Perceptions of nurse administrators regarding the importance of needed administrative competencies.

The educational preparation a nurse administrator has received is thought to influence the professional socialization of the administrator. The professional socialization influences the perceptions of the nurse administrator which then influence the actions of actions of the nurse administrator. Does the advanced educational preparation of top nurse administrators significantly affect their perceptions of what are important competencies for today's nurse administrators? An adaption of Nancy Goodrich's tool 'Determining the Type and Level of Competencies Needed by Nurse Administrators' was sent to 190 randomly selected, top nurse administrators employed by hospitals greater than 300 beds in the United States. The result indicated nurse administrators with advanced educational degrees in nursing had significantly higher mean scores for the categories of education, nursing, personnel management, organizations, research, and trends in health care when compared to nurse administrators with advanced educational degrees in a non-nursing area. Nurse administrators with an advanced educational degree in nursing administration were compared to nurse administrators with an advanced educational degree in any non-nursing area. The nursing group differed significantly from the non-nursing group in only one category: Trends in Health Care. This nursing group consisted only of nurses with nursing administration degrees; those with advanced clinical degrees were not included in this nursing group. This suggested a major influence of clinical education in the socialization of nurse administrators. Weak correlations were found between category scores of perceived importance and years as a registered nurse, years as a staff nurse, and years of management experience.

PERCEPTIONS OF NURSE ADMINISTRATORS REGARDING THE IMPORTANCE OF NEEDED ADMINISTRATIVE COMPETENCIES Robin L. Phlllips and Kim E. Phl11'ips A dual thesis submitted to the faculty of The Un iversi ty of Utah in partial fulfillment of the requ1rements for the degree of Master of Science Co llege of Nursing The University of Utah August 1992 Copyrlght @ RobIn L. Ph111 ips and KIm E. Ph111 ips 1992 Al J Rights Reserved THE UNIVERSITY OF UTAH GRADUATE SCHOOL SUPERVISORY COMMITTEE APPROVAL of a thesis submitted by Robin L. Phillips This thesis has been read by each member of the following supervisory committee and by majority vote has been found to be satisfactory. Judith A. Kiernan THE UNIVERSITY OF UTAH GRADUATE SCHOOL SUPERVISORY COMMITTEE APPROVAL of a thesis submitted by Kim E. Phillips This thesis has been read by each member of the following supervisory committee and by majority vote has been found to be satisfactory. Judith A. Kiernan THE UNIVERSITY OF UTAH GRADUATE SCHOOL FINAL READING APPROVAL To the Graduate Council of The University of Utah: I have read the thesis of Rob; n L. Phi 11 ; ps in its final form and have found that (1) its format, citations, and bibliographic style are consistent and acceptable; (2) its illustrative materials including figures, tables, and charts are in place; and (3) the final manuscript is satisfactory to the Supervisory Committee and is ready for submission to The Graduate School. . ~ C)Ht 60'>-q I Itlq~ ~' . ~'----' Date ThomJMann Chair, Supervisory Committee Approved for the Major Department La c ~ ddt;t4 ~ L ;nda K. Amos I / Chair/Dean Approved for the Graduate Council B. Gale Dick Dean of The Graduate School THE UNIVERSITY OF UTAH GRADUATE SCHOOL FINAL READING APPROVAL To the Graduate Council or The U ni versi ty or Utah: I have read the thesis or ___K _i_m_E _. _P_h_i _"_'...;,"P _s_ ____ in its final form and have found that (1) its format, citations, and bibliographic style are consistent and acceptable; (2) its illustrative materials including figures, tables, and charts are in place; and (3) the final manuscript is satisfactory to the Supervisory Committee and is ready for submission to The Graduate School. . ~ ~12Ci, 1.('f{/2- ~.' ~ Date Thmn:ManSn Chair, Supervisory Committee Approved for the Major Department Llkt JIt~ ~$r~ PML Linda K. Amos . Chair/Dean Approved for the Graduate Council B. ale Dick Dean of The Graduate School ABSTRACT The educationa1 preparation a nurse administrator has received is thought to lnf1uence the professional soclal1zatlon of the admlnfstrator. The professional socialization process influences the perceptions of the nurse adm1nistrator which then Influence the actions of the nurse administrator. Does the advanced educat10nal preparation of top nurse administrators signlf1cantly affect their perceptlons of what are Important competencies for today's nurse administrators? An adapt10n of Nancy Goodrich's tool "Determining the Type and Level of Competenc1es Needed by Nurse Adm1n1strators" was sent to 190 randomly selected, top nurse administrators employed by hospitals greater than 300 beds 1n the United States. The results Indicated nurse administrators with advanced educational degrees in nursing had significantly higher mean scores for the categories of education, nursing, personnel management, organizations, research, and trends 1n health care when compared to nurse administrators with advanced educational degrees 1n a nonnurs1ng area. Nurse administrators who had received an advanced educational degree specif1cally in nursing administration were compared to nurse administrators who had received an advanced educational degree in any nonnurslng area. The nursing group d1ffered significantly from the nonnurslng group in only one category: Trends in Health Care. This nursing group consisted only of nurses w1th nursing adm1nlstratlon degrees; those with advanced cl1nical degrees were not included 1n this nursing group. This suggested a major influence of cllnical education 1n the socialization process of nurse adm1n1strators. Weak correlatlons were found between category scores of perce1ved importance and years as a registered nurse, years as a staff nurse, and years of management experience. v T ABLE OF CONTENTS ABSTRACT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1\/ LIST OF TABLES ................................................. \/111 ACKNOWLEDGMENTS ................................................ x Chapter I. INTRODUCTION .................................. to ... 1 Overv1ew .......................................... 1 Sign1flcance and Rat10nale ................... , .. , , , , . 2 Prob lem Statement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 5 Purpose ....................... ,................... 5 Research Quest 1 ons .............................. ,' 6 Theoret1cal Framework ......... , . . . . . . . . . . . . . . . . . .. 7 General Soc1a11zat1on Theor1es ................. 7 Spec1fic Profess1onal Soc1a11zat1on Theor1es/Model ................. , .. ".".. 1 1 Operat1onal Def1n1t1ons , . . . . . . . . . . . . . . . . . . . . . . . . . .. 16 Assumptions ................ , , ..... , .............. 16 L1m1tatlons ....................................... 17 Summary ......................................... 17 II. REVIEW OF LITERATURE .............................. 18 I ntroduct ion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 18 Comparisons of Nursing and Business ... , ............ 18 Relevant studies .................................. 20 Summary ......................................... 25 III. METHODOLOGY .. .. .. .. .. . .. . . . .. .. . .. . . .. . . . .. . .. .. .. 27 Introduction ..................... , , ............... 27 Research Design and Procedure ...................... 27 Instrumentation .................................. 28 Populat1on and Sample Selection .................... 31 Data Ana lys is. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 Summary ......................................... 34 IV. RESULTS ........................................... 35 Introduct1on ...................................... 35 DemographIc Descr1pt1on of the Sample .............. 35 Ffnd1ngs by Research Question ...................... 40 Summary ............................. " ............ 67 V. DiSCUSSiON ........................................ 69 Introductfon ...................................... 69 ConclusIons ......... " ........................... 69 Implications ...................................... 73 Recommendat1ons ................................. 75 APPENDIX ........................................................ 78 REFERENCES ...................................................... 88 v11 LIST OF TABLES 1. Demographic Data for Total Sample ......................... 37 2. Educational Degrees Obtained by Respondents ............... 41 3. Means and Standard Deviations of Categories for Total Sample ......................................... 44 4. Means and Standard Deviations of Variables Related to Nursing Category for Total Sample ......................... 45 5. Means and Standard Devlations of Variables Related to Leadership Category for Total Sample ...................... 46 6. Means and Standard Deviations of Variables Related to Organizations Category for Total Sample ................... 47 7. Means and Standard Deviations of Variables Related to Health Care Economics Category for Total Sample ........... 49 8. Means and Standard Deviations of Variables Related to Personnel Management Category for Total Sample ........... 50 9. Means and Standard Deviations of Variables Related to Resource Management Category for Tota 1 Sample ............ 51 10. Means and Standard Deviations of Variables Related to Qual1ty Assurance in Health Care Category for Total Sample .. 52 11. Means and Standard Deviations of Variables Related to Education Category for Total Sample ....................... 54 12. Means and Standard Deviations of Variables Related to Community Category for Total Sample ...................... 55 13. Means and Standard Deviations of Varlables Related to Research Category for Total Sample ........................ 56 14. Means and Standard Deviations of Variables Related to Trends in Health Care Category for Total Sample ............ 57 15. Means and Standard Dev1at1ons of Respondents with Baccalaureate Degrees in Nursing and Nonnurslng ............ 59 16. Means and Standard Deviations of Respondents with Master's Degrees in All Nurslng Areas and All Nonnurslng Areas ........ 61 17. Means and Standard Deviations of Respondents With Master's Degrees in Nursing Administration and Any Nonnursing Area ... 62 18. Means and Standard Deviations of Respondents with Master's Degrees in Nursing Administration and Business ............. 64 19. Correlations of Years as a Registered Nurse to Category Scores for Total Sample ....................... 65 20. Correlations of Years of Staff Nurse Experlence to Category Scores for Total Sample ....................... 66 21. Correlat1ons of Years of Management Experience to Category Scores for Total Sample ....................... 