The Importance of Nursing Leadership in Today’s Health Care System
The modern health care system is constantly changing and evolving. As the current health care system has become complex and multifaceted, there is a need for dynamic and inspiring nursing leadership to meet the demands of care. Effective nursing leadership has the potential to create a productive and efficient workforce. With the use of their analytical and problem solving skills, nurse leader plays a role in giving direct guidance to nurse and collaborating with staffs, management and executive team to supervise the delivery of high quality care (Scully 2015). Understanding of key aspects of nursing leadership and management is important for nurse leaders to effectively apply theories in real practice based setting. A nurse leader has to deal with several aspects in practice and these may include transforming education, bringing a planned change, implementing ethics, quality control and managing staffing. Based on my personal experience of working as a manager in the gynecology ward of King Faisal hospital, I feel that staffing is an important aspect of nursing leadership. Shortage of staff was a major issue in the hospital and this created many challenges for nurse leaders. The main purpose of this paper is to review the issue of staffs shortage at King Faisal hospital and critically analyze the impact of staff shortage by applying nursing leadership and management theories. The paper also provides solutions to overcome the issue of staff shortage and improve the quality of care in the selected organization.
King Faisal Hospital is a modern tertiary care hospital located in Riyadh, Saudi Arabia. Currently the ward does not have adequate number of staffs to handle patients. Due to staff shortage issue, the staffs at the gynecology ward of the hospital have to go through stressful environment (King Faisal Specialist Hospital 2019). The nursing staffs at the hospital face the direct consequences of staff shortage. They work for longer hours and they have a very schedule throughout the day. The maximum shift hours for nurse have been 15 hours per day. Although the facilities provide to the recruited staffs are adequate, however long working hours has been identified as one significant issue that can seriously hamper quality of care and staff’s motivation to work at the hospital too. Unless the issue of staff shortage is addressed, realizing the goal and vision of the organization must be difficult. Hence, from the perspective of a nurse leader or manager, recruitment and retention of professional staffs is one of the serious challenges while working at King Faisal Hospital. Because of several negative effect of staff shortage, enhancing recruitment and staff development has become one of the strategic priorities of the hospital. The main goal is to promote welfare and satisfaction of employees both in workplace and social setting and enhance staff retention process (King Faisal Specialist Hospital 2019).
The Problem of Staff Shortage at King Faisal Hospital
Health care staffing is an area which has become a critical area of focus for leaders and management of health care setting. The main rationale behind this is the link between staffing level and patient satisfaction. This is because staffing is directly linked to patient outcome. An observational study has revealed that nurse work environment and percentage of nurses in hospital is associated with patient mortality, as improved nurse staffing reduce the rate of preventable in-hospital deaths (Cho et al. 2015). As nurse-patient ratio is maintained, higher level of staffing minimizes the number of care left undone and increase patient satisfaction (Peršolja 2018). These evidences further indicates that nursing management efforts for higher number of registered nurse in hospital setting is the pathway to improving patient satisfaction and achieving the goal of quality care. For King Faisal Hospital, the increase in value of staffing level is understood from the fact they have listed staffing and staff retention as one of the strategic priorities in their strategic plan for 2013-2020 (King Faisal Specialist Hospital 2019). Hence, proper application of nursing management concepts will determine how the nurse leaders can overcome challenges of staff shortage at the gynaecology ward.
The value of staffing level in current health care setting is also understood from the fact that staffing level has become a focus of attention in many quality improvement initiatives at health care setting. This has occurred because of the negative impact of staff shortage on hospital’s financial performance (Everhart et al. 2013). It increases the cost involved in dealing with adverse patient event and repeated hospitalization. For example, large number of patients per nurse is associated with high incidence of administration of wrong medication, patient falls and pressure ulcers. However, higher registered nurse staffing decrease the risk of hospital acquired pneumonia and other patient outcomes (Kunaviktikul et al. 2015). Hence, it can be said that today’s health care managers have identified area which is leading to unnecessary cost and implementing effective management strategies to differentiate between efficient and inefficient cost cutting measures. Current acute care hospitals are competing for patients, medical staffs, physicians and other resources to control cost. As more and more hospitals are competing for quality, nursing staffing has become an integral part of their marketing strategy (Everhart et al. 2013).
Leaders are strongly advocating for staff’s health and well-being and in this effort, increasing staffing level has been a critical priority. Extended work hour leads to burnout and intention to leave the jobs. As work-life balance is hampered and employees experience emotional exhaustion, retaining staffs in the job becomes a challenge. Apart from job dissatsification, extra workload is also associated with frustration and negative job outcomes. This shows the direct effect of staff shortage on burnout (Boamah and Laschinger 2016). Hence, by reducing staffing level, nurse managers are creating supportive work conditions so that health care staffs greater sense of git between quality work life and organization goal. Such strategic plans are acting as solution improve job satisfaction and reduce turnover rate too. The above leadership action is in relevance with the concept of transformational style of leadership and Maslow’s hierarchy of needs theory. Transformational leaders focus on welfare of staffs and empowering others so that they contribute to the success of the organization (Alghazo and Al-Anazi 2016). By focusing on staff shortage issues, leaders play a role in providing healthy work environment and meeting self-actualization needs of staffs. Such form of strategies in nursing leadership can lead to improved patient care, fewer experiences of burnout and decreased attrition rate (Thomas 2015). Hence, this discussion reflects that staff motivation in health care environment is dependent on leadership style of nurse leaders or managers.
