Clinical settings just like other organizations require effective leaders and managers to enhance the delivery of services to clients. Individuals in leadership and management positions must be aware that healthcare organizations are prone to administrative and regulatory challenges. Some of the challenges that face clinical settings include confidentiality of patient information, safety, sexual harassment, poor organizational culture among others. It is for this reason that these leaders and managers should understand what they ought to do to ensure that the clinical settings they work in are free from such challenges. In particular, nurse leaders and managers ought to be innovative to solve the challenges that are related to modern healthcare settings. However, it is important to make a distinction between leadership and management since although the two are interrelated they operate on different scales and apply different strategies. This distinction will be evident by focusing on abuse faced by the elderly who are placed in Adult Day Health Care (ADHC). An analysis of how to deal with this issue establishes that indeed nursing managers differ from nursing leaders to a certain degree.
The Clinical Issue under Discussion
Clinical settings just like any other setting experience its own fair of challenges, which requires immediate redress to enhance effectiveness and productivity. The issue that will form the basis of this discussion is helping ADHC staff to treat the elderly people in their care in a dignified manner. In this regard, it is important to establish that most centers are understaffed as compared to the needs of the clients who have to be assisted. The staff members are likely to become frustrated with the clients and shove or even neglect them, which may worsen the conditions, the elderly, may be having. At times, the clients may be prone to verbal or physical abuse considering that they may not be in a position to defend themselves. Additionally, most of the staff at ADHC lack the requisite training which means that they may not be in a position to offer adequate care to the elderly people in their care. For this reason, it is possible to witness dangerous and injurious situations owing to possibility of negligent behaviors on the side of the staff. If this were to happen, then the managers and leaders would have a hard time dealing with lawsuits and bad reputation and it would end up affecting performance. For this reason, it is imperative for nursing leaders and managers to come up with innovative approaches to ensure the staff treats the clients well.
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How a Manager and Leader Would Deal with the Issue of Abuse in ADHC
Nurse managers and leaders have the responsibility of ensuring that they handle issues and situations that arise in the course of their duties in clinical settings. While the end is similarly aimed at resolving issues and situations, the means to those ends tend to vary significantly. The reason for this variation is the fact that nurse leaders and nurse managers have different perspectives, orientations, and ways of dealing with challenges. In the case of dealing with abuse and unprofessionalism in ADHC leaders and managers would apply different approaches related to their discourse.
Nursing leaders are individuals who are not elected to power positions but tend to get their power through other means especially through recognition by others and their peers. This kind of recognition is important as it contributes to a buildup of loyalty from followers considering that their power is ascribed (Machon, Cundy and Case, 2019). In this regard, nursing leaders are capable of working with others well to establish the genesis of the situation and the best way to deal with the issue. In particular, nursing leaders are capable of focusing on group process something that proves valuable due to its ability to enhance information gathering. Moreover, group processes enable the leaders to get and give timely feedback and this way helps in empowering the followers. In the case of ADHC, a nurse leader is able to interact with the staff on a personal basis something that would help the leader to understand the situation from the staffs’ perspective. Additionally, leaders, unlike managers, are not part of the formal organization and this lack of formality is beneficial as it removes barriers (Lee, Daugherty, and Hamelin, 2019). The followers view the leader as one of their own as the absence of rigid bureaucracies allows followers to voice their concerns without fear or a feeling of intimidation.
Nursing leaders tend to have a wide array of roles as compared to nursing managers considering that they are not part of the organization's formal structure. The independence from the formal structures allows these leaders to pursue personal interests that are outside the organization's interests. In this case, nursing leaders are able to view the situation from a nonprofessional’s perspective and this would help in alleviating the situation. Unlike managers who would prefer to follow protocol in dealing with complaints leveled against ADHC staff, nurses’ leaders would explore informal avenues. In this way, the affected staff would be free to explore several alternatives, which then ensure that operations are not halted and that the clients are comfortable.
Managers in clinical settings differ from nurse leaders in different aspects something that affects how they approach the issue abuse in ADHCs. Unlike the leaders who are not formally elected nursing managers act in official capacities as representatives of the top management. For this reason, it is possible that when addressing the issue at hand, they will follow bureaucracies that are outlined in the organizational structures. The adherence to bureaucracies then means that the affected staff may not have much say regarding the organization’s decision regarding how they ought to relate with clients. Considering that managers have legitimate power that is assigned by the organization, they may be rigid and may not accept contrary opinions. More so, the affected staff may not be free to air out personal convictions as doing this would be contrary to the organization’s edicts and guidelines.
