Effective Leadership in Nursing - Essay Example

Introduction

The age of transformation and technology has drastically changed the approaches taken by organizations as they compete in the global society (Bagshaw and Bagshaw, 1999). Both the public and private sector have to adapt to the challenges and demands of the current period. The health care system, just like other institutions, has to respond to the various and increasing demands to the industry.  Nursing, being an integral part of the health sector, has to establish an approach that will bring the institution forward in the 21st century, since there are many challenges that nursing face. Some of which are “new roles, new technology, financial constraints, and greater emphasis on participation, cultural diversity and education” (Curtis, de Vries and Sheerin, 2011, p. 2006). In this regard, effective leadership, in nursing in particular and health care service in general, has been given ample consideration as one of the primary strategies that can appropriately respond to the changes and challenges of the 21st century (Greenfield, 2007; Sutherland and Dodd, 2008).

It is recognised that an effective leadership in nursing is crucial in providing high quality health care services to the patient and efficient and professional discharge of nursing functions (Curtis et al., 2011; Shirrey, 2009; Tregunno et al., 2008). However, it has been observed that there are limited literatures pertinent to nursing leadership, especially, if it is compared with nursing management which has been the focus of discourses (Curtis et al, 2011; Stanley, 2008).  In this situation, this research will look into some of the theories in leadership and on some of the issues that it may raise in practise settings. The aim of the study is to provide a comparative analysis of contemporary theories of leadership in order to ascertain which among the theories may appropriately fit into the unique structure and demands of nursing (Jackson et al., 2009). This is significant because by identifying the suitable type of leadership for nursing, high quality nursing care service is secured, job satisfaction is increased, and in whole there is a positive effect in the patient, among the nurses and the organisation as a whole (Curtis et al., 2011; Shirrey, 2009;Tregunno et al., 2008).

For the study, the researcher will be discussing transactional leadership, transformational leadership and the servant leader. These have been chosen because these three theories are primarily humanists and holistic in approach (Heisler and Carter, 2010), which in turn, has a close affinity to the nature of nursing (Jackson et al., 2009). This decision does not discount the fact that other leadership theories, such as democratic leadership, strategic leadership, and others, may also be used. Nonetheless, the decision to focus only transactional, transformational and servant-leader acts not only as limitation for this research, but also supports the notion that these three theories of leadership are more congruent with the nature of nursing (Jackson et al., 2009).

The research will be having the following structure. The first part is consists of the comparative analysis of the transactional leadership, transformational leadership and servant-leadership, while, the second part will be dealing with the reflective account. In the end, it is hope of the researcher that this analysis may further nursing leadership.

Leadership and Nursing:  An Intricate Relation

The idea of leadership often evokes the notion of power, authority, dynamism, vigour, charisma, personalities, organisation and other similar concepts. These various connotations have contributed to the wealth of definition that is attached to leadership. Some define leadership as “a stream of evolving interrelationships in which leaders are continuously evoking motivational responses from followers and modifying their behaviour as they meet responsiveness or resistance, in a ceaseless process of flow and counter flow”(Burns, 1978 as cited in Masood et al, 2006:499). Meanwhile, other defines leadership as ‘the ability to influence people toward attainment of goals’ (Daft, 2000). Some view as empowering people from behind (Bagshaw and Bagshaw, 1999).  These definitions show that there is no one universal definition for leadership. This presents the notion that leadership may be understood from various perspectives and that there are many ways in which the concept may be apprehended.  

Nursing, on the other hand, is a unique profession. It is a “synthesis of practice, multidimensional assessment / intervention, interpersonal communication, case management, and resource-linking on behalf of patients” (Jackson et al., 2009, p. 150). It is an institution that demands technical knowledge and skills while maintaining a caring approach in en every patient encounter (Gastmans, Dierickx and Schotsman1999). Currently, it thrives in diversity as its workforce from different countries, as such; the practice is marked by cultural diversity (Curtis et al., 2011). Finally, the practice is both a science and an art (Jackson et al., 2009). In this sense, obtaining the appropriate leadership that will fit in to the unique nature and culture of nursing is a challenge, since, there are recognized benefits derived from effective leadership and effective leadership is attained if there is a match between leadership and organisation.

