Leadership in Clinical Practice - Essay Example

Leadership in Clinical Practice Department Leadership in Clinical Practice Introduction In the context of clinical governance and patient safety, leadership is imperative for the achievement of positive or projected outcomes. The kind of leadership approach employed and leadership behaviours adopted have a direct correlation with performance. Due to existing challenges that impede healthcare in relation to nursing, achieving the needed change requires a proper or positive approach to leadership. This paper explicates the contribution of leadership to healthcare with a clear demonstration of clinical leadership, theories and styles of leadership, and leadership behaviours. Definition of leadership According to a definition cited by Stanley (2005, p.108), a clinical leader is a leader who holds quantifiable medical and scientific skills, knowledge and proficiency in nursing practice and one who employs the use of interpersonal proficiency to facilitate provision of quality care by nurses and other care providers. There are also other factors that are used in explicating nursing leadership. Further explication by Stanley (2005, p.109) asserts that excellence in clinical practice coupled with provision of a conducive or positive environment that empowers nurses are fundamental elements of nursing leadership. Another definition of nursing leadership asserts that a nurse leader is "A nurse directly involved in providing clinical care that continuously improves care through influencing others" (Stanley, 2005, p.109). In extrapolation, this definition of a nurse leader shows that it is not a prerequisite for nurse leaders to be higher-ranking officials in nursing practice. In other words, a nurse can be a leader despite the position held. Leadership theories and styles in the context of clinical governance There are a number of leadership theories that in essence categorises leadership. One of these theories is denoted by Curtis, Vries and Sheerin (2011, p.307) to include trait theory. This theory focus primarily on individual characteristics that facilitate leadership. The second theory is referred to as the behaviour approach that expounds leadership in a leaders viewpoint and in fact spotlights on leadership behaviours (Curtis, Vries and Sheerin, 2011, p.307). The third theory is the contingency approach that views leadership in the context of the interface and communication between a leader, existing circumstances and his or her actions (Curtis, Vries and Sheerin, 2011, p.307). Fourthly is the transformational theory that spotlights on the association or connection between a leader and his or her employees (Curtis, Vries and Sheerin, 2011, p.307). Though all the leadership theories and styles are applicable in nursing leadership, Curtis, Vries and Sheerin (2011, p.307) emphasises that available literature has "Supported the use of transformational leadership as a suitable choice for advancing nursing leadership". Relating leadership behaviours to patient safety Patient safety is considered one of the performance indicators in nursing. Before elucidating the concept of leadership in the context of patient safety, it is worth noting factors that negatively affects patient safety. One of the factors that impede patient safety as alluded to by Greco, Laschinger and Wong (2006, p.41) relates to retention of nurses. Low retention of nurses can be contributed by stressful working conditions that lead to anxiety, low motivation levels, high levels of job dissatisfaction, disrespect from leaders and other care providers, ineffective communication, lack of recognition, lack of opportunities for growth, distrust, and heavy workloads (Hunt, 2009, p. 5). The leadership style and behaviours employed by the management can help address these issues that directly affect the quality and safety of services. An important element of leadership behaviour in nursing include empowerment. Greco, Laschinger and Wong (2006, p.43) posits that empowering behaviours facilitate evocativeness, cultivate collaboration in making pronouncements, aids achievement of individual objectives, ensures articulation, communication and confidence in relation to achievement of quality outcomes, facilitate independence among nurses and contributes to empowerment among nurses. In so doing, safety is guaranteed. Attributes of an effective nurse leader The behaviour and performance of nurse leaders is dependent on their individual attributes. As noted by Stanley (2006, p.109), nurse leaders are able to achieve their objectives because they are able to demonstrate their principles, morals and ideals in their manner of conduct. There are six fundamental facets that a nurse leader must have outlined by Moss (2005, p.45). These include "Conflict resolution, initiative, inquiry, advocacy, decision making, and critique". In addition, Moss (2005, p.45) cites a number of leadership attributes that a nurse leader ought to have including ability to inspire others, self-belief, aggressiveness, flexibility and resilience. Aggressiveness as an attribute relates to the need to assesses existing circumstances, identify unmet needs in leadership, and formulate action plans to meet the needs. Flexibility is attributed to the need to accept and accommodate change. Others attributes such as ability to inspire others are needed when interpreting or deciphering the vision and mission of an organisation in relation to the leadership function. The attributes of a nurse leader cannot be examined without a reference to communication skills. For positive outcomes to be achieved, a nurse leader must have the ability to communicate the organisations vision, mission, and values in a clear and concise manner (Nagelkerk, 2006, p.143). Subordinates are the executioners of an organisations vision and therefore, the nurse leader must similarly communicate what each and every nurse is expected to achieve. In other words, effective communication skills are imperative in ensuring subordinates understand and comprehend their roles and responsibilities in relation to the achievement