as can be seen on table 3) required as supervisor, none among the respondents acquired units for graduate education. In Article VI, Section 29 of Republic Act 9173 requires nurse managers to have nine units in management administration courses at the graduate level. This was caused to weak implementation and reinforcement of the rules and regulations to be implemented. Further, the weak educational qualification of the individual hampers to receive promotion because of the seniority or ones political affiliation. On the other hand, nurse supervisors had undergone trainings like shadowing and peer-coaching (see table 3). The data implies that the respondents were able to acquire knowledge that was used in supervisory role in the area of assignment. Previous research by Dehghani et al has explained that the nurse managers are responsible to directly supervise transactions in the nursing service and aid in reaching the goals of the organization (7). Dehghani et al further explicated that supervisors are responsible to expand knowledge, skills and commitment of the staff nurses and nursing personnel for efficient delivery of care that is why high educational qualification is needed to guarantee the quality of care implementation.

. Table 4 displayed the predominant management functions of nurse supervisors in the health care facility and focuses on Henri Fayol’s five management functions. Based from the results, nurse managers’ predominant function was commanding (4.807), while the least delivered function was planning (2.363). The data implies that nurse manager’s primary role was to command subordinates and ensure strict observance to chain of authority. This is to ensure proper communication and staff-manager relationship. The establishment of this connection motivates the staff nurses to shelter compliance and respect to institutional policies governing the practice of nursing. On one hand, the planning function of the nurse managers was least delivered. This effect supported the findings of Brown et al (2013) that planning as a dynamic function of a nurse manager was acquired on both experience and continuing education agenda (8). The know-how prepares the nurse when circumstance of the same would ensure in the future. Education and equipment of comprehension were obtained in formal instruction course through earning a degree.

The management is about enforcing laws or setting tolerable standards in the performance and not being proactive. Management by exception was often related to poor satisfaction and absenteeism. The fast turnover of nurses in the workplace limits the nurse manager’s capacity to control human resource due to low salary rate and high nurse to patient ratio. As stated in the House Bill number 2145 of the Philippines’ House of Representatives, the nurse-patient ration in government hospitals and public health system was generally below the standard of quality nursing care. However, according to Umil (2015) that nurses were forced to perform on-duty longer than the mandated eight hours of hospital work because of the insufficient supply of nurses (9). The worsening condition of government hospitals became one of the leading challenges in Philippine health care sector. This resulted to inability of the nurse managers to control human resource for safe delivery of care (10).


Conclusions and Suggestions

From the findings of the study, the researcher concluded that nurse managers were generally young adult, earning a gross income of 25,000 pesos per month on the average. The nurse managers acquired supervisory skills through peer-coaching and shadowing from senior managers as overseer of the daily transaction in nursing service. All of them did not obtain units in graduate programs, however attended trainings, conventions and fora for professional growth. The findings also revealed that planning and controlling were the two of the management functions least delivered while commanding was very well executed. Fast turnover of nurses and absenteeism were among the prime problems encountered by nurse managers. Based from the results, the researcher suggests the following measures. First, nurse managers are encouraged to enroll to a graduate degree program to enhance managerial and supervisory skills in the workplace. Second, the government or state legislators to revisit laws and policies in the provision of outright compensation to generate more job opportunities among nurses in the hospital to address fast turnover of nurses. Third, to develop actions to highlight other supervisory functions of the nurse such as staff development especially on human resource utilization.

References

1. American Nurses Association. Standards and Practice of Nursing. 2012.

2. Masters K. Role Development in Professional Nursing Practice. Jones & Bartlett Publishers; 2015. 474 p.

3. Sullivan EJ, Decker PJ. Effective Leadership and Management in Nursing. Pearson/Prentice Hall; 2005. 372 p.

4. Zwick T. Seniority Wages and Employee Participation. In: Advances in the Economic Analysis of Participatory and Labor-Managed Firms [Internet]. Emerald Group Publishing Limited; 2012. p. 343–60. (Advances in the Economic Analysis of Participatory & Labor-Managed Firms; vol. 13). Available from: https://www.emeraldinsight.com/doi/abs/10.1108/S0885-3339(2012)0000013016

5. Wilson BL, Butler MJ, Butler RJ, Johnson WG. Nursing Gender Pay Differentials in the New Millennium: Gender Pay Differentials. J Nurs Scholarsh. 2018 Jan;50(1):102–8.

6. Rodolfo MCLS, Dacanay J. Challenges in Health Services Trade: Philippine Case [Internet]. PIDS Discussion Paper Series; 2005. Report No.: 2005–30. Available from: https://www.econstor.eu/handle/10419/127910

7. Dehghani K, Nasiriani K, Salimi T. Requirements for nurse supervisor training: A qualitative content analysis. Iran J Nurs Midwifery Res. 2016 Feb;21(1):63.

8. Brown P, Fraser K, Wong CA, Muise M, Cummings G. Factors influencing intentions to stay and retention of nurse managers: a systematic review. J Nurs Manag. 2013 Apr 1;21(3):459–72.

9. Umil AM. The worsening ‘toxic’ work condition of Filipino nurses [Internet]. Bulatlat. 2015. Available from: http://bulatlat.com/main/2015/03/31/the-worsening-toxic-work-condition-of-filipino-nurses/

10. Clark L. Leading by example. Nurse Manag. 2008;15(6):12–5.



Journal of Health Science and Prevention, Vol.2(2), September 2018

ISSN 2549-919X (online) 66