A Model of Leadership in Nursing - Essay Example

Leadership in Nursing Introduction In health care, there is a correlation between the quality of patient care, staff morale and effective nursing leadership (Manley 1997). Effective nursing leadership is the most important factors influencing the retention of nurses and the maintenance of quality nursing care. Dramatic reductions in the numbers of nurse leaders were made in the early to mid-1990s as part of a program of cost-saving initiatives. The remaining nurses often experienced substantial increases in their workload. This reduction contributed to the perception that nursing leadership and the involvement of nurses in decision making were not valued (Heather, 2005). Objective This paper aims to provide a model of leadership in nursing. It also outlines factors that influence leadership styles, discusses approaches to leadership and the impact of the leadership style on nursing care. Besides, impact on nursing education/practice, role of the nurse, problem identification, solution, and nursing implication is discussed at length. Literature review Leadership is about knowing how to make visions become reality. This definition remains constant whether it is nursing, medical or healthcare leadership. In general the vision that nurses have is one where patients are treated with dignity and respect at all times; where systems are designed for the benefit of individual needs; and where the work performed by nurses is valued and respected. From a nursing perspective the three key foundation stones that helped nursing achieve the vision of a patient centred health service are development of patient centred care measures as part of performance management and the clinical governance agenda; leadership based on personal growth and development principles and; new clinical career and competency framework for nursing (Kitson, 2001). Achieving these visions will require a paradigm shift in the philosophy, priorities, policies, and power relationships of the health service. While a fall in the number of nursing leaders may be attributed to the current nursing shortage, studies have noted that there is also a significant deficiency in the number of nursing leaders. Even at major research and teaching hospitals, chief financial officers are worried about the scarcity of nursing staff (Singhapattanapong, 2002). Unfortunately an overlooked aspect of this nursing shortage is the dearth of leaders among nurses. In 2002, nurses are in a distinct position to influence healthcare policy and legislation. There is a need for nursing leadership to exert that influence and by nurturing both leadership as well as clinical skills. The nursing profession trains new nurses on operating the latest technology and complex medical equipment. In contrast, once at the bedside they rarely get the opportunity to apply even basic leadership principles. Nursing as a profession does a disservice to new nurses by not developing their leadership capabilities (Valentine, 2002). Nursing Leadership Theories While there are several theories of nursing leadership, it’s important to review those most applicable to the new nurse. The three theories that can be best practiced as a new nurse are quantum leadership, transformational leadership and the dynamic leader-follower relationship model. These three theories are appealing specifically for their embrace of leadership at all levels. Porter-O’Grady (1997) observed, "Leaders issue from a number of places in the system and play as divergent a role as their places in the system require". Porter-O’Grady (1997, 1999) opened up a new process of thinking about leadership by noting how the changing healthcare system required new leadership characteristics and roles. He observed that knowledge of technology has changed the traditional hierarchy of leadership. Conventionally, worker knowledge rose vertically as the worker moved up the chain of command. In general, knowledge bases increase as position increases. Now leadership and the knowledge associated with it has shifted. As new nurses enter the profession with ever expanding skills, "Technology has made possible this growth in the horizontal connections" (Porter-O’Grady, 1997). Staff nurses at the bedside 24 hours a day; seven days a week are on the front lines and have a distinct power to influence sustainable outcomes and productivity. They are, in fact, at the first level of decision-making. By permitting some autonomy in their decision-making however slight, we lay the foundation of leadership. New nurses decide appropriate times to call a physician, choose applicable care plans and relevant interventions. These early independent steps form the building blocks of leadership. To motivate leadership from the initial stages of nursing practice, mangers can "develop staff self-direction rather than giving direction" (Porter-O’Grady, 1999). Again, these simple steps facilitate new nurses’ enhancement of their own leadership skills. Transformational leadership merges ideals of leaders and followers (Sullivan and Decker, 2001). Its focus is to unite both manager and employee to pursue a greater good and "encourages others to exercise leadership". Transformational leadership can readily pertain to situations common among new nurses. Transformational leadership promotes change and suites the extremely dynamic health care system. Its focus on change can be directly applicable to nursing. New nurses are in a unique position of evaluating end results of both new and old policies and procedures. Sofarelli and Brown (1998) favor the transformational leadership style and find it empowering. By using transformational leadership, managers can encourage new nurses to submit feedback on how well unit specific procedures are carried out and implemented. The