This study describes the managerial competencies of head nurses at central hospitals in Hanoi and proposes measures to improve their managerial competencies to enhance the quality of pat
Trang 1Chapter I BACKGROUND 1.1 Brief introduction
Head nurses are the ones in charge of managing human resources, medical
equipment, financial resources and information to ensure the provision of quality
health care services in hospitals They also connect hospital’s orientation, goals and
tasks with staff who provide daily care for patients The managerial competence of a
head nurse is assessed through the competencies in terms of expertise, human
resources management, thinking, leadership and finance management Head nurses’
managerial competence has an impact on patient care outcomes at hospitals This
study describes the managerial competencies of head nurses at central hospitals in
Hanoi and proposes measures to improve their managerial competencies to enhance
the quality of patient care
1.2 Reasons choose research topic
Improving quality of health service delivery is urgently needed to attract and
create trust for patients In which, developing human resources is obviously a decisive
factor Recognizing this, hospitals have paid attention to improve managerial
competence of head nurses However, when implemented in hospitals, managerial
competence of head nurses is still limited, especially in resolving interdisciplinary
relationships, strategic planning, personnel management, resources and financial
management Therefore, in order to capture the overall picture of managerial
competencies of head nurses at central hospitals in Hanoi and propose measures to
improve their managerial competencies to enhance the quality of patient care, the
author conducts a research thesis with the title “Managerial competencies of head
nurses at central hospitals in Hanoi”
1.3 Study aim and research questions
The aim of this study is to describe the managerial competencies of head nurses
at central hospitals in Hanoi and propose measures to improve their competencies
The following questions were addressed in this study:
Firstly, what were included in the head nurses' managerial competencies
measurement framework?
Secondly, how is the managerial competencies of head nurses and patient care
results related?
Third, what factors of head nurses' managerial competencies should be
improved most?
Fourth, what factors affect the managerial competencies of head nurses?
1.4 Object and scope of research
Research object was managerial competencies of head nurses at central hospitals
in Hanoi through the survey conducted on hospital chiefs and vice chiefs of nursing, head nurses and staff nurses
Research place and time: The study was conducted at 7 central hospitals in
Hanoi: Viet Duc University Hospital, National Pediatric Hospital, National Psychiatric Hospital, Vietnam National Cancer Hospital (also known as Hospital K), E Hospital, Hanoi Medical University Hospital, Huu Nghi Hospital from 2017-2018 Data collected includes both primary and secondary data The study focuses on researching and evaluating managerial competencies of head nurses at central hospitals in Hanoi according to 05 main categories: technical skills, human resource management skills, conceptual skills, leadership and financial management skills
1.5 Research process
Research theoretical basis and overview Identify research gaps develop models and research hypotheses collect and analyze data present discussions and propose recommendations
1.6 New contribution of the thesis
New academic and theory contributions
The thesis systematizes general theoretical issues about the managerial competencies of head nurses, factors affecting their managerial competencies The results of the study will make certain contributions to finalizing the theoretical framework for the assessment of managerial competencies of head nurses in Vietnam The study used a scale which is the set of criteria to evaluate managerial competencies of head nurses which was applied in Vietnam for the first time Therefore, the study is the basis for further studies to continue finalizing the set of evaluation criteria close to the health system in Vietnam in the near future
A research model between head nurses’ managerial competencies and results of patient care was developed and tested in this study Therefore, the research results reflect the reliability; supplement and develop methodology in evaluating the managerial competencies of head nurses; and proposing feasible solutions
Practical contributions
The study applied several methods and multi-dimensional views to synthesize, analyze and evaluate the head nurses’ competencies Each method and viewpoint was applied appropriately according to each research question This thesis can be used a
Trang 2reference for other researchers who are interested in evaluating the managerial
competencies of head nurses in particular and assessing managerial competencies in
general
The study results are also the basis for managers to develop appropriate policies
for head nurses and nursing system in Vietnam
1.7 Structure of the thesis
The thesis includes introduction, conclusion, tables, figures, charts, list of
references and 5 chapters:
Chapter 1: Background
Chapter 2: Rationale for managerial competencies of head nurses
Chapter 3: Research Methodology