68 lx ACKNOWLEDGMENTS We would l1ke to gratefully acknowledge the contr1butions of all who helped us throughout our graduate stud1es and thesis project: - Most importantly, Lauren, our daughter, whose first three years of life have been spent with her parents in graduate schoo1. - Gygi Nielson and everyone at the Intermountain Hea1th Care ·We Care" Child Development Center for caring for Lauren throughout our chal1enging and cont1nual1y changing schedules. - Thorn Mansen, R.N., Ph.D., Superv1sory comm1ttee chair, for his constant support and guidance. - Jud1th K1ernan, R.N., Ph.D., and Barbara Kerr, R.N., M.S.N., Superv1sory committee members, for their expertfse and support. - Gail Tuohlg for her ass1stance with our stat1st1ca1 ana1ys1s. CHAPTER I INTRODUCTION Overv1ew Current health care issues place increased demands on nurse administrators. Healthcare expenditures and the number of uninsured people cont1nues to increase while the amount of monies avallable in healthcare continues to decrease. More serv1ces are needing to be rendered 1n a time of a nursing shortage. More external controls are being placed on the pract1ce of nursing administration. Hospitals face a very competit1ve environment. The number of health care serv1ces aval1able has grown and the trend of hea1th care has changed from one of 1npatlent care to one of outpat1ent care. People no longer have just one choice of how and where they wish to receive their health or medical care. The ent1re shape of the hea1th care system 1s cont1nuallyevolving. The manner 1n which nurse administrators may have practiced 1n the past 1s Quickly becom1ng obsolete. Nursing administration 1s enter1ng a new h1storical age 1n society and administrators must be prepared for the challenge of change. rf not ready, the practice of nursing 2 and nursing adminstrat10n will be left behind the times. Signjficance and Rationale H1storically, ·nurses who demonstrated good bedside skllls were often promoted to managerial positions, without the theoretical education and skills in adm1n1strat1on Jl (Baj, 1986, p. 5). In 1980, only 21~ of nurses 1n adm1nfstrat1ve posft1ons (1.e., adm1ntstrators, superv1sors, head nurses) had a baccalaureate degree In nurs1ng, and on1y 6.6~ of nurses 1n administrative positions had a master's degree 1n nurs1ng (ANA, 1985). Today more nurses 1n administrat1ve position are choosing to obtain advanced degrees. By 1984 the percentage of nurses 1n administrative positions holding a baccalaureate degree 1n nursing had increased to 25~ and the percentage of nurses 1n administrative positions holding a master's degree in nursing had increased to 13~ (ANA, 1987). Some nurses are choosing to pursue degrees in nursing while others are seeklng advanced degrees in nonnursing fields. There is a trend of more nurses pursuing advanced degrees 1n nonnursing areas, specifically business. Nursing services represent the largest, single, fixed labor cost in the hospital's operating budget, so the nurse administrator is required '. to understand and adapt to the environment of the business sector (Baj, 1986). Therefore it is not surprising that so many nurses are choosing to obtain advanced education in the dlsc1pl1ne of bus1ness. 3 "Nursing 1s the only professlon that entertains the notton that its future leaders can be prepared 1n other disc1plines. The numbers of nurses in programs of health care management and business administration should be of concern to all members of the profession- (Poul1n, 1984, p.39). There are several poss1ble explanations for the 1ncreased number of nurses pursuing advanced educational degrees 1n nonnurs1ng areas. One poss1ble explanation might be the belief that an advanced degree in nursing does not -get you anywhere". Others may think that advanced degrees 1n nursing administration do not prepare today's nurse adm1nistrator for what is needed In the fast paced and ever-changing health care environment. Nurse admin1strators are 1eaders wlth1n the nursing profess1on and w1th1n many healthcare del1very systems. Nurses must be -able to speak for nursing, interpret nursing to other d1scipllnes and groups and clarify the approprIate author1ty ro1e for nursing wfthln the health care system II (Poul1n, 1984, p.39). The American Nurses Association has developed standards for organized nursing servjces and the role of nurse administrators, The ANA standard states: W1thin organized nursing services, the nursing process is used as the framework for prov1d1ng nursing care to reclp1ents .... Within organized nursing serv1ces, research In nursing, health, and nursing systems are fac11 ita ted; research f1ndings are disseminated; and support 1s prov1ded for Integration of these f1ndlngs into the de11very of nursing care and nursing administration .... As administrators of a signif1cant component of a health care organization, nurse executtves exercise the authority inherent 1n their position to fulfill their responsibi11ty to the organ1zation, the profession, and the health care consumer. They provide leadersh1p and vision for nursing'S development and advancement within the organization. (ANA, 1988, p.S,8,9) 4 It 1s obvious from ANA's statement that a nurse administrator must have a very strong nursing base 1n every aspect of the nurse administrative role. Nurse administrators are naturally placed 1n a leadership position within the hospital organizational system. It 1s vital that the nurse administrator is able to articulate to everyone w1thin the organization the role nursing plays; specifically with'in the organization and 1n general within the health care system. How can others within the organization understand the concepts and s1gnificance of humanistic patient care issues if the nurse administrator does not have the abil1ty or has lost the ab111ty to explain these concepts to others within the organizat10n? If a nurse can not explain the importance of nurSing, no one else can, will, or should. As more nurses are choos'lng to pursue advanced degrees 1n non-nurs1ng areas as opposed to nursing areas, one must Question what the effect of this trend will be. W1ll1t be benef1c1al or detrimental to the practice of nursing administration? Krugman (1990) noted the need for data about nurse executive education and role 1dentiflcations as important. The nurse administrator has a high level of professional visibility and 5 power; therefore the nurse must be able to clearly articulate the rationale and justification for nursing practice decision making, and be an advocate for nursing w1thln the health care setting (Krugman, 1990), problem Statement The educational preparation a nurse adm1n1strator has received 1s thought to influence the profess1onaJ soc1aJ1zat1on of that a~m1n1strator. The professional socialization process is thought to have an impact on the nurse administrator's perceptions of what are important competencies for a nurse adm1nlstrator's role. The problem was that differences in perceptions of nurse administrators with advanced degrees 1n nursing and nurse administrators with advanced degrees in nonnursing fields needed to be clarified. The perceptions of specific types of competencies that are considered to be important for a nurse adm1nlstrator have not been compared or analyzed. purpose This research was designed to identify nurse administrators' perceptions of the type and the level of competenc1es needed by a nurse admln1strator. Differences in percept10ns between a group of nurse administrators with advanced degrees in nursing and a group of nurse administrators with advanced degrees 1n nonnurstng areas were exam1ned. The type of competencies invest1gated included nursing, leadership, organization, health care economics, personnel management, resource management, qual1ty assurance in health care, education, community, research, and trends in health care. This study looked for insights into how these two groups differ. This study also analyzed the relationships that exist between demographic data, such as years as a registered nurse, years of management experience, years of staff nurse experience, and the perceptions of nurse administrators. Research Questions This research addressed the following research Questions: 1. What are the perceptions of top nurse administrators regarding important competencies needed by a nurse administrator? 2. What are the differences in perceptions of nurse administrators educationally prepared in nursing and nurse administrators educat10nally prepared in nonnurs1ng fields regard'ing the importance of selected competencies needed by a nurse administrator? 3. What are the d1fferences 1n percept10ns of nurse admin1strators with advanced educat10n 1n nursing and nurse admin1strators with advanced education in a nonnurslng f1eld regard1ng the importance of selected competencies needed by a nurse administrator? 4. What 1s the relat10nship between years as a reg1stered nurse and 6 perceptions of competencies needed by a nurse adm'in1strator? 5. What 1s the relationship between the years as a staff (bedside) nurse and perceptlons of competencies needed by a nurse administrator? 7 6. What 1s the relationship between years as a nurse administrator/manager and perceptions of competenc1es needed by a nurse adm inistrator? Theoretical Framework General Socialization Theories Professional social1zation is the aCQuisition and internaHzation of the knowledge, skil1s, and sense of ldent1ty characteristics of a profession (Jacox, 1978; Moore, 1970), Many be11eve professlonal soc1aHzatlon is the most cruc1allssue 1n nursing today (Jacox, 1978; McCain, 1985; Styles, 1982). The process of professional soc1al1zatlon 1s necessary for the continued professional1zat1on of nurslng practice (Hinshaw, 1977; Jacox, 1978; LynnJ McCa1n, & Boss, 1989), There 1s currently no one theory for nurse execut1ve soc1al1zat1on. There are, though, some general theories of socta1 ization and some more specific theories of professional sociallzation. Both general and specific theories were useful 1n the deve10pment of this study. Three general theories that relate to socialization were utilIzed: Simpson's 8 soc1al1zat1on theory) Bandura's soclal1earnlng theory, and symbolic 1nteract1on theory. Simpson's socia11zatjon theory consists of three def1ned phases and 1s shown 1n Figure 1. The f1rst phase Is the transition from anticipatory expectations of roles to spec1f1c expectat10ns of r01es as defined by a societal group. The second phase is the attachment to s1gn1f1cant others within the social system noting and labeling lncongruencies 1n roles expectatfons. The th1rd and fina1 phase 15 the Internalizations, adaptations, and integration of roles and values of the reference group (Simpson, 1967), PHASE ONE PHASE TWO PHASE THREE Anticipatory Ro1~~ ___ -tl>"tt~ment to'~f-__ ~~lntern811Z8t1on and Expectations Sfgnificant otKersl ntegrat10n of Role in Social System Values vs Role Expectations of Socializing Group ~ F1gure 1 ~ Labellncongruencles 1n Value Systems Adapted from S1mpson (1967) 9 When nurses are pursuing advanced administrative education 1n a nonnursing area such as business, Simpson's theory causes one to Question who will be the "significant other" within the socializing group. If one assumes faculty most often assume this role then Simpson's theory would pred1ct that the nurse would look toward the "buslness" faculty for their significant cues eventually lead1ng to an internal1zation an~ integration of the business faculty member's role values. If a nurse is in a graduate business class with a majority of business-oriented students and faculty who have internalized a business perspectlve it would seem likely that this nurse would have very little opportunity to internalize "nursing II role values. Schecter (1988) ut111zed Simpson's theory of socialization to investtgate the concepts of occupatlonal attraction. The concept of occupational attraction 1s one of the components of Slrnpson's theory and is thought to occur as the student progresses from phase two to phase three when one adopts the roles and values of the profession. Another theory of socialization that has influenced this study IS A1bert Bandura's social 1earning theory. Bandura's theory states socialization occurs d1rectly through observational learning, which occurs by the observation of role mode1 behaviors that are then coded and 1nternaltzed for future response retr1evaL Soclal learning theory also 10 states that the amount and strength of the soclal1zatlon process 1s directly related to the amount of positive reinforcement given by the role model. The more positive reinforcement a person receives from their social group role models. the more likely the new social system's values will be internalized and reinforced (Bandura, 1969). This theory stresses again the importance of identification with a role model within a particular social group during soc1alization. The social or norm group drives the soclal1zation process. Symbolic fnteractionism is based on the bel1ef that human behavior can be interpreted as a -response to the symbol1c acts of others - notably gestures and speech - the response being 1n effect an 1nterpretation of those acts" ( Hardy & Conway, 1988, p. 64). Symbol1c lnteract10n1sm views soc1ety and 1ts institutions as a framework with1n which people make the1r roles explicit. Th1s societal framework 1s seen as only a broad ·skeleton" within which individuals construct and organize their