The Negative Impact of Staff Shortage on Patient Care and Nurse Work Life
Nurse leaders working at the gynecology ward of the King Faisal hospital have experienced severe challenges due to the issue of staff shortage in the ward. Reducing staff shortage needs to be prioritized in King Faisal hospital just like other hospitals competing for high quality care. This is because of the evidence of many negative impact of staff shortage on the performance of the hospital. One of the impacts that has been seen is the affect of staff shortage on quality of nursing work life and turnover intention. A cross sectional study investigated about the quality of nursing work life and its impact on nurses working in King Faisal Specialized Hospital. The interview with nurses revealed that majority of nurses reported intention to turnover and dissatisfaction with their work life (Kaddourah, Abu-Shaheen and Al-Tannir 2018). This kind of outcome is alarming as it may contribute to more complex challenges for nurse leaders. Taking immediate steps to improve recruitment and working condition of staffs at the hospital is necessary to preserve the current workforce and meet the vision of providing high quality care.
Staffing level is directly linked to adverse patient event and care burden. One of the challenges faced while working at the hospital was dealing with increased rate of poor patient outcomes. Many nurses were compelled to work for longer hours and they reported not being able to provide right attention to people as they had to care for too many patients in an hour. They reported rushing and being in a hurry all the time thus leading to negative patient event such as falls and needle stick injuries. Low motivation was found in majority of nurses. These affects are common to what other staffs have faced when they are forced to work for longer shifts. A study done to investigate the impact of nursing duty hours on quality of care in medical surgical wards also revealed that nurses working for longer shifts had perceived poor quality and unsafe care (Rahman et al., 2018). Hence, research evidence and evidence on negative impact of staff shortage on nursing staff at King Faisal Hospital gives many implications to nursing leadership and management staffs to examine environmental variables and process factors within the setting and engage in critical thinking to reduce staffing issues.
In relation to the issue of staff shortage, nursing leadership and management are facing many unprecedented challenges. The first challenges for them will be to restructure work hours and recruitment pattern. This is in relation to the process related changes that nursing management will have to tackle. However, transforming the recruitment structure and current staffing strategies will be difficult because of the presence of high number of expatriate nurse and lack of organizations support for change (Scully 2015). Nurse manager’s need to display effective leadership attribute to successfully bring change in the King Faisal Hospital. Their ability to extrapolate situations and find ways to bring change based on situation at hand are some of the attributes of effective leadership. Both the personal trait and situational theories of leadership state that effective leadership is dependent on the personality of the leader, situation at hand and the qualities of the followers (Nawaz and Khan 2016). Hence, for nurse managers at the hospital to engage in effective leadership, they need to acknowledge the significance of the situation, develop a vision, communicate the vision to others and do proper planning to make things a reality (Scully 2015). The challenges awaiting nurse managers in the context of staff shortage at King Faisal will be to deal with cost cutting and increased demand for service.
Challenges Faced by Nursing Leadership in Managing Staff Shortage at King Faisal Hospital
Secondly, another challenge confronting nurse leaders include they will have to deal with quality issues like controlling patient event and improving staff satisfaction. Both of this will require critical insight so that they can master situation even in a changing environment. After the modification of recruitment plans of the King Faisal hospital, the most significant challenge for the leaders will be to modify work environment in the presence of excessive service demand. To find an effective solution that leads to cost saving as well as quality improvement, the challenge for the nurse manager will be to find the systematic way out to bring the changes in an effective manner. To be successful in this venture, nurse managers at the hospital need to possess broader knowledge of contemporary issues and they must have the critical insight to measure negative and positive impact of the same for the whole organization. Focussed perspective, innovative ideas and assessment of possible risk in new venture will be important to address the issue of staff shortage and fulfil the vision of King Faisal Hospital (Forrester 2016).
Overcoming the issue of staff shortage will depend on nurse manager’s proper application of nursing leadership theory to the clinical situation at the King Faisal Hospital. The challenge for the nurse manager is huge and this is understood from the fact that inadequate number of staffs is not only limited to maintaining adequate staff-patient ratio but also because of its negative impact on patient. Reducing long shift patterns as well as maintaining good quality of care will be a challenging task to achieve in a limited time (Hassan et al. 2016). To resolve this aspect, applying theories related to motivation and staff development will be critical. This is necessary because staffs need to be motivated to change their attitude and provide highly focused care. Some of theories that would be applicable to resolve the issue in the hospital include adapting the ideas of the transformational leadership theories. This form of leadership is based on the concept that leaders and the followers motivate each other to higher level. The four leadership component that will inspire staffs to move towards the common goal of reducing staff shortage and achieving high quality care includes strong motivation, intellectual stimulation and consideration of personal barriers or conflict (Fernet et al. 2015).
