Nursing Leadership in Healthcare Reform - Scholarship Essay Example

? NURSING LEADERSHIP IN HEALTHCARE REFORM Introduction: The word reform, according to the Oxford Dictionary, means bringing about change in a set of practices or in an organization for improvement. It could mean reform or change in a particular area or department or a major one that could affect the system as a whole. Most management experts and practitioners agree on one thing – that reform or change is not an easy process in most instances, one of the major obstacles being resistance to change. Reforms, especially strong ones also need capable and efficient leadership to manage and implement the change process. These factors hold good whether the reform takes place in the public or private sector, and whether it takes place in a service or manufacturing industry/area. As can be seen from the above section, the change process requires leadership from all levels of the organization including physicians, top management, nursing staff, and other sections of service providers in the healthcare sector. This paper reviews the concept of nursing leadership in the context of healthcare reforms. It is felt that developing leadership among nurses is important since they play an important role in healthcare. It is these employees who have the closest association with patients and are responsible for implementing any reforms that are implemented for their (patient’s) benefit. In the process, the paper will review the concepts of leadership (in nursing) reform/ change management, and how it can be applied to the nursing sector. The area of study (through review of literature) will be the healthcare reforms in the United States. Leadership in the nursing industry – a brief review: The problem within an organization is to identify and develop leadership qualities among its employees at different levels. The problem with the nursing sector was that they are seen as submissive to the demands put forward by their hierarchical superiors and the demands of the patients (Ivanov & Blue, 2008, 19). With such behviours engrained into the profession, it would be a challenge to develop competent nurse leaders even in a status quo situation. It becomes more challenging when reforms are involved. Secondly, the nursing profession has been plagued by a command and control style according to Moss (2005, 80). In effect, an autocratic style of leadership is exhibited by nursing managers towards their subordinates. The author is of the opinion that this creates an atmosphere that is not conducive to development of leadership within the profession. What is required is a participative or transformational approach by the leader who is attuned to the sensitivities of their subordinates and patients. They should also be receptive to new ideas whether it is provided by superiors or subordinates. The advantage here is that subordinates will have a sense of fulfillment and will become willing participants in the reform process. More on leadership styles and its impact on the nursing leadership concept will be given in later sections of this paper. The third major challenge, especially in the United States is severe shortage of qualified nurses. According to some studies, a shortage of forty thousand to one million nurses will be experienced in the healthcare sector in the country by 2020. It can be said that these are the main challenges to developing effective nursing leadership. Healthcare reform in nursing: Nursing is all about caring and the profession should develop a humanistic approach with regard to patients, other staff members, the organization and the community (Marshall & Coughlin, 2011, 185). Healthcare reforms usually focus on streamlining the affordability of healthcare, insurance issues, and solving the problems associated with Medicare and Medicaid (through reduced government spending), these does not directly affect the nursing profession at the grassroots level. These are basically administrative, social, and financial issues and nursing professionals have to implement the statutes and guidelines that are brought about by healthcare associations and government. While these are important reforms that could be brought about in the US healthcare sector, those reforms that directly affects the nursing profession will only be discussed here. Marshall & Coughlin provides several guidelines for reform that is specific to providing basic healthcare. The 1st one is to develop a relationship (continuous if needed) with the patient. Unlike standardized manufacturing, health care should take into consideration specific physical, emotional and cultural factors into account. The US population is culturally and religiously diverse. For example, a Muslim patient should not be provided with medication (as far as possible) that is prohibited by their religion. Communication with the patient is extremely important so that he or she feels reassured regarding the care provided. Inter-staff communication and sharing of knowledge and information is essential. Safety and transparency of treatment should be ensured. Nurses should be trained to anticipate the needs of the patient. Communication among all levels of service providers (doctors, nurses, administrative staff etc) is essential. So nursing leadership should be equipped to implement these reforms as well as have the ability to nurture leadership talent among their subordinates. Leadership and nursing – a theoretical perspective: Nursing leaders should have the ability to “plan and manage both predictable and unpredictable changes” (Daly, Speedy & Jackson, 2007, 192). The three critical components required in this instance are basic leadership skills, effective communication, inter-personal skills, management of groups, and the ability to identify and solve problems. The ability to motivate others and to communicate the need for reform is also essential. A lot of change management theories and the specific steps on overcoming resistance to change have evolved over the years. Combined with an effective leadership style, reforms can be implemented effectively within the nursing healthcare sector. Several leadership styles that seem appropriate (and inappropriate) can be seen in the nursing sector. They include autocratic, transformational, transactional, situational, and participative approaches (Forman, 2011, 84). As can be seen from the above sections, nursing profession in general is dominated by an autocratic approach. Transformational leaders are usually charismatic and have the ability to inspire, challenge, enthuse and provide an environment of team spirit. Transactional leaders are more inclined towards anticipating and satisfying the