Fig. 1 The Connection

Source: Researcher

This figure shows that having the ‘right fit’ between nursing and leadership is essential in order to achieve the benefits that affect everybody and not just a few.  It has been observed that currently nursing is borrowing from other fields as they address the issue of leadership in nursing (Jackson et al., 2009).  Although, there are already movements within the nursing to come up with specific kind of leadership that is suitable to nursing itself (Curtis, 2011; Jackson et al, 2009; Stanley, 2008).  In effect, as the search continues for the leadership theory that is drawn from nursing itself, what cannot be discounted is the fact that existing theories of leadership brings nursing closer to the realisation of nursing leadership. In the following section, transactional leadership, transformational leadership and servant leadership will be analysed.

Transactional Leadership: Straddled Between the Past and the Present

Transactional leadership works on the premise that there is a clear hierarchy in the organisation, roles are well-defined and objectives and goals are clear (McGuire and Kennerly, 2006). Generally, it is more closely associated with traditional leadership because it is the kind of leadership that is more concern and adept in handling day-to-day operations of the organisation without much organisational change (Dunham and Klafehn, 1990). Moreover, transactional leadership focuses on reward and punishment. This implies that behaviours and actions that yield positive result for the company are rewarded, while, actions and behaviours that disrupt or do not contribute to the growth of the firm are punish. In other words, under transactional leadership, rewards and punishment are used to reinforce behaviour that leads to the achievement of the firm’s goals.

In addition, transactional leadership is concern with the proper exchange of resources. It holds the notion that the employees get what they want as long as the leader also gets something in return (Kuhnnter and Lewis, 1987). Although, it has often been associated with transformational leadership, transactional leadership is inherently different with transformational leadership in terms the relationship between the leaders and the followers. Under transactional leadership, the employees are motivated by rewards and punishments, while the leaders set out in giving rules, directives and goals. As such, in transactional leadership, leaders “emphasise process in setting goals and giving directions and strive to compromise, manipulate, and control the situation and followers” (McGuire and Kennerly, 2006, p.180). Furthermore, transactional leaders use praise, bonus, honours, merits, promotions, recognition as forms of rewards. Rewards or punishment are dependent on the employees’ performance.  As such, employees are motivated in performing their tasks as there are clear parameters in terms of rewards and punishment. In effect, it is recognised as the employees are made aware of the expectations, rewards, behaviours and goals are set, there is an increased job satisfaction, enhanced clarity of goals and tasks and marked improvement in job performance (McGuire and Kennerly, 2006).

Transactional leadership has three important dimensions. These are contingent reward, management by exception- active and management by exception – passive (Judge and Piccolo, 2004). Contingent rewards pertain to the establishment of a constructive system of transactions or exchanges with the followers. The leader set the objectives, the rules and goals and establishes the framework wherein rewards, merits and punishment may be understood by the followers/ employees.  Both management by exception- active and management by exception - passive pertain to the involvement of the leader in dealing with issues and concerns of the organisation. If the leader actively monitors, informs, guides, anticipates the problem, corrects the behaviour and take actions even before the problem creates serious concerns, then the leader is adopting management by exception – active. On the other hand, when the leader waits for the problem to occur and only acts when there is a already a concern as a result  of the behaviour or action, then the leader is adopting  management by exception- passive (Judge and Piccolo, 2004).

