In this section of the NCLEX-RN examination, you will be expected to demonstrate your knowledge and skills of concepts of management in order to:

  • Identify roles/responsibilities of health care team members
  • Plan overall strategies to address client problems
  • Act as liaison between client and others (e.g., coordinate care, manage care)
  • Manage conflict among clients and health care staff
  • Evaluate management outcomes

Many people think that leadership and management are the same thing but they are not, they are different.

Supervision, as discussed somewhat before, is the oversight and evaluation of care, aspects of care and other nursing functions that have been delegated and assigned to others.

Management, on the other hand, is meeting established goals and objectives by planning, organizing and directing actions and efforts towards established goals.

Registered nurses serve in both management and supervision functions.

Nurses, as managers, serve as a collaborator with others, a priority setter, a decision maker, a problem solver, and coordinator of care; they have the knowledge, skills and abilities relating to these functions which facilitate the movement towards established goals, as well as clinical skills and abilities.

Identifying the Roles and Responsibilities of Health Care Team Members

As the manager of client care, registered nurses must be able to identify the functions, roles and responsibilities of the other members of the multidisciplinary health care team members in order to correctly garner these services. The roles and responsibilities of a wide variety of other members of the multidisciplinary health care team were described and discussed above under "Collaborating with Healthcare Members in Other Disciplines When Providing Client Care".

Planning Overall Strategies to Address Client Problems

Registered nurses must be able to identify and employ overall strategies to address client problems and healthcare concerns.

Some of these strategies can include:

  • Supervision and delegation to insure that all client care is done in a complete, effective, proper and timely manner
  • The complete, effective, proper and timely execution of the Nursing Process including assessments, planning, implantation and evaluation
  • Collaboration and communication with other members of the multidisciplinary health care team when the need arises
  • Actively engaging and involving the client in all aspects of care
  • Providing education and training to clients and staff when the need arises

Acting as a Liaison Between the Client and Others

As previously discussed, registered nurses coordinate and manage care as they serve and act as the liaison between the client and others as they advocate for the client and the fulfillment of their needs.

Often, the registered nurse serves and acts as the liaison between the client and family members, significant others, other members of the multidisciplinary team, upper healthcare facility administrators and even healthcare insurance companies to negotiate care that is medically necessary and to obtain reimbursement for the necessary care and treatments that the client needs.

Managing Conflict Among Clients and Health Care Staff

One of the most upsetting and distressing things that occur when people work together is conflict. One thing that we must understand, however, is that conflict can be beneficial and it is a natural process that will occur and one that cannot be prevented among members of a group.

Simply stated, conflicts arise when two or more people have differences in terms of their beliefs or, opinions. Conflicts can be readily identified when arguments, a lack of trust among those involved in the conflict arise, when the flow of work is disrupted, when interpersonal relationships are impaired, when criticism of others and frustration occur.

Conflicts can be beneficial when they are resolved in a healthy, mutually satisfying manner so that all involved in the conflict can "win". Conflicts and healthy conflict resolution can lead to and promote personal and group growth and development, creativity, innovation and innovate thought, the free expression of one's beliefs and opinions, and lead to divergent thinking.

Conflict resolution and "win-win" conflict resolution is facilitated when group members and group leaders focus on the issues at hand rather than differences between and among people with diverse opinions and beliefs, when opinions and beliefs are presented in a clear, understandable manner after some research, when all maintain respect for others and their diverse opinions and beliefs, and when the conflicting parties are open to the viewpoints of others.

Ineffective conflict resolution and "win-lose" conflict resolution is destructive; it can lead to anger, frustration, a lack of commitment to common goals, disputes, struggles for power and control, and impaired thinking processes.

Registered nurses, therefore, must be able to recognize, identity, and report conflicts so that conflicts do not tatter the team when they are not identified and resolved. Ignoring conflicts will cause problems; resolving and addressing conflicts can lead to personal and group growth.

