Leadership in Nursing Practice - Essay Example

Introduction Drs. Luna and Majali share their experiences of running a nursing programme in the Kingdom of Saudi Arabia. In their experiences, they identified important elements of the Saudi society and the health sector. “Like most countries in the world, the kingdom of Saudi Arabia suffers from a shortage of nurses. Since the beginning of modern healthcare in Saudi Arabia in the 1950s, most nurses have been non-Saudi expartriates” (Luna and Majali, 2007 p240). This shows that the Saudi society has a major cultural and social issue. This is because the nurses and the patients are somewhat different in outlook, values and personality. Due to the differences in the Saudi people and the nursing/hospital staff, the Saudi government has come up with requirements for expatriate nurses. The important requirements for nurses working in Saudi Arabia include: 1. The need to speak the language of the patients. 2. Understand the culture, customs and religion of Saudi Arabia (Luna and Majali, 2007 p241) Due to these requirements and other demands placed on the nursing staff of Saudi Arabia, there are various systems and structures in the Saudi care setting. These requirements are very different from what exists in other countries, particularly Western nations. As such, a nurse in Saudi Arabia has an obligation to adjust to meet the requirements of the Saudi society. This paper examines the relationship between management/leadership theories and the actual running of a tertiary neonatal unit in the Kingdom of Saudi Arabia. It involves an evidence based practice approach to examine how a major health facilities can be ran in relation to dominant concepts and theories of management and leadership in the nursing profession. The research explores the impact of the Saudi governments policy, inter-professional practice and leadership requirements on the role of nursing in Saudi Arabia. The paper concludes with recommendations for future practice in the region. The Tertiary Level Neo-Natal Setting of Saudi Arabia According to Wilson et al (2009), a tertiary level facility is usually one that provides education of medical students and serves about 10 million people in a given geographical area. Such tertiary level facilities co-ordinate with primary level facilities and take up serious cases. In a neo-natal facility of such a hospital, intensive care services are available for mothers and their babies. Nursing in such a facility comes with different requirements. There is a larger scope of work. As such, there is the chance for more severe cases to be reported to such facilities. Also, the scope of human relations in such an institution is generally meant to be more than it exists in other smaller hospitals. Most tertiary level neo-natal facilities in Saudi Arabaia are heavily capitalised and are technological based facility. Research and innovation are key elements of the hospital. The staff include consultant physicians and senior nursing staff who involve expertise from different parts of the world. Modern tertiary hospitals in Saudi Arabia are committed to the highest global standards. It observes extremely high world-class standards and provides high quality services to the public in the region and beyond. At certain times of the year, during the Hajj pilgrimage sessions, exceptional eventualities are referred to the facility. Also, other cases from outside Saudi Arabia, which typically include top ranking officials from Islamic nations around the world are referred to such hospitals. The hospitals operations are steeped in the establishment of good relationships with patients and their families. The staff members are trained to remain culturally sensitive, respectful and compassionate. This end is attained through extra training that is offered to new staff and refresher programmes meant to bring staff members up to date on new trends. The hospitals operations are based on Islamic standards and practices. Being a Wahabbi conservative Islamic state, the Saudi authorities advocate for the observance of Sunnah, which include rulings, traditions and customs based on the Sunni branch of Islam. The neo-natal unit of the hospital involves the use of state-of-the-art record keeping systems on pregnant women and their births. These records are kept according to the highest standards of confidentiality. Also, the hospital has very comfortable and luxurious world-class admission facilities meant for pregnant women nearing their time of delivery. There are delivery services, post delivery services and child care activities in the hospital. Traditional Systems of Leadership in Nursing Leadership has several facades. As such, it is always difficult for the nursing profession to present a single universal definition of leadership. Greenleaf identified elements of leadership that ensures that nurses attain the best results (Milstead and Furlong, 2006 p8). This include ten elements which are: listening, empathy, awareness, healing, persuasion, conceptualisation, foresight, commitment to the growth of people, building