Some Concerns with Transactional Leadership as Adapted in Nursing

Although transactional leadership is closely associated with traditional leadership because transactional leadership is suitable for organisations with less changes and recognises hierarchy, and nursing considered as hierarchical and traditional (Stanley, 200),it can be claimed that at first glance it may appear that this form of leadership may be suitable for nursing. However, upon closer scrutiny, there are several observations regarding some issues that may be raised under transactional leadership. These are first; it does not enhance team spirit. This is maintain based on the notion that as nurses fulfil their tasks for merit, the team spirit which is necessary in dealing with patients, especially if the ward is full, may be decreased. There is an increased that nurse will only deal with her/his patients and do not help out other colleagues. Second, under transactional leadership, the technical side of nursing may be given more attention than the holistic approach in nursing. This is significant since Milton (2008) has warned nurses regarding the danger of focusing on the technicalities of nursing care is detrimental to nursing as an institution. He warns that nurses should learn from the lessons of history, specifically WW II, when nurses were used by the Nazi regime in implementing genocide. Finally, third, it does not respond to the challenges of innovation and diversity which are attributes of modern nursing (Curtis, 2011). In this regard, as transactional leadership may be adapted in order to accommodate the traditional paradigm of nursing, which is hierarchical (Stanley, 2007); it cannot be authentically responsive to the nursing since it does not accommodate diversity, team spirit, and the holistic approach of nursing.

Transformational Leadership: The New Vision

Transformational leadership is considered by some n nursing scholars as the most appropriate leadership theory for nursing (see Judge and Piccolo, 2004; Spinelli, 2006; Watson, 2009). Transformational leadership is concern with the personhood of both the leader and the follower. It transcends short-term goals and motivates employees and followers in achieving higher ends and purposes (Judge and Piccolo, 2004).  In addition, as transformational leadership values the human person, the leader motivates the employees/followers to transform their values, beliefs, attitudes and behaviours (Bass, 1985). Under transformational leadership the charisma, personality and vision of the leader act as one of the cohesive factors that unite the leader and the followers as they move towards the attainment of goals and ends. The vision of a transformational leader is effectively communicated to the followers by inspiring them not only in words, but also in actions (Bass, 1999). The leadership supports individual endeavours as it enhances collective efforts (Bass and Avolio, 1990). This is done by recognising and enhancing the intellectual capacities of the employees, fortifies commitment, develops self-efficacy by recognising individual abilities and creativity, and creating the interpersonal relationship that is built on helping co-employees (Bass, 1999; Rafferty and Griffen, 2004). As such, it has been maintained that transformational leadership has a positive correlation with decrease in turnovers (Rafferty and Griffen, 2004).

Looking at transformational leadership and on how the whole ethos of leading is being with the followers and employees, as their humanity is a recognised and affirmed in an interpersonal relationship wherein both the leaders and the employees share the same vision and goal and moves towards a common goal, it becomes understandable why there is a generalise sentiment that transformational leadership is the leadership that fits nursing. This is because nursing and transformational leadership meet at a common point – the human person with dignity.  As such, with transformational leadership, values become the foundation and the catalyst for change. In the same manner, as the firm is transformed by the vision and the charisma of the leader, the sense of team and collegiality among the employees are enhanced and solidified. Finally, transformational leadership establishes genuine commitment, confidence, competence and desire for continuous learning (Bamford-Wade and Moss, 2010).

In effect, it is wholly different with transactional leadership, since it is not concern wit exchange, but with transformation. On the other hand, it is not the same with servant leadership, as transformational leadership is inspired by ideals and not by service.

Some Issues with Transformational Leadership

As mentioned earlier, transformational is considered by some scholars as the most suitable leadership theory for nursing. However, it has been perceived that there are some issues wherein transformational leadership may be considered as not congruent with the ideals and vision of nursing itself.  Some of the issues that are raised are the following.

First, nurses are already inspired of their own vision and perception of what nursing may and can do to the lives of their patients. As such, the transformational leader may not be able to meet nurses’ demands for grounded and more solid manifestation and example of nursing care. This point has been raised by Stanley (2008), when he claims that the vision of nurse leaders are those that are at the bed side working and being with the patients and not some ephemeral ideals.

Second, as the charisma and personality of the leader is fundamental in transformational leadership, the trust and loyalty of the nurses may be divided between the leader and the profession. Charisma blurs the lines between the ideal and what is real. In a study it was found out that idealism and being visionary is not one of the ideal traits of a nurse leader (Stanley, 2003). As such, transformational leadership may not be able to respond to the experiential leaders that most nurses look upon.