Chapter 4: Assessment of managerial competencies of head nurses at central
hospitals in Hanoi
Chapter 5: Solutions to improve managerial competencies of head nurses by 2025
CHAPTER 2: RATIONALE AND OVERVIEW 2.1 Hospital nurses and head nurses
2.1.1 Hospital nurses
Nurses are technical and professional officials in healthcare, who directly give care or assist in caring for patients at medical facilities Nurses have specific tasks such as performing or supporting in patient care, assist the implementation of patient care techniques, monitoring vital signs, helping the doctor, giving first aid, implementing Good Storage Practices of medicine and assets, participating in health education, practicing medical ethics, complying with medical professional regulations and law
The main professional duties of nursing: Health counseling and education; helping patients with personal hygiene, mental care, nutrition care; rehabilitation care; care giving for patients with indications for surgery or procedures; medicines for patients; end - of - life care delivery for patients in the dying stage and death patients; implementing nursing techniques; monitoring and evaluating patients; ensure safety and prevent medical errors; writing medical records
2.1.2 Hospital head nurses
Head nurse is the nurse in charge of staff nurses in a department who is responsible for the performance of nursing in their department The head nurse is also
an intermediate nurse, who is responsible for directing the implementation of strategy planned designated by the hospital director of nurse
Responsibilities of head nurses Patient care management: Head nurse is the person in charge of organizing nursing care of patient in each department To effectively manage patient care, the head nurse needs to focus on directing and managing patient care delivery, including: Understand the disease and psychological status of each patient in their unit; Organize care to meet the needs of patients; ensure follow doctor's indications effectively; Ensure that nursing techniques are followed by all staff nurses; ensure full compliance with regulatory and professional standards
Staff management: Educate and build an ethical and professional working environment for each staff nurse; Assign work in accordance with the ability of each
individual; Train and create favor conditions for personnel to continue their
professional development of qualifications and skills; Evaluate task accomplishment and job performance of personnel This is one of the most important tasks of a head
Trang 3words that hurt employees' honor, protect individuals in the unit from outside
criticism
Unit - hospital management: Professional management: Ensure that the rules,
policies, professional processes are followed by everyone Minimize differences in the
implementation of professional technical processes; Human resource management:
Ensure that resources are used effectively and for the right purposes; Management of
infrastructure, equipment, consumables: Ensure that resources are used for the right
purposes and effectively; Management of working environment: Ensure the
department and wards are always clean and tidy; ensure safety for patients and health
workers; Management of ethics and service culture: Create caring and ethical care
environment, patient-center care in nursing and staffs help each other to ensure the
best care service following patient rehabilitation
2.1.3 Quality of patient care and indicators reflecting patient care outcome at
hospitals
Criteria to assess head nurses in hospitals include criteria attached with the results
of treatment and care of the hospitals These are the rate of patient’s falling, patient’s
satisfaction towards nursing care, length of inpatient treatment, rate of pressure ulcers,
average cost of caring per patient, rate of complications due to caring, hospital infection
rate; cross-infection rates due to caring, rate of medication administration errors
2.2 Managerial competencies of head nurses at hospital
2.2.1 Competency
The definition of competency used by the author in this thesis “is the abilities
of an individual, expressed in knowledge, skills and attitudes that contribute to the
outcome of his or her work to achieve get the goals of the organization”
2.2.2 Managerial competency
Managerial competency is assessed based on the ability to apply knowledge and
skills on management including knowledge of management skills and content
Proficient implementation of management processes and working attitude based on a
sense of responsibility, solidarity, self-discipline and for common sake
2.2.3 Brief summary of the assessment of managerial competencies of head nurses
Katz has provided a legacy conceptual framework with threeskill approach
includes technical skill, human skill and conceptual skill This is a general competence
review for all managers, and does not reflect the characteristics of nursing and nursing
management
AONE has provided a conceptual framework of competency-based theory for
communication, professionalism, knowledge, business skills, all intersecting with leadership competencies In studies around the world, this approach is often applied to research of senior nursing managers such as nursing directors and hospital chief of nursing
