Importance of nursing leadership for patient care
Discuss About The Advancing Leadership Capacity In Nursing.
Leadership refers to the ability of a particular individual or organization to set and accomplish intended goals and vision, take decisive and swift action, and outperform competition from others. This acts as a source of inspiration and morale boost for enhancing the performance. In other words, a leader works towards motivating and inspiring all people to engage in a vision, manages delivery of that vision, and builds and coaches a team that is effective in accomplishing the goal or vision. Nurses are the foot soldiers for all forms of patient care. They act as the frontline of patient safety and are involved in caring and advocating for patients. regardless of their cultural or ethnic backgrounds (Wong, Cummings and Ducharme 2013). In addition to ensuring delivery of optimal healthcare services to all patients, nursing also requires demonstration of proper leadership capabilities. The nursing profession most often requires the professionals to display a submissive attitude. I hold the personal view that nursing is a kind of a political act, in addition to being a practice discipline. Nursing leadership hence involves several aspects that are focused on decision making, critical thinking, patient advocacy and action.
Therefore, nursing leadership is imperative for the immediate lives of nurses and creates a significant impact on the existing healthcare system (Doody and Doody 2012). Hence, the healthcare systems are in need of a steady supply of energetic and visionary nursing leaders across all disciplines, who are courageous, credible, inspiring and visible to others. Nursing leaders are also expected to hold authority and have access to modern resources that will support their professional and innovative practice. Thus, it can be stated that I strongly believe that clinical or nursing leadership is not an act for healthcare professionals who are submissive and subservient. It is rather a part of the dynamic profession of nursing that requires confident staff at all levels.
Leadership is an essential aspect in the healthcare setting that can be attributed to the fact that there are plethoras of issues that are faced by the local or national healthcare organizations. Management of these issues require demonstration of adequate skills related to leadership, pre-cognition and management of the care provided to patients (Gottlieb, Gottlieb and Shamian 2012). Nursing leadership is generally considered an essential force that shapes or governs the formulation of healthcare policies and legislations, similar to other countries. Furthermore, evidences from several studies also indicate that nursing or clinical leadership is crucial for maintaining nursing workforce, staff retention and avoiding conflicts.
Therefore, nursing leadership requires that all nurses are well aware of their roles and responsibilities at the beginning of their nursing graduate program and are able to continue with their duties throughout their career. Nursing leadership is of utmost importance in helping nurses to lift their professional practice. This enables them to consider their profession not only as a series of scientific caring practice that is able to change the overall health and wellbeing of individuals, but also as a lifelong commitment towards political actions that bring about a change in the healthcare system (MacPhee et al. 2012).
The role of nursing leadership in shaping healthcare policies
An interview was conducted with two Certified Legal Nurse Consultants (CLNCs) who have been part of this profession for more than 15 years. The interview was conducted on a face-to-face basis and involved direct interaction that helped in gaining a sound understanding of the individual characteristics and leadership styles that the two CLNCs displayed during their career. The interview also helped in understanding about the different challenges faced by them during the course of their career. Thus, it can be stated that conduction of the interview was a worthwhile experience as it facilitated gaining knowledge on the visions and goals of a healthcare organization and the different approaches that are adopted by nursing professionals to achieve that goal. Both the interviews began with questions that made the respondents talk about the beginning of their profession, what made them pursue nursing and their career advancement with regards to their higher education.
The nursing profession primarily focuses on caring for families, individuals, and communities that helps the latter maintain or attain optimal health and improved quality of life. Nurses are differentiated from other healthcare professionals by the approaches they adopt towards caring for their patients. The scope of nursing practice has evolved since the traditional times. This has resulted in shaping the public image of nurses over the years. Post the world war time, nursing education has also undergone huge diversification towards specialized and advanced credentials, which in turn resulted in bringing about changes in their traditional roles (Mannix, Wilkes and Daly 2013). Furthermore, nursing professionals are also required to foster an effective collaboration with other healthcare professionals, such as, physicians, occupational therapists, and also need to initiate effective conversation with the patient and their family members. In most countries, nurses are required to diagnose health abnormalities and prescribe appropriate pharmacological or non-pharmacological interventions for the same. Moreover, nurses also help in coordinating patient care, while working in the multidisciplinary team (Ceravolo et al. 2012). Thus, it can be stated that nursing is a holistic profession and is regarded crucial in the healthcare scenario owing to its role in managing fiscal constraints and reducing the workload that occurs due to staff shortage (Dignam et al. 2012).
