Critically Evaluate the Effectiveness of Clinical Learning Leadership - Term Paper Example

Clinical Nursing Leadership Insert name Insert institution Clinical Nursing Leadership Introduction This paper explores the topic of Clinical Nursing Leadership and some associated sub-topics. The paper critically looks at the effectiveness of clinical nursing leadership on patient and staff outcomes basing the discussion on available peer-reviewed literature, not forgetting the controversy surrounding the formation and implementation of CNL and arguments behind the controversy. Also discussed herein is the rationale of applying effective clinical leadership in the clinical practice environment in the idealised situation of a new graduate nursing student in this environment. Research conducted has pointed to the fact that clinical nursing leadership when introduced to a given organisation has beneficial outcomes on both patients and staff alike. This remains the central theme of this discussion. A lot of research has been done in the field of clinical nursing leadership. It has been shown by research that CNL is beneficial to both patient and staff by bringing about positive outcomes according to researchers such as Brown (2008). However there are some controversies over the necessity of CNL as a distinct field in health care. Various arguments have been put forth on this controversies but the eventual outcome perhaps remains to be seen in the long run. The main aim of this paper is to critically assess the effectiveness of CNL and discuss how, when and where principles behind CNL can be applied by a new graduate registered as a nurse leader in the field. The Clinical Nursing Leadership concept emerged as a result of the increasing apathy of the health care system that was the cause of mistakes and errors that often resulted in injuries and deaths of patients in the United States (AACN, 2007). The AACN recognized the vital role played by nurses in improving healthcare and as a result set up the Task Force on Education and Regulation for Professional Nursing Practice (TFER) in 1999.After a series of deliberations, the role of the Clinical Nurse Leader was elaborated in a 2003 paper known as Working Paper on the Role of the Clinical Nurse Leader (Tornabeni & Miller, 2008). It was further refined in the 2007 White Paper on the Education and role of the Clinical Nurse Leader.The participants in the task force agreed that CNL must be taught at the graduate level in order to impart multidisciplinary skills and clinical experience necessary to health practice .The educational requirements were set out such that the CNL would be a generalist since the nurse leader would practice across a wide variety of clinical settings. Health care outcomes on the front lines could be positively affected by the CLNs through collaboration with other health care disciplines and therefore ensuring coordination of care (Thomas, 2010). Clinical nurse leadership is a relatively new addition to the healthcare system but clinical outcomes are already beginning to show promising results in situations where clinical leadership is being implemented. The skills and abilities of CNLs do make a difference. Current knowledge of the impact of CNL is limited to individual healthcare systems (Ott et al., 2009) The presence of nursing leadership has resulted in increased patient satisfaction. The role of the nurse on the patient’s experience is not in doubt. There is universal agreement that nurses have great influence on the patient mainly because patient care is nurse-led. Previous research has shown that today’s patients are more informed of their own health needs, treatments and practice (Fradd, 2004). Through advanced training and skills, the nurse leader is better placed in a position to coordinate patient care while at the same time integrating and organising treatment plans from multiple disciplines (Brown, 2008). When a patient knows that he or she is in the hands of a skilled and knowledgeable health worker then he or she is more likely to be satisfied with services offered at a certain institution that has the services of a nurse leader. Initial studies indicate that the rates of appointment cancellations have reduced in instances where CNL units have been put in place. The major reason for appointment cancellation is when a patient feels that they may not be receiving value for their money and also if the treatment plan does not appear to be changing their health circumstances significantly (Hix et al., 2009). This can be attributed to the fact that the CNL is in a better position to connect the patient with the right kind of treatment plan. This increases the patient confidence in the given healthcare provider. Implementation of CNLs has in some cases improved the levels of prophylactic