In ANA's approach, the capacity of a head nurse consists of two groups of factors: Competency in management practice and the required practice of nursing and management expertise Following this approach described above, ANA follows the nursing manager's decision-making and implementation process in accordance with the head nurses’ managerial competence This is an approach that separates activities according to the nursing process, although it also makes the assessment more specific
to nursing, but in the context, the nursing process is understood differently in different countries, which is not yet commonly applied in Vietnam This set of standards should only be applied when studying on a group of nurses with a high level of homogeneity, such as at one hospital or hospitals of the same specialty, with the same characteristics
Chase 1994's approach, which was used by Ten Haaf in measuring head nurses’ competencies in 2007 and was reported by Chase himself in his doctoral dissertation in 2010 This is an approach that fully presents the features of the head nurses’ managerial competencies, and is also challenging when conducted on different
specialized nursing groups, therefore, the author will apply this approach in this study
2.3 Factors affecting the managerial competencies of head nurses
2.3.1 Internal factors of head nurses
Qualities and talents are very important factors for managers Qualities and talents are genetic or congenital factors The economic capacity of the head nurse himself also largely determines the managerial competence, which includes the family economy, their ability to do business Business-minded people are often good managers Age and gender also significantly affect the managerial competence of head nurses Older managers are often more experienced than young people, while young people are more active than older people
2.3.2 Hospital’s factors
Elements of human resource management: Quality and planning of head nurses; Recruitment: enlist good nurses who graduated from well-known training facilities; assign head nurses in the right position, right forte; Remuneration also significantly affects the managerial competence of head nurses Offering head nurses good incentives will stimulate them to promote their capacity and potentials, show their inquiring mind, passion for work and career aspirations;
Factors from senior leaders of head nurses, doctors and staff: Attention of
Trang 4leaders and the board of directors, heads of department; the dependence on doctors’
indications and medical intructions; staff
Cultural and organizational factors of hospitals and patients: Hospital
policies and mechanisms; hospital culture; patient overload
2.3.3 Factors outside hospital
Government mechanisms and policies, nation's culture, cooperation between
hospitals; coordination of nursing training between hospital and training facilities;
international cooperation; patients’ cooperation are also the factors that affect the
managerial competencies of head nurses
CHAPTER 3 RESEARCH METHODOLOGY
3.1 Design and selection of research framework
Figure 3.1: The conceptual framework used in this study 3.2 Sample size and method
3.2.1 Sampling method
Hospitals deliberately selected include general hospitals, specialized hospitals, large hospitals and small hospitals t at central level that located in Hanoi
Convenience sampling of hospital chiefs and vice chiefs of nursing, head nurses and staff nurses was conducted to find those who are willing to share information In each hospital, the research was carried out on hospital chiefs and vice chiefs of nursing, head nurses and staff nurses in each unit under convenience sampling method
3.2.2 Sample size
The author included 14 hospital chiefs and vice chiefs of nursing, 60 head nurses and 538 staff nurses in this study
3.3 Data collection
3.3.1 Secondary data collection
Secondary data was collected from management agencies including Administration of Medical Service - Ministry of Health, Department of General
Trang 5compare data, and review data to ensure the data was consistent and reliable
3.3.2 Primary data collection
The researcher interviewed the research subjects with questionnaires designed
for head nurses and staff nurses (see appendix 3 for the survey questionnaire and
questionnaire design) and then entered and cleaned the data
3.4 Data management and analysis
3.4.1 Research process
The research process of the thesis is implemented through the main stages: (1)
Preliminary research, (2) In-depth quantitative research In particular:
Preliminary research: The research focuses on developing research indicators,
identifying variables used in the research, making questionnaires and preliminary analysis
of questionnaires by qualitative methods
In-depth quantitative research
- Piloting on 100 subjects and assess the uniformity of the scale, adjust the
scale to eliminate questions that completely reduce the quality of the scales
- Conducting the surveys on research subjects (14 chiefs and vice chiefs of
nursing, 60 head nurses and 538 staff nurses in 60 departments of 07 central hospitals
in Hanoi), describing characteristics of study population, carrying out basic statistical
analysis
3.4.2 Data cleaning and analysis
Quantitative analysis: mainly to test the uniformity of the scale, principal
component analysis and logistic regression analysis