main purpose of this is to actively listen and institute relevant suggestions that not only promote client outcomes, but also again help to build a base of leadership with the new nurse. Transformational leadership provides new nurses with a method of taking an active and participatory role in policy within a new nurse’s jurisdiction and power. A third nursing leadership theory that can be readily used by new nurses is modeled after Ida J. Orlando’s nursing model. Orlando’s middle-range theory concentrates on the process nurses’ use to identify a patient’s distress and immediate needs. It specifically draws on cues in the interpersonal process to reach those objectives. Using Orlando’s theory as a backdrop, Laurent (2000) proposes a dynamic leader-follower relationship model. The theory is that the leader and follower exchanges are dynamic. Both parties are vital to the success of the unit. "The leader provides direction to the employee, not control, allowing for maximum participation by the employee or a dynamic relationship" (Laurent, 2000). This type of interaction between manager and new nurse can instill motivation and commitment. At the time new nurses are finding their niche, they can simultaneously develop basic leadership principles facilitated by interaction with established nursing leaders. Central to the theme of new nurses as leaders is the fact that effective leaders are also proficient clinically. New nurses can incorporate leadership fundamentals while developing competency in their profession. In exploring the Synergy model Kerfoot (2001) contends, "A leader cannot provide direct care. The leaders obligation is to create the environment in which good people can provide good care". Many leadership studies and professional opinions, disagree with this statement. In the United Kingdom, a "lack of consensus on nursing leadership has led to leadership development programmes for nurses which have emphasized the development of corporate and political skills, often to the detriment of nursing knowledge" (Antrobus and Kitson, 1999). Obviously, some will surrender the title of leader and would rather follow. That is necessary for the system to operate. Leaders in the lower rungs have less responsibility, but still can act as a leader. This is leadership in training. The fact is that while new nurses provide the majority of care and spend the majority of time with a patient, they are clearly not at the same power-level/structure as physicians or administrators. Few new nurses have input on major decisions affecting an organization. What new nurses can do is propose improvements to the existing status quo. They can submit new scheduling options, take the lead in presenting in service training or consult on retention and recruitment issues. Leadership Initiative for Nursing Education It is incumbent on nurse leaders to orient nursing education to emerging health delivery systems. In the United States, acute care hospitals have influenced the content of nursing education. Many of nursings heuristic methods, especially its models of clinical education, assumed that acute care hospitals would always be at the center (Donley, 2001). The Leadership Initiative for Nursing Education enhances the leadership skills of nurse educators, clinicians and nursing students. It is essential to: • Enhance the leadership skills of academic and clinical nursing educators responsible for developing the next generation of nurses. • Strengthen the leadership competencies of nurse educators and administrators to enable them to be instruments of change in their home institutions. • Promote effective working relationships between nurse educators and employers who depend on nursing programs to produce a workforce prepared for the leadership challenges of the new century. • Assist educators to produce nursing graduates with the leadership skills demanded by the new health care system (Leadership Initiative for Nursing Education: Case Studies, 2002). Students in nursing schools may have some exposure to the policy-making process, but the reality is that the majority of practicing nurses need to improve their level of influence in the policy process. Core competencies and training for nursing leaders in the arena of policy awareness, influencing the policy formulation process, and understanding the basics of government processes and health care financing mechanisms are necessary for nurses to begin to explore the area of political participation and policy making. As leaders, nurses must learn how to strategically identify and work with decision makers; understand where the power lies in the workplace, communities, and state- and federal level organizations; and understand who controls the resources for health care services. In their four- stage framework of political development, Cohen et al. (1996) described a continuum of policy awareness through which a nurse may travel. The stages range from the novice coming to an understanding that political action is important to the expert level of providing leadership in the policy arena (Wilson, 2002). It is critical for today’s nurses to learn how to exert legislative power, seek out policy and decision-making leadership positions, and build alliances and coalitions with consumers, nursing organizations, and health care provider groups. Many nursing schools and universities offer classes and courses on health policy for nurses in upper division coursework, but the audience is usually limited to those enrolled in formal graduate-level or doctoral-level study. Some nursing schools do offer lectures and courses in leadership with a focus on the policy-making and legislative processes. Creating a partnership between education and practice allows for practical application of theory (Ferguson and Drenkard, 2003). Role