Some of the challenges that have been identified to resolve the issue of staff shortage at the King Faisal hospital include restructuring recruitment patterns, changing work environment, motivating existing towards patient safety and motivating staffs to stay in the job. These challenges have emerged at the hospital due to the dual impact of staff shortage on quality of care. It has created issues not only for the employees but also for the patients. Hence, it is planned to overcome the challenge by adapting the traits of effective leadership. In a chaotic and unstable health care environment, the main role of a leader is to keep staffs inspired and maintain productivity. When aiming to bring any change in the organization, effective leaders are those who are flexible and consider the values and needs of constituents (Fischer 2016). Hence, the first solution will be to change the method of staff retention as this can help to maintain appropriate staff-patient ratio as per work demand.
Strategies for Overcoming Staff Shortage and Improving Quality of Care
To effective plan new methods for staff retention, the solution proposed is to first analyze the aspects of the work environment that has the biggest impact on staff retention. In context of staff shortage, long and extended working hours is the major factor leading to turnover intention. However, it is planned to analyze other elements of the environment such as physical environment, professional practice and work relationship (Cho et al. 2016). Consideration of this factor will help to identify contextual factors that might be leading to staff’s intention to leave. Evidence has revealed that nurse leaders play a vital role in developing a positive work environment. As a nurse leader, my focus will be to have open discussion with staffs regarding the reasons for turnover intention and enhance accessibility for staffs. My focus will be to become highly visible and accessible to staffs (Roche et al. 2015). Such open discussion will help to reduce the work hours and also identify additional skill set that is needed by staffs to work effectively and minimize adverse event in a busy gynecology ward. Roche et al. (2015) supports that when nurse leader’s focus on nurse’s concern and clarity of issues, they are successful in reducing turnover intention and improving patient outcome. Hence, implementation of a modified work schedule is the key to provide work-life balance and provide positive work environment.
Responding to negative patient event because of burnout and staffing issue has also been identified as one of the challenges for leaders at the King Faisal hospital. To resolve this challenge arising due to staff shortage, the aim is to resolve the issue by identifying additional training needs and foster the provision of training course and mentorship programme for nursing staffs at the ward. This can be identified by conducing meetings with nurse and identify their perception about training needs and skill development. This form of internal communication is likely to increase efficiency and positivity among staffs in the organization. This solution is in relevance with the action of a transformational leader as such leaders appreciate taking feedback from staffs and uses them to enhance skills of staffs (Wong 2015). The advantage of using this strategy is that it would create opportunities for training and skill development so that staffs are better prepared to perform effectively even in a busy ward. For example, incidence of negative event at the gynecology ward might be occurring not only because of staff burnout. Instead it might be occurring because staff’s do not adhere to patient safety strategies like safe handling of equipments and hand hygiene techniques. This multifaceted approach of targeting both recruitment pattern and training opportunities would help to overcome the burden of staff shortage at the hospital. Coventry et al. (2015) revealed that customized training programs enables nursing workforce to develop the kind of workforce they need to deliver outstanding care. This solution would pave way for professional development of staffs at the hospital too.
Conclusion:
From the analysis of the staff shortage issue at the gynecology ward of the King Faisal hospital and its impact on selected health care organization, the paper summarized the critical role of nurse leaders in resolving the issues. To deal with the challenges of staffing issues, strong nursing leadership trait and proper application of relevant theories to practice is needed. The report has proposed adapting effective leadership trait to bring change at the selected setting. The two solutions proposed for change is to modify recruitment pattern and engage in open communication by identifying training needs and other additional factors needed to resolve staff staffing issue. Transformational leadership style is needed in a changing health care environment to acknowledge uncertainties and motivate employees towards skill development and better work performance.
Apart from the two solutions proposed to overcome staffing issue as a nurse leader, other recommendations proposed to King Faisal hospital for improving the quality of patient care are as follows:
- Nurse leader or managers at the hospital need to adapt multi-faceted approach to resolve staffing issue.
- To realize significant cost savings, investment should be done on training programs so that unwanted adverse event due to staffing issues are reduced.
- Establishing strong connection with staff is necessary to develop good work relationship and provide adequate work environment.
- Following the systematic process of change starting with assessment of the problem, deciding priorities and suggesting solutions in an appropriate way is important (Kodama and Fukahori 2017).
- Fostering positive work environment is necessary to retain nurses (Kol, ?laslan and Turkay 2017).
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