Nursing leadership is an essential determinant of the vibrant professional work undertaken by all nurses in the healthcare system. Demonstration of this leadership is imperative for supporting high-quality professional practice and also assists all nurses to feel respected, safe and valued. It also develops a sense of human caring among the professionals. Appropriate leadership styles create a sense of ethical obligation when there is lack of adequate resource. Nursing leaders are also involved in informing the employers about potential threats that affect patient safety.
Leader A- I spent my childhood with my grandparents and was extremely close to them. I loved caring for them, used to monitor if they took regular medicine, and had proper food intake. Gradually, I developed an interest in making a difference in the lives of all people. I wanted to pursue a career that would bring cheer and hope in their lives. Although I was aware of the fact that nursing is a challenging profession and a nurse is responsible and answerable for all her actions taken to improve the health outcome of distressed people, I decided to join it. By far the experience has been highly rewarding. Although there are several instances that create challenges in our practice, I am extremely satisfied with my work experience.
Skills and responsibilities for successful nursing leadership
Leader B- I was around 8 years of age when my father had suffered a heart attack and had been admitted to the district hospital for his treatment. It was a tough time as we all were extremely distressed and worried of his health. Although the physician offered excellent treatment services to my father, the nurse-in-charge took all possible efforts to administer proper medications, feed him, and assist him during walking. I was highly impressed of the care that she took for her patient. During my growing years I eventually understood the importance of nurses for all patients and wanted to repay the kindness that was shown towards my father. This made me join this profession. I have thoroughly enjoyed my work over the years. Most often I have successfully developed a good rapport with my clients, which in turn has helped me improve my practice.
There are ranges of leadership styles, demonstrated by nursing professionals. The personal style of leadership is found to create significant impacts on the operations of the healthcare facility and has far-reaching implications. The autocratic style of leadership is found to involve a nurse manager or a leader who is responsible for making pertinent healthcare decisions, giving specific orders, and issuing a plethora of directives towards subordinate employees who are expected to obey the commands of the nurses, under the leader’s watchful supervision. Autocratic nursing leaders are also found to strongly discourage their subordinates from questioning the reliability and relevance of the directives (Galuska 2012).
Leader A- I believe that nursing leaders are expected to form an effective collaboration with all healthcare professionals and their subordinates for achieving the directed vision of the healthcare organization. A nursing leader should also be able to inspire the subordinates to take all possible efforts for improving patient outcomes and should also be trusted by all.
Leader B- I strongly believe that all nursing or clinical leaders should encourage their workers by rewarding them when the latter demonstrates a good nursing practice. However, it is also essential to point out the mistakes performed by the subordinates. Punishments also form an essential discipline of nursing leadership.
Transactional leadership encompasses the method of leading through implementation of routine transactions, in the form of punishments or rewards, when a task gets completed. It is focused on transactions that occur between the managers, nurses and subordinate staff due to its foundation on the theory that discipline and rewards are crucial for motivating workers. A transactional leader fails to look into the future while managing a particular organization (Chaudhry and Javed 2012).
Transformational leadership illustrates the importance of encouraging all staff for performing their best through sheer influence of the optimistic personality of a nursing leader. The leadership style often operates on the notion that positive, rather than negative incentives boost the morale of all employees and helps them receive motivation (Hutchinson and Jackson 2013). Transformational nursing leaders encourage creativity, team building, and innovation for transforming the staff and accomplishing the intended objectives.
Insights from interviews with Certified Legal Nurse Consultants (CLNCs)
The Laissez-Faire leadership style allows all employees the freedom to work with little or no guidance from their superiors. Such nursing leaders are found to give minimal directions and always permit their subordinates to have virtually unlimited leeway. Authority is invested upon all employees and they are held responsible for their decisions (Eneh et al. 2012). This leadership style results in a slow rate of change in practice and quality of care service. Nearly retiring or new and experienced leaders are found to adopt this leadership style.
Research studies state that congruent leadership is based on the beliefs, values and principles of a leader and explains the position of the leader. Congruent leaders believe in inspiration, have god interpersonal skills and bring about effective transformation. There is lack of hierarchical position in this leadership (Makaroff et al. 2014). Aesthetic leadership encompasses leaders who encourage their subordinates to exemplify and share an aesthetic vision that helps in establishing a harmonious and calm environment at the workplace.
Leader A- My experience so far helps me understand that I possess the transformational leadership style. I believe that I have committed myself to my profession and have never focused on power control for motivating my subordinates and co-workers. I have never intentionally repressed them. Most often I have tried to develop an understanding and a good rapport with my subordinates for delivering optimal healthcare services to all clients, and have been successful in doing so.