of the Nurse The following principles apply wherever nursing is practised and are considered the framework for supporting quality, efficient and effective nursing services in the interest of the public. A quality professional nursing practice environment is supported by: • A chief nursing officer who provides valued leadership for the discipline; • Middle managers who are regulated nursing personnel; • Nurses involved in decision-making at the board and executive levels; • Nurses involved in organizational strategic planning activities; • Nurses responsible and accountable for nursing care standards; • Nurses collaborating with other health care professionals in determining standards of client care; • Nurses who participate in organization-wide decisions to assess and select supplies, equipment and information systems and technology; • Nurses who have a strong voice in determining resource utilization; • The involvement of nurses in quality improvement activities that are integral to the organization’s functioning; • Nurses with clinical practice expertise who are in leadership positions; • A formal mentorship program for nurses that fosters sharing of expertise; • A work design in nursing allowing time for reflection and decision-making about one’s own practice; • Organizational decisions analysed with respect to their effect on client outcomes and nursing worklife; • Appropriate staff development and professional education that support nurses in maintaining continuing competence; • Additional management education that is accessible to nurse leaders and potential leaders; and • Formal links that enhance evidence-based practice, such as cross-appointments with educational institutions, to facilitate access to research and education expertise (Canadian Nurses Association, 2002). Conclusion Nursing requires strong, consistent and knowledgeable leaders, who are visible, inspire others and support professional nursing practice. Leadership plays a pivotal role in the lives of nurses. It is an essential element for quality professional practice environments where nurses can provide quality nursing care. Key attributes of a nurse leader include being a (n): advocate for quality care, collaborator, articulate communicator, mentor, risk taker, role model and visionary. Effective nursing leadership is the only way in which nursing practice and effective health care policies can be shaped and influenced (Antrobus and Kitson, 1999). Leadership is a shared responsibility. It is essential that nurses in all domains of practice and at all levels must maximize their leadership potential. To support distinction in professional practice, humanism must be restored to the work environment to help nurses feel safe, respected and valued. Nurses have the responsibility to their clients to demand practice environments that have the organizational and human support allocations necessary for safe, competent and ethical nursing care. Developing and supporting quality professional practice environments is a responsibility shared by practitioners, employers, governments, regulatory bodies, professional associations, educational institutions, unions and the public. References Antrobus, S. and Kitson, A., (1999). Nursing Leadership: Influencing and shaping health policy and nursing practice. Journal of Advanced Nursing 29, 746-753. Canadian Nurses Association, (2002) Nursing Leadership. Position Statement. Retrieved on November 7, 2006 from http://www.cna-nurses.ca/CNA/documents/pdf/publications/PS59_Nursing_Leadership_June_2002_e.pdf Cohen, S. S., Mason, D. J., Kovner, C., Levitt, J. K., Pulcini, J., and Sochalski, J. (1996). Stages of nursing’s political development: Where we’ve been and where we ought to go. Nursing Outlook, 44(6), 259-266. Donley, S.R. (2005) Challenges for Nursing in the 21st Century. Nurs Econ. 2005;23(6):312-318. Ferguson, S.L. and Drenkard, K.N. (2003) Developing Nurse Leaders in Health Policy: An Education and Practice Partnership. Policy, Politics, & Nursing Practice Vol. 4 No. 3, August 2003, 180-184. Heather, M. (2005) Nursing Leadership. Nurses Association of British Columbia. Retrieved on November 6, 2006 from http://findarticles.com/p/articles/mi_qa3916/is_200502/ai_n11826276 Kitson, A. (2001) Nursing leadership: bringing caring back to the future. Quality in Health Care 10: ii 79-84. Kerfoot, K. (2001). The Leader as Synergist. MEDSURG Nursing, 10(2), 101-103. Laurent, C.L. (2000). A nursing theory for nursing leadership. Journal of Nursing Management, 8, 83-87. Leadership Initiative for Nursing Education: Case Studies, (2002). Retrieved on November 6, 2006 from http://www.futurehealth.ucsf.edu/pdf_files/2001_LINE_Case_Study.pdf Manley, K. (1997) A conceptual framework for advanced practice: an action research project operationalizing and advanced practitioner/consultant nurse role. Journal of Clinical Nursing. 6, 179-190. Porter-O’Grady, T. (1997). Quantum Mechanics and the Future of Healthcare Leadership. Journal of Nursing Administration, 27(1), 15-20. Porter-O’Grady, T. (1999). Quantum Leadership: New Roles for a New Age. Journal of Nursing Administration, 29(10), 37-42. Singhapattanapong, S. (2002). Nurse shortage hurts UCLA Medical Center. UCLA Daily Bruin, 2002, March 11 p.1. Sofarelli M.. & Brown, R. (1998). The need for nursing leadership in uncertain times. Journal of Nursing Management, 6(4), 201-207. Sullivan, E.J. & Decker, P.J. (2001). Effective Leadership and Management in Nursing (5th ed.). Upper Saddle River, NJ: Prentice Hall. Valentine, S.O. (2002) Nursing Leadership and the New Nurse. Journal of Undergraduate Nursing Scholarship Vol. 4, No. 1, Fall 2002. Wilson, D. (2002). Testing a theory of political development by comparing the political action of nurses and non-nurses. Nursing Outlook, 59, 30-34. Read More