interventions in patients. Prophylactic intervention refers to medical or public health procedure designed to prevent disease. This has been evident for both primary prophylaxis: the prevention of the development of a disease and secondary prophylaxis: where disease has already set in but measures are put in place to prevent the patient condition from worsening. This is attributed to the fact that the CNL is first of all a skilled clinician and through training is better placed to analyse or synthesise data from the microsystem to evaluate effectiveness of interventions for an individual patient or group of patients (Hix et al., 2009). Research has shown that use of the effective use of the clinical leader has resulted in the creation of a healthy work environment which has helped reduce high staff turnovers especially in critical fields. It has been observed that staff nurses are in the best position to confirm whether planned initiatives created to improve the work environment are successful since they are the people on the ground (Kramer and Schmalenberg, 2008). In areas where a healthy work environment has been created the nurse leaders give their nurses a voice or a channel of communication in the unit and in the system as a whole. This has worked where leaders have engaged staff in development of shared work values. This involves a shift from the conventional command-and-control supervision style to a transformational style where the CNL enhances morale, motivation and performance of their juniors and essentially reduced staff turnovers (Faila & Stichler, 2008). Staff turnover is also reduced when staff feels that they are supported in their work. Lack of support usually resorts to staff deciding to leave an organisation. Evidence points to the fact that healthy work environments and staff retention are realised when staff feel supported by their nurse leaders (Shirey, 2006). In association with the Gannett Healthcare group and the Bernard Hodes group, the Association of critical care Nurses has conducted national surveys to assess the role of healthy work environment. Results from the 2006 and 2008 studies indicate that there are issues in the work environment that can hamper quality of care, patient safety and job satisfaction (Ulrich et al. 2009). In spite of the benefits of CNL to health care, there are some controversies that continue to draw the debate of researchers. Role conflict is one of them; it is argued that many health workers may not comprehend CNLs capabilities since CNL is an addition to the traditional nursing roles. CNLs have a diverse set of skills and it is important to know exactly where their role lies to avoid becoming engaged in too many uncoordinated tasks. The contribution of CNLs may not be fully understood by colleagues and patients and there is the danger of conflict with other professionals such as patient care coordinators (Otto et al., 2009). The speed by which the CNL methodology has been implemented has raised concern in some quarters. It has taken less than a decade to implement, from the initial task force of 1999 to the final certification and examination in 2007. The issue raised here is whether this new role adequately addresses the challenges of the 21st century. Some have compared it to the old adage of the Jack of all trades but master of none (McCabe, 2006).This is perhaps the greatest controversy of CNL where some clinical nurse specialists argue that role confusion may arise due to parallels in some role objectives. Thomson and Lulham (2007) have argued that though similarities do exist in both fields, they mainly serve to complement rather than compete with each other. CNS personnel provide expertise in the macrosystem while CNL provides expertise on the microsystem level to both nurses and patients. One of the areas of consideration as a new graduate nurse is the identification and understanding of one’s self. Personal mastery is a vital ingredient for success in leadership. This gives a leader 1) Self-confidence 2) Ability to trust others and 3) Ability to empower others. In self identification one can communicate better in the knowledge that communication and action have an impact on staff and generates a level of emotional awareness in leadership, for example encouraging staff silence when a staff member is making a contribution. This kind of authentic nursing leadership is described as the glue that holds staff together Shirey (2006). It is important to realise as a new graduate student that leadership is a science and an art that involves influencing people’s behaviours and managing relationships. For example, it is easy to get great players for a basketball team but getting them to play as a team is another issue. The same is the case at the health care workplace. In many instances places team