socfal action. The roles indfvidua]s play in soc1ety depend on the 1nteractions of each indivldua] with others in each specific soc1al s1tuation. A symbolic interactlonlst's view of this study would not expect that 1f a nurse received advanced adm1nistrat1ve educat10n with a role group of nonnurses the nurse would most likely be effected by the unique 1 1 interactions within this group, If thls Nbus1ness· role group views admin1stration from a different perspective than the nurse, then the 1nteract1ons that take place between the nurse and others within the "business" role group would affect and shape the nurse's own thoughts and perceptions about adminstrat1on. Spec1f1c Professlonal Soc1al1zatton Theories/Model Three spec1f1c theor1es and one model of profess1onal soc1al1zat1on were uti Hzed: Merton's theory of the sociology of professions, Cohen's stage model of professional development, Kelman's theory of sac1al influence, and Benner's from novlce to expert theory. The first theory slgnff1cant to the study 1s Merton's theory of professional socla11zat10n. Th1s theory is based on assumpt10ns. The first assumption 1s a profession is lnstitutlonal1zed in society and a professional subculture develops around the profess10n. The second assumption 15 a ma1n env1ronment of this culture ls the profe5510nal school and 1ts faculty who are charged by theIr parent profe5s10n w1th tnstruct1ng students 1n the knowledge and skfl1s of the1r part1cular profess10nal pract1ce and through contact w1th students, lntroduc1ng them to the norms and lore of the profess1on. Merton feels faculties' and students' roles are tied together through complementary interests. Soclal1zatlon involves the acquisition of attitudes and values along w1th the skills and behav10r patterns that constitute the professional role ... including direct learning through didactic teaching and indlrect learning through example and sustained involvement with others tn the professional subsystem. (Merton, 1957, p.41 ) 12 Cohen's model of professional soc1allzat10n is based on the work of Ha~ey, Hunt, and Schroeder, who developed a stage theory of child cognitive deve1opment, which was based of the earlier work of Piaget. Cohen described professionals progressing through four stages of cognitive development as they move through the professional soclal1zation process (Cohen, 1981). The first stage 1s uni1ateral dependence. During this stage individuals place complete reliance on external control to guide them. The 1nd1vlduals are very dependent on ru1es and limit setting by authority fIgures. Stage II 1s referred to as negative 1ndependence. Dur1ng this stage the indIviduals attempt to free themselves from the controls and rules that they became so dependent upon In stage I. Students develop the ab111ty to question. Most often students exper1ence stage II w1th1n a group, Individuals gain security by remaining within the supportive environment of a group. Stage III 1s referred to as dependence/mutual1ty. During this stage a more real istlc view of the environment 1s gained. Students begin to think Independently 1n more abstract terms. Students are now able to 13 incorporate the ideas of others into their own personal and unique thoughts and judgements. Students are now able to not only perform and understand, but to evaluate their thoughts and experiences. Stage I V is referred to as interdependence. During th1s flnal stage students are able to be autonomous and dependent on others as needed. They are able to learn from others and at the same t1me exerc1se independent judgement in reaching solutions. Cohen thinks reaching this stage is very important especially for health providers. Each health prov1der has something important and unique to offer and many groups must work closely together to produce health care. Profess10nals must be able to work 1ndependently and tnterdependently at the same time and at t1mes this can be a very d1ff1cult thing to accompllsh. Also due to the rap1dly changlng nature of health care ind1viduals must be able and wl1Hng to Incorporate new and innovat1ve 1deas as they are developed. Even after a 4 year nursing educat 10n, a student may have progressed only through stage II or III. One would Question where do the flna) stages of profess1onal development take place. It 1s assumed new graduates in the work setting are often forced to comply with a totally dtfferent system of rules and norms than what they were exposed to durtng the1r formal education. It 1s doubtful the completlon of the soclal1zatlon stages would occur tn the practice sett1ng. If 1t 1s assumed the f1nal stages of profess1onal soc1allzation take place with graduate educat1on, then the d1sclplfne of advanced educat10n such as nursing or business would become very important. 14 Another theory of profess1onal development utll1zed for this study was Kelman's theory of soc1al1nfluence. Kelman's theory follows very closely with S1mpson's and Cohen's theories of soc1aJ1zat10n. Kelman's theory describes three steps individuals experience 1n any soc1al sltuatfon (Kelman, 1967). The flrst step ts compl1ance, which happens when an 1ndlvtdua1 accepts influence from another person or group 1n exchange for a favorable response from the group such as positive reinforcement. They do not adopt a behav10r because they belleve In it but because 1t g1ves them what they desire - soctal acceptance. Most often their professors play the role of the professional soc1al1zer or the group from wh1ch the student wants to ga1n acceptance from. The second step is Identification which 1s when the individual experiments w1th adopting the behaviors of one s1gnificant person w1th1n the soc1al group because the Individual wants to be noticed by that part1cular person. Jndlviduals carefully choose which parts of the professional role are appea11ng to them and accept the roJe ident1ty that 1s both personany and professlonal1y acceptable. 15 The third and final step 1s interna11zatlon. Dur1ng this step, which 15 analogous to Cohen's stage III and I V, students begin to accept the thoughts and values of the profession as their own. These theories and model are each unique 1n some way but all lead us to the same conclusion, a person's social group 1s a very 1nfluential force in the process ca11ed socialization. If we assume a nurse administrator pursuing an advanced degree is continuing the socialization process, then the educational time spent w1th the soc1a1 group would l1kely have some effect on their perceptions of nursing administration. The purpose of Benner's ( 1987) theory from novice to expert is to explain and pred1ct knowledge that accrues w1thin the practitioner over time, w1th exper1ence in the1r appl1ed d1sc1pl1ne. The theory explains how ga1ning exper1ence 1n a practice moves a person through levels of Increased proficiency. Educat10n ts seen as helpful for teach1ng the beginner practitioner or administrator what to cons1der and how to organize fnformation. Experience 1s recognized as a major factor tn Increasing the proficiency of a nurse's practice and causes one to consider the Influence of years of experience 1n life, 1n beds1de nurs1ng, and in administration regarding the perception of the 1mportance of selected competenc1es needed for nurse administrators. Ooerational Def1nlt1ons The following are operat10nal def1nltlons uti llzed in this study. 1. AdVanced nursing degree: A master's degree 1n nursing obtained from an accredited nursing program (i.e .• Master of Science in Nursing, Master of Arts 1n Nursing), 16 2. Advanced nonnursing degree: A master's degree obtained from an accredited program in an area not directly related to nursing (Le., Master of Business Admlnlstratlon, Master of Public Admlnlstratlon, Master of Health Serv1ces Adm1nistration, Master of Public Health). Assumptions 1. The 114 competenc1es used from Goodrich's tool are appropriate competenc1es needed by today's nurse administrator. 2. People complete the survey as honest1y and open1y as poss1ble. 3. The tool measures the respondents true perceptions. 4. The educational preparation one receives influences professional soc j a 11 zat 1 on. 5. The social1zation process affects a person's perceptions of his profess1on. 6. The professional soc1allzatlon process 1s not completed at the bacca 1 aureate J eve 1. L imitat10ns t. The study was mailed to top nurse administrators 1n hospitals 11sted in the American Hospitals Association' Guide to the Health Care Field (1990) with size greater than 300 beds. This sample limited the generalizations of the study to that population. 2. The study lnvo lved a one time mall ing of a survey Quest lonnalre to each admln1strator in the sample population. There was no follow up letters or telephone calls. 17 3. The study was l1mited to providing information on the percept10ns of top nurse adm1nistrators .. but d1d not prov1de information on how these perceptions impact the practice of nursing administration. Summary This research was intended to identify the perceptions of top nurse administrators regarding the Importance of needed administrative competenc1es. The study also Identified any differences in perceptions of top admInistrators based on their advanced educatlona1 preparation. In addition, the study examined the re1ationships between perceptions of the needed competencies and years as a registered nurse, years as a staff (beds1de) nurse, and years as a nurse adm1n1strator/manager. CHAPTER II REVIEW OF LITERATURE t ntroductlQn A l1terature review was made and concentrated pr1marl1y on sources publlshed within the last decade. This approach was used because of the rapidly evolving role of the nurse adm1n1strator. This chapter contains 1fterature comparing nursing and bus1ness as well as specifically relevant studies on nurse admfnlstrator soclal1zatjon and percept10ns. Comparisons of Nursing and Bus1ness Few stud1es have been fdentified that look specifically at the differences that exist between nurses who have advanced degrees in business and nurses who have advanced degrees in nurs1ng. It 1s often assumed the any differences are obvious. Many stud1es do exist that focuson the need for nurs1ng admfn1strat1on educat10n to integrate some sort of a business perspective with a strong theoretical base 1n nursing. Fralick (1989; 1987) fs a strong advocate for the combfnation of nursing and business without 10s1ng the nursing focus. Fralick states: 19 Nursing Administrators need to clearly understand and conceptua11ze the cl1nical scene, the abi11ty to evaluate and design nursing systems and the facl1itation of nursing research activity 1s the edge that competent nursing administrators bring to their positions (Frallck, 1989, p. 5,7). Nursing administrators must be a hybrid - a blend of nursing and buslness person (Frallck, 1987, p. 35). Good Nursing Admin1strators never consider nursing services to be buslnesses that simply woo customers, nursing care 1s not viewed as a product to be bought and sold In the free market. ... Values of commerc1al1sm should not supersede those of serv1ce. There is no need to create disarray 1n the theoretical base of nursing admin1stration because of the perceived threat of shift1ng values . . , ,Human car1ng, a soc1ally responsible attitude and good business management are not mutually exclusively principles .... We must produce nursing administrators whose expertise and competence bring power and influence and resources to the practice of nursing (Fralick, 1989, p. 7). Jackson (1988) agrees with FraJ tck and is a strong proponent of a master In nurs1ng being the first master's degree which she thinks should precedes a master's degree In business administration, health administrat1on, or publ1c health. -The sound theoretical and advanced pract1cal bases of graduate nursIng preparation provIde a framework for the applfcatlon of advanced bus1ness knowledge at the master's level" (Jackson, 1988, p.8). McC1osky, Gardner, Johnson, and Maas (1988) d1scuss the beneffts of combtnlng advanced nursing education with advanced education in management. It 1s bel1eved that: although some nurses can obtain advanced degrees 1n Hosplta1 Administration, Health Administration, or Bus1ness Administration