Finally, third, it downplays the essential role of action in nursing and glosses the idea of idea as significant in the field. This means that nurses follow not just because of the vision created, but because they share the same ideals with the leader, they see in the leader the values that they hold, and they are one with the leader as they embark actions that authentically a patient –centred and not vision guided (Manley, 2000).

Servant- Leadership: A Paradigm Shift

Servant-leadership is basically a paradox. The leader is the one that serves. The leader is not the ‘source’ of authority, instead, the leader is the key person where authentic service is learned and experienced. It is a paradox the servant –leader does not seek to guide the community to his/her vision, but the leader lets the community share the decision making and experience the community. At the centre of this kind of leadership is service.  It is the beacon that guides the leader. As such, the care given is authentic and person centred. It does not assert its position as the repository of power, but it holds the integral importance of collaborative action and decision making of the community. This is the humanist side of nursing and affirmative of what nursing practise is – a moral practise (van Hooft, 1999).

Some Apprehensions

Some of the apprehensions with servant –leadership pertains to actual time. With nurses doing so many things at the same time, will they still have the energy and the strength to undertake mentoring and collaborative work?  Ideally, they support the notion that there is a need for collegial decision making and mentoring, but in actual practise, can it really be done considering the high demands of nursing care in and out of the ward. The nurse servant -leader is the ideal nurse. Although the tone of this discourse is a bit sceptic, the researcher is only asking, can it really be done.

Further Analysis:  Transactional, Transformational and Servant Leadership

Characteristic

Transactional Leadership

Transformational Leadership

Servant - Leadership

Motivation

Success

Transform/ Change

Service

Approach

From the Top

With Others

Behind you

Relationship

Exchange

Transformative

Collaborative

Decision-making

Leader

Team

Shared

Ethos

Expectations

Loyalty and Trust

Service

Guide

Rewards

Ideals/Vision

Service

Source: Researcher

The table presents the existing similarities and differences among the three types of leadership that have been discussed.  Noticeable that there is a marked difference in among the three kinds of leadership in the identified attributes. However, there is closer affinity between transformational and servant-leader ship in decision–making, but that is just it.

When these attributes are placed side-by-side  with the unique nature of nursing profession, one gets the idea that as both transformational and servant leaderships are encouraged in the field of nursing, the need in coming up with a theory that will fit the nature and demands of nursing is still a long quest. The various theories that have been analysed show that nursing leadership can draw and build from existing theories. This position is supported on the premise that it appears that existing leadership theories do not cover integral attributes of nursing. As such, it is held that as current theories are adopted for nursing leadership, the search for the type of leadership that suits the field of nursing should be continuously undertaken. A good example is the one proposed by Stanley (2008) the notion of a congruent nurse. Briefly, the congruent nurse leader lives and lead by example. The bedside nurse leader is not a visionary, but is fully grounded on the nursing care needs of the patients and the needs of her colleagues and other members of the health care team.

Summary

Current theories of leadership such as transactional leadership, transformational leadership and servant- leadership present the dynamic changes that are happening in terms of views and perception of what leadership ought to be in 21st century. As institutions continue to find the suitable leadership that will lead and sustain them in the current period, nursing is also challenged to develop nursing leadership that is fit and appropriate for the unique nature of nursing. However, as the search has still a long way to go, existing theories compensates. The innovativeness, creativity and willingness to adopt facets of each theory that best fit the practise are one of the guides.

Part 2 Reflective Account

the second part of the research, a reflective account of an experience in the ward will be retrospectively looked upon to learn and further understand what it means to be a nurse in the ward. For the reflective account, I will be using Gibb’s model. This has been chosen not only because it guides you in the entire process of reflection, but it also allows the person to come up with alternative solutions in case the event happen again. This is crucial as nurses create a web of experience that is inclusive and can be shared with others. With this scenario, the possibility learning increases and the potential for growth is realized.