playing is a problem and this is where clinical leadership skills need to be exhibited through positive leadership style and attitudes. It is important to guide team members to go past daily problems, communication issues and conflicts in order to create a high performance work team where interdependence and team synergy are required for quality patient care. Once again communication here is a vital ingredient in the pursuit of team synergy (Sherman & Eggenberger, 2009). It has become apparently clear that that there is a relationship between the provision of quality healthcare services and financial stability. There has been increasing pressure on leaders to maintain cost effective means in operating an organisation. Many organisations have this challenge. The nursing leader is not only a technical leader but must possess more than rudimentary knowledge of financial management. The area of finances in healthcare reform has been a source of debate in the recent past and there is increasing pressure for leaders to possess financial management skills (Van Dyke, 2008). It is therefore vital that the right decisions are made at all times bearing in mind the financial ramifications of every decision made. Conclusion In conclusion, despite controversy stirred up CNL is here to stay. The best line of approach is that taken by Thomson and Lulham (2007) who acknowledge that there are similarities of CNL to CNS but deduce that in spite of this CNL and CNS complement one another. CNL is definitely the way to go. As concerning the speed at which it has been implemented, it can only be said that it was as a result of the urgent need of this system in the healthcare field seeing the wanting situation of the healthcare system at the time of its implementation. Perhaps rather than arguing against CNL it would be better to concentrate on the nature of the changing workplace. The workplace today has been increasingly affected by globalisation. There is now a growing number immigrant workers from different cultural backgrounds in the medical field creating a multicultural workplace. There is therefore need to address this issue as well, it may be more significant than other issues raised References American Association of Colleges of Nursing (AACN). (2007). White paper on the Education and Role of the Clinical Nurse Leader. Retrieved from http://www.aacn.nche.edu/Publications/WhitePapers/CNL2-07.pdf Tornabeni, J., & Miller, J.F. (2008). The power of partnership to shape the future of nursing: The evolution of the clinical nurse leader. Journal of Nursing Management, 16(5), 608-613. Stanley, J.M., Gannon, J., Gabuat, J., Hartranft, S., Adams, N., Mayes, C., … Burch, D. (2008).The clinical nurse leader: A catalyst for improving quality and patient safety. Journal of Nursing Management, 16(5), 614-622. Fradd, L. (2004).  Political leadership in action.  Journal of Nursing Management, 12: 242-245.  Thomas, P.L. (2010) Quality care and risk management. In J.L. Harris & L. Roussel (Eds.), Initiating and sustaining the clinical nurse leader role: A practical guide (pp. 111-131). Sudbury, MA: Jones and Bartlett Publishers. Hix, C., Mckeon, L., & Walters, S. (2009). Clinical nurse leader impact on clinical microsystems outcomes. The Journal of Nursing Administration, 39(2), 71-76. Ott, K.M., Haddock, K.S., Fox, S.E., Shinn, J.K., Walters, S.E., Hardin, J.W., Durand, K., & Harris, J.L. (2009). The clinical nurse leader: Impact on practice outcomes in the Veterans Health Administration. Nursing Economics, 27(6), 363-383. Faila, K.R., & Stichler, J.F. (2008). Manager and staff perceptions of the manager's leadership style. Journal of Nursing Administration, 38(11), 480-487. Van Dyke, M. (2008). CNOs and CFOs team up to teach nurses business skills. NurseLeader, 6(6), 17-25. Sherman, R., & Eggenberger, T. (2009). Taking charge: What every charge nurse needs to know. Nurses First, 2(4), 6-10. Shirey, M.R. (2006). Authentic leaders creating healthy work environments for nursing practice. American Journal of Critical Care, 15(3), 256-276. Ulrich, E.T., Lavandero, R., Hart, K.A., Woods, D., Leggett, J., Friedman, D., et al. (2009). Critical care environments 2008: A follow-up report. Critical Care Nurse, 29(2), 93-102. Kramer, M., Maguire, P., Brewer, B., Chmielewski, L., Kishner, J., Krugman, M., et al. (2007). Nurse manager support: What is it? Structures and practices that promote it. Nursing Administration Quarterly, 31(4), 325-340. McCabe, S. (2006). What does it take to make a nurse? Considerations of the CNL and DNP role development. Perspectives in Psychiatric Care, 42(4), 252-255. Thompson, P., & Lulham, K. (2007). Clinical nurse leader and clinical nurse specialist role delineation in the acute care setting. The Journal of Nursing Administration, 37(10), 429- 431. Read More