and successfully integrate this knowledge into their nursing perspective and have little trouble readjusting to the nursing world that they must 20 manage, most nurses find it easier and more he lpful to acquire the too 1s of management within the context of a nursing perspective. (p. 94) Baj (1986) and Poul1n (1979; 1984) discuss the phenomenon of nurses seeking only advanced education in the area of business 1n three separate articles. These authors think that doing so endangers nursing wlthln an organlzation. They beHeve nurses must have an alleglance to nurs1ng so that they can speak for nurs1ng w1thin the organization and interpret nursing to other disc1pl1nes involved 1n the prOduction of health care. They suggest when receiving advanced admin1strative educat10n strictly 1n a business area, one might entirely loose the nurs1ng perspect1ve. This may, then, create a reductlon of nurs1ng lnfluence within the organ 1 zat f on. Although there are many articles of opinion about the Importance of nurse admln1strators keeping a nursing perspective within their management positfon, there are very few research based articles Inquirfng or examln1ng what true differences, If any, ex1st between adm1n1strators who have advanced administrative degrees 1n business only or nursing only. Relevant stud1es Krugman (1989) specifically examined nurse executive sociallzation. Several tndependent var1ables and how they related to the dependent variable of occupatlonal1mage were 1nvest1gated and ana1yzed. Nurse 21 executives who occupy the uppermost management position 1n their organization were studled. A primary rationale for the study was to clar1fy the impact or influence of educational preparation on the process of socializing the nurse executive. The relationship between the type of adm1n1strat1ve educat10n and how nurse execut1ves perce1ve occupational image was studied. Krugman found nurse executives are coming to their position well-educated about the professional values and standards of their profession, regardless of a particular type of graduate program. It was assumed much of this professional socialization was introduced in the primary education level and has become integrated into the nurse's essence of professional 1dentity and has survived. (Krugman, 1989) The population used in Krugman's study conslsted of members of the American Organization of Nurse Executives. This sample may not be a true representative sample of the population of nurse administrators 1n the United States. It is assumed a nurse administrator has a high occupatlonal1mage to j01n an organ1zation of nurse administrators. Anytime a sample 1s der1ved from a professional organization membership llst, there is a risk of havlng a group of individuals who are homogenous in some way. Therefore in Krugman's study the sample may have originally had a high level of occupatlonallmage, regardless of their graduate educational level. It can not be known 1f the results are true for the 22 general populat1on unless a random sample 1s taken from the general population of nurse administrators 1nclud1ng all geograph1cal areas of the Unlted States regardless of the1r affil1ation with a professional organization, Schecter (1988), ut111zing Simpson's theory of socialization, tried to identify what affected occupat1onal attract10n to the nursfng profession. The finding was that faculty d1d, in fact, playa role in this process and that "humanistic· behaviors contributed most to occupational attraction whl1e nonhumanistic behaviors impeded occupational attraction. This study showed the s1gnificant role faculty play In how nurse's feel about the nurs1ng profession. This study leads one to question what impact business faculty potentia11y have on a nurse's occupational attraction. One study was identified that did focus on the differences that possibly exist between nurse administrators who graduated from different types of management-oriented master's programs. Duffy and Gold (1980) sampled nursing service administrators who held master's degrees 1n two specific areas: nursing and nonnurslng. The tool measured the perceptions of how adequately each specifiC program prepared the adm1nfstrator in 23 different areas. In 78% of the management sk1lls Included 1n the tool, the findings showed the graduates of both nurs1ng administration and 23 nonnurslng admin1stration master·s programs perceived their educational preparation simllarly. The maln areas that nonnurslng administration majors felt their preparation was preferable to nursing-prepared adm1nlstrators were budget1ng, statistics, and marketing., whereas nurs1ng admin1strat10n majors felt they were better prepared 1n the areas of research princ1ples and programm1ng for 1nserv1ce educat10n. This study also revealed that the mean responses of both groups were 1n the moderate level of perceived preparation and none were 1n the excellent level. Regardless of the type of administrative degrees of these two groups, both groups perceived there was much room for improvement 1n their program of study (Duffy & Gold, 1980). Gold and Duffy'S (1990) study showed d1fferences of how each group felt about the preparation they had received. This study, however, d1d not address whether these d1fferences 1ncluded how adm1n1strators perceive what a competent nurse administrator needs to understand. This study does not give 1ns1ght 1nto whether or not nurse adm1n1strators who receive the1r administrative education from a business perspective wil1 think that "nursing" competencies are any more or less important. Findings also pertinent to thIs study was a d1ssertat1on by Goodrich (1982), which investigated the d1fferences in percept10ns of type and level of competenc1es needed by a nurse adm1nistrator. The perception of the 24 level of prof1ciency needed in each competency area by today's nurse administrator was examined. Goodrich developed a tool to measure perceptions of proficiency levels utllizing the De Iphl technique. The three groups included in the sample were hospital nurse administrators, community health nurse administrators, and nursing administration faculty. The differences that may potent1al1y exist among these three groups were studied (Goodrich, 1982). The results of particular relevance in Goodrich's study were that the ratings of importance and prorlciency were found to have no signlrlcant relationship to the respondent's basic educational preparation or advanced educational preparation. Goodrich recommended further research to determine if selected demographic data such as educational preparatton have a signIficant Influence upon the competency ratings. Although Goodrich found no significant relationship between educational preparation and competency ratings, the descrfptive part divided respondents into nursing and nonnursing educational preparation. The tool did not specifica11y 1dentify business from several other common nonnurstng degree such as Pub 1i c Hea I th or Hea I th Serv ices. Due to th j s genera 1j ty J 1t 1s believed that the too1 wou1d be very useful when utll1zed to look spec1 fica Ily at any d1 ff erences that m tght ex1st between nursing adminIstrators who hold advanced degrees in nursing and those who hold 25 advanced degrees in specific nonnursing areas such as business. Throwe and Fought (1987) note the need of students participation in cl1nical activities as well as in the classroom during the sociallzation process. It is crucial that learners view the professional role implemented in a setting similar to their practice work site. This will enable them to incorporate the new concepts more easily into their own practice. The RN learner needs support and reinforcement iri a clinical setting to facil itate acquisition of these new behaviors (Throwe & Fought, 1987), Commonly nurses pursuing an advanced degree in a nonnursing field do not participate in c1inical activities such as a residency or practlcum with an experienced nurse administrator. The om1ssion of clinical activities removes the experienced nurse administrator as a socfaJizing agent. Summary The review of the literature revealed no existing work that specifically addressed the d1fferences in perceptions of nurse administrators with different educational preparations regarding the importance of needed competenCies. Many authors had personal opinions about the type of educational degrees that would increase the competency of nurse administrators, but there was controversy and a lack of 26 consensus. There is a need to conduct a national survey to measure the perceptions of nurse administrators regarding needed administrative competencies. Comparisons then need to be made to ldent1fy any differences of perceptions in groups with different educational degrees. Relationships also need to be investigated between these percept10ns and years as a registered nurse, years as a staff (bedside) nurse, and years as a manager. CHAPTER III METHODOLOGY IntrQductlon This chapter includes the methodology used in conducting the study. Research des1gn and procedure, instrumentation, population and sample selection, and data analysis are d1scussed. Research Design and procedure This was a descriptive study using a survey design to jnvestigate relationships and differences between groups. A questionna1re and cover Jetter was mailed to the subjects. A penny was taped to the top of the cover Jetter with the logo U A penny for your thoughts. It This strategy was used to attract the subject's attention and to encourage them to respond. The Questfonna1re was formatted to make the 1nstruct1ons very clear, the prlnt easy to read, and the black-to-wh1te rat10 appeal1ng to the eye (see Appendix). A self-addressed stamped envelope was included w1th the questionnaire. Permlss10n from the University of Utah Institutional Rev1ew 28 Board was obtalned before sending the Questionnaire. The cover letter contalned an explanation of the purposeJ the proposed rlsksJ the presumed benefits of the studYJ and the protection of confidentiality for the partictpants (see Append1x). Informed consent was 1mp11ed by anyone completIng the survey and return1ng it to the 1nvest1gators. Instrumentat1Qn The Quest10nnalre used 1n this study cons1sted of two parts. Part I measured the perceptions of type and level of competencies needed by nurse admin1strators. Part II gathered demographic data about the respondents. Part I of the quest10nnaire used in this study was an adaptation of a too) developed by Goodrich (1982) and fncluded 114 quest10ns measuring perceptions of Importance of type and level of competencies needed by nurse admInistrators. PermIssIon was granted by Goodrich to use the tool 1n th1s study. Goodr1ch's goal In the development of the tool that was borrowed for this study was to comprise a list of a) 1 areas that a nurse adminIstrator should be competent. Due to the subjective nature of this task the Delphi technique was extremely Important so that there would be somewhat of an organ1zed method to arrive at this list. The De Iph1 technique uses expert samp 11ng. Several rounds of Questionna1res on a specific top1c are sent to experts wIth the goal of el1citing their opinions. The data are then analyzed, the Questions are reformulated and sent out again. The 90a11s group consensus. 29 Goodrich selected a panel of experts in nursing administration to elicit their opinions about needed competencies for nurse administrators in accordance with the following specific set criteria: 1. Recommendation by the National League for Nursing, the American Hospital Associatlon, and the Amer1can Nurses Association. 2. Representation of directors of nursing in both small and complex hospitals and in community health agencies. 3. Representation of graduate educators from a program with emphas1s in hospital nursing administration and a program wlth emphasis in community health administration. 4. Representat10n from other heaJth d1sc1pl1nes, notably health care administratIon and medicine. 