Leadership and Management in Nursing Essay

Nursing is a very demanding and dedicated profession and the current shortage is a serious problem at all levels of nursing and is the dearth of leaders among nurses. Leadership and management are essential skills for all qualified healthcare professionals and have a pivotal role in ensuring a delivery of high standards of care. Developing future nurse leaders is one of the greatest challenges faced by the nursing profession, (Mahoney, 2001). The author is currently working as a midwife in one of the big hospitals in Riyadh, Saudi Arabia. The average deliveries per month are 500-600. There are 22 midwives in this unit and there are eight vacant posts for midwives . Due to the shortage of midwives, these professional staffs are subjected to personal and work related stress. Preston et, al. (1981) defined stress as an adaptive response, mediated by individual characteristics or psychological processes. The negative effects of stress could be evident in staff absenteeism, hostility, and aggression. This will impair the provision of quality care and the effective functioning of the organization. (Healy & McKay, 1999). The adverse effect of workload and stress in the author’s placement has lead to an alarming high staff turnover. Apparently, the increased workload has affected the staff performances and the quality of nursing care. When the staff feel that they are not cared for, then they find it difficult to care for patients ( Atwater & Bass 1994, Lancaster 1999). In this assignment, the author will explore the various leadership styles and their theories and also distinguish the functions between leadership and management. The author will also critically explore the manager’s leadership practice in labor and delivery suite, thus creating a culture of reducing stress. The link of leadership style from the aspect of work, environment, communication, empowerment, delegation, implications, conclusion and recommendations will be discussed further. Leaders are not someone who holds top position but also able to give assistance to others, (Mahoney, 2001). Whereas in my placement, the head nurse, who is the leader, never gives a helping hand during the deliveries. She anticipates the midwives to conduct and manage the deliveries, even though there’s shortage of staff. The nurse manager has to prepare the correct number of staff on each shift with the credentials to do the job and must be aware of the policies regarding overtime, floating from one unit to another. She must form a competent team and manage them to carry out the plan for reaching the goal of excellent patient care. Effective leaders are not merely someone who is skillful but they must acquire good attitudes, (Cook, 2001). The nurse manager must understand the factors surrounding the current situation in the unit and have the knowledge of various approaches to leadership that will help to understand and determine the best leadership approach to create a positive work environment to reduce stress. Leadership is defined as the ability to influence, inspire and motivate a group of people towards the achievement of its goal, (Yuki, 2002). Management is a process of getting things done effectively through planning and organization of services which is one of the basic function of management whereas the leader is an intermediary between work group and the top management, (Marquis and Huston, 2006). The manager uses a formal and rational method whilst the leader uses passions and stirs emotions. Without enabling and empowering nursing leadership, efforts to improve the quality and safety of healthcare will be limited and short-lived, as said by Kelly (2008). For a leader to achieve the goal, she must have the three essential things which are power, authority and influence to act in a way that will stimulate a positive respond from the staff (Tomey, 2009). Leaders will emerge when nurses feel valued and inspired to strive for excellence. They aim to improve patient care via a cohesive work force by focusing on interpersonal relationships between leaders and subordinates, (Malby 1997). A nursing leader should have a distinctive set of personal qualities, integrity, courage, initiative, ability to handle stress, think critically, able to resolve problems without conflicts, skillful communication and must be empathetic. They are not those who control others but they act as visionaries who help staff to plan, lead, control and organize their activities, (Jooste,2004). There are many types of leadership. Autocratic type of leaders are those who make all decisions and expect others to follow without questioning and never seek advice from others, (Sullivan & Decker 2005). This situation had made some of the midwives to leave for greener pastures. The current health system has advanced in technology and improved in care giving services (Cook, 2001). The author feels that this leadership style is no longer tenable and fits into the contemporary nursing practice and a consumer responsive culture. Democratic leaders encourage the participant of staff and use a consensus for decision making, (Sullivan & Decker 2005) whereas bureaucratic leadership occurs when a leader rigidly adheres to rules, regulations and policies of the organization, (Jenkins and Henderson, 1984). Instead of providing sufficient support and consideration, my nurse manager demonstrates these leadership qualities because she uses rules and policies thus expecting strict compliance from the midwives. . By following the organizational hierarchy’s influence, she puts herself in a high position but never use her power constructively (Masquis & Huston, 2006). Due to top management instructions, she adheres to the current