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Draining wounds, fistulae, and peristomal wounds present challenges to nurses and can cause significant concern to patients and their carers. The management of these wounds can be complicated—depending on the individual patient, the wound, the resources available, and the skill of the nurse. This chapter discusses draining wounds, fistulae, and peristomal wounds.

The application of evidence-based practice to health-care management is relevant to people at all levels of health care—and this includes the nurse manager, who is responsible for the overall coordination of nursing team resources.

As consumers of health services have become more knowledgeable about their care and treatment, their expectations have risen. There has been a similar growth in the knowledge and expectations of the relatives of those receiving care—relatives want and expect high standards of care and treatment. This chapter explores some of the background to relatives’ concerns and suggest strategies that can be used by nurse managers when dealing with a concerned relative.

Nurses as ‘knowledge workers’ will stay committed to their employers if they are provided with the resources for interesting work, and if they are able to learn, grow and use all of their skills. If such an environment is not forthcoming, nurses, like other knowledge workers, will move on. This presents nurse managers with challenges in creating an environment in which nurse practitioners can flourish and perform effectively.

Hostility and overt aggression have been identified as factors that have a significant influence on the delivery of clinical care (Gournay 2001) and on the recruitment and retention of staff (Jackson, Clare & Mannix 2002). Such hostility is not restricted to interactions with patients and their families; it also occurs in interactions between staff members.

All managers rely on information to make decisions. It is therefore essential that nurse managers understand how to use information effectively. In the past, nurses have tended to see technology as dehumanising and counterproductive to the art and science of nursing (Ammenwerth et al. 2003).However, those now entering the nursing profession have been educated with computers and are aware of the possibilities that the Internet and other computer information systems can provide. Attitudes have shifted within the modern nursing workforce (Richards 2001). There is now a move to a requirement of having computers at the place care is provided through hand-held devices (Erdley 2006). Not only is this point-of-care technology seen as providing safer care but also saves time, allowing nurses to spend more time providing nursing care (Smith et al. 2005).

A budget is a formalised planning tool used by management to compare expected revenues with expected expenses for the year (Finkler & Kovner2000). The objective of budgeting is to maximise organisational resources to meet short-term and long-term goals (Marquis & Huston 2003). A budget is therefore a written financial plan that aims to control resources (Huber 2000).

There are many areas in contemporary nursing that involve far-reaching ethical issues—such as informed consent, substitute decision-making, effective use of health-care resources, moral distress of staff, and conflict between staff and patient’s family members. This chapter examines some common ethical issues that nursing managers face, the notion of a moral community and ways to combat moral distress among staff.

The current global shortage of nurses has created a highly competitive market in the recruitment of nurses. Health services are competing with each other to recruit suitably qualified nurses and the health industry as a whole is trying to attract school and university students to undertake nursing studies. This competitive environment has ensured that a critical component of the work of nurse managers is the recruitment and retention of nursing staff.

Job descriptions play a vital role in the success of organisational performance. The term job description has been largely replaced by position description (Dessler et al. 2004). Both provide a clear written template of roles and expected performance for both an organisation and for individual employees. At the recruitment phase, a job or position description gives the prospective employee an opportunity for self-assessment suitability. In a sense this represents the commencement of the culling phase of selection. Throughout the period of employment the job description serves as an ongoing framework for performance evaluation, as well as for position review and for position redesign. When an employee leaves the organisation, the job description can be further reviewed and refined to assist the organisation in achieving its goals.

In coming to grips with any topic, the first task is to define the key terms—in this case policy. Within this context, there are two sorts of policy: public policy and organisational policy. The activities listed below clearly refer to government functions, hence the term ‘public’; indeed, public policy is allabout how public resources are used and the expected outcomes from theallocation of resources. However, the principles behind each of these points can be adapted to policy areas of health services; that is, ‘organisational’ policy. The umbrella term of policy describes a number of organisational activities(Hogwood & Gunn 1984), including: a label for field of activity; an expression of general purpose or desired state of affairs; specific proposals; decisions of government; formal authorisation; programs; output; outcome; theory or model; and process.

Quality in health care has been defined as ‘doing the right thing, the first time, in the right way, and at the right time’ (NSW Health 2002). Consumers of health care expect that the services provided will be safe, effective, appropriate, consumer-focused, accessible and efficient. The challenge for providers of health care is to monitor and improve systems continuously to satisfy these expectations.

The nature of nursing means that every day many nurses are injured or become ill as a result of work. Causes include physical violence, ergonomic hazards (such as manual handling), exposure to infectious diseases (airborne, blood borne and direct contact), fatigue (due to physically and mentally demanding work), work organisation and shift work, radiation (ionising and non-ionising), handling toxic drugs and exposure to chemicals.

Managing risk is an overarching aspect of the nurse manager’s role. In providing clinical services, the nurse manager’s paramount concern must be to ensure the health and safety of patients and staff. This chapter teaches nurse managers about how to manage risks proactively by assessing what can possibly go wrong, developing a plan to manage these risks, act on this plan, harness the efforts of the team and then recognise the improvements.

Managing performance is a vital management tool if nurse managers are to inspire, motivate and lead their teams to clinical excellence. Performance management includes the evaluation of an individual’s work practice, the review of goals, the setting of new objectives and career planning.

It is not an easy task to manage workers in health-care settings. High levels of stress caused by unsociable working hours together with the emotionally, physically and intellectually draining nature of clinical-care delivery contribute to ‘unhelpful’ behaviour.

When a staff member comes to a nurse manager for counselling, that staff member expects to take part in a confidential, professional interview through which he or she hopes to feel better and receive help in solving problems (Geldard & Geldard 2001). Counselling staff involves skilled intervention, confidentiality and, most importantly, the ability to help staff members find a solution to their problems. Counselling is not a pleasant chat between friends; rather, it is a structured attempt to provide help in a problem situation.

Meetings are critical elements in the management of health-care facilities but for a busy nurse manager they can be a liability if not managed well. These gatherings can be held in various settings and be formal or informal; however, if they are to create value for the organisation, meetings must have key elements and outcomes of defining issues of importance, resolving problems and making decisions.

Delivery of health care is a collaborative effort, and each person has a valuable contribution to make. Although many important aspects of care are not specific to any particular discipline—for example, those that involve the basic principles of positive human interaction—other aspects are determined by the specific expertise and requirements of various disciplinary or occupational groups.

A new nurse manager is often plunged into an unfamiliar leadership role, as well as having many other challenging responsibilities. They will find themselves on an acute learning curve: adapting to new policies and procedures, observing occupational health-and-safety rules and becoming aware of abstract legal responsibilities.