Testing the uniformity of the scale is a technical method to check variables in
each target group to see if there are similarities in measurement or not This test will
help reshape the structure of these factors more clearly and logically through the
identification and elimination of interference factors and increase the reliability of
input data
Principal component analysis (PCA) is the second quantitative analysis tool
to help organize survey variables from the questionnaire into groups of indicators
Each group of indicators will represent a factor of competence of head nurses PCA
helps determine significant factors and reshape the structure of head nurses’
competencies into main criteria These criteria will be used to evaluate the
importance of each competency indicator and to assess the quality of nursing
activities In addition, component analysis helps to synthesize survey variables into
main components and will be the input for the regression analysis to assess the
Next, logistic regression analysis will evaluate the effects of the above classified components on variables that reflects the quality of nursing activities The results of logistic regression analysis will clarify the relationship of each factor, compare the relationship between the factors, and orient the improvement of executive quality of head nurses
Finally, although all staff nurses access the same questionnaire, there is still a possibility that differences exist in the evaluation between groups by age, gender, experience, etc
3.4.3 Methods to identify strengths and weaknesses of managerial competencies
- The distance between the expected competencies and the current competencies of the head nurses as assessed by staff nurses was calculated by the
difference between the average of expected score (the requirements for head nurses by
2025 set out by chief and vice chief of nursing) and the average score of the current managerial competencies of the head nurses as evaluated by staff nurses
- The distance between the expected competencies and the current competencies of the head nurses as assessed by themselves was calculated by the
difference between the average of expected score (the requirements for head nurses by
2025 set out by chief and vice chief of nursing) and averages score of the current managerial competencies of the head nurses as evaluated by themselves
- Each distance was divided into high and low group The high group included criteria with higher average score than the median, the low group included criteria with lower average score than the median
- Strengths were determined as the criteria had both of these above distance at
low group
- Weaknesses were determined as the criteria had both of these above distance
at high group and the average of Importance lied above the median Weaknesses was
an important basis for recommending solutions to improve managerial competencies
of head nurses in hospitals
Trang 6CHAPTER 4 ASSESSMENT OF MANAGERIAL COMPETENCIES
OF HEAD NURSES AT CENTRAL HOSPITALS IN HANOI
4.1 Head nurses at central hospitals
The youngest studied head nurse was 34 years old and the oldest was 60 years
old, 49% of them were over 40 years old In terms of education level, the majority of
head nurses (75%) hold a university or higher degree, this confirms the role as well as
the importance of technical training for each head nurse to meet 52 out of 60 head
nurses took short-term training on management, yet there were two of them who had
not been trained for management
4.2 The current status of managerial competencies of the (studied) head nurses at
central hospitals in Hanoi
4.2.1 Job performance of head nurses
66.7% of departments had less than 30 staff nurses; meanwhile there were only
4 departments (6.7%) that had many staff nurses (over 50 nurses)
The head nurses who took part in the questionnaire survey said that they spend
a little time on planning, most of them spend less than 15% of their time planning
Whereas the time spent on organizing operation activities and leadership was
relatively appropriate, most head nurses responded that they spent between 16-30% of
the time on this activity The majority of head nurses focused on controlling nursing
activities
Head nurses encountered difficulty most in planning, 7 of them (accounted for
11.7%) admitted that planning faced many obstacles However, in general, it can be
seen that currently head nurses have been facilitated to practice nursing management
fairly well; over 70% of the head nurses said that their management activities were
carried out in favourable or very favourable conditions
4.2.2 Research results on the requirements and importance for managerial
competencies of head nurses
The technical skills of head nurses were determined based on 11 criteria These
criteria with the highest requirements included evidence-based practice; and
comprehensive understanding of patient classification system Meanwhile, the criteria
with the lowest requirements were knowing and good practice of medical records,
understanding of nursing care regulations The most important criteria included
understanding of nursing practice standards, nursing care planning, and understanding of
nursing care regulations The least important criteria included practice clinical skills in
nursing, comprehensive understanding of patient classification system, good infection control practice, and evidence-based practice