policies, making no changes in them but gives verbal instruction and changing policies to her likes and dislikes. This swifts away trust and open communications between the manager and the midwives. Due to unvented stress and high expectations from the nurse manager, the midwives burnout level have been exacerbated . Burnout is a syndrome of emotional exhaustion, depersonalization and lack of personal accomplishment, as said by Maslach &Jackson (1981). Reports have proved that in this kind of environment, patient’s safety is at risk (Institute of Medicine, 2004). Participative leadership allows staff to participate in decision making and actively seek out the participation of those involved. This type of leadership allows staff to feel more committed to the goals they were involved (Faugier & Woolnough, 2002). The author feels that the head nurse should have these qualities so that the unit will run smoothly, and the staff will be appreciated and acknowledged so that good nursing care can be rendered. Transformational leadership is especially well suited for today’s fast changing healthcare environment where adaptation is extremely important (Welford,2002). It starts with the development of a vision that will excite and convert potential followers, (Outhwaite, 2003). To achieve organizational success, this style advocates for strong leadership qualities and these leaders use motivation in their approach than use rewards and punishment as said by Kouzes & Posner (2002). In the author’s point of view, this leadership is proposed as empowering leadership style which well suits in my unit and to be recognized by the nurse manager. According to Bowles & Bowels (2002), transformational leaders create a leadership culture for all team members nurturing empowerment, increase their autonomy and open communication for inclusive decision making. The nurse manager takes responsibilities for discussing care related matters with the midwives which makes them to be motivated and work more effectively to contribute to the development and provision of the unit, (Murphy. 2005). The ability of the leader to articulate a shared vision is an important aspect of transformational leadership (Faugier & Woolnough, 2002). Another leadership style is transactional leadership which focuses on providing day to day care between leaders and their employee. It aims to maintain equilibrium and harmony by using incentives to enhance staff loyalty and performance (Bass and Riggio, 2006). Laissez faire leadership is another style that leaves the staff alone to work with no directions or facilitations and is a highly risky form of leadership, (Sullivan & Decker 2005). Since the author’s placement is labor and delivery, it’s not advisable to have this kind of leader in this unit as it will increase the mortality rate. The high level of burnout and increased workload due to shortage of midwives and less rest days has resulted them to leave. This disequilibrium may trigger the risk of physical and mental health of these midwives. The manager has depleted the nurses basic psychological needs which are rest and sleep and at the same time reducing their self- esteem, as said in Maslow’s theory of human motivation. The leader should explore barriers and identify conflicts when they arise and collaborate with the team and be able to understand the employee’s perspective (Outhwaite,2003). A more effective form of leadership maybe situational leadership where the leader switches the style depending upon the situation at hand and upon the competence of the staff, (Faugier & Woolnough, 2002). The nurse manager must be good clinician and have judgment skills to handle any problem that cannot be handled by the staff. By doing so, the staff will listen to her as she guides them. Communication also plays a vital role as this can prevent conflict and smoothes the progress of team building in the unit Calpin-Davies, (2000). A good communicator gives the staff detailed instructions to perform tasks that are necessary to reach the goal. The nurse manager uses a communication book to provide important information to all the staff in the unit, as supported by Sullivan & Decker (2005). By reading and acknowledging with a signature, she assures the message has been reached effectively. As a leader, the nurse manager has to be a good listener. It provides the opportunity to receive valuable feedback that is used to avert some problems and resolve others and also giving greater understanding of the issues being discussed. When there are incidences in the unit, the nurse manager gives a listening ear to the staff and tries to solve the problems. She puts aside preconceived ideas or prejudices when listening to staff. Being a leader, the nurse manager delegates some of the tasks to the staff to focus on more complex aspects of running the unit. She delegates the right task to the right person, for example sending and collecting of narcotics by the midwife as these drugs used are cautioned in Saudi Arabia. A good leader fosters a congenial work environment by coaching, praising and training the staff to perform an excellent job and also by conducting continuous nursing education. Supervision goes in the observation of staff and to evaluate in the yearly performance appraisal. The author would recommend that the nurse manager in this unit has to change her leadership style to She should resources for proper quality care Conclusion Today, healthcare environment requires leaders to be skillful and knowledgeable and have strong inspirational leadership qualities across the health care organization. In this millennium, nursing must make a dedicated effort to nurture its young nurses to grow into effective and motivating leaders.