NSG/451 Week 1: Leadership and Management Roles, sample paper

Leading and Managing in the Same Week: Role Analysis of a Nurse Manager on a 34-Bed Medical-Surgical Unit

[Student Name]

University of Phoenix

NSG/451: Professional Nursing Leadership Perspectives

Week 1 Assignment

[Instructor Name]

[Date]

The nurse manager and unit described are a composite written for a model paper.

Nurses often use "leader" and "manager" as if they meant the same thing, and on a busy unit the same person frequently does both jobs before lunch. This paper separates the two roles, applies them to one week in the working life of a nurse manager on a 34-bed adult medical-surgical unit, and argues that the distinction matters less as a label than as a way to decide which kind of work a situation actually needs. A manager who treats a morale problem as a scheduling problem, or a staffing shortfall as a vision problem, will spend the week solving the wrong thing.

Leadership and Management Defined

Kotter (1990) drew the classic line between the two. In his account, management exists to handle complexity, so its tools are plans, budgets, structures and controls; leadership exists to handle change, so its tools are a direction, people aligned behind it and the motivation to keep going when the change gets hard. Management produces predictability; leadership produces movement. Marquis and Huston (2021) keep the same distinction in nursing terms. In their account, a manager holds an assigned position with legitimate authority over resources and outcomes, while a leader influences others toward a goal and may or may not hold a formal position at all.

The nurse manager competencies published by the American Organization for Nursing Leadership (AONL, 2015) build both into one role. Its framework asks the nurse manager to manage "the business" of the unit, including finances, human resources and performance improvement, and at the same time to lead the people, which covers relationship management, shared decision making and the manager's own development. The framework does not treat these as two jobs. It treats them as two sets of skills that one position must hold together.

One Week on a Medical-Surgical Unit, Read Two Ways

The composite nurse manager, here called the manager, oversees 34 beds, about 58 full-time equivalent staff and a unit that has run above its budgeted hours per patient day for three consecutive pay periods. Her week offers a clear view of both roles.

On Monday she reconciled the schedule for the next four weeks, approved two overtime requests and moved a float nurse to cover a gap on Thursday night. On Tuesday she reviewed the unit's variance report with finance and identified that most of the excess hours came from one-to-one sitters for patients at risk of falls or self-harm. Both tasks are management in the sense Kotter (1990) used: they plan, allocate and control resources so the unit functions predictably. Neither required anyone to change what they believed.

On Wednesday the work changed. At the monthly staff meeting, several nurses said they no longer trusted the sitter decisions because the criteria seemed to change with each charge nurse. The manager did not answer with a new policy. She asked two experienced nurses and a nursing assistant to review the last month of sitter assignments with her and propose a common set of criteria. That is leadership work: she set a direction (sitter use that staff can predict and defend), aligned the people who would carry it out, and gave them ownership of the answer. The distinction matters because a policy memo would have controlled behavior without changing the trust problem the staff had actually raised.

On Friday she held a difficult conversation with a nurse whose documentation errors had appeared in two incident reports. The conversation was management, because it enforced a standard with the authority of her position. How she held it, by asking what was happening on those shifts before stating the expectation, was leadership, because the goal was a nurse who would choose to meet the standard rather than one who would merely avoid being caught.

Where the Roles Overlap and Collide

The week also shows where the roles compete. The variance report pushes the manager toward cutting sitter hours quickly; the staff meeting pushes her toward a slower, shared process that may not reduce hours for another month. She cannot fully satisfy both. Wong et al. (2013), reviewing studies of nursing leadership and patient outcomes, reported that relational styles of leadership went with higher patient satisfaction and lower mortality, medication errors and restraint use. Cummings et al. (2018) reached a similar conclusion for the workforce itself: relational styles were associated with better staff satisfaction, retention and work environment, while task-focused styles were associated with weaker outcomes for nurses.

Those reviews do not say management is optional. They say that when the two roles collide, a manager who reaches only for control tends to lose the staff she needs to meet the budget in the first place. The manager in this case chose a middle path: she approved sitters for the highest-risk patients during the review period and told finance, in writing, when the unit expected to return to budget and why. That combination kept the controls in place while leaving room for the staff to shape the answer.

The collision is not unique to sitters. The same week, the manager was asked to pilot a new electronic handoff tool on the unit. Implementing it on schedule was a management task with a deadline and a training budget. Persuading nurses who already distrusted one system change that the tool would save them time was a leadership task with no deadline at all. The AONL framework is useful here because it places both demands inside one competency set (AONL, 2015), which removes the temptation to treat the people side as something a manager attends to only after the operational work is done. In practice, the manager scheduled the training hours first and then asked the two nurses who had led the sitter review to be early users, so that the people most trusted on the unit would be the first to report whether the tool helped. The operational plan and the influence plan ran together rather than one after the other.

Informal Leadership at the Bedside

A role analysis that stops with the manager misses most of the leadership on a unit. The nursing assistant on the sitter review had no authority over anyone, yet her account of which patients actually tried to leave their beds shaped the criteria more than any chart audit did. Marquis and Huston (2021) describe this as informal leadership: influence that comes from expertise, credibility and relationships rather than position. On a medical-surgical unit, the charge nurse who calms a tense handoff and the experienced nurse whom new graduates copy are leading every shift. A manager who recognizes those people, and brings them into decisions, gains influence she could not get from the organizational chart.

Implications for My Practice

As a staff nurse who will likely move into a charge role, I take two commitments from this analysis, and they come from what I saw the manager do rather than from the definitions alone. First, before I respond to a problem I will ask whether it is a complexity problem that needs planning and control or a change problem that needs direction and buy-in, because the two call for different tools. Second, when a decision will change how the staff work, I will bring the people who do that work into it early, even when a faster answer is available, because the reviews suggest that trust built that way is also what protects outcomes. Neither commitment requires a title, which is the point the informal leadership section makes: a charge nurse controls very little of the budget but a great deal of how a shift feels, and that is where most of a unit's leadership actually happens.

Conclusion

Leadership and management are distinct roles with distinct purposes, but in nursing they rarely arrive separately. One week on a medical-surgical unit showed a manager scheduling, budgeting and enforcing standards, and in the same days setting direction, aligning staff and sharing ownership of a hard decision. The skill the week demanded was not choosing one role over the other. It was recognizing which one each situation needed.

References

American Organization for Nursing Leadership. (2015). AONL nurse manager competencies. https://www.aonl.org/resources/nurse-leader-competencies

Cummings, G. G., Tate, K., Lee, S., Wong, C. A., Paananen, T., Micaroni, S. P., & Chatterjee, G. E. (2018). Leadership styles and outcome patterns for the nursing workforce and work environment: A systematic review. International Journal of Nursing Studies, 85, 19-60. https://doi.org/10.1016/j.ijnurstu.2018.04.016

Kotter, J. P. (1990). What leaders really do. Harvard Business Review, 68(3), 103-111.

Marquis, B. L., & Huston, C. J. (2021). Leadership roles and management functions in nursing: Theory and application (10th ed.). Wolters Kluwer.

Wong, C. A., Cummings, G. G., & Ducharme, L. (2013). The relationship between nursing leadership and patient outcomes: A systematic review update. Journal of Nursing Management, 21(5), 709-724. https://doi.org/10.1111/jonm.12116