The stages of conflict and conflict resolution are:

  • Frustration: Frustration occurs when those involved in the conflict believe that their goals and needs are being blocked and not met.
  • Conceptualization: Conceptualization occurs when those involved in the conflict begin to understand what the conflict is all about and why it has occurred. This understanding often varies from person to person and this personal understanding may or may not be accurate. The conflict continues.
  • Taking action: Those involved in the conflict act. Some act in an active manner and others act in a passive manner. For example, one person affected by the conflict may act out with anger, hostility and even physical force; and another may just withdraw from the situation because they simply cannot tolerate the feelings that the conflict evokes.
  • Resolution: Resolution occurs when the group is able to come to some agreement with mediation, negotiation or another method. This resolution is done with the participation of all of those who are involved in the conflict.

Conflicts, according to Lewin who also developed a theory of planned change, include these four basic types of conflict:

  • Avoidance-Avoidance Conflicts: Avoidance-Avoidance conflicts occur when none of the people involved in the conflict do NOT want any of the possible alternatives that could resolve the conflict.
  • Approach- Approach Conflicts: Approach- Approach conflicts, in sharp contrast to Avoidance-Avoidance conflicts, occur when the people involved in the conflict want more than one alternatives or actions that could resolve the conflict.
  • Approach-Avoidance Conflicts: Approach-Avoidance conflicts occur when the people involved in the conflict see all of the alternatives or actions as NEITHER completely satisfactory and acceptable or completely dissatisfactory and unacceptable.
  • Double Approach – Avoidance Conflicts: Double Approach – Avoidance conflicts occur when the people involved in the conflict are forced to choose among alternatives and actions, all of which have BOTH positive and negative aspects to them.

Conflicts can be effectively resolved using a number of different strategies and techniques. These strategies include those below:

  • Collaboration and Open Communication: Collaboration and open communication within a trusting and supportive environment can resolve conflicts in a beneficial manner. Collaboration and open communication foster good working relationships among group members, it promotes the active participation between and among conflicting parties, and it facilitates a deeper understanding of the issue at hand.
  • Compromise and Negotiation: Compromise and negotiation facilitates the conflicting parties to be and remain to be assertive, rather than aggressive and cooperative; it also promotes a balance of power between and among the conflicting parties.Negotiation consists of focusing on common goals and interests rather than individuals and their different and disparate opinions, clearly separating the conflicting parties from the conflict and problem, exploring options and alternatives in an open and trusting environment, and using objective characteristics and criteria to describe and define the problem and the alternative solutions.
  • Mediation: This strategy includes one-to-one communication with each of the conflicting parties to learn about each person's concerns, beliefs and opinions after which members of the group can explore and employ mutually beneficial actions to resolve the conflict.

Ineffective and unhealthy methods of conflict resolution include those below.

  • Avoiding and Withdrawing: Avoiding and withdrawing is a form of passivity. Although a temporary avoidance can give the conflicting party some time to cope with and think about the conflict and possible resolutions, prolonged avoidance and withdrawal can lead the lack of conflict resolution. Sticking one's head into the sand is not helpful in terms of conflict resolution.
  • Competition: Competition thwarts conflict resolution because it is not consistent with group goals and progress towards a shared mission or goal. Competition can lead to power and control struggles, coercion, manipulation of others and an unhealthy desire of one or more of the conflicting parties to "win" at all costs at the expense of others.
  • Accommodating Others: The sacrificial accommodation of others is also detrimental to good conflict resolution. Accommodating others is not assertive, it does not promote negotiation, compromise or mediation, and it does not meet the needs of the person who is accommodating others.

Evaluating Management Outcomes

The outcomes of effective management can be measured and ascertained by scrutinizing the effects of management in terms of a number of different outcomes and variables including but not limited to staff satisfaction, staff productivity, and the provision of high quality effective, cost effective, and timely nursing care and services. It can also be measured and ascertained by evaluating the outcomes of client care and their level of satisfaction with the care and services that were provided to them, for example.


SEE – Management of Care Practice Test Questions

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