Nurse Managers Exist Unhappily in a Grey Zone

Nurses are classic examples of professional hybrids. “Hybrid” professionals are required to create discrete professional and managerial leader identities — and these duelling identities as caregivers and managers can create emotional stress and conflict.

Though they are traditionally viewed as subordinate followers of physicians rather than leaders in their own right, nurses play an influential role in medical decisions and treatments and cannot be perceived as merely passive team members. So the problem is not with medical hierarchies but with accommodating discrepancies between leader and professional identities.

Nursing is a predominantly female profession, with 90 per cent of the workforce made up of women. This is, in part, due to the inherently “feminine” identity of the profession, which encourages the ideals of obedience, altruism and passive caring.

By contrast, male nurses, a small minority group, occupy a disproportionate number of nursing leadership positions. This reflects the underlying societal assumption that men are more desirable leaders — associated with identities such as masculinity, authoritativeness and influence over others — than women. As such, nurses moving into hybrid roles must communicate leader identities to others while remaining representative of the collective nursing identity.

Fulfilling versus functional identities

Against this backdrop of identity conflict, researchers Charlotte Croft, Graeme Currie and Andy Lockett, all of Warwick Business School in England, examined how nurse managers attempt to align a distinctly feminized professional identity with a more masculine leader identity.

After extensive interviews and conversations with 32 nurse managers, the researchers found that discussions about nurse identities evoked passionate and animated responses. In contrast, when talking specifically about their identity as managerial leaders, discussions became less animated and more subdued. In addition, the interviewees saw the demands of their leader identity as a functional requirement of their hybrid role and the demands of their nurse identity as more emotionally fulfilling.

To rub salt into the wound, nurse managers are sometimes required to detract from behaviours associated with nurse identity, such as being able to prioritize caring for a patient, in order to fulfil the demands of their leader identity.

Due to their dual roles and priorities, nurse managers also reported that they no longer enjoyed influence among others in the nursing group. This made them feel like outsiders and undermined their group leadership potential. Identity conflict, confusion and a sense of loss ensued.

From confusion to coherence 

In an attempt to deal with their identity conflicts and overcome negative emotional experiences, the researchers found that nurse managers engage in different types of identity work.

The first type involves distancing themselves from behaviours associated with undesirable managerial leader identities. First, nurse managers attempt to deflect negative reactions to managerial decisions onto other, higher-level managers, to protect their identity as members of the nurse group and to make it clear that they do not agree with the inconsistent behaviours of “managers”.

Second, nurse managers try to distance themselves from a manager identity by highlighting their own commitment to behaviours associated with a nurse identity, suggesting a typical “manager” would not act in a similar way. For example, one nurse manager said, “Those normal managers, they don’t want to get up at six in the morning and they don’t want to work Christmas Day or New Year’s Night ... It’s not like that for me, it’s not about the spreadsheets and leaving by 5 p.m. ... I’m still part of the team, it’s important for them to see that.” 

The next type of identity work by nurse managers involves attempts to construct their leader identity by framing it in language that is typically associated with their nurse identity. The common features of such language include animated, positive and emotional discussions that are symbolic characteristics of the nurse identity. Rather than trying to accommodate managerial leader identity demands, they rely on their continuing emotional attachment to their nurse identity to guide how they view themselves as professional nursing leaders. 

Removing the emotional attachment 

While the above two types of identity work enable nurses to overcome some of the identity conflicts, they continue to report negative emotions as they feel a loss of nursing group influence. But some nurse managers did find a way to experience less identity conflict and emotional distress. How exactly did they achieve that?

Although a small group, these nurse managers — now general managers — had moved into strategic management positions and were able to resolve their identity conflict and overcome negative emotional experiences because they were no longer emotionally attached to the formation of a desired nurse identity. As a result, the researchers found, they no longer experienced negative emotions when they felt others did not perceive them as nurses. That is not to say that these managers dissociated themselves from their past experience as a nurse; rather, they no longer associated their “true self” with an ability to develop a desired nurse identity.

Despite a degree of relief that the identity work might offer, nurses remaining in hybrid roles continue to experience negative emotions and feel a loss of nursing group influence. While existing research suggests hybrids are ultimately able to overcome identity conflict by relying on emotionally important group identities, the researchers argue that it is not always the case.

The tactics employed by nurse managers allow them to overcome individual identity conflicts to some extent, but they are far less adept at overcoming the emotional distress associated with their perceived loss of an emotionally important and desired group identity. Negative emotions could only be resolved by foregoing emotional attachments to the professional group.

More research into effective solutions for emotional detachment might offer some much-needed tonic to nurse managers and other hybrid professionals.

This article is adapted from a story that originally appeared in CoBS Insights, a publication of the Council on Business and Society. Smith School of Business is a member of CoBS.