Human resource management skills of head nurses were determined based
on 12 criteria The most demanding criteria included effective communication and effective discipline Meanwhile, the criteria with the lowest requirements were good sense of humor and optimistic The most important criteria were constructive performance evaluation and staff development strategies The least important criteria included having appropriate retention strategies, good recruitment strategies, good clinical examination, good sense of humor
The head nurses’ conceptual skills were determined based on 8 criteria The most demanding criteria were mastering nursing theories and good knowledge of ethical standards and principles The criteria with the lowest requirements were having strong political stance and having strategic planning/ goal development The most important criteria included mastering nursing theories, having knowledge about legal issues related to nursing care The least important criteria were having good administrative/organizational theories, having knowledge on the overview of quality management process
Leadership skills of head nurses were determined based on 14 criteria The most demanding criteria were being able to manage time well and knowing how to assign work properly Criteria with the lowest requirements included subtle and effective in expressing power and empowerment appropriately; research and proposal
of process The most important criteria were having ability to train employees, having good time management, interdisciplinary care coordination Meanwhile, the least important criteria included having good knowledge of policies and procedures, and ability to make decisions
Financial management skills of head nurses were determined based on 07 criteria The most demanding criteria were having appropriate measures to increase productivity, having appropriate measures for cost containment and cost avoidance practices Criteria with the lowest requirements included having ability to develop/find financial resources and having good unit budget control measures The most important criteria were having appropriate measures for cost containment and cost avoidance practices, having appropriate measures to increase productivity Meanwhile, the least important criteria included having good unit budget control measures and having ability to develop/find financial resources
4.2.3 Research results of current managerial competencies of head nurses Technical skills: As seen by staff nurses, head nurses had performed well the
Trang 7evidence-based practice and fluent use of information technology and computers
However, understanding of nursing practice skills and understanding of nursing care
regulations of head nurse were rated as less competent The studied head nurses evaluated
themselves to be the most competent at understanding of nursing care regulations and
understanding of patient classification system Meanwhile, fluent use of information
technology and computers and nursing care planning were rated as less competent
Human resource management skills: Staff nurses evaluated that head nurses were
humorous, optimistic and had reasonable retention strategies, on the other hand they rated
head nurses as poorly competent at being able to communicate effectively, and not having
good clinical examination Head nurses perceived their communication skill and group
process to be most effective Meanwhile good sense of humor and team building
strategies were assessed to be their worst competence by themselves
Conceptual skills: Staff nurses assessed head nurses’ competence to be best at
having strong political stance and mastering nursing knowledge, worst at strategy
planning and goals development, teaching/learning theories Whilst head nurses perceived
themselves as good at mastering nursing theories, understanding ethical standards and
principles, in contrast they rated themselves poorly competent at strategy planning and
goals development having an overview of quality management process
Leadership skills: Staff nurses evaluated that head nurses had the best competence
in interdisciplinary care coordination, knowledge of policies and procedures, and worst in
problem- solving and organization of unit work The studied head nurses evaluated
themselves to be the most competent at organization of unit work and workflow process
and being able to solve problems appropriately and thoroughly They saw themselves
weak at creating sophisticated and effective motivational strategies and demonstrating
power and empowerment appropriately
Financial management skills: As seen by staff nurses, head nurses had performed
well cost-benefit analysis and capital budget forecasting However, cost containment and
cost avoidance practices, and unit budget control measures of head nurses were rated as
less competent The studied head nurses evaluated themselves to be the most competent at
unit budget control measures, cost containment and cost avoidance practices, and worst at
having appropriate measures to increase productivity, capital budget forecasting
4.3 Factors related managerial competencies of head nurses
Individual demographics factors such as age, management experience, length of
service, educational level, managerial qualification explained 39.1% change of technical
