Management in Nursing - Essay Example

Sundry Issues on Nurse Managers’ Leadership Management Styles: Reflective Essay There has been a distinction cited between leadership and management. In particular, it has been noted that leadership is just one of the numerous desirable facets that a manager ought to have. The eventual goal of a manager is to optimize the productivity of the firm through effective administration. To carry this out, the manager must effectively carry out the functions of organizing, planning, staffing, directing, and controlling. Thus, leadership is said to only be a single aspect of the directing role. Moreover, Predpall (1994) suggests that senior management must manifest profound involvement and be a role model; such involvement by senior management cannot be delegated. There are several noteworthy issues which I have had the opportunity to reflect on during the course of my clinical placement. My insights were analyzed in light of the different leadership styles, and the strategies employed by each nurse manager who exhibited the style. The first leadership style, that of the autocrat, leads through the use of unilaterism to achieve one objective. This style, on the whole, requires that the leader exert constant pressure and directing from the leader to accomplish results. In addition, a prevalent outcome is submissive resistance from subordinates. While viewed negatively, there are also situations in which the use of this style is appropriate such as situations which are urgent or when subordinates are familiar or more amenable to its use (Bittell, 1989). For instance, I have personally observed some nurse managers who simply give out directives to their staff, especially nurses who are still neophytes under Benner’s (1982) learning stages (based from Dreyfus & Dreyfus’ (1980) original framework). When a subordinate nurse belongs to the early stages of this skills and acquisition development model, that is, novice and advanced beginner, he or she may opt to take concrete instructions from his superior rather than making decisions autonomously (Benner, 1982). In fact, in the novice stage, procedures and operations patients underwent are studied lengthily; moreover, they eagerly learn by asking more senior staff with queries, more frequently dealing with technical matters. The next management style is the democratic style. With it, the nurse manager makes decision through consultation with his whole team. However, he or she still maintains a reasonable level of control of the group. Moreover, he permits his team to decide on how the task ought to be approached and who will be the point person in carrying it out. An effective democratic leader is thus able to promote engagement and to delegate efficiently; but still holds real accountability for his leadership role. Often, he undertakes group discussions routinely and attempts to synergize all opinions of team members towards the best output. He teaches his team members self-reliance and confidence in themselves (Goodworth, 1988; Veccio, 1988). While this style is often perceived by nurse subordinates as liberating and empowering, there is also a down side. There are some who perceive it as a lack of competence and confidence by the nurse manager in his own decisions and ways of seeing things. Some do not think it is necessary to gain consensus or to solicit suggestions from their nurse colleagues. In addition, there are some instances when the process of exercising this type of leadership is too slow for matters with a high sense of urgency. Thus, it may not be appropriate during emergencies, which are actually predominant in the hospital / healthcare setting. The nurse who is in the advanced beginner stage takes note, based on actual experience, ‘the recurrent meaningful situational components (Benner, 1982, p. 403). Transformation occurs when the nurse starts to acknowledge facets of situations that require from her a specific response (Benner, 1982). This recognition does not emanate from a book or from similar learning material, but from exposure to or familiarity to the situation. Under this stage, the nurse already has the capacity to change ones view or approach as appropriate response to changes which would seem ‘unintelligible nuances in the situation (Benner, 1982). Finally, the expert level is beyond proficiency; for instance, there ceases to be a struggle to employ novel approaches as necessary. The incumbent is able to reframe most easily, and transpires at the preconscious level. This suggests that she is free to address other tasks (Benner, 1982). It is during these stages of competent, proficient, and expert that nurse managers ought to use laissez-faire and democratic leadership styles. I have observed that as a subordinate nurse becomes more proficient with making clinical decisions, they cease to conform to rule-based reasoning. This is consistent with O’Neill & Dluhy’s (1997) findings which suggests that they are not highly dependent on rules as a gauge of their performance, which are based on scientific principles and nursing processes, and are not too stringently guided by the American Nurses Association standards of nursing practice. These prescriptive standards present the manner in which nurses are expected to carry out patient care (American Nurses Association, 1998). In effect, those nurses who are already able to exercise a more analytical, logical and intentional pattern of thinking (Benner, Tanner, & Chelsea, 1996) are given more autonomy by their nurse managers. As mentioned, the laissez-faire management style may even be recommended for those subordinates who have manifested exceptional skill and competence and have had lengthy and thorough clinical experience. However, I think that the democratic leadership style is still more apt for those in the advanced beginner stage because they have only begun to learn and develop critical thinking (Halpern, 1989). Thus, nurse