Role of nursing director as perceived by administrators and their subordinates in five selected hospitals in West Java, Indonesia

Abstract

The job of the Director of Nursing (DON) is not standardized and is thus subject to many interpretations. The roles of the DON if not well defined may be misunderstood by the nursing staff. The DON performs multiple and complex roles and it is difficult to do all of these things at the same time. There must be a priority of roles of the DON. This study was conducted to define the relative importance of five roles of the DON and to determine the difference in perception of nursing administrators and their subordinates regarding the importance of the director's roles. This information should be valuable in guiding the DON's priority activities, in designing job descriptions of the DON, and for promoting leadership development of professional nursing students and leadership trainees. A tool developed for this study contained a demographic section and a 50-item Likert scale. The scale items were clustered into five subscales (Planning, Directing, Controlling, Developing, and Representing) based on a modification of Tappen's Theory (1989). Face validity and reliability were established on the tool- (total scale coefficient alpha was .89, with each subscale > .70). Subjects rated each scale item on a 6-point Likert scale for importance from very important (5) to no importance (1) and a zero point meaning I don't know. A random sample of 150 selected professional nurses from five hospitals located in west Java, Indonesia, completed the tool. Seven null hypotheses were used to answer six research questions. One research question without a null hypothesis was answered based on the highest and lowest rated items to determine the relative importance of the roles and various activities of the DON. The data were analyzed using ANOVA and t test to determine whether the hospital, years of service in the institution, position, and years of holding specific position affected perceptions on importance on the total scale score or subscales. The Mann-Whitney U Test was used to compare perceptions of nursing administrators and supervisors to that of head nurses and staff nurses on the 50-item scale. Major conclusions were that the most important roles of the DON were Planning and Developing. Items rated as high in importance in the Planning subscale were budgeting, strategic planning, standard of patient care, and setting hospital strategic plan. Most highly rated items in the Developing subscale had to do with promoting management and professional growth of the nursing staff. The least important roles of the DON were Controlling and Representing. Items rated relatively low in importance in the controlling subscale were in evaluation of facilities, processes, and activities of nurses; and giving feedback and rewards. Items rated relatively low in importance for the Representing subscale were liason activities and conflict management. Nursing administrators and supervisors tended to rate items higher than did head nurses and staff nurses. Nurses have fairly high level of agreement about the roles of the DON across hospitals, position, years of service in present employment, and years in present position. Major recommendations for practice were to give advanced leadership training to nurses who are in or have just accepted an administrative level of management.