5. Geographic location with attention to a balanced national representat 10n. 6. ProfeSSional activ1ty and leadersh1p at the nat10nalleve1. The selected panel of experts took part in two rounds of surveying to arr1ve at consensus of what competencies nursing adm1nistrator needed to have. The final vers10n of Goodrlch·s tool1ncluded two major parts. Part 30 I measured importance of competency; Part II measured 1mportance of proflencency. Each of these parts contains the same list of 117 ind1vidual competencies, which were categorized into several broad competency categories. Goodr1ch computed correlation coeff1clents between the mean for each 1nd1vidualltem and the mean for a111tems 1n Part I and Part II because the tool was original and had not been previously used or tested. Correlation coefficients for all items in Part I of Goodrich's tool wlth the exception of two 1tems ranged from 0.27 and 0.67, which was found to be stat1st1cally s1gnificant. The two items were: advanced nursing practice (distribut1ve setting), and advanced nursing practice (episodic setting), All other items 1n the tool were found to be rellable. Due to this finding these two Items were eliminated from the tool for use 1n this study. The or1g1nal tool of 234 Questions had two major parts: levels of importance of competency and 1evels of 1mportance of proficiency. The one half of the tool that measures perceptions of importance of type and level of competency needed by nurse admin1strators was util1zed for this study. For the purpose of this study) a tool was required that measured the perceptions existing between groups of nurse administrators. Ut1Hzlng the first half of the tool (or 117 questions) accomplished this goal w1thout d1scouraglng completion because the tool was too long or 31 cumbersome. Respondents were asked to rate the importance of individual competencies needed by a nurse administrator on a scale of 0 to 3. The ratings were defined: 3 = Essential (required for administrative competency), 2= Important (contributes to administrative competency), 1 = Low importance (has minimal effect on administrative competency), 0= Unimportant (has no effect on administrat1ve competency. The individual competencies were divided into 11 categories. The 11 categories included: Nursing, Leadership, Organizations, Health Care Economics, Personnel Management, Resource Management, Quality Assurance in Health Care, Education, Community, Research, and Trends 1n Health Care. There were a different number of variables 1n each category. Part II of the Questionnaire was designed by the researchers and consisted of Questions to obtain demographic data. The section of Questions on educational preparation was designed to be very specific. Data were requested on all educat i ana 1 degrees the respondents had obtained, the year obtained, and speciallzatian of degrees (see Appendix). Population and Sample Selection The sample was selected from a group of top nurse administrator 1n hospitals in the United States. The American Hospitals Associations' 32 Guide to the Health Care Field (1990) was ut111zed to obta1n a l1st of all hospitals 1n the United States with stated size greater than 300 beds. The Questlonnaires were malled to the top nurse administrator at each of the 190 randomly selected hospitals. The larger sample size of 190 was selected with the intent of increasing the actua1 number of returned surveys. The response rate for mal1ed surveys with no follow up is usually low at 20-}0". The population chosen (top nurse administrators) are a population with many time constraints and a lower response rate was expected. It was decided to send the questionnaire to the top nurse administrator at each hospItal because these are the nurses in the organization who sets the tone for nursing practice at their respect1ve hospitals. Data AnalysiS BaSic statistical analys1s of the data contained descr1ptive statlstlcs. The data were treated as lnterval data and parametr1c statistiCS were used. T -tests were used to compare the significance of differences between groups w1th1n the samp1e. Pearson product moment correlat1on coefficients were used to analyze the relationships existing between descriptive data and the perceptions. The specif1c statistical test used to answer each research question is as follows: Question 1 (what are the percept10ns of top nurse administrators regarding important competencies needed by a nurse administrator) used descriptive stat1stics. Question 2 (what are the d1fferences in perceptions of nurse 33 adm j n j strators educat i ona l1y prepared f n nurs 1 ng and nurse adm j n j strators educationally prepared 1n nonnursfng ffelds regard1ng the 1mportance of selected competencies needed by a nurse adm1n1strator) used ,t-tests. Question 3 (what are the dIfferences in perceptions of nurse administrators with advanced education in nursing and nurse administrators with advanced education in a nonnursing field regarding the importance of selected competencies needed by a nurse administrator) used ,t-tests. Question 4 (what 1s the re1ationship between years as a registered nurse and percept10ns of competencies needed by a nurse administrator) used Pearson product moment correlat1on coeff1cients. Question 5 (what is the relationship between the years as a staff (bedside) nurse and perceptions of competencies needed by a nurse administrator) used Pearson product moment correlation coefficients. Question 6 (what is the relationship between years as a nurse administrator/manager and perceptions of competenc1es needed by a nurse admln1strator) used Pearson product moment correlation coefffcients. 34 Summary This chapter presented the methodology used to conduct the research. The research design and procedure are d1scussed. The origln of the 1nstrument used and its modifications are presented. Finally, the population and sample selection are discussed and the statistical analysis procedures used to answer each research Question 1s presented. CHAPTER IV RESULTS 1 ntrQduct ion This chapter begins with a description of the sample populat1on. The research quest10ns are then presented w1th the results for each Question. Demographic Description of the Sample Ninety-four surveys were returned for a response rate of 49Si. The usual response rate for a mal1ed questionnaire w1th no fo11ow up was estimated at 20-30Si. The above average response rate of the study was contributed to the special attention g1ven to the cover letter wtth logo. The response rate also lndtcated an overwhelm1ng 1nterest 1n th1s top1c by today's nurse adm1n1strator. Four of the returned surveys were unusable because of missing data, and two surveys were received too late to be included In the data analysis, for a total of 88 useable surveys. The title VIce President of Nursing/Patient Care Serv1ces was held by S2.3~ of the respondents, Assocfate Administrator for Pat1ent Care 36 Serv1ces (18.2~), Dlrector of Nursing Services (13.6~), and Chief Nurse (10.2%) (Table 1). The types of hosp1tals employing the respondents were Not-For-Profit Nongovernmental (73.9"), Nonfederal Governmental, (12,5~)J Federal Government,( 11.4%) and For Proflt Investor-owned, (2.3%). The size of the hospitals employing the respondents ranged from 220 beds to 938 beds (Tab1e 1). The population included nurse administrators of hospitals listed In the American Hospital Association's Guide to the Health Care Field (1990) with greater than 300 beds. Five nurse adm1nlstrators returned surveys and l1sted the bed size of the1r hospltalless than 300 beds. The decrease 1n bed size was assumed to be related to the current trend of downsiz1ng hospitals. The respondents' ages ranged from 34 to 60 w1th a mean age of 46.23 and 93.2% were female whl1e 6.8% were male (Table 1). The rat10 of female to male respondents Is close to the nat10na1 ratio of females to males In the nursing professions. Quest10nnaires were returned from 39 states. There was representation from every geographical area 1n the United States (Table 1), Years as a registered nurse ranged form 9 to 41 with a mean of 24.034. Years of exper1ence in a management role ranged from 3 to 36 w1th a mean of 15.536 (Table 1). Years of experience as a staff (beds1de) 37 Table 1 Demographic Data of Total Sample n Descript1ve Data (n=88) ~ Sample Title Vlce Presldent of Nursing/Patient Services 46 52.3 Associate Administrator for Patient Care Services 16 18.2 Director of Nursing Servlces 12 13.6 Chief Nurse 9 10.2 Other 2 2.3 Type Qf Hospital Non-Governmental, Not-For- Prof1t 65 73.9 Governmental, Non-Federal 1 1 12.5 Governmental, Federal 10 11.4 Investor-Owned, For-Prof1t 2 2.3 Size Qf Hospital 220-299 5 5.7 300-499 47 53.4 500-699 27 30.7 700-938 8 9.0 Descript ive Data ~ 34-40 41-45 46-50 51-55 56-60 Gender Ma1e Female Geograph i ca 1 Areas Pacific West Mountain West Central South Northeast Southeast Table 1 Continued n (n=88) ~ Sample 8 33 20 17 8 6 82 4 8 26 19 18 13 9.0 37.5 22.7 19.3 9.0 6.8 93.2 5.0 9.0 30.0 21.0 20.0 15.0 38 39 Table 1 Continued n Descrlpt 1ve Data (0=88) % Sample Y~ar~ a~ g R~gj~t~r~g N!Jrs~ 11-20 27 30.6 21-30 42 47.7 31-40 17 19.3 41 1.1 years Management Experfence 3-10 22 25.0 11-15 28 31.8 16-20 18 20.4 21-25 9 10.2 26-30 3 3.4 31-36 4 4.5 Y~ars Staff Nyrs~ E~lleri~[l~~ 1- 5 44 50.0 6-10 32 36.3 11-15 7 8.0 16-21 2 2.3 40 reg1stered nurse ranged from 1 to 21 with a mean of 6. 188 (Table 1). Years of experience in their current position ranged from 1 to 27 wlth a mean of 5.628 (Table 1), Respondents were asked to list a11 degrees that they had obtained 1n nursing. Assoc1ate Degree had been obtained by 13.6~, D1ploma (44.3~), Baccalaureate (70.5~), and Masters (61.4~). No one Included 1n the sample had obtained a Doctorate degree 1n Nursing. This may be related to the limited number of nursing doctoral programs available 1n the United States. Respondents with master's degrees in nursing were grouped by areas of specialty: nurs1ng administration (27.3%) and cllnlcal areas (26.1 %) (Table 2), Respondents were also asked to l1st all nonnurslng degrees that they had obtaIned. Baccalaureate degrees were obtained by t 3.7~, Master's (27.2%), Doctorate (8.0%) (Table 2). Findings by Research Quest jon Research quest ion one stated: What are the perceptions of top nurse adm1n1strators regard1ng important competencies needed by a nurse admfnistrator? The total mean score for each category was divided by the number of var1ables in the category to obtain the individual category's mean score. The leadership competency category had the highest overall mean score Table 2 Educational Degrees Obtained by Respondents Degree n (.0.