1. Description: The Event

I am currently working as a nurse in the medical-surgical ward of X hospital. I am in the night shift. The group is composed of different nationalities. However, it is not only that, the night shift is made up of nurses of varying age and interests, which makes the team an amalgam of culture and nursing experience.

The event that I am going to share with you happened on my duty. I was in night shift and it was my third-day (straight). Dr. A was the resident during that night. It was a toxic as the ward was full. But it was not only that. Two weeks before incident, the hospital had implemented computerized charting and point-of-care testing. There was mixed emotions and perceptions regarding the introduction of new technology in the ward. The younger nurses and HCAs were more open and accommodating, while the older nurses and HCAs grudgingly accepted the new technology. In the two weeks that computerized charting and point-of-testing care testing was implemented, some of my co-nurses, as well as some of the HCAs, were stressed. This was understandable since everybody was adjusting to technological changes.

As I mentioned, the night the event happened, the ward was full and the work was heavy. I was doing my rounds and attending to my patients when I saw Dr. A in one of the computer terminals. Dr. A was not popular to the group, but we noticed some positive changes from Dr. A after the write-up. Then, I saw one Nurse 1 talking with Dr. A. At first, there was nothing. Then, suddenly, Nurse 1 was shouting at the top of her voice, arguing with Dr. A. Meanwhile, Dr. A was calmly asking and explaining things to CNA 1 regarding some data in the chart of the patient, but still Nurse 1 was ranting.

2. My Feelings

When I saw and heard what was happening I was shocked and ashamed. To be honest, at first, I did not know what to do. I thought Nurse 1 would hit Dr. A because she was raving mad and uncontrollable. I was shocked. Yes, nobody in the floor was friendly with Dr. A, but everybody was professional until that night.  Nurse 1 was saying things which were foul and uncalled and what made it more disgraceful was that some of the patients were awaken by what was happening. I would not call it argument because Dr. A was not doing anything to aggravate the situation. It was Nurse 1 who was unruly. It was totally way out character for Nurse 1. I knew her for a time already and I did not think that she would be able to do that.

Although the event did not happen to me personal, I felt terrible. Terrible, because what happened was very unprofessional, events like that should not be happening in the ward. It added to the existing divide among the care providers in the ward and it was something that I felt nobody should be subjected to such humiliating situations. I knew most in the ward were not really in a congenial mood but it was not a reason to vent it out to Dr. A. I just really thought that it was something that was very inappropriate. It was something that should not have happened or it was something that should have been averted if people in the ward were not so egged up with the idea of technology or being able to use new technologies. And when I learned that Nurse 1 was being asked by Dr. A about her entries in the computerised chart of the patient, the more I felt that what had happened was something that should not have happened. I felt that it happened when Dr. A was showing what the doctor had learned from experiencing being write-up. In fact, we were all wondering why the Dr A. had change the manner in which the doctor was dealing with us. Dr. A was more respectful of the people in the ward, which was not like the attitude and behaviour of the doctor before. It was really something horrible. I might be sounding like I am only rooting for Dr. A, but the way she was lambasted was really foul. Hearing what Nurse1 was saying against the doctor at the top of her voice in the middle of the night was really way out. I felt during that time that the ward failed to provide a respectful space for all the carers of the patients. I believe then, and until now, that a respectful space is to be created not just by one person but by everybody.

 As a team whose priority was to respond to the care needs of the patient, the event between Dr. A and Nurse 1 shows the growing rift among some of the members of that team. I really feel that regardless of one’s position everybody who is taking care of the patient is part of the team. And to effectively implement the care that the patients need there must be respect to the personhood of each member of the healthcare team of the ward.