competence, 56% change of personnel management competence, 52% of change in
financial management competence
Length of service was inversely correlated with technical skills (beta = - 0.338, p = 0.019); educational level was positively correlated with personnel management skills (beta = 0.031, p = 0.031) and positively correlated with conceptual skills (beta = 0.094, p
= 0.028); length of service had a positive correlation with personnel management skills (beta = 0.222, p = 0.043); managerial qualification was positively correlated with conceptual skills (beta = 0.134, p = 0.031) in the managerial competencies of the head nurses
4.4 Relationship between managerial competencies of head nurse and patient care outcomes
Technical skills had negative correlation with the rate of patients falling (beta = - 0.267, p = 0.012), and was inversely correlated with the rate of pressure ulcers (beta = -0,216, p = 0.001), There was a negative correlation between technical skills with the rate
of medication administration errors (beta = -0,153, p = 0.021) Human resource management skills were inversely correlated with the rate of pressure ulcers (beta = - 0.182, p = 0.035) Leadership skills had a negative correlation with the rate of medication administration errors (beta = -0.94, p = 0.029) Conceptual skills and financial management skills were not correlated with patient care outcomes
4.5 General assessment of managerial competencies of (studied) head nurses at central hospitals in Hanoi
4.5.1 Strengths in managerial competencies of head nurses
Strengths in technical skills of head nurses: The skills that head nurses performed well (strong points) were those of which the two distance were short when compared with the expected competencies Strengths in nursing technical skills included understanding of nursing care regulations; having knowledge of and good practice records management; understanding nursing practice skills; good practice of nursing clinical skills
Strengths in human resource management skills: Strengths in personnel management skills of head nurses included good clinical examination competence; being optimistic; ability to implement group process; having staff development strategies; having appropriate retention strategies
Strengths in conceptual skills of head nurses: Strengths in head nurses’ conceptual skills included having strong political stance; knowledge of legal issues related to nursing care
Strengths in leadership skills of head nurses: Strengths in leadership skills of head
Trang 8training staff; understanding policies and procedures; having good stress management
skills; research and propose processes
Strengths of financial management skills of head nurses: Strengths in financial
management skills of head nurses included ability to develop/find financial resource;
ability to implement unit budget control measures; ability to analyse cost- benefit
4.5.2 Limitations and causes in managerial competencies of head nurses
Limitations and causes in technical skills of head nurses:
Criteria for technical skills of head nurses were considered weak when there was a
difference between the expected and the actual competencies assessed both by staff nurses
and themselves plus the score for the importance was high Weaknesses included nursing
care planning, evidence-based practice, and good application and use of new technology
Causes: Head nurses had not been trained in planning nor updated with knowledge
about evidence-based practices and new technologies, or maybe they were subjective, got
used to following their past experiences, habit and feeling leading to missing out of
required steps In addition, since hospitals had no requirements or regulations on
mandatory implementation of the above contents, the implementation was not consistent
Limitations and causes in nursing skills human resource management skills:
Weaknesses in human resource management skills of head nurses included the
ability of effective communication and effective staffing strategy
Causes: Head nurses had not been trained or well trained on communication skills
They often conducted communication when they felt it necessary or upon requests, they
had not had long-term communication strategies The development of staffing strategies
of head nurses was limited due to the specific nature of healthcare service that had divided
nurses into specialties and departments This division had previously been interpreted by
default as the possibility of chief or vice chief of nursing or the hospital board of directors
Therefore, head nurses were still passive to carry out this skill
Limitations and causes in head nurses' conceptual skills:
Weaknesses in head nurses’ conceptual skills included being able to teach and
study well; having strategy planning and goal development
Causes: Head nurses had not been trained in pedagogy The teaching/coaching
process was mainly practical with hands-on instructions, without any long-term and
well-planned training strategies Well planning also needs to improve because they had not yet
paid enough attention to it, plans developed was mainly developed similar to the plans of
previous years
Limitations and causes in head nurses’ leadership:
solving, time management, organization of work of unit and workflow process, and interdisciplinary care coordination