=88) % Sample Nurs i ng Degree Associate 12 13.6 Diploma 39 44,3 Bacca 1 aureate 62 70.5 Masters 54 61.4 Doctorate 0 a Noonurslng Degree Bacca laureate 12 13.7 Masters 24 27.2 Doctorate 7 8.0 ECCLES HEALTH SCIENCES LIBRARY 41 Degree Masters in Nurslng Nursing Admin1stration Cltnical Unknown Masters in Nonnursing Business Hea1th Administration Pub11c ·Admlnlstrat1on Unknown Table 2 Continued o (0=88) 24 23 7 9 9 3 3 42 % Sample 27.3 26.1 8.0 10.2 10.2 3.4 3.4 43 (2.805). Trends 1n Health Care (2.560) and Qual1ty Assurance 1n Health Care (2.543) were rated with the next h1ghest mean scores. Categories w1th mean Cleve 1 of 1moortance) scores less than the" 1mportant "rat 1ng were Resource Management (1.990), and Research (1.985) (Table 3). The results of each of the 11 competency categor1es are presented1n regards to the mean score for the ind1vidual competencies 1n the category. The Nursing category contained six individual competencies: The 1ndlvfdua1 competency of baslc nursing practice had the highest mean score (2.966). The means of all1ndividual competencies 1n this category were contained between the "essential" and "important" ratings except the nursing theory competency mean (1.989) (Table 4), The Leadership category contained 16 individual competenCies. The individual competency mean scores ranged from communIcation, 2.989, to supervision,2.425. The means were all rated between the "essent1al" and -important" ratings (Table 5). The Organizations category contained 11 individual competenc1es. The mean score for the ind1v1dual competenCies ranged from phi1osophy, purpose, objectives, 2.678, to management by objectives, 1.793. AlJ individual scores were contained between the "essential" and "1mportant It ratlngs except the management by objectives means score (Table 6). The Health Care Economics category contained 19 individual Table 3 Means and Standard Deviations of Categories for Total Sample Category leadership Trends 1n Health Care Quality Assurance in Health Care Personne J Management Nursing Organ j zat 1 ons Health Care Econom1cs Community Education Resource Management Research Total Mean <n=88) 44.884 12.795 27.977 33.284 14.193 27.953 43.931 15.375 14.636 21.894 11.909 Var1ables Indfv1duaJ 1n Category Mean 3.035 16 2.805 1.954 5 2.560 3.548 1 1 2.543 4.908 14 2.377 2.766 6 2.366 4.469 12 2.329 6.374 19 2.312 3.445 7 2.196 3.312 7 2.091 4.838 1 1 1.990 3.135 5 1.985 44 Table 4 Means and Standard Deviations of Variables Related to Nursing Category for Total Sample Variable Basic Nursing Practice Nursing De 1 fvery Systems Standards of Practice Nursing Care Evaluation Methods Nursing Care Planning Methods Nurs1ng Theory Mean (n=88) 2.966 2.773 2.625 2.477 2.102 1.989 .183 .473 .612 .643 .759 .750 45 Table 5 Means and Standard Deviations of Variables Related to Leadership Category for Total Samp1e Varlable Communication Decislorl Making Interpersonal Relet10ns Adm inistrative/Organlzational Behavlor Setting Priorities Problem Solving Change Process Group Prooess Conflict Management Motivation Risk Taking Delegation Power Stress Management Interdlsclpl1nary Coordination of Patlent care Supervision Mean (n-ee) 2.989 2.977 2.966 2.909 2.897 2.885 2.885 2.875 2.874 2.864 2.849 2.793 2.702 2.667 2.580 2.425 .107 .150 .183 .289 .342 .321 .321 .333 .334 .345 .392 .407 .485 .521 .562 .583 46 Table 6 Means and Standard Deviations of Variables Related to Organizations Category for Total Sample Variable Philosophy, Purpose, Objectives Planning Methodologies Po 1iC les and Procedures Systems Approach Regulation of Health Care Agencies Management / Organ1zational Theories Governance in Health Care Agenc1es Hospital Informatlon Systems Participatory Management Contractlng Contracting Management by Objectives Mean (n=88) 2.678 2.632 2.276 2.586 2.540 2.448 2.402 2.322 2.163 2.057 1.793 .517 .531 .641 .540 .587 .586 .559 .638 .684 ,635 .765 47 48 competencies. The competency means ranged from cost conta1nment, 2.782, to fund rais1ng, 1.437. Four individual competency means fell below the" important - rat1ng: accountlng, 1.893, data processing systems, 1.851 ~ financ1al aud1ts, 1.782, and fund raising, 1.437 (Table 7). The Personnel Management category contained 141nd1vldual competencies. The means of the competencies ranged from Retention, 2.705~ to collective bargaining, 2.080. All individual competency mean scores ranged between the "essential- and" important - rating (Table 8). The Resource Management category contained 11 individual competencies. The means ranged from employee health and safety, 2.364, to distribut1on, 1.466. Five of the 11 competency means were rated 'In the "low importance- range: procurement, 1.931; standard1zation, 1.807; inventory control, 1.625; supply, 1.529; and distribution, 1.466 (Table 9). The Quality Assurance in Health Care category contained 11 1ndividual competencies. The mean scores for the individual competencies ranged from accreditation, 2.875, to health services agencies/community planning, 2.092. Allindivldual mean scores were contained between the "essential- and" important - ratings (Table 1 0). The Education category contained seven individual competencies. The individual competency mean scores ranged from trends and issues, 2.625, to learning evaluation, 1.693. Three of the seven competency means Table 7 Means and Standard Deviations of Variables Related to Health Care Economics Category for Total Sample Variable Cost ContaInment Product1v1ty GeneratIon and Control Operatlonal BUdget Generat 10n and Control Manpower Budget Cost Effectlveness Process FlexIble Budget Forecasting Cost Benef1t Analys1s 6enerat1on and Control Capltal BUdget Cost Reduct10n Process Cost Contro 1 Process Program Plann1ng BUdget Systems F1xed Budget Zero-Based Budget1ng Market1ng Account1ng Data Process1 ng Systems F1nanc1al Aud1ts Fund Ra1s1 n9 Mean (n=88) 2.782 2.770 2.621 2.609 2.586 2.517 2.506 2.494 2.494 2.483 2.471 2.355 2.172 2.080 2.080 1.893 1.851 1.782 1.437 .492 .423 .534 .536 .495 .503 .608 .568 .568 .607 .587 .610 .702 .686 .575 .547 .620 .579 .604 49 Table 8 Means and Standard Deviations of Variables Related to Personnel Management Category for Total Sample Variable Retention Counseling Performance Evaluation Labor Laws Discipl1ne Personnel Po11c1es Staff1ng Promotion Affirmative Act10n Workload Measurement Front-Lfne Management Sklll Job Ana lys 1 s Mid-Lfne Management Skill Collective Bargaining Mean (0.=88) 2.705 2.682 2.602 2.489 2.466 2.443 2.420 2.420 2.330 2.205 2.159 2.148 2.136 2.080 .483 .492 .515 .587 .586 .604 .601 .601 .620 .646 .725 .704 .628 .805 50 Table 9 Means and Standard Deviations of Variables Related to Resource Management Category for Total Sample Variable Emp 1 oyee Hea 1 th and Safety Infection Control Emergency Serv 1 ces Forecast i ng Disaster Planning Value Analys1s Procurement Standardization I nventory Contra 1 Supply D1stribution Mean (n=88) 2.364 2.318 2.318 2.207 2.193 2.148 1.931 1.807 1.625 1.529 1.466 .610 .635 .635 .794 .658 .736 .695 .641 .716 .644 .660 51 52 Table 10 Means and Standard Deviations of Variables Related to aual1ty Assurance in Health Care Category for Total Sample Var1able Accred1 tat ion Licensure Legal Aspects of Nurs1ng Practice Ethics Programming for Qua11ty Assurance Professional Standards Revfew Certlficatlon Organfzatfon Peer Review Intematlonal Audlt/Evaluatlon Health Services Agencies/Community Plann1ng Mean (n=88) 2.875 2.807 2.739 2.693 2.655 2.523 2.466 2.477 2.318 2.239 2.092 .364 .425 .467 .511 .524 .567 .660 .567 .653 .567 .658 53 were below the 1& important II rating: teaching strategies, 1.989; inservice education, 1.864; and learning evaluation, 1.693 (Table 11). The Community category contained seven lndividual competencies. The individual competency mean scores ranged from public relations, 2.443, to epidemiology, 1.727. The epidemiology competency was the only individual competency means score to fall be low the II important" rat ing (Table 12). The Research category contained six individual competencies. The individual competency means ranged from interpretation, 2.239, to economies of research, 1.789. Four of the six individual competency means fell below the "important II rating: statistics, 1.977; legal aspects of research, 1.852; research design, 1.841; and economics of research, 1.784 (Table 13), The Trends in Health Care category contained five individual competencies. The individual means were all rated between the "essential" and «important" ratings and ranged from delivery systems, 2.705, to new technology, 2.420 (Table 14), Research question number two stated: What are the differences in perceptions of nurse administrators who have been educationally prepared at the baccalaureate level1n nursing and nurse administrators educationally prepared in a nonnurs1ng field regard1ng the importance of selected competencies needed for nurse administrators? Table 11 Means and Standard Deviations of Variables Related to Education Category for Total Sample Variable Trends and Issues Professional Education Continuing Education Teaching/Learning Theories Teaching Strategies Inserv1ce Educatlon Learning Evaluation Mean (n=88) 2.625 2.386 2.057 2.023 1.989 1.864 1.693 .593 .633 .701 .643 ,634 .681 .632 54 Table 12 Means and Standard Deviations of Variables Related to Community Category for Total Sample Variable Pub l1c Re lations Political Process Socio Economic Trends Health Problems Consumerism Assessment of Community Health Needs Epidem10 logy Mean (n=88) 2.443 2.409 2.330 2.227 2.216 2.023 1.727 .623 .637 .638 .620 .718 .678 .723 55 Table 13 Means and Standard Devlat10ns of Variables Related to Research Category for Total Sample Variable Interpretation of Research Implementat10n of Findings Stat1stics Lega 1 Aspects of Research Research Des1gn Economics of Research Mean (0=88) 2.239 2.216 1.977 1.852 1.841 1.784 .625 ,669 .587 .720 ,676 .765 56 Table 14 Means and Standard Deviations of Variables Related to Trends in Health Care Category for Total Sample Variable De livery Systems Manpower Health Care Laws Advances in Medical Care New Techno logy Mean (n=88) 2.705 2.659 2.568 2.443 2.420 so .459 .500 .542 .564 .519 57 58 Respondents were asked to l1st all educational degrees they had obtained (associate degree in nursing, d1ploma in nursing, baccalaureate in nursing, baccalaureate in nonnursing, masters in nursing, masters in nonnursing , doctoral degree in nursing and nonnursing. All respondents who had obtained a baccalaureate degree in a nursing area were included in group 1. All respondents who had obtained a baccalaureate degree in a nonnursing area were included in group 2. A i-test was computed comparing the mean scores between the two groups for each of the 11 categories. No significant differences were found between the two groups for any of the 11 categories (Table 15), Research question three stated: What are the differences in perceptions of nurse administrators with advanced education in nursing and nurse administrators with advanced education in a nonnurslng field regarding the importance of selected competencies needed for nurse administrators? All respondents who had obtained a master's degree in any nursing area were included in group 1. All respondents who had obtained a master's degree in any nonnurslng area were included in group 2. A i-test was computed comparing the mean scores between the two groups for each of the 11 categories. There were significant differences found between the two groups in 6 of the 11 categories. The Education category had the most significant difference between the 2 groups ( i = 2.18, ll.< .05, two 59 Table 15 Means and Standard Deviation for Respondents With Baccalaureate Degrees 1n Nursing and Nonnursing Category Nursjng Mean SO (n=62) Nursing 14.291 2.477 Leadership 44.836 3.371 Organizations 27.836 4.674 Health Care 43.073 6.973 Economics Personne1 32.927 4.666 Management Resource 21.509 4.714 Management Quality 27.855 3.525 Assurance 1n Health Care Educat10n 14.618 2.909 Commun1ty 15.164 3.468 Research 11. 782 3.041 Trends in 12.709 2.052 Health care * P i.OS Nonnursing Mean S.Q. (n= 12) 12.546 4.435 44.182 2.639 27.273 3.927 43.636 3.828 31.451 .6.451 21.455 5.447 26.818 4.355 12.909 5.375 14.091 4.700 11.000 3.821 12.364 1.963 1. 1.27 0.71 0.18 -0.38 0.59 0.03 0.74 1.02 0.72 0.64 0.53 Sign. Leve1 .231 .485 .862 .708 .568 .976 .471 .327 .486 .534 .605 60 tailed). Nursing (t= 2.11, p, .05, two-talled) and Personnel Management (t= 2.07, p< .05, two tailed) were also found to be signif1cant. Three categories were found to be slgnificant for a one-tailed test. Research (t= 1.93, p<.05, one-tailed) 1 Organizations (t= 1.84, p< .05, one-tailed), and Trends in Health Care (t= 1.67, p< .06, one-tal1ed) (Table 16), The respondents who had obtained a master's degree in nursing were further divided into groups who had obtained a master"s degree in nursing administration and those who had obtained a master's degree in a clinica1 nursing area. Only those respondents who had obtained a master's degree in nursing administration were included in group 1. Respondents who had obtained a master's degree in any nonnursing area were 1ncluded in group 2. A i-test was computed comparl ng the mean scores between the two groups for each of the 11 categories. The only significant d1fference was found was in the Trends 1n Health Care category (t= 1.93, p<.05, one­tailed) (Table 17), The respondents who had obtained a master's degree in a nonnursing area were further divided into groups who had obtained a master's degree 1n business, health administration, public administration or an unknown area. Respondents who had obtained a master's degree in nursing adm1nstration were inc1uded 1n group 1. Respondents who had obta1ned a masters degree in the nonnurs1ng area of business were 61 Table 16 Means and Standard Deviation for Respondents With Master's Degrees in All Nursing Areas and All Nonnursing Areas Category Nursing Mean 5.Q. (n=54) Nursing 14.638 2.488 leadership 45.149 2.646 Organizations 28.170 4.435 Health Care 43.702 6.878 Economics Personnel 33.723 4.740 Management Resource 22.021 4.857 Management Qualfty 28.213 3.381 Assurance 1n Health care Education 15.170 2.815 COmmunity 15.553 3.367 Research 12.277 2.887 Trends in 12.851 2.000 Health care ** Pi. 05 (2 Tail Significance) * P.i .05 ( 1 Tail Significance) Nonnursing Mean ~ (n=24) 13.000 3.362 44.125 3.505 26.250 4.003 43.167 5.419 31.167 5.027 21.000 4.863 26.708 3.951 13.042 4.329 14.208 3.901 11.875 2.894 12.000 2.043 1. 