materialistic needs of subordinates. There would be no dissatisfaction, but the elements that are seen in transformational leadership would be low or missing in this instance. This style is more suited to an environment where reform or change is not necessary. A participative approach, as the name suggests, involve subordinate input and participation. This would make them (subordinates) that their views are important in implement the reform process. As a result, they will be more enthusiastic in becoming a part of it. Situational leadership is a combination of the above styles. The leader will execute a particular style depending on the situation at hand. The nurse leader will be strict when the need arises, but will also use other styles in order to effectively implement the reform process. In modern day management practices, the situational leadership is seen as the most effective. Since nursing is a noble service oriented profession, the nursing leader can also exhibit qualities of servant leadership. In this approach, the leader only attempts to serve and does not expect any service (for the leader) from the subordinates. Reform/change management: Nursing leaders should be educated as to how reforms and resistance to change can be managed. Several theories about reform and change management have evolved over the years, prominent among them being the eight step process (Sare & Ogilvie, 2010, 217) developed by John Kotter. The first step is to create a sense of urgency with regard to reforms. The second step is to form a team or coalition. This could be an informal team without taking recourse to hierarchy. The team could include influential staff, whether they hold official positions or power or not. The third step is to create a vision for reform followed by effective communication of the same among subordinates. The fifth step involves empowering employees to implement the change process without bureaucratic or other hurdles coming in the way. The sixth step involves developing short term visions and targets. This is important since achievement of these short term targets will motivate subordinates to higher challenges and ultimately achieve the ultimate aim of the reform process. If possible, any individual who actively resists the change process should be removed from the system. The final step is to anchor the change or reform process. Recommendations and suggestions: Klainberg & Dirschel (2010,43) feels that the current qualification to obtain employment as a nurse only provides clinical training. For those aspiring for managerial and leadership positions should have a bachelor’s degree and a license from the state in which he or she is employed. But according to the authors, aspects like sociology, psychology, and management studies (which are components of leadership) are not adequately provided under such bachelor programs. There are high level doctoral degrees like Doctor of Nursing Practice (DNP) which do provide education is social and behavioral sciences. But these are primarily aimed at individuals who can obtain top management and even board positions in healthcare organizations. In effect, tailor made training that will help to develop leadership among the lower levels of the hierarchy, especially those involved in direct care with the patients is still lacking. Those holding doctoral degrees usually may not have direct contact with the day to day activities of healthcare and would be more involved in policy making and strategic planning. The DNP program has to some extent aims to correct the problem. According to a statement made by the American Nurses Association (ANA), their purpose of this doctoral degree is to “ensure that all patients have access to affordable healthcare benefits and services, and the ability of all health professions and organizations to innovate and improve quality of care” (Klainberg & Dirschel,2010,48). While this is commendable, there is no specific mention as to how leadership training can be implemented lower down the hierarchy. What could be done to rectify the problem is to develop leadership courses (probably diplomas in nursing leadership) to equip the lower level hierarchical staff to develop the required qualities. Another suggestion would be to utilize DNP qualified personnel to develop and provide training classes within an organization or region so that their skills and knowledge can be imparted. Another important aspect is to eliminate the submissive role along with autocratic management on the part of nursing managers and supervisors that is inherent in this profession. Instead of being autocratic, a participative, transformational, situational, and even a servant leadership approach is best recommended. It is felt that only then will a second rung of leadership will evolve. Such aspirants should be identified and trained to become future leaders especially among those working at the bottom of the healthcare hierarchy. With regard to reform management, nursing leaders can make use of several change management theories that have evolved over the years. The one recommended here is the eight step process developed by John Kotter. Conclusion: Reforms involve a change process aimed at improving organizational performance or a set of practices. The paper discussed healthcare reforms and leadership in the context of the nursing profession. Any reform process requires effective leadership and management of change. This is also true for the nursing profession. Challenges like autocratic leadership and submissive attitudes are obstacles in this regard. The reform process focused on patient care, team building, communication, and management of change. It can be concluded that leadership is an essential component of the reform process. Proper training at all levels of nursing practice especially at the lower levels of hierarchy is essential. A training program that involves theories of leadership and change management is seen essential in order to bring about the necessary healthcare reforms in the nursing profession. References Daly, J., Speedy, S. & Jackson, D (2007). Nursing leadership, Elsevier. Forman, H (2011). Nursing Leadership for Patient-centered Care, Springer. Ivanov, L.L. & Blue, C.L. (2008). Public health nursing: leadership, policy, & practice, Cengage Learning. Klainberg, M.B. & Dirschel, K.M. (2010).Today's nursing leader: managing, succeeding, excelling, Jones & Bartlett Learning Marshall, E. & Coughlin, J.F. ((2011). Transformational Leadership in Nursing, Springer. Moss, M.T. (2005). The emotionally intelligent nurse leader, Wiley. Sare, M.V. & Ogilvie, L (2010). Strategic planning for nurses: change management in health care, Jones & Bartlett Learning Read More