Leader B- I sincerely believe that I am a transactional leader. Over the years, I have promoted compliance by my subordinates and followers through both punishments and rewards. I have always focused on paying attention to the work of all colleagues and subordinates for finding their good performance, as well as faults, with the aim of improving patient experience, and avoiding conflicts.
An analysis of Leader A’s response suggests that she has been successful in developing her leadership style through her experience. She primarily focuses on developing an efficient collaboration with her team members and does not have an authoritarian approach. Her response suggested that she works with her subordinates for identifying the areas that need a change and focuses on creating a vision that will inspire her co-workers (McCleskey 2014). She acts as a role model for the subordinates and inspires them for raising their interest in the nursing profession (Ross et al. 2014). This also enables her to identify the individual strength and weakness of her followers.
Leader B’s response indicates that she believes in supervising her followers and giving feedbacks about their performance by either punishing them for a wrong practice or giving them rewards as a token of appreciation when they demonstrate good nursing practice. Thus, Leader B sets certain goals for her team and articulates explicit agreements regarding her expectations from the team members. She also creates provisions for making the workers know how they will be praised for their commitment and effort towards accomplishing the goals (Scott and Miles 2013).
Several research evidences can support the leadership attributes in both. While leader A believes in empowering her team members by assisting them to develop into successful professionals and emphasizes on the work quality of the entire tram work, leader B uses her managerial qualities by relying on punishments and rewards for achieving optimal job performance from individual subordinates. It is therefore quite evident that leader B does not believe in collaboration or improvement of the entire team (Remus and Kennedy 2012). She rather focuses on individual performance that will help each team member realize his or her potential.
The evolution of the nursing profession and its impact on healthcare
Leader A- I think transformational leadership is crucial in clinical practice as delivering optimal healthcare services to a particular patient does not only rely only on nurses. There needs to be an equal collaboration with other healthcare providers for improving the quality of care and patient outcome. Therefore, I always think that transformational leadership is imperative for a nursing leader. It is of utmost importance to demonstrate leadership skills that include extraversion, neuroticism, agreeableness, openness, and conscientiousness. Thus, transformational leadership is essential for achieving the vision.
Leader 2- I consider transactional leadership to be most relevant in nursing practice as it allows the leader to monitor the progress of each team member. It also creates provisions for the subordinates to identify their strength and drawbacks in the scope of nursing practice. Furthermore, getting rewards help them to continue with the good work and a punishment makes the subordinates avoid wrong practice in future.
Clinical governance refers to the systematic approach that improves and maintains the quality of patient care. It is of utmost importance in healthcare service as it acts as a framework that makes the organizations and all healthcare providers accountable to improving quality of the services being provided (Giltinane 2013). Thus, clinical governance encompasses three major attributes namely, transparent accountability and responsibility, high standards of care, and dynamic improvement. Research findings support the fact that a clinical leader is expected to adorn the role of a model and stimulate motivation or inspiration among all employees (Werdhani 2017). A leader should also display a genuine concern and care for the demands and needs of all workers or team members (Haycock?Stuart, E.L.A.I.N.E. and Kean 2012). However, most studies have emphasized on the fact that nursing staff display discontent and dissatisfaction with their leaders when the latter fails to resolve workplace conflict or are incompetent of clarifying work issues. Lack of administrative skills, poor interpersonal communication skills and decision making skills, and low problem solving skills most often contribute to such failures (Scully 2015).
I am in complete agreement with these findings as my interview with the two leaders also helped me identify that at one instance, a leader failed to resolve the work place issue that led to the development of dissatisfaction and resentment among her subordinates (Chaudhry and Javed 2012).
Leader A- Most often, I had to delegate nurses that required me to transfer authority. This made me select nurses for performing specific nursing tasks, to competent subordinates, depending on their expertise. This was a huge burden on me as it involved entrusting power, authority and responsibility to another professional. Such instances often arised when there were new installations in the healthcare units or a new intervention was proposed to be applied based on relevant evidences.
Leader B- At most instances I tried to understand the need of implementing a proposed change in the organization. While making the change I had to consider several aspects. Most often I was able to manage time constraints and delegate the staff according to their expertise, while bringing about the change. I always focused on asking for the support of my subordinates.
Nursing as a holistic profession
An analysis of their responses shows that the transformational leadership skills of Leader A helped her in implementing changes in the organization. The fact that she emphasized on positive development and intrinsic motivation of the followers, and was able to foster higher moral maturity in her followers helped her successfully implement her leadership style in such scenarios. She was able to delegate nursing staff appropriately due to her ability to promote harmony and cooperation between the workers. Her inspirational trait, emotional responsiveness and creative expression were the key attributes that assisted her in managing such situations (Doody and Doody 2012).
