After having a long conversation with the nursing manager of an autism unit, it emerged that it is one of the most admirable positions to pursue in the future. Being a charge nurse for the weekend offered a good opportunity to exercise the manager's role to the letter. Working closer to the manager was quite educative on nursing and administrative duties. Regular conversation with the manager offered a clearer picture of the manager's role and more so was motivating to work towards this dream role.
Critical aspects emerged about the nurse manager’s roles and responsibilities. One of the most important remarks she made was that she is a nurse first, and an administrator second. She said that it was important not to be taken over completely by the executive aspects of her role, for being a nurse remains the very essence of her career (Jolly, 2015). In this regard, she said, she remains subject to the same obligations as charge nurses. In dealing with intellectually disabled and autistic patients, she strives every day to build and maintain long-term relationships with the patients in her unit ( Giarelli & Gardner, 2012). She also ensures that such a relationship is based on trust and effective communication involving both verbal as well as nonverbal communication (Jolly, 2015). Besides, she affirmed that a nurse attached or working with this group of patients need knowledge and skills such as social skills and not only other than just diagnosis (Jolly, 2015). She also noted the complexity of classifying patients using DSM-V and social labels. The use of labels such as disabled masks the unique needs of patients. Autism is an aspect of neural diversity but not disability.
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Evident in these elements is patient-centered care and evidence-based interventions. She pointed out the necessity for evidence-based treatment and continuous education in the provision of tailored care. Autism is a spectrum, thus patients have different needs (Jolly, 2015). Further, their different beliefs and cultural values require contextual approaches. She recognizes that patient-centered care is difficult to achieve in autism cases (Jolly, 2015). However, she also noted that things get much harder with patients who are unable to express – or have difficulty expressing – themselves (Jolly, 2015). This hampers the provision of patient-centered care. The even bigger risk for nurses in this unit, she argued, is that the patients’ relatively powerlessness poses a greater ethnic dilemma for the nurses.
That said, she did express great appreciation for her position, i.e. the executive aspect of her job. As the manager for her unit, she supervises about 25 nurses, all of whom report to her. She is responsible for staff recruitment and management, budgeting and scheduling, planning of discharge, management of records, as well as the development of educational plans ( Marquis & Huston, 2009). She acknowledges the dangers of having this much power and pointed out the need to focus on the most important goal ( Marquis & Huston, 2009). As a head nurse, she mobilizes the other staff in sharing the vision of promoting quality care and continuity of care (Marquis & Huston, 2009). Focusing on this, she said, always keeps her grounded and humbled, as she understands that she is not the center of attention. Instead, she is only one small piece of the system involved in the provision of care to the patients and their families.
Moreover, she expressed appreciation for the bright side of this power, specifically when used positively. Both as a nurse and nursing manager, her roles also include advocating for the staff to ensure a safe working environment, mentoring and supporting her staff ( Marquis & Huston, 2009). The problem, she noted, is that the capacity of nurses to perform these duties is subject to other factors within the organization. Power dynamics is one of the factors that affect participation in leadership and decision-making processes ( Marquis & Huston, 2009). Some nurses who head units or departments enjoy significant authority over their subordinates. Consequently, their authority means that such a nurse has the audience of the key decision-makers ( Marquis & Huston, 2009). As such, they have access to a strategic platform from where they influence processes and change concerning staff management and health processes. In this context, the implementation of a nurse overseeing an autism unit promotes autistic care and overall quality of health.
The nurse gave an example of a certain period when the unit had a shortage of nurses. The heavy workload led to burnout and increased turnover. This problem, she noted, was also affecting the patients. The patients often had to deal with new faces (replacing those who had quit) (Jolly, 2015; Giarelli & Gardner, 2012). Long-term relationship and trust are key factors for intellectually challenged and the sensitivity of autism patients (Jolly, 2015; Giarelli & Gardner, 2012). In this light, turn-over and staff retention negatively affect healthcare in autism. It gave the nurse great satisfaction when she pushed for extra staff and how this improved safety and quality care in the unit.
This long interaction brought out the significant weight of responsibility on the nurse manager's shoulders. Her decisions have a direct impact on staff and patients. This pressure can be overwhelming. Nonetheless, working in an autism unit present a chance to advance career-wise and acquire knowledge as a contributor to quality care and continuity of care in the autism community.
References
Giarelli, E., & Gardner, M. (2012). Nursing of autism spectrum disorder: evidence-based integrated care across the lifespan . New York, NY: Springer Publishing Company.
Jolly, A. A. (2015). Handle with care: Top ten tips a nurse should know before caring for a hospitalized child with an autism spectrum disorder. Pediatric Nursing , 41 (1).
Marquis, B. L., & Huston, C. J. (2009). Leadership roles and management functions in nursing: Theory and application . Philadelphia, PN: Lippincott Williams & Wilkins.