Causes: Firstly, nursing work was very hard and full of pressure from work processes, patients and patients’ family members These pressures created conflicts frequently Head nurses faces difficulties and were even impossible to resolve all these conflicts Secondly, the above weaknesses were common and required a long time for the head nurses to undergo, learn from experience and overcome Thirdly, the fact that job description for each position had not been completed lead to the overlapping, unmanageable, not fully assigned coordination of common workloads of their unit
Limitations and causes in financial management skills of head nurses:
These weaknesses included the ability to control unit budget and take appropriate measures to increase productivity
The causes for these weaknesses were mainly due to the starting point of head nurses They were the ones who switched from practicing as an RN in the beginning, and they had not been trained on financial management Only at hospital had department of finance, there was no team specialized in financing at department level In addition, little had head nurses been trained on financial management as enterprise managers had Furthermore, nursing activities were mainly performed following processes At the time
of the study, head nurses paid more attention to safety and proper implementation of procedures than to productivity measurements This is one of the weaknesses that needs to
be improved, especially in public hospital
Trang 9CHAPTER 5 SOLUTIONS TO IMPROVE MANAGERIAL COMPETENCIES
OF HEAD NURSES BY 2025
5.1 Orientation to improve managerial competencies of head nurses
5.1.1 The need for improving managerial competencies of head nurses
In order to improve the quality of care, ensure safety for patients and enhance
performance of head nurses, in the coming years, the Health sector needs to pay attention
to following issues:
1- Transforming nursing policy, nursing management system
2- Increasing both in quantity and quality of human resources for nursing and
midwifery
3- Transforming service attitude and style and improving quality of care
towards patients’ satisfaction
4- Issuing nursing care process and implementation guidelines
5.1.2 The goals of improving managerial competencies of head nurses from now on
to 2025
By 2025, Vietnam needs to achieve the following goals:
1- Enhancing the completion of legal provisions related to the role, position,
functions, obligations and responsibilities of head nurses
2- Developing and standardizing skill sets for head nurses; as a basis for staff
nurses to strive for, and a basis for recruiting head nurses with good education
level and management qualifications as well
3- Consolidating training curriculum, syllabus, teaching facilities and standard
teaching staff toward practical and effective teaching/coaching about resource
management – administration
4- Enhancing the effectiveness and efficiency of nursing management of the
current head nurses
5.1.3 Viewpoint on improving the competencies of head nurses by 2025
Improving the competencies of head nurses in particular and nurses in general
should:
- Be implemented scientifically, persistently and aggressively
- Be fully allocated resources on policies, personel, facilities and conditions for
practicing theories obtained
- Be supplemented with “work management tools” to ensure feasibility and
effectiveness
- Adopt appropriate policies to support and encourage skillful staff and acknowledge the contributions of head nurses
- Receive high consensus of head nurses in self-planning, looking for opportunities to improve their own skills
5.2 Recommendations to head nurses
5.2.1 Recommendations for improving technical skills in managerial competencies
of head nurses
The relationship between length of service and technical skills is statistically significant and negatively correlated (beta = -0.338, p = 0.019) Therefore, in addition
to improving managerial competencies, head nurses still need to update and practice nursing skills regularly so they can participate in the development of technical processes and supportive work for management Recommendations to management units: It is necessary to supplement the regulations and compulsory requirements for head nurses on updating, supplementing and improving technical skills annually Criteria that need to be focused on improving include nursing care planning, evidence-based practice, good application and use of new technology
Head nurses need to complete the planning in 5 steps as follows: (1) Assessment; (2) Nursing diagnosis; (3) Care planning; (4) Implementation; (5) Evaluation (Kozier, B 2004)
Evidence-based practices need to be based on four key aspects: (1) summarizing evidence from quantitative research; (2) clinical and technical evidence; (3) patients’ preferences and actions; (4) clinical state and circumstances: care environment, beneficial factors, harmful factors, etc
In order to implement well the criteria of good use of information technology, a part from regularly attending training courses and updating knowledge, head nurses must proactively study and practice newly techniques and technologies, so that they can keep up with the development of nursing in Vietnam in the period 2020-2025
5.2.2 Recommendations for improving human resource management skills in managerial competencies of head nurses
