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Chapter 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

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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.

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:

Therefore, the study is the basis for further studies to continue finalizing the set of

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?

patient care was developed and tested in this study. Therefore, the research results reflect the

Third, what factors of head nurses' managerial competencies should be
improved most?
Fourth, what factors affect the managerial competencies of head nurses?

Practical contributions
The study applied several methods and multi-dimensional views to synthesize,

evaluation criteria close to the health system in Vietnam in the near future.
A research model between head nurses’ managerial competencies and results of

reliability; supplement and develop methodology in evaluating the managerial
competencies of head nurses; and proposing feasible solutions.

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


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reference 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

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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
nurse; Protect each individual in the unit from others, even before themselves; limit


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words that hurt employees' honor, protect individuals in the unit from outside

communication, professionalism, knowledge, business skills, all intersecting with

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

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

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

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

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

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

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.

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.

2.2. 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

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

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”.

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

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
nurse manager leadership. This model captures competencies in the areas of

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

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leaders and the board of directors, heads of department; the dependence on doctors’

CHAPTER 3

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

RESEARCH METHODOLOGY
3.1. Design and selection of research framework

managerial competencies of head nurses.

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
Administration at hospitals. The researcher reached out to collect data, collate and


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compare data, and review data to ensure the data was consistent and reliable.

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Next, logistic regression analysis will evaluate the effects of the above

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)

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.

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

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

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.

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

- 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.

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.

3.4.2. Data cleaning and analysis
Quantitative analysis: mainly to test the uniformity of the scale, principal
component analysis and logistic regression analysis.

- 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.

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

- 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

input data.
Principal component analysis (PCA) is the second quantitative analysis tool
to help organize survey variables from the questionnaire into groups of indicators.

an important basis for recommending solutions to improve managerial competencies
of head nurses in hospitals.

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
impact on the quality of patient care.


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CHAPTER 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

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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


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evidence-based practice and fluent use of information technology and computers.

financial management competence.

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

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.

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

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 = -

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

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 = -

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

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

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

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

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 (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

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

clinical skills.
Strengths in human resource management skills: Strengths in personnel
management skills of head nurses included good clinical examination competence; being

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

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

service, educational level, managerial qualification explained 39.1% change of technical
competence, 56% change of personnel management competence, 52% of change in
conceptual competence, 33% change in leadership competence and 34% change in

care.
Strengths in leadership skills of head nurses: Strengths in leadership skills of head
nurse included being able to solve problems appropriately and thoroughly; ability of


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training staff; understanding policies and procedures; having good stress management

solving, time management, organization of work of unit and workflow process, and

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

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,

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.

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

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

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

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.

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

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

procedures than to productivity measurements. This is one of the weaknesses that needs to
be improved, especially in public hospital.

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 wellplanned 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:
Weaknesses in leadership skills of head nurses included the ability of problem-


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CHAPTER 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

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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

to following issues:
1- Transforming nursing policy, nursing management system
2- Increasing both in quantity and quality of human resources for nursing and

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

midwifery
3- Transforming service attitude and style and improving quality of care
towards patients’ satisfaction
4- Issuing nursing care process and implementation guidelines

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.

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

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.
Criteria that need to be focused to improve include: Being able to evaluate staff


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performance, being able to communicate effectively, having good recruitment strategy,

prevent and control potential risks. They also need to review and supervise regularly

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

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

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

With the competency framework, Department of Personnel and Organization
will design a questionnaire to evaluate each specific skill of head nurses using 360degree evaluation method. Strengths and limitations of head nurses’ working skills can

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

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

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,

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

etc.
5.2.4. Recommendations for improving leadership in managerial competencies of
head nurses

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

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.

+ 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.

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.

+ 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

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.

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

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

behaviors for staff in general and head nurses in particular. Behavior and attitude are
extremely important skills that are components of managerial competencies head
nurses.


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5.4. Recommendations for state management agencies
Ministry of Health leaders need to be aware of the significance, role and
importance of managerial competencies of hospital head nurses in general to enhance
the image and stature of head nurses and encourage them to promote their managerial
competencies.
Renovating and perfecting policies, standards for the practice of head nurses’
managerial competencies will create a favorable legal corridor for the development of
nursing system in Vietnam. The Ministry of Health needs to develop and promulgate a
framework for managerial competencies of head nurses.
Policies should be developed and favorable conditions for training centers to
train skills and in-depth knowledge of management for hospital head nurses to

CONCLUSION
The study was conducted with the participation of 14 chiefs and vice chiefs of
nursing, 60 head nurses and 538 staff nurses at 7 central hospitals in Hanoi. Some

outstanding research results as follows:
-

Demographic information: Most of the studies head nurses were female (81.9%),
the youngest 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, 87% head nurses took short-term training on
management.

-

improve their skills should be created.
In addition, activities to improve nursing skills should be integrated with the
implementation of other plans.

Performance results of head nurse: The head nurses spent less than 15% of their
time planning, 16-30% of the time on organizing operation activities and
leadership. The majority of head nurses focused on controlling nursing activities.
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.

-

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.

-

Strengths in managerial competencies of head nurses:
+ Strengths in technical skills of head nurses 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 of head nurses included good


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LIST OF RELATED MANUSCRIPTS

clinical examination competence; being optimistic; ability to implement
group process; having staff development strategies; having appropriate
retention strategies.
+ Strengths in head nurses’ conceptual skills included having strong political
stance and knowledge of legal issues related to nursing care.
+ Strengths in leadership skills of head nurse included being able to solve problems
appropriately and thoroughly; ability of training staff; understanding policies and
procedures; having good stress management skills; research and propose
processes.

-

Weaknesses in managerial competencies of head nurses:
+ Weaknesses in technical skills of head nurses included nursing care planning,
evidence-based practice, and good application and use of new technology.
+ Weaknesses in human resource management skills of head nurses included the
ability of effective communication and effective staffing strategy.
+ Weaknesses in head nurses’ conceptual skills included being able to teach and
study well; having strategy planning and goal development.
+ Weaknesses in leadership skills of head nurses included the ability of problemsolving, time management, organization of work of unit and workflow process,
and interdisciplinary care coordination.
+ Weaknesses in financial management skills of head nurses included the
ability to control unit budget and take appropriate measures to increase
productivity.
* Study limitations and orientation for further studies

-

The study sampling method was convenience sampling; therefore, the
representativeness of the sample was not as superior as that of random sampling.

-

As the survey was based on cross - sectional study, the research results only
assessed managerial competencies at the timing of the snapshot. It could not be
as superior as case–referent study (case-control study) or study following groups
of individuals over time (cohort study).

-

Quantitative research method could not understand deeply about the causes,
strengths and weaknesses in the managerial competencies of head nurses. Further
studies may add qualitative research to have a deeper look into this issue.

-

The framework has been applied effectively overseas, however, when applied in
Vietnam some criteria need to be revised accordingly. The framework offers
scales that was applied only to the nursing system, evaluation from doctors on the
managerial competencies of head nurses should be supplemented to the study.

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Social Publisher Company Limited, 2018, 66-83, Hanoi.
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care in Hanoi city: current situation and recommendations”, Journal of Economics
and Development, Vol. 252 (II), June 2018, 86-94.
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nurses at Simacai General Hospital - Lao Cai province”, Journal of Economics and
Forecasting, Vol. 33, November 2018, 57-60.
-

Nguyễn Văn Uy, Nguyễn Thị Ngọc Huyền (2019),” Improving managerial
competencies of head nurses at central hospitals in Hanoi, Journal of Economics
and Development, Vol. 263, May 2019, 74-84.