3. Evaluation

When Nurse 1 was already shouting at Dr. A, I went out of the patient’s room and tried to ease out the tension. I asked Nurse 1 to calm down, however, when I asked her to calm, she became more aggressive and she started saying that she was being ganged up and that it was Dr. A’s fault. When I saw that Nurse 1 was really all fired up, what we did was to ask Nurse 1 to move to the nurses’ lounge. She was asked by the charge nurse to relax and calm down.  Meanwhile, all of the nurses who witnessed what happened were apologetic to Dr. A. I, myself, who saw everything, apologised to the doctor. During that time, I knew it was the right course of action since as a team and as a basic rule in human decency we should not be doing any harm to anybody.  Although it was not me who was directly involved in the event, I felt that it was something that I must be apologetic. Dr.       When, we were assured that Dr. A was already ok, our charge nurse went back to Nurse 1. Together with our charge was the night shift supervisor.  I was not privy as to what was discussed among them, but when I was asked by the supervisor, I told them everything that I saw without embellishing the facts. At the back of mind, there was already a tension because Nurse was one a colleague and a good friend. She is industrious and dependable. I really like her personally. I was in a dilemma because I can lie and cover up for Nurse 1 and say that it Dr. A. It was easy for me to do, a most may accept my description of what may happen not only because I was there when it happened, but also because of Dr. A’s reputation.  It was like being drawn between covering up for a friend and righting a wrong act.

When, I was called to tell them what I saw, I told them what I saw. To be honest, I knew that I have to be truthful in order to be fair to everybody involved in the issue. I tried to be as objective as possible. I told them what I saw and what I heard. Although it was really big for me because it can put Nurse 1 in a perilous situation in terms of her job, but I knew that I have to be truthful. I believe that being honest and respectful in communication is one of the fundamental elements necessary in turning teamwork into a reality and an action necessary in order to establish a respectful space for everybody in the ward (Dennis, 2003). I believe that I can show my ‘peer support’, which is essential in team work by being honest (Dennis, 2003).

I guessed it is part of the challenge in establishing an authentic teamwork, when personal feelings and affinities sometimes affect and influence our perceptions and decisions. What I did was really heavy for me because Nurse 1 is a good friend and good person, but I have to be honest. Looking at it retrospectively, I still get the same sense and feeling that I am caught in tow opposing poles. But I have also developed a stronger sense of the necessity of being honest which I believe is critical in dilemmas that nurses encounter in co-worker issues (Fry and Johnstone, 2002).

4. Analysis

The old adage tells us that honesty is always the best policy. However, sometimes we are caught in a situation wherein we feel that we are in a dilemma as we are to choose between being honest and keeping up relationships (Fry and Johnstone, 2002). At the same time, the issue honest communication being necessary in establishing peer support and teamwork is crucial if we are to develop and create teamwork and respectful space in the ward (Dennis, 2003; Gallagher, 2007).

Teamwork is critical not only for the goof of the patient, but also through collaborative effort health care is optimised and work satisfaction is achieved. One of the prerequisites in establishing teamwork is an open and honest communication among the members of the team (Xyrichis and Ream, 2007). Establishing an open and honest communication does not only pertain to exchanges of information regarding patient care, but it also includes being open and honest in peer relationship (Dennis, 2003). It is in this way that respectful space is created and becomes part of the ethos that supports healthy work environment and job satisfaction. The demand for honest and respectful nurse is not between patient and nurse relationship. It is all encompassing, which implies that the nurse has to be honest and respectful to all the people that she/he encounters. There is no exception (Gallagher, 2007).

What happened during the event was very unfortunate, but I also found myself in a situation wherein I have to decide whether I will be open and honest in telling what had happened. Friendship is crucial in keeping the smooth flow of work in the ward, honesty, communication and truthfulness are also critical and crucial in keeping not only teamwork but the integrity of nurses’ function and in upholding the respectful space (Fry and Johnstone, 2002; Gallagher, 2007). In deciding to tell the truth and not covering up what had happed, was difficult not because I have to tell the truth but because of the establish relationship that I have with Nurse 1. Looking at it now, I have on one side Gilligan’s paradigm in her work In a Different Voice wherein she claims that women’s ethical development is not concern with abstracted ideals of justice and truth, but is rooted on existing relationships that the woman has as she lives and traverses life. On the other hand, Kant’s categorical imperative - duty to tell the truth regardless of who may be affected, since, truth and lying have no colour.