2.11 1.26 1.84 0.36 2.07 0.84 1.59 2.18 1.44 1.93 1.67 Sign. Level .042** .216 .071* .721 .045** A07 .119 .036** .158 .059* .101 * 62 Table 17 Means and Standard Dev1at1ons for Respondents w1th Master's Degree 1n Nurs1ng Adm1n1strat1on and Any Nonnurslng Areas Category Nsg. Adm. Mean .s.Q (n=24) Nurs1ng 13,952 2.958 19l1tership 45.000 2.569 Organ 12fJUons 28.191 4.654 Health Care 44.762 6.670 Economics Personnel 34.143 4.912 Management Resource 22.381 4.842 Management Quality 28.523 3.415 Assurance in Hea1th Care Education 14.619 3.041 Community 15.714 3.466 Research 12.429 2.942 Trends in 13.238 1.947 Health Care * p ~ .05 ( 1 Ta11 Significance) Nonnursfng Mean .s.Q (n=24) 14.089 3.021 44.644 3.220 26.956 4.178 42.800 6. 111 32.222 4.695 21.244 4.735 27.267 3.646 14.156 3.735 14.600 3.677 11.422 2.943 12.244 1.956 .t. -0.17 0.48 1.04 1.14 1.50 0.89 1.36 0.54 1.19 1.29 1.93 Sign. Level .863 .632 .307 .261 .142 .377 .180 .595 .240 .203 .061* included in group 2. A i-test was computed comparing the mean scores between the two groups. No significant differences were found between the two groups for any of the 11 categories (Table 18). Research quest i on four stated: What is the re latlonship between years as a reglstered nurse and perceptions of competencies needed by a nurse administrator? Correlation coefficients as demonstrated in Table 19 revealed a 63 weak but signif1cant correlation between years as a registered nurse and 4 of the 11 categories. Three of the four significant correlations were positive: Organizations (.c. = .2132, Jl <.05), Health Care Economics (.c. = .1899, Jl = <.05), and Resource Management (.c. = ,1763, Jl ~ .05); and one correlations was negative, Nursing (.c. = -.2002, Jl <.05), Research question five stated: What is the re lationship between years as a staff (bedside) nurse and perceptions of competencies needed by a nurse administrator? Correlation coeff1cients as demonstrated in Table 20 revealed weak correlations between years of staff nurse experience and all 11 categori es. Research question six stated: What 1s the relationship between years as a nurse administrator/manager and perceptions of competencies needed by a nurse adminfstrator? 64 Table 18 Means and Standard Deviations for Respondents Holding Master's Degrees in Nurslng Adminlstration and Business Category Nsg. Adm. Mean ~ (.0.=24) Nursing 13.565 3.102 leadership 45.217 2.558 Organizations 28.130 4.445 Health Care 44.870 6.434 Economics Personnel 34.261 4.702 Management Resource 22.478 4.650 Management QuaHty 28.478 3.260 Assurance 1n Health Care Education 14.478 3.073 Community 15.957 3.404 Research 12.087 3.029 Trends in 13.174 1.922 Health Care * P.i .05 Business Mean 5Q (.0.=9) 12.000 2.976 44.000 3.464 26.375 5.449 42.750 7.649 31.375 5.553 20.125 5.842 27.250 4.862 12.750 2.816 14.125 3.603 11.000 3.665 12.250 2.712 1.27 0.91 0.82 0.70 1.31 1.03 0.66 1.46 1.26 0.75 0.89 Sign. Level .228 .384 .430 .498 .216 .326 .523 .168 .234 .467 .396 Table 19 Correlations of Years as a Registered Nurse to Category Scores for Total Sample Variable Organ i zat ions Nursing Health Care Economics Resource Management Quality Assurance in Healthcare Leadership Research Community Personne 1 Management Education Trends in Healthcare .05 Significance Level Correlation (n=88) .2132 -.2002 .1899 .1763 .1563 .1417 .1403 .1037 .0909 .0384 .0176 P Value .024* .031 * .039 * .053 * .075 .097 .096 .168 .200 .361 .435 65 Table 20 Correlations of Years of Staff Nurse Exper1ence to Category Scores for Total Sample Variable Education Health Care Economics Resource Management Qual1ty Assurance in Healthcare Nursing Community Organizat ions Research Leadership Trends 1n Health Care Personne 1 Management '* .05 Significance Level Correlation (a=88) .1500 - .1490 .1281 .1183 - .1134 .1086 -.1039 .0464 -.0328 -.0298 -.0280 P Va1ue .085 .088 .126 .143 .151 .161 .175 .337 .384 .398 .400 66 67 Correlation coefficients as demonstrated in Table 21 revealed weak but signlficant years of management experience 1n 2 of the 11 categories: Organizations (c = .1933, Q <.05) and Health Care Economics (r. = .1901) Q <.05). Summar;! The findings for each of the six research questions have been presented 1n this chapter. Research question 1 was answered by presenting the total sample population's mean score for each of the 11 categor1es and the mean scores of all lndlvldual variables in each category. Research questions 2 and 3 were answered by using i-tests to compare differences between groups. Research questions 4, 5, and 6 were answered by using Pearson product moment correlation coefficients. Table 21 Correlat1ons of Years of Management Experience to Category Scores for Total Sample Variable Correlatlon P Va1ue (n=88) Organizations .1933 '.041 * Health Care Economics .1901 .043* Leadership .1265 .129 Personne 1 Management .0966 .191 Qua 1f ty Assurance 1n Hea 1th care .0906 .209 Nursing -.0707 .261 Commun1ty .0629 .285 Resource Management .0598 .298 Research .0426 .350 Trends in Health Care -.0182 .435 Education -.0088 .468 * .05 Slgnif1cance Level 68 CHAPTER V DISCUSSION Introduction This chapter will discuss the conclusions that have been formulated from the research flnd1ngs. Implications of the f1ndlngs and recommendat 1 ons for future research w 111 also be out 11 ned. Conc luslons More nurse administrators are choosing to obta1n advanced education today and the results of th1s study showed the advanced educatlonaJ preparation a nurse administrator obtains does influence the perceptions of that nurse administrator. Sixty-one percent of the sample had obtained a master's degree in nursingJ but only half had specialized in nurs1ng administration (27.3~). The other half had special1zed in a clin1cal nursing specfalty area (26. 1 ~). I f nurse admIn1strators are socia11zed during the educational process, then the type of degree obtained will have some affect on their perceptions. This study found the ratlngs of importance of several categor1es (Nursing, Organlzations, Personnel Management, Education, Research, and Trends in Health Care) significantly different when comparing nurse admlnlstrators who had obtained master's degrees in any nursing area (group 1) to nurse administrators had obtained master's degree in any nonnursing area (group 2) (Table 16). The nursing group perceived these competency categories as significantly more important than the nonnursing group. 70 A highly pertinent result was found when the nurse administrators with nursing master's degrees only in the area of nursing admlnistration (group 1) were compared to nurse administrators with master's degrees in any nonnursing area (the same group 2). The differences in the categories of nursing, organizations, personnel management, education, and research were no longer significantly different (Table 17). The trends in healthcare category was the only category that remained s1gnif1cantly d1fferent. The only difference in the two comparisons was the removal of the nurse administrators with nursing master's degrees in clinical areas. Th1s leads one to assume that the group of nurse administrators with an advanced nursing degree in a cl1nical area made the scores significantly h1gher for the total nursing group when compared to the total nonnurslng group. These results suggest that those adm1nistrators who received advanced education in a clinical area were more highly soclallzed in a nursing perspective than those who had a strictly nursing adm1nstrat10n educational focus. Maybe the education today of nurse administrators 1s not as effective at nursing soclallzat10n as we might have assumed. 71 A comparison was also made between the groups of respondents who had undergraduate preparation 1n a nursing area and respondents who had an undergraduate preparation 1n a nonnursing area (Table 15), The data revealed no s1gnificant d1fferences between these two groups. This might be related to the small the sample size for those who had an undergraduate degree 1n a nonnursing area (n= 12). The results may also be re lated to the 1dea that a nurse administrator 1s social1zed at the advanced education level and not at the basic educat10n level in nurSing. The purpose of th1s study was to 1dent1fy if educat10nal preparation 1nfluenced percept10ns of nurse administrators regard1ng important competenc1es needed by a nurse adm1n1strator. There were to top level nurse adm1nistrators of the 88 respondents that had not obtained advanced education 1n any field. Two of these 10 nurse administrators l1sted a Diploma 1n nurs1ng as their highest educat10nallevel obta1ned. Wh1le the number of ind1v1duals in the sample without advanced educational preparation was not large, it showed there are nursing departments in the United States belng led by nurse adm1nistrators without any kind of advanced educational preparat1on. Th1s is a startling fact when one 72 considers the major 1mpact the top nurse administrator of a hospital has on shaping the future of the health care system. No individual in the sample reported havlng obtained a Doctorate degree in nursing and those who d1d report having obtained a Doctorate degree had obtained it to a nonnursing area (n = 7), If we assume educational preparation is important then one must Quest10n whether this trend has had an impact on health care organizations. A large majority of the samp le (76~) had spent less than 10 years as a staff nurse before changing to a management position; 50% spent less than 5 years. A nurse who has spent very l1ttle time practicing direct patient care may not have the same perspective regarding the importance of nursing as a nurse who has spent a large amount of time pract1cIng direct pat1ent care. An excellent beds1de nurse does not necessarily make an excellent nurse adm1nistratorJ but tt seems l1kely the more years that are spent close to patient care the more clearly one would perceive the Importance of nursing wtthin the complex and often times non caring world of the health care organization. The results of th1s study showed only a weak correlation between years of exper1ence as a staff nurse and the oerceotjons of importance of the variab1es included 1n the survey, but one needs to consider if nurs1ng may be 100s1ng someth1ng valuab1e in the actual practice of nurse administrators who have actually spent very l1ttle time delivering the nursing care that they must now lead within an organization. Fifty-two percent of the sample held the title V1ce-Pres1dent of Patient Care Services. The title of V1ce President is more eQu1valent to the titles of other top leaders 1n health care organ1zat1ons and ind1cates top leaders of nursing have increased their status with1n the organizational bureaucracy. This Is seen as a positive factor 1n allowing nurs1ng to have a legItimate voice In the operations of the organizat1on. Implications 73 The major implication of this study related to the educational preparation of nurse administrators. It was shown that nursing admin1strators with advanced educat10nal preparat10n 1n nurs1ng adm1n1strat10n rate the1r percept10ns 1n specif1c areas of nurs1ng, teaching, and research, personnel management, organizat10ns, and trends 1n health care h1gher than nurse administrators with advanced degrees 1n nonnursing areas. The data supported the conclusion that 1t was the perceptions of nurse adm1ntstrators w1th advance nurs1ng degrees in cUnical areas that made the significant d1fference. This must cause one to reexamine the effect of cl1ntcal education on the percept10ns and pract1ce of nursing adm1nistrat10n. Mur1eJ Poul1n led a major debate 1n the 19805 about the need and tmportance of lnc lud1ng 74 cUnical educat10n within the scope of a nurs1ng adm1nistrat1on degree. The results of this study certainly have given reason to reopen the debate. Is there some need or advantage for clinical educatlon for a nurse administrator? Thfs study showed that for some reason those with advanced nursing degrees in cUnlca1 area rated some areas s1gn1ficantly higher. If It Is beJieved that an increased perception of importance for areas such as nursing, educat10n, and research are 1mportant, factors that make those nurse admln1strators with clinical nursing degrees so d1fferent need to be Identified. If those differences can be Identified and Quant1fled then nursing administration curr1culum must be altered to better meet the needs 0 f today' s nurse adm 1n t s trator. This study also showed that there were no people 1n the sample who had obta1ned a doctorate degree In a nurs1ng area. Th1s may be re lated to the relatively l1mlted numbers of avaiJable doctoral programs In the United States. Recently more doctoraJ programs have been developed, and this trend needs to be cont1nued and supported. This stUdy hlghl1ghted the need to support a more comprehensive graduate education, Including a cUnlca) component In the nursing administrations curriculum, as well as the development more doctoraJ nursing programs specifically designed for nurse adminIstrators. 