of patient safety. Contribution of leadership to care quality The Governance Institute (2009, p.3) reiterate that quality of care in healthcare organisations is largely dependent on an array of factors including organisational culture, planning, availability of resources, level or number of staff, and continuous appraisal of healthcare activities and processes. Governance Institute (2009, p.3) notes that "Only the leaders of a healthcare organisation have the resources, influence, and control to provide for these factors". Leaders have an obligation to the propagate the ideas and objectives geared towards achievement of quality and safety of the care provided. Leaders are also regarded as the drivers of strategic planning as their positions bestows them the decision-making function. The institution of an organisational culture that promotes and facilitates quality and safety in healthcare activities is also dependent on the leaders as they are the role models and consequently, subordinates are obligated to follow the directions they articulate. In relation to the level of staff, a leadership style that motivates employees, in this case nurses, empowers them and provides opportunities for growth is likely to lead to higher retention levels. Higher retention levels have a direct impact on the quality of services. In reference to RACGP (n.d, A4) one of the functions of clinical leaders is to create and promulgate a methodical and efficient approach to monitoring, directing, as well as advancement of safety strategies. In a bid to achieve this function, clinical leaders define and ensure employees, including nurses and other care professionals, are accountable to their actions and behaviour. Clinical leaders ensure achievement of quality through encouraging teamwork (Baker, Day and Saalas, 2006, para.7), formulating and implementing action plans to alleviate or lessen risks associated with healthcare to both the staff and patients (Harris and Roussel, 2010, p.230), providing opportunities for learning and sharing quality related issues such as safety, and implementing strategies to ensure efficiency of services. These aspects to achieving quality also necessitate clinical leaders to encourage nurses to respect others and be commitment to excellence. Excellence can be guaranteed through recognition in terms of giving rewards and incentives in an effort to motivate and encourage subordinates to achieve better results To achieve quality or change in clinical practice, a leader ought to identify his or her strengths and weaknesses (NHS Leadership Academy, 2011, p.12). This aids in the identification of attributes to focus on in achieving quality and also attributes that need improvement. For instance, a leader may have effective communication skills and conversely be ineffective in working as a team. In this viewpoint, it would be important to focus more on communicating the organisations vision, mission, and goals in order for the employees to comprehend their roles and responsibilities (Finkelman and Kenner, 2010, p.279). When employees understand their roles, they are able to focus their energy in the achievement of quality outcomes. Conclusion In conclusion, it is important to reiterate that quality healthcare is dependent on the kind of leadership style employed. To achieve projected outcomes on quality, it is important for clinical leaders to adopt an approach characterised by empowering, motivating and supporting nurses and other individuals involved in the process of care in clinical practice. A transformation style of leadership is one of the theories that could facilitate quality in nursing as it focuses on relationships. Some of the attributes necessary for a clinical leader in the achievement of quality include effective communication skills, integrity, honesty, flexibility, assertiveness, and aggressiveness. In achieving quality, clinical leaders also ought to identify their strengths and weaknesses, manage, and monitor care practices to ensure their alignment with the vision, mission, and goals of the organisation. References Baker, D.P, Day, R, and Salas, E. (2006) Teamwork as an Essential Component of High- Reliability Organizations. Health Service Resource, 41(4), pp. 1576-1598. Available at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1955345/ Curtis, E.A, Vries, J.D, and Sheerin, K. (2011) Developing Leadership in Nursing: Exploring Core Factors. British Journal of Nursing, 20(5), pp. 306-309. Finkleman, A, and Kenner, C. (2010) Professional Nursing Concepts: Competence for Quality Leadership. London: Jones & Bartlett. Governance Institute. (2009) Leadership in Healthcare Organization. Available at http://www.jointcommission.org/assets/1/18/WP_Leadership_Standards.pdf Greco, P, Laschinger, H.K, and Wong, C. (2006) Leader Empowering Behaviours, Staff Nurse Empowerment and Work Engagement/ Burnout, 19(4), pp. 41-56. Harris, J, and Roussel, L. (2010) Initiating and Sustaining the Clinical Nurse Leader Role: A Practical Guide. London: Jones & Bartlett. Hunt, S.T. (2009) Nursing Turnover: Costs, Causes, & Solutions. Available at http://www.nmlegis.gov/lcs/handouts/LHHS%20081312%20NursingTurnover.pdf Moss, M. (2005) The Emotionally Intelligent Nurse Leader. San Francisco: Josey-Bass. Nagelkerk, J. (2006) Leadership and Nursing Care Management. Amsterdam: Elsevier. NHS Leadership Academy. (2011) Clinical Leadership Competency Framework. Available at http://www.leadershipacademy.nhs.uk/wp- content/uploads/2012/11/NHSLeadership-Leadership-Framework-Clinical- Leadership-Competency-Framework-CLCF.pdf RACGP. (n.d) Standards for general practices (4th edition) including Interpretive guide for Aboriginal and Torres Strait Islander health services. Available at http://www.racgp.org.au/your-practice/standards/standards4thedition/safety,-quality- improvement-and-education/3-1/clinical-governance/ Stanley, D. (2006) Recognizing and defining clinical nurse leaders. British Journal of Nursing, 15(2), pp. 108-110. Available at http://www.uwa.edu.au/__data/assets/pdf_file/0004/1879465/Recognising-and- defining-clinical-nurse-leaders.pdf Read More