Management of Practice & Influence in Health Systems

Management of practice and influence in health systems encompasses the initiative nurses take in planning and managing patient care in health systems through support of nursing practice and through particular types of collaborative relationships with other healthcare personnel.

The dimension is operationally defined by its three concepts, shown in green colour in the diagram below. They take place within the context of the philosophy and the therapeutic milieu, and in relation to practice competence and excellence and professional authority. 

As yet this dimension and its concepts are not well developed. But it is assumed that nurses have a fundamental management responsibility regarding direct patient care and in the organisational system/s in which patient care is provided. Thus, their management responsibilities are implemented at a range of levels from 'the bedside to the boardroom', although the focus so far is at the bedside. All nurses are considered managers at some level.

Three concepts

Support of Nursing Practice

This support refers to nurses' engagement in supporting, strengthening and evaluating implementation of the philosophical principles, the therapeutic milieu and practice competence and excellence, and fostering a sense of professional authority (nursing expertise) at all organisational levels. This presupposes our intellectual engagement in our continuing education and professional development.

This concept encompasses inspiring and motivating both ourselves and our colleagues, thus it encompasses leadership. This becomes the energy that drives the concept. How this energy is used is dependent on our understanding of hospital and health systems organisations, how they operate, continually change and are transformed – nothing is fixed, many things that happen are unpredictable, there is never a best time to try something new.

While a certain hierarchy and order is necessary, it is important to recognise the need for a free-flowing sense of collaboration among individuals and distinctive professional groups based on acceptance of their equal value. Meaningful support comes from within groups where members are sensitive and kind to one another, mutually respectful and helpful, dynamic and innovative. To a large extent nurses living the concepts of the therapeutic milieu dimension will provide the greatest support for nursing practice. 

Trustworthy Collaboration

This concept concerns our working relationship with other health professionals in the multidisciplinary team and with health systems administrators. It includes our often taking the initiative in addressing patient needs or problems that arise; being perceptive and exercising prudent judgement and fortitude. Issues and challenges are addressed with patience, respectfulness and an eye to enhancing human relations. Questioning of situations or methods is done with 'exquisite tact' and determination to act in patients' best interest. 

Participative-Authoritative Management

This concepts concerns nurses' working relationship with nursing assistants and other assistive personnel wherein assistants work according to the directions of professional nurses who have authoritative responsibility for their care of patients. Nurses participate with assistants to some extent to model how to carry out tasks with skill and attitudes which are consistent with the Careful Nursing philosophy and caritas, compassion, contagious calmness, patience, 'perfect skill' in fostering safety and comfort, and having great tenderness in all things.

This concept is closely associated with the idea of learning through role modelling. A role model is a person who inspires others by their attitudes and activities. In reference to professional nurses acting as positive role models for nursing assistants, because we are committed to nursing ideas and values we demonstrate this naturally in our practice. Our role modelling communication would be mainly subjective but have the quality of being contagious. With guidance, care assistants can begin to naturally imitate the attitudes and activities of professional nurses with whom they work.



Therese C. Meehan ©      April 2015