Nurse Managers Confront Paradox

Joseph Hannan



As a profession, nursing faces a number of paradoxes, particularly in the Nurse Manager position. In her chapter of "On the Edge," Deborah Tregunno and Brenda Zimmerman identified and explained nursing paradoxes through a Complexity Science lens.

Tregunno pinpointed several nursing paradoxes in her chapter, "A Mobius Band: Paradoxes of Accountability for Nurse Managers. She and Zimmerman wrote the following:

We have identified three areas of tension for nurse managers in today's demanding practice settings: 1) efficiency and effectiveness, 2) task and relationship, and 3) stability and change. Any of these can pose seemingly contradictory responsibilities for nurse managers in their daily activities.

Tregunno and Zimmerman defined each of the paradoxes in the following way:

1) "Do more with less."
2) "The tension between task orientation and relationship management."
3) "To innovate and adapt and yet to keep things on track and predictable."

Tregunno is aware of the usefulness of a good story and sought one that would help to illustrate paradox in nursing. "What story can I use to illustrate the complexity?" Tregunno asked. She immediately thought of the SARS outbreak in Canada, examining the different reactions to the outbreak in Toronto and Vancouver.

The chapter mentions two completely different reactions to the outbreaks in Tornoto and Vancouver, illustrating a paradox.

Breakout session participants said the balanced scorecard approach to nurse management may actually be affecting patient care. "We don't focus on patient care," one participant said. Under the demands of the balanced scorecard approach, patient care may take a back seat to the completion of paperwork--an area that the Joint Comission scrutinizes.

"If we only pay attention to these measures, then we can be missing a lot of things," Tregunno said.

This breakout session really came alive with discussion, particularly with the introduction of R. Cook and J. Rasmussen's "Going Solid: A Model of System Dynamics and Consequences for Patient Safety."

Participants discussed challenges of working within the present healthcare system--particularly the inability of nurses to refuse to take on additional demands, the inability "to say no," as one person said.

"There is a finite resource to our time," one participant said. It would seem that paradox is an issue nurse managers will continue to confront in the ever-evolving healthcare system.