5. Conclusion

Looking at it now, I have come to understand why I felt that there was a dilemma, like I was push against something. It was something that I felt when I was called by the supervisor and the charge nurse. It was like am I going to betray the trust and friendship with Nurse 1. Questions like what she will feel if she comes to learn that I told everything that I saw and heard to the charge nurse and supervisor was crossing my mind. However, now, I have come to understand, that the ‘dilemma’ that I felt was not a genuine one. Truth, honesty and open communication are some of the most crucial buttresses in establishing team work and respectful space in the ward. Although there was a hesitation on my part to tell the truth, but I told it. Am I heroic? No. It was difficult because I could divert a little from what had happened without ‘hurting’ anybody, but I chose not to. As I have mentioned that nurses are not only in relationship with their patients, but they are also dealing and establishing relationship with other nurses, with  the administration, with the doctors, with the pharmacists, with the CNAs, with the patients’  family and a lot more. In effect, we are creating a web of relationships that should be established on solid grounds and ideals- truth and respect. Nurses are not called to move heaven and earth, simple acts like telling the truth are sufficient in developing respectful space and caring presence (Covington, 2005; Gallagher, 2007).

In addition, being honest, truthful and open are crucial in establishing trust in order to create teamwork. I now also understand the fear that I felt during that time. It was not just fear of lying; it was fear of hurting a friend or breaking a relationship. It is difficult, but I have come to realise that truth, indeed, is liberating. Since, that event, I have come to establish a deeper appreciation of the web of relationship that as a nurse I have established. A truthful and respectful nurse is already building the respectful space that contributes to a healthy work environment and it is also a testimony of Stanley (2008) is referring to when he conjured the idea of a congruent nurse leader. In this concept of congruent nurse, Stanley (2008) is supporting the idea that nurse leaders are not somebody that can conjure the best ideals for the organisation, but the congruent nurse leaders are those nurses who live nursing. This means nurses who are on the bed side, performing critical nursing care. It entails nurses who deal with the personal issues and concerns that may affect the personal relationship of nurses with her colleagues. It is also about motivating other nurses not just by words, but by actions.

6. Action Plan

After the incident, the ward had a meeting and what was discussed was how to handle such situations. It was there that I have learned how my other colleagues saw and appreciate what I did. Being honest and truthful was something that they appreciate as a character or quality of a nurse. Although I am still a bit anxious about telling the truth, especially, if a good friend is involved. Likewise, it has been agreed, that there will be more thorough training for everybody for the computerised charting and point of care testing so that any negative perceptions, questions, understandings and problems in relation with the technological developments in the ward will be dissipated. Also, it has been agreed as a policy, that all discussions and questioning will be done in the lounge area where the patients will not be bothered by issues among the members of the health care team. This does not mean that the patient should be excluded on matters that concern him/her. What this means is that when personal issues are involved between the staffs and doctors, it should not be discussed in the hallway. In addition, it has been agreed upon by the night shift to come up with means or venues that will foster the relationship among the health care team. The relationship, for it to work and authentically respond to the needs of the patient and establish a harmonious working environment, must in itself is healthy. As such, more pathways for communication and respect are being conjured in order to establish and develop a professional and congenial working relationship with all the members of the health care team.

Postscript

After the event, Dr. A has become more comfortable with the all the members of the night shift. Gone were the antagonistic attitudes and behaviours that Dr. A usually display when she is called or doing the rounds. Nurse 1 was suspended for two week. She did not talk to me for several months because she claimed that I did not cover her back. Again, I feel guilty about hurting her feelings, but I have also resolved that I have done the right thing not only for one person, but for all the persons in which I have established a relationship. It is not an easy task, but we live nursing. We set our examples of what authentically is nursing care is not in a glass walled ceiling, but in the bedside, along the hallways of the ward and in the nooks of the computer terminals. Being a nurse leader, is a nurse in action. An experiential nurse leading by example and motivating by living the tenets of nursing care, not just for the patients, but for people who are part of her/his web of relationship.