The success of Leader B in managing such cases can be attributed to her leadership style that made her value structure and order. According to research evidences and her responses it can be deduced that her leadership capability made her command military operations, lead international projects and large corporations (McCleskey 2014). This enabled her to bring about changes in the organization that required regulations and rules for completing the intended objectives or delegating and moving people in an organized way. Her formal authority and responsible position in the organization facilitated the scenario (O’Neill 2013). Thus, it can be stated that a leader is responsible for scrutinizing the need for bringing about changes and is also expected to motivate and empower her followers and subordinates for implementing a certain change. Thus, leader A considers this effective engagement with workers imperative for such scenarios. This made her focus more on effective communication and collaboration. This was a correct approach as research evidences have also supported the fact that communication is a crucial leadership attribute. On the other hand, leader B considers military regime and strict adherence to rules and regulations essential for achieving the goals (Odumeru and Ogbonna 2013). Owing to the fact that transactional leaders are able work best with employees who know their jobs well and are extremely motivated by the reward-punishment system, the leader B was able to meet these challenges well (Buckner et al. 2014).
Workplace conflict or organizational conflicts can be defined as states of discord that are caused die to perceived or actual opposition of needs, interests and values, between people who work together. Such conflicts result in inevitable clashes between the formal authority and individuals or groups who are affected. Conflicts generally arise over disputes regarding division of revenues, work organization or other challenges (Elena Losa Iglesias and Becerro de Bengoa Vallejo 2012). The two CLNCs were also questioned about instances that resulted in conflicts and the way they managed them.
Leader A- Conflicts at workplace are quite common and I encounter them once in every four or five months. I can recall one such instance when the nurses who were entitled with the duty of working during night shifts were extremely dissatisfied with their work as they considered nurses working in the day shifts received more benefits. My role as a nursing leader made me convince all the nurses for a personal conversation that would help me understand their grievances. I engaged in an effective conversation with them using my communication skills and tried to motivate and inspire them regarding their profession. After noting down their demands, I had a talk with the administration where I advocated for the rights of the workers and made them assign the nursing shifts on a rotation basis.
Strategies for advancing leadership capacity in nursing
Leader B- I encounter workplace conflicts thrice or more, every year. Once there was huge dissatisfaction among the nurses due to staff shortage and huge workload. This created an impact on their work and they failed to show adherence to the scope of their nursing practice. I tried to convince them that if they are able to successfully care for the patients and stay in the job, they will be rewarded. However, the nurses were not motivated and many of them left the organization.
It is quite evident from research studies that nursing and clinical leaders are expected to demonstrate an understanding of the needs of the situation and their subordinates. Display of a compassionate and empathetic attitude towards their clients and adherence to the ethical standards of nursing practice is crucial for the role of a leader (Elena et al. 2012). Conflict management principally encompasses five different aspects such as, accommodating, avoiding, competing, collaborating, compromising, and competing (Blaney 2012). Conflict management is an essential criterion of leadership repertoire. Thus, it can be stated that while the transformational skills of leader A helped her in managing conflicts, leader B’s transactional skills were not helpful in such situations as the reward-penalty system does not work in all cases (Chan, Sit and Lau 2014). They were also interviewed about the actions they will take while recruiting subordinate nurses as leaders.
Leader A- I will try to recall my experiences that I have acquired over the years and will try to identify the subordinates who are most suitable for carrying out the role of a leader effectively. My good rapport with the workers will help me to get a sound understanding of the strength and weakness of all. I will try to talk to the administration about the workers who have proved their efficiency in the past years and will select the most appropriate leader from them.
Leader B- I will focus on going through the records of the workers who got the maximum rewards and least penalties. I will shortlist the ones with most number of rewards and will select a candidate based on their performance.
Thus, it can be concluded that most healthcare organizations require nursing leaders who will be able to develop nursing care and will advocate for the nursing profession, thereby creating a positive effect on the healthcare setting. Leadership roles are therefore different from management functions. Therefore, leaders should be equipped with specific strategies and plans that will increase their desire to direct the organization and the team. Thus, it can be argued that absence of a strong leader results in moral and ethical complications (MacPhee et al. 2012). There is a need to recruit courageous and brave leaders to meet the demands of scare resources and ever-increasing healthcare demands. This interview provided me with a clear understanding of the characteristics and qualities of a clinical leader. The leaders were able to motivate me and instil in me a passion for the profession.
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