community and stewardship. These elements define the concept of servant-leadership. And since nurses are meant to have strong links and connections with suffering and ailing patients as well as the administrative structures of health facilities it is imperative for us to build these skills to enable us to collaborate as middle class as well as top-level personnel in the health sector. In order to attain the top-level management and leadership positions, nurses need to build competencies in critical thinking. According to the Marquis-Huston model, critical thinking involves personalised learning, group processes, problem solving and deductive theory (Marquis and Huston, 2008 p4). These skills enable the nurse to become a leader of interpersonal interactions as well as a strong player and influencer in group processes. Also, the elements of critical thinking enables the nurse to become very astute and comprehensive in her thoughts. This leads to positive actions that causes the group to move from one point to another in a positive manner. Through the Marquis-Huston model, nurses are expected to build strong skills in identifying solutions to problems as leaders. This involves problem identification, context definition of issues, prioritisation, analysis of options and optimal choice (Marquis and Huston, 2008 p4). Currently, the following important aspects of management and leadership have been added to the functions of nurses. They include: 1. Information technology 2. Focus on quality 3. Globalisation and 4. Growth and survival of business organisations (Clark, 2008). These pointers provide the framework within which nurses must operate in the 21st Century. These important aspects put more demands and requirements on nurses than it existed twenty or thirty years ago where nurses were to provide just supportive technical services without much management concerns. Typically, the main setback in leadership amongst nurses include amongst other things: 1. Wrong attitude or behaviour of nurse managers 2. Limited professional grounds. 3. Inadequate salaries. 4. Poor relationships with nurses and physicians 5. Organisational hierarchies and 6. Lack of job status and power (Barker, 1992 pp3-4) Saudi Government and Social Policies The work environment of Saudi Arabia is somehow different from what exists in different parts of the world. The Saudi economy is very strong due to the vast petroleum wealth. On the other hand, the kingdom has a sparse population and there is more income per capita throughout Saudi Arabia. Socially and culturally, Saudi Arabia leads the world in Islamic matters. The country is a theocracy headed by a king whose title is “the custodian of the two holy Mosques” (Ramady, 2010 p5). As the controller of the holiest sites of Islam, the Saudi society has a responsibility to lead the global Islamic community as a model for other Arab and Muslim nations to follow. Due to this, all sectors are strongly influenced by the principles of Orthodox Islam which is evident in every aspect of the kingdom. Mufti (2000) states that a number of changes have been put in place in Saudi Arabia to promote the health sector and improve healthcare of residents in the country. First of all, there is a cost containment system which seeks to provide effective and efficient use of resources in the health sector. There is thus the need for the justification of costs in the health sector. Also, there a national health insurance system for both Saudis and non-Saudis (Mufti, 2000 p78). This leads to some kind of a loss of economic incentive amongst the health sector (Mufti, 2000 p79). The Saudi Ministry of Healths policy of providing universal health insurance has led to higher demands for health services throughout Saudi Arabia. Also, the whole insurance system is Islamic in nature since some form of Western insurance is forbidden by Islam. Mufti also reports that there are long-term facilities being constructed for older Saudis (2000 p81). The Statistics show that 18% of the Saudi population are above 60 years (Mufti, 2000 p81). As such, more resources are being committed into facilities for such persons in the Saudi society. The country relies heavily on expatriate nurses and doctors. In a survey conducted by Mitchel (2009), it was identified that there are some challenges that expatriate nurses identified. They include amongst others: 1. Increasing work load for nurses since there are more patients. 2. Limits in terms of holistic care so treatments are done in units and parts. 3. Non-licensed nurses working as registered nurses due to government policies of Saudization, which leads to a shortfall in skills. 4. High staff turnover. 5. Nurses performing non-nursing functions. 