Just like any industry, there are "old school" and "new school" approaches to nurse management. In the 21st century, many managers still cling to old ways of thinking that are, to a great extent, based on top-down, hierarchical corporate structures steeped in 20th-century patriarchal culture.
Nursing has a chance to break that pattern.
Hierarchy in healthcare
Healthcare is a hierarchical culture, and probably for good reason. That hierarchy creates a structure that allows for appropriate supervision and division of labor, perhaps similar to the command structures of the military. There are benefits to hierarchy, and many industries — including healthcare — cannot function without them.
In the control of disease outbreaks or emergency response to disasters, tight hierarchical structure is essential to efficiency, and I have witnessed such command structures in graceful (and not so graceful) action.
Hierarchy is agreed to be essential in healthcare settings, but how managers use that structure is an entirely different story.
Lines of command
In the hospital, there are lines of command that are helpful in a variety of scenarios.
If a surgeon orders post-surgical care, that order is given to the nurses who work "under" the surgeon, and those nurses know exactly who to approach with questions or concerns. Meanwhile, the nurse manager watches the bigger picture of what's happening on the floor, making decisions that directly impact the function of the unit.
Lines of command provide structure and help us to avoid chaos, and this is prudent in most cases.
Management as war
Some managers treat their position in the hierarchy as a right, a reward that they have earned. They believe their elevated position warrants respect and acquiescence on the part of their subordinate direct reports.
There are thousands of books and articles about styles of management. In the 1980s, some business books used Sun Tzu's ancient Chinese "Art of War" treatise on military strategy as a basis for a particular approach. The reality is that Sun Tzu's work was actually geared towards gaining victory with the least amount of force possible, and some may feel that certain 20th century managers heeded the word "war" more than they paid attention to the word "art."
Medicine has arguably had a military-style command structure for centuries, and some nurse managers have internalized that structure quite deeply. Meanwhile, some of us wonder if there's another way.
It's all about style
Even within a patriarchal, hierarchical structure, individual managers can utilize a variety of approaches. Managers can be soft-hearted pushovers, unyielding dictators, or anything in between. There are as many styles of leadership as there are leaders, and cultural and corporate norms of behavior influence how particular individuals choose to lead.
The profession of nursing has a certain holism at its core that many nurses accept, and that some likely reject out of hand. Certain nurse managers embrace a more open style that allows for dialogue, compromise and the flow of ideas.
While the term "open source" is generally used to describe software development strategies that allow any user to improve or alter software to which anyone has access, Wikipedia (a popular open-source encyclopedia) and other entities have brought the notion of "open source" into the popular culture.
Some managers are beginning to use an "open source" style of management that allows for increased dialogue within agreed hierarchical structures, and this could be a boon for the nursing profession.
Open-source nurse management
In open-source management, the manager recognizes his or her place of authority and responsibility, while also understanding that his or her direct reports are the best source of new ideas and fresh approaches.
In a strictly "old school" environment, the trembling employee timidly approaches the manager with an idea, verbalizes it in a shaky voice, knowing full well that the dictatorial manager will barely look up from his desk before pronouncing the idea dead in the water.
In an open-source environment, the manager actively encourages the flow of ideas, and that manager's direct reports excitedly debate solutions to problems, building upon one another's strengths and talents. The open-source manager sits back, guides the conversation as necessary, inserts ideas and questions in order to elicit further innovative thinking. Then, if warranted, the manager attempts to distill those ideas into potential action steps for further review.
Thus, the open-source nurse manager uses his or her position to boost the team's collective and individual thinking, encouraging the free exchange of ideas that leads to breakthroughs and innovation.
Building innovation
An open source style of management doesn't throw the old hierarchical structures away entirely. These structures are useful for many reasons, and within those structures, increasingly open lines of communication and creativity can be built.
The savvy nurse manager of the 21st century recognizes and encourages the innovative thinking of the team, creating an environment wherein nurses thrive, grow, innovate, create and feel free to use their expertise for the good of the whole.
The open-source nurse manager brings the energy of collaboration to the fore, using a style of leadership that brings out the best in the team, individually and collectively.