There was a correlation between education level (beta = 0.031, p = 0.031), length of service (beta = 0.222, p = 0.043) and human resource management skills, this was positively correlated Therefore, when planning and appointing, compulsory requirements and priorities for those who meet these criteria
Trang 10performance, being able to communicate effectively, having good recruitment strategy,
and being able to obey effective discipline, and have staffing strategy Therefore, head
of nurses need to coordinate to develop a set of criteria for evaluating staff nurses’
performance, and detailed job descriptions for each position In addition, head nurses
also need to perform well the organization of work of unit, create solidarity, and act as
bridge for staff nurses to coordinate well to improve work efficiency, thereby creating
the stature of the unit and building trust for patients
5.2.3 Recommendations for improving conceptual skills in managerial
competencies of head nurses
There was a correlation between education level (beta = 0.094, p = 0.028),
management qualifications (beta = 0.134, p = 0.031) and conceptual skills and that
was positively correlated Therefore, education level and management qualifications
should be set as standards when planning and appointing head nurses
Head nurses need to focus on improving following criteria of conceptual skills:
ability to teach well and study well, strategy planning and goals development In
addition to being fully trained and possessing management qualifications, head of nurses
need to obtain a certificate in pedagogy in clinical teaching and at the same time attend
continuing medical education training courses at least 48 lessons in 2 consecutive years
or long-term courses like nursing specialist level 1, level 2; doctoral program in nursing,
etc
5.2.4 Recommendations for improving leadership in managerial competencies of
head nurses
Head of nurses were less competent in time management, change process
control, organization of unit work and workflow process, interdisciplinary care
coordination These skills require head of nurses to have fundamental training in
management skills as well as practical management experience for a long time
Hospital leaders and chief of nursing need to have a strategy to train and improve
managerial competencies for head nurses, regularly review and supervise so that
timely changes are carry out to minimize errors
5.2.5 Recommendations for improving financial management skills in managerial
competencies of head nurses
Head of nurses were less competent in having appropriate measures for cost
containment and cost avoidance practices, unit budget control, productivity increase
In order to minimize the above shortcomings, head nurses need to develop detailed
budget plan that covers every step of the implementation process, with measures to
prevent and control potential risks They also need to review and supervise regularly the implementation to gain experience and increase performance efficiency
5.3 Recommendations for hospitals to improve head nurses’ competencies Strengthen training and improve training quality:
Attention should be paid to innovation of method of evaluating training effectiveness: standards-based assessment; pre-assessment; post-assessment, and re - assessment after a certain time
Use competency framework for head nurses
With the competency framework, Department of Personnel and Organization will design a questionnaire to evaluate each specific skill of head nurses using 360-degree evaluation method Strengths and limitations of head nurses’ working skills can
be pointed easily out after the evaluation Based on the evaluation results, senior manager can arrange and assign head nurse to suitable work positions to maximize their strengths while overcoming the remaining weaknesses
Regularly assess head nurses using competency framework
It is required to renew the assessment in order to improve managerial competencies effectively The most specific assessment tool is the management competency framework for head nurses, which provides specific and detailed criteria
to evaluate the performance of head nurses Moreover, the assessment must apply the 360-degree evaluation method for true and fair view to determine qualified candidates
to take up the position of head nurse
Create work motivation for head nurses
+ Monetary incentives and rewards: Promptly commend head nurses who gain achievements Head nurses who have outstanding achievements in their work should
be rewarded in accordance with the law on emulation and commendation, get a raise ahead of time, be prioritized when being considered for higher positions
+ Spiritual incentives: There are various forms to honor and reward head nurses who are dedicated to take care of patients wholeheartedly, those who have made great and long-term contributions, for instance: emulation Fighter at grassroots level or ministerial level, medal “For People's Health, certificates of merit awarded by the director and by hospital, etc
Build hospital’s culture based on the competency framework
Hospital’s culture is created as a basis for forming working attitudes and behaviors for staff in general and head nurses in particular Behavior and attitude are extremely important skills that are components of managerial competencies head