7S The above average response rate (49~) showed the existence of substantial interest 1n the toplc of competencies for nurse administrators. This showed that nurse administrators of today, even with their busy schedules, were interested 1n part1cipat1ng in research which w111lead to the development of nurs1ng administration curriculum which w1ll best prepares nurse administrators for their posit10ns. Recommendati ons The results provide a descript10n of the perceptions of nurse admin1strators and how these perceptions relate to their educational preparat10n. Due to the level of data that was obtained, the conclusions that can be drawn are somewhat l1mited. Th1s study, however, does create several Quest10ns that should be pursued by future research stud1es. The first recommendation for future research would be to repltcate th1s study to measure any differences or changes 1n percept10ns that may occur over time with1n the population of nurse administrators. Their r01e w1thin the health care environment 1s continually evolving and this will 11kely change the1r percept10ns of needed competenc1es. Other recommendations arising from this study all relate to gathering information that exceeds the scope of th1s study. How do the d1fferences that might exist between nurse admin1strators 1mpact the actual practice of nursing adm1n1strat10n? 76 Th1s study found nurse adm1n1strators with nursing adm1n1strat1on degrees perceived competency categor1es similarly to those with nonnurslng degrees. Do these results really mean anything detrimental to nursing within health care organizations. Future research needs to invest1gate the actual practjce of nurse administrators. Do they make decisions. act. or respond differently because of their particular perceptions? C11nical experience and cl1ntcal education were shown to be influential in the percept10ns of importance of competenc1es, now one must quest10n if nurse administrators only need to focus on adm1nlstrat1on or c11n1cal or both. Is it possible to 1ncorporate both and g1ve e1ther the time ft deserves? Further studies need to be done on the Impact of the chosen spec1alty area w1thtn the nurs1ng domain (nurs1ng adm1n1stration compared with cl1nical areas). What character1stlcs make nurse admin1strators w1th clin1cal nurs1ng degrees d1fferent, and are those d1fferences 1mportant to the pract1ce of nursing administrat1on. How do demographic var1abJes such as years as a registered nurse, years of management exper1ence, and years as a staff nurse re Jated to actual differences in the practice of nurse administrator? What impact do doctoral degrees in nurs1ng have on the practice of nurse a<fm1n1strators? What Is the benefit, 1f any, of rece1v1ng doctoral 77 education 1n nurs1ng administration? All of these recommendations attempt to further clarify the factors that are Involved in the preparation of today's nurse administrators. Educators needs to be able to objectively arr1ve at some organ1zed way to prepare nurse administrators so they are ready to lead nursing within the hea 1 th care organ 1 zat 1 on. APPENDIX 79 A PENNY FOR YOUR THOUGHTS Your have been selec+..ed from a random sample of nurse administrators to pa.rt:icipate in an important rese:lI'Cll study. The pw:pose of this rese:JI'Ch is to identify your perceptions of what competencies are important for today's nurse administrators. The result of this research will benefit the future preparation of nurse administrators. All information that you give will be strictly confidential. All statistical reports will be made from. aggregate data to assute complete confidentiality. Participation in this study is entirely voluntary; if you decide not to participate you are free to withdraw your participation at any time. There are no identified risks associated with participation in . this study. By completing the questionnaire and returning it to the investigators you have expn:ssed your willingness to participate. If you should have:my questions, ple:lse contact Robin Phillips at (801) 581 .. 2336. If you have questions regarding your rights as a researc.b subject, or if problems arise which you do not fe:l you can disc'JSS with the investigators, please contact the Institutional Review Board at [phone]. Sincerely, Robin Phillips, RN MS Candidate University of Utah College of Nursing Kfi+ Kim Phillips, IN MS Candidate University of Utah College of Nursing 80 1. DETERMINING THE TYPE AND LEVEL OF COMPETENCIES NEEDED BY NURSE ADMINISTRATORS Instructions: Please rate how important you feel each competency area. is by circling the appropriate number. 3 = Essential-required for administrative competency. 1 = Important--contributes to administtative competency. 1 = Low Importance-has minimal effect on administrative competency. o = Unimportant-does not contribute to administrative competency. 1-6 NURSING (Circle number) 1. Standards of Practice 3 2 1 0 2. Nursing Theories 3 2 1 0 3. Nursing Delivery Systems 3 2 1 0 4. Basic Nursing Practice 3 2 1 0 5. Nursing Care Planning Methods 3 2 1 0 6. Nursing Care Evaluation Method 3 2 1 0 7-22 LEADERSHIP (Circle number) 7. Administrative/Organizational Behavior 3 2 1 0 8. Interdisciplinary Coordination of Patient Care 3 2 1 0 9. Group Process 3 2 1 0 10. Interpersonal Relations 3 2 1 0 11. Communication 3 2 1 0 12. Decision Making 3 2 1 0 13. Motivation 3 2 1 0 14. Power 3 2 1 0 81 3 = :Essential 2 = Important 1 = Low Importance o = Unimportant 15. Delegation 3 2 1 0 16. Supervision 3 2 1 0 17. Change Process 3 2 1 0 18. Conflict Management 3 2 1 0 19. Stress Management 3 2 1 0 20. Problem Solving 3 2 1 0 21. Setting Priorities 3 2 1 0 22. Risk Taking 3 2 1 0 23·34 ORGANIZATIONS (Circle number) 23. Management/Organizational Theories 3 2 1 0 24. Governance in Health Care Agencies 3 2 1 0 25. Regulation of Health Care Agencies 3 2 1 0 26. Systems Approach 3 2 1 0 27. ~hilosophy, Purpose, Objectives 3 2 1 0 28. Policies and Procedures 3 2 1 0 29. Planning Methodologies 3 2 1 0 30. Patient Classification Systems 3 2 1 0 31. Management by Objectives 3 2 1 0 32. Hospital Information Systems 3 2 1 0 33. Participatory Management Contracting 3 2 1 0 34. Contracting 3 2 1 0 82 3 = Essential 2 = Important 1 = Low Importance o = Unimportant 35·53 HEALTH CARE ECONOMICS (Circle number) 35. Marketing 3 2 1 0 36. Fund Raising 3 2 1 0 37. Cost Containment 3 2 1 0 38. Productivity 3 2 1 0 39. Forecasting 3 2 1 0 40. Cost Benefit Analysis 3 2 1 0 4l. Zero-Base Budgeting 3 2 1 0 42. Program Planning Budget Systems 3 2 1 0 43. Generation and Control Manpower Budget 3 2 1 0 44. Generation and Control Operational Budget 3 2 1 0 45. Generation and Control Capital Budget 3 2 1 0 46. Fixed Budget 3 2 1 0 47. F:lexible Budget 3 2 1 0 48. Cost Control Processes 3 2 1 0 49. Cost Effectiveness Process 3 2 1 0 50. Cost Reduction Processes 3 2 1 0 5l. Accounting 3 2 1 0 52. Data Processing Systems 3 2 1 0 53. Financial Audits 3 2 1 0 83 3 = F&sential 2 = Important 1 = Low Importance o = Unimportant 54-67 PERSONNEL MANAGEMENT (Circle number) 54. Personnel Policies 3 2 1 0 55. Front-Line Management Skill 3 2 1 0 56. Mid-Line Management Skill 3 2 1 0 57. Labor Laws 3 2 1 0 58. Collective Bargaining 3 2 1 0 59. Staffing 3 2 1 0 60. Job Analysis 3 2 1 0 61. Workload Measurement 3 2 1 0 62. Performance Evaluation 3 2 1 0 63. Retention 3 2 1 0 64. Promotion 3 2 1 0 65. Affirmative Action 3 2 1 0 66. I?iscipline 3 2 1 0 67. Counseling 3 2 1 0 68-78 RESOURCE MANAGEMENT (Circle number) 68. Procurement 3 2 1 0 69. Inventory Control 3 2 1 0 70. Standardization 3 2 1 0 71. Forecasting 3 2 0 72. Value Analysis 3 2 1 0 84 3 = Essential 2 = Important 1 = Low Importance o = Unimportant 73. Distribution 3 2 1 0 74. Supply 3 2 1 0 75. Infection Control 3 2 1 0 76. Emergency Services 3 2 1 0 77. Disaster Planning 3 2 1 0 78. Employee Health and Safety 3 2 1 0 79-89 OUALITY ASSURANCE IN HEALTH CARE (Circle number) 79. Programming for Quality Assurance 3 2 1 0 80. Internal Audit/Evaluation 3 2 1 0 81. Peer Review 3 2 1 0 82. Professional Standards Review 3 2 1 0 83. Organization 3 2 1 0 84. Health Services Agencies/Community Planning 3 2 1 0 85. Ethics 3 2 1 0 86. Legal Aspects of Nursing Practice 3 2 1 0 87. Accreditation 3 2 1 0 88. Licensure 3 2 1 0 89. Certification 3 2 1 0 90-96 EDUCATION (Circle number) 90. Teaching/Learning Theories 3 2 1 0 91. Teaching Strategies 3 2 1 0 85 3 = Essential 1 = Important 1 = Low Importance o = Unimportant 92. Leamer Evaluation 3 2 1 0 93. Inservice Education 3 2 1 0 94. Continuing Education 3 2 1 0 95. Professional Education 3 2 1 0 96. Trends and Issues 3 2 1 0 97-103 COMMUNITY (Circle number) 97. Assessment of Community Health Needs 3 2 1 0 9S. Epidemiology 3 2 1 0 99. Public Relations 3 2 1 0 100. Socio-Economic Trends 3 2 1 0 10l. Political Process 3 2 1 0 102. Health Problems 3 2 1 0 103. Consumerism 3 2 1 0 104-109 RESEARCH (Circle number) 104. Statistics 3 2 0 105. Research Design 3 2 1 0 106. Legal Aspects of Research 3 2 1 0 107. Economics of Research 3 2 1 0 lOS. Implementation of Findings 3 2 1 0 109. Interpretation of Research 3 2 1 0 3 = Essential 1 = Important 86 1 = Low Importance o = Unimportant 110-114 TRENDS IN HEALTH CARE (Circle number) 110. Advances in Medical Care 3 2 1 0 111. New Technology 3 2 1 0 112. Delivery Systems 3"2 1 0 113. Manpower 3 2 1 '0 114. Health Care Laws 3 2 1 0 II. NURSE ADMINISTRATOR PROFILE This information is vital to the study. Please circle your response or fill in the blank following the question. 1. Title of current position: ___________________ _ 2. State of Residency: _____________________ _ 3. Type of Hospital of Employment: 4. Size of Institution: Beds 6. Gender: __ (1) Female __ (2) Male ___ (1) Governmental, Nonfederal ___ (2) Nongovernmental Not-For-Profit ___ (3) Investor-owned, For Profit ___ (4) Government, Federal ___ (5) Osteopathic 7. Years as a Registered Nurse: __ Years 8. Educational Preparation and Year Obtained: (ANSWER ALL THAT APPLy) Year Obtained ___ (1) Associate Degree in Nursing ___ (2) Diploma in Nursing ___ (3) Baccalaureate in Nursing 87 ___ (4) Baccalaureate in Non-nurisng field (List field)"'-_______ _ ___ (5) Master's in Nursing (List Specialty) ___________ _ ___ (6) Master's in Non-nursing field (List Major) _________ _ ___ (7) Doctorate in Nursing (List Area) _____________ _ ___ (8) Doctorate in Non-nursing Field (List Area) ____ ~----- 9. Employment Background: a. Staff Nurse: ____ Years ("Bedside Nursing") b. Nurse Administrator/Manager: __ Years (Total Number of years in management­first level and above) c. Years in Current Position: Years THANK YOU for your time and valuable contribution to this research. Please return your completed questionnaire to Robin and Kim Phillips, 9919 Dolomite Lane, Sandy, Utah 84094. A self-addressed, stamped envelope has been included for your convenience. 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