managers still tend to handhold staff who are undergoing this stage of learning (Benner, 1984). Participating in varied learning experiences offers the chance to apply classroom theory in the clinical setting. These experiences can help them in developing the learner from the novice phase to advanced beginner. The advanced beginner has been exposed to choice real-life situations and therefore has more contextual rules. Advanced beginners, however, are in greater need for supervision and guidance. They are only starting to learn repetitive meaningful patterns in clinical practice (Benner, 1984). Finally, laissez-faire management is distinguished by little or no control over the group, with little participation or engagement from himself as a leader (Veccio, 1988). Because there is an apparent lack of direction and motivation, productivity and morale decrease. Again, I have observed that there are certain instances when such approach can be recommended. For instance, it is apt when the nurse manager is already leading a team of highly motivated and competent staff. These subordinate nurses are already capable of delivering exceptional work in the past. This points out to the imperative of establishing a confident, capable and highly motivated team. To carry this out, the nurse manager ought to give his subordinates a reasonable amount of autonomy and know when to stop handholding them because they have manifested enough technical expertise and have developed maturity and perspective. On the whole, constant interference from a strongly autocratic nurse manager would create resentment among staff, and cause them to have reduced effectiveness in their work. By making them develop a strong sense of ownership of the task, the nurse manager can develop empowerment amongst his group and facilitate the achievement of goals. Through the autocratic or democratic management styles, a nurse manager must allow his subordinates as much clinical exposure as possible. Clinical experiences enable the formation of meaningful related information on the basis of what the nurse has learned in the classroom. There is an expectation that with more experience, this novice can move from the level of advanced beginner to the level of competence by program completion (Anderson, 1993; Carnaveli & Thomas, 1993). Clinical judgment is defined as nursing decisions about which areas to assess, analyzing health data, prioritizing which task to do, and who should carry it out (Anderson, 1993; Carnaveli & Thomas, 1993). For clinical judgment to be assessed as sound, it should be arrived at using critical thinking and logical reasoning, that will enable the deduction of valid conclusions, and the decisions that may be borne from these. This process of learning how to think critically is first handled effectively through an autocratic hands-on management style, but again, with the acquisition of skills and knowledge, the nurse manager must learn how to let go and give his staff a more substantial degree of autonomy. There is a need for hospitals to find more novel and innovative means of improving the management styles of their nurse managers towards increased satisfaction of their subordinates. Based on the most pressing issues faced by nurses of the day, leader managers ought to consider some form of action plan which will allow them to address the contemporary nurses’ needs and to adapt their leadership style as appropriate (Bégat, Ellefsen, & Severinsson, 2005; Raelin, Scholl, & Leonard, 1985): 1) Nurse managers ought to gauge the work environment and assess if it supports the desires for productivity of the hospital and ‘psychic’ income of the staff nurse. 2) Take the requisite steps in balancing the management-leadership emphasis on business an resources and put more premium on valuing people. 3) Encourage experimentation in work in the organization, in leadership styles and in work modes. 4) Monitor, measure, and recognize those changes which are towards enhanced quality of life. 5) Focus on vitality and effectiveness rather than on short-term results. 6) Reevaluate the selection and on-boarding process of new nurses to ensure that the psychological contract is open and well-defined. Still another critical personnel idea is establishing and securing the support and commitment of top management. While nurse managers may be able to modify their management styles, this would be close to futile if not accompanied with firm support from the institution. The end goals of nurse satisfaction, motivation and productivity must be considered seriously and acted upon to sustain morale and increase retention. This must be undertaken with a clear vision from top management, a clear comprehension of the outcomes of their initiatives, and accountability for these efforts from all parties concerned, especially nurse managers (Marquis & Silva, 1996). References American Nurses Association. (1998). Standards of Clinical Nursing Practice, 2nd ed. Washington, DC: American Nurses Association. Anderson, J.R. (1990). Cognitive psychology and its implications, 3rd ed. New York: WH Freeman. Bégat I., Ellefsen B. & Severinsson E. (2005). 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Halpern D.F. (1989). Thought and knowledge: an introduction to critical thinking, 2nd ed. Mahwah, New Jersey: Erlbaum. Marquis, E., & Silva, K. (1996). Process for profit: The how-to approach of TQM. Dubuque, Iowa: Kendall-Hunt. ONeill E.S. & Dluhy N.M. (1997). A longitudinal framework for fostering critical thinking and diagnostic reasoning. Journal of Advanced Nursing. 26, 825–832. Predpall, D. (1994). Developing quality improvement processes in consulting engineering firms. Journal of Management in Engineering, May-June 1994, 30-31. Raelin, J., Scholl, C., & Leonard, D. (1985). Why professionals turn sour and what to do. Personnel, October, 62(10), 28-41. Veccio, R. (1988). Organizational behaviour. The Dryden Press. Read More