6. Inadequate covering during holiday and vacation times (Mitchell, 2009 p203). Saudization involves an attempt to train Saudi Arabian citizens to take over job slots in the country (Sabbagh, 1996). In the past, Saudi Arabian law forbade women from taking up employment outside the home. However, with periods of reforms and changes, there is an increase in the number of women taking up jobs and nursing is one of the most popular job slots (Ramady, 2010 p203). As such, there has been an increase in the number of nursing schools throughout the Kingdom (Oxford Business Group, 2009 p203). Effects on Inter-Personal Practice and Collaborative Working Due to the social structures that exists in Saudi Arabia, a number of trends occur which determines life in the neo-natal unit of the tertiary healt care facilities. They include amongst others: 1. The conception that nursing is a womans job since it is a convenient professional extension of the role of housewives in the Saudi society. 2. In the health facility, nurses are treated as a separate social grouping and they gain some autonomy in units that are interested in feminine and paediatric practices. This makes the neo-natal unit a very female and nurse dominated unit. 3. Administrative control of the unit comes under the mainstream unit of the organisation, which is male dominated and physician in outlook. 4. There is little room for dialogue and women are not very much involved in key decision making at the hospital level, except for the neo-natal unit where their advice is taken. 5. The hospital seem to be interested in taking lower qualifications for nurse-manager roles in the neo-natal unit as compared to similar facilities in Europe or North America. 6. Nurses are expected to adjust quickly to the Islamic cultural environment. 7. Work pressure in the neo-natal unit has been increasing due to the non-Saudi inclusion in the national health insurance. Most people, particularly foreigners seek medical help very early in the pregnancy and they continue to come for regular review after delivery. 8. Increase in the number of Saudis who work as nurses in the neo-natal unit. 9. Relatively less infrastructural development in the neo-natal unit when compared with the elderly section of the hospital. Professional Reflection The social and cultural structures of Saudi Arabian hospitals are likely to remain Islamic in the cultural and social manner into the future. This is because of the central role that the Kingdom plays in the global Islamic community. Theories in leadership and management in nursing need to take time to evolve this is because there is a resistant cultural system that stands in the way of the implementation of Western oriented ideas. Also, the sex roles will thrive into the foreseeable future. However, for change to occur, there will be the need for nurses to be more assertive, rather than aggressive in promoting the evolution. This can be done through better communication and interpersonal skills. Recommendations 1. Dialogue on the community level to promote womens right. 2. Nurse representation should be made stronger at the hospital level. 3. Gender balance should be sought amongst nurses in the hospital. 4. There is the need for more funding at the neo-natal unit. 5. The evolution should be done through assertive communication and interactions. Conclusions Tertiary level medical centeres in Saudi Arabia have world-class staff, technology and facilities. Leadership and management are gradually becoming essential aspects of nursing around the globe. The Saudi society is strongly influenced by Islam and nurses are somewhat restricted based on these traditions. There is the need for some assertive discourse to promote stronger leadership and management amongst nurses in the neo-natal unit. References Barker, A. M. (1992) Transformational Nursing Leadership: A Vision for the Future New York: Jones and Bartlett Learning. Clark, C. C. (2008) Creative Nursing Leadership and Management New York: Jones and Bartlett. Gasim, T. (2012) “Gestational Diabetes Mellitus: Maternal & Perinatal Outcomes in 220 Saudi Women” Oman Medical Journal Vol 22 Issue March, 2012. King Fahad Hospital - Patients (2012) Patients Rights [Online] Available at: http://www.kfsh.med.sa/KFSH_Website/KFSHDefault.aspx?V=28&DT=T&T=0 Accessed: 29th May, 2012. Luna, L. and Majali, S. S. A. (2007) “A Unique Source Education Partnership to Advance Nursing in Saudi Arabia” Nursing Without Borders: Values, Wisdom and Success Markers Indianapolis, IN: Sigma Theta Tau. Marquis, B. L. and Huston C. J. (2008) Leadership Roles and Management Functions in Nursing Amsterdam: Kluwer Publishing Milstead, J. A. and Furlong, E. (2006) Handbook of Nursing Leadership: Creative Skills for a Culture of Safety New York: Jones and Bartlett Learning Mitchell J. (2009) Job Satisfaction & Burnout Among Foreign-Trained Nurses in Saudi Arabia Phoenix: Proquest Publishing. Mufti, M. H. (2000) Healthcare Development Strategies in the Kingdom of Saudi Arabia London: Springer Publishing. Oxford Business Group (2009) The Report: Saudi Arabia Oxford: Oxford Business Group. Ramady, M. A. (2010) The Saudi Arabian Economy: Policies, Achievements and Challenges, London: Springer Sabbagh, S. (1996) Arab Women: Between Defiance and Restraint Riyadh: Interlink Books. Wilson, E., Saunders, R. A. and Trivedi, R. H. (2009) Pediatric Opthalmology: Current Thought and a Practical Guide London: Springer. Read More