Systems-level thinking to formalize responsibilities

Confronting implicit biasMaster’s-degree leadership student Carel Troutman, left, investigated role confusion for nurses in frontline leadership positions.

Staff nurses are the backbone of the health care system, because their knowledge, skills, work and commitment are pivotal to ensuring the quality of care in the acute-care setting. Yet how their role is defined and understood brings confusion within health care systems. So Carel Troutman, a nurse and master’s-degree leadership student at the Betty Irene Moore School of Nursing at UC Davis, used her thesis to explore how providers formalize and structure the staff nurse position with leadership and management responsibilities.

“We’ve heard a lot about bedside nursing shortage, but there’s also a looming nursing leadership shortage. I wanted to look at how we could increase and improve success as these frontline nurses transition into leadership positions,” said Troutman, a performance improvement nurse in the Trauma Program for Zuckerberg San Francisco General Hospital and Trauma Center. “If we can help nurses make small steps into nursing leadership it can be compounded into a larger scale into the community.”

While the titles for this role vary across setting, including charge nurse, clinical supervisor or assistant manager, it’s regarded as a common first step into nursing leadership. Previous research has shown that the position is multifaceted, requiring a diverse skill set; yet, the position is not clearly understood and the literature suggests role confusion and little training in preparation for this position.

Troutman collected data from 10 acute-care hospitals to review documents including, organizational charts, job descriptions for the staff nurse, frontline nursing and management positions, as well as recruitment strategies for nursing leadership and management positions and training manuals. Gaining a better understanding of how organizations formalize this position provided a foundation for further research to develop evidence-based job descriptions and training programs to increase position preparedness and decrease role confusion among the nurses in this position.

“I wanted to see how organizations understand the role of these nurse leaders compared to the actuality of the position. I discovered organizations have a clear definition of the role, while nurses have role confusion. There is a mismatch and we need to find out why,” Troutman explained. “Nurses felt a lack of preparation, which I understand, because as nurses we focus so much on clinical and patient outcomes. Organizations need to focus on nurses to make sure they get the training, mentoring and support they need to be successful.”

“Carel’s thesis reflects a systems-level approach to addressing the quality and value of nursing services in acute care settings,” explained Elena O. Siegel, assistant professor at the School of Nursing and Troutman’s thesis chair. “Her work focuses on the way employers formalize expectations for staff nurse positions that take on leadership and management responsibilities.”

Troutman credits Siegel with bringing an organizational psychology perspective to her research and the School of Nursing with enabling her to look at her work from a new perspective.

“As a nurse in the trauma program, I now look at roles and responsibilities closer, who is the best person for a job and whether or not they met expectations,” Troutman said. “I’m able to break things down a bit more and communicate better. Colleagues see me as a problem solver. I’m not afraid to ask the questions and ask them in a way that makes sense to people.”

“The biggest change I’ve seen in her Carel during her master’s-degree program is the growth in her ability to effectively communicate,” explained Vivian Curd, a nurse, colleague and Troutman’s mentor. “She is genuinely curious and interested in exploring alternate ways to achieve a common goal. She is that new generation of nurses bringing innovation to the profession.”

Troutman says her School of Nursing education enabled her to meet different types of leaders who influenced her and gave her the support and strength to become a nurse leader. The experience also bred a love of research she hopes to continue long after graduation.

“This school allows people to be passionate and allows us to pursue those passions,” Troutman said.