Nursing managers are directive, achievement-oriented, supportive, or participative depending on the kind of leader they are. For instance, transactional managers are focused on getting the work done to enhance the smooth running of the organizations. With this in mind, these kinds of managers would want to ensure that the ADHCs are operational in spite of abuse claims. In this regard, these kinds of managers would want to dialogue with the affected staff to find immediate solutions before the problem escalates to unmanageable levels. On the other hand, transformational managers are directed by a vision and would prefer if the followers shared the same vision. This kind of manager would then try to influence his or her vision on the staff so that they do their best to ensure the comfort of the elderly under their care. Overall nursing managers are known to emphasize decision-making, control, decision analysis, and results. For this reason, they would want to view all the possible solutions and adapt to the one that benefits the organization more.
Challenges that Nursing Leaders Face in a Modern Clinical Setting
Modern clinical settings present a myriad of challenges for nursing leaders as compared to traditional clinical settings. Technological advancements increased regulations, human rights activism and increased knowledge are some of the contributors to modern challenges. In particular, modern clinical settings are more open to scrutiny as patients, relatives, government bodies and human rights activists demand better healthcare services. In the backdrop lies, a wide array of medical and clinical conditions that are yet to get medical breakthroughs. Apart from this, there is an increased concern about the safety of patients in an era of technological advancement that calls on the digitization of all aspects in clinical settings. Healthcare organizations are required by law to ensure that patient information is protected from falling into the wrong hands as this would attract legal ramifications.
Nurse leaders are operating in a culturally diverse clinical setting, which requires them to be culturally competent to enhance equality in healthcare delivery. This requirement has proven to be challenging to most nursing leaders, as most of them as well as their staff is not exposed to other cultures. The US, for instance, is a culturally diverse country and wit this diversity comes to increase clinical demands. The nursing leaders are usually forced to go back to the drawing board to come up with culturally competent services. This objective is not satisfactory met considering that there are issues of communication barriers, opposing cultural and religious beliefs and values (Lee, Daugherty, and Hamelin, 2019). In this regard, nurse leaders are forced to recruit culturally competent nursing personnel in the hope of bridging this challenge.
Clinical setting relies on employees to thrive and to provide quality, affordable and effective healthcare services to the public. While employees undertake this noble task, it is not a guarantee that the nurse leaders will have adequate and competent employees to fill these vacancies. At times, the leaders have to grapple with a shortage of labor force or a high turnover rate as the employees keep on resigning (Hallock, 2019). The high employee turnover rate is sure to affect the delivery of healthcare services. The employees demand increased perks and benefits something that is not feasible owing to the unavailability of funds. The problem with such a scenario is the fact that the number of individuals who require healthcare services remains high. At times, patients are held from accessing healthcare services owing to long waiting lists due to these shortages.
Literature Review on Nursing Leadership and Management
Nursing leadership and management is a topic that receives a lot of attention owing to it contributed to the success of a healthcare setting. Nursing leadership is a crucial aspect that is associated with long-term care (LTC) facilities that take care of older adults who demonstrate instability and medical acuity. According to Stefanaci and Riddle (2019), it is time that LTC’s require the supervision of competent nurse leaders who are capable of recruiting and leading a higher number of staff as LTC requires intensified care. Effective nurse leaders will ensure that the LTCs are full of capacity to ensure there is enough revenue to support the program as well as help in reducing malpractice. From this proposition, it is evident that there is a special interest in the field of nurse leadership and management and only the most qualified should take up this position. In as much as there is a shortage of nurse leadership and management, there is no need to worry as there are opportunities to learn. Machon, Cundy, and Case (2019) are of the idea that leaders have an opportunity to learn requisite skills to be effective in different clinical settings. In particular, nurse leaders have an opportunity to become innovative and creative to be effective in their positions. “Executive Fellowship in Innovation Health Leadership” is one of the programs that exist to train nurse leaders on how to be innovative and creative. Nurses who go through this program develop skills that are needed to “accelerate their own organizations’ capacity to innovate”. In as much as most leaders find the program to be challenging, the benefits associated with the program outweigh the challenges as they help in transforming the clinical landscape.
The modern clinical settings are a contrast to the healthcare facilities in the 20 th century, which demonstrated authoritative leadership styles. According to Bowers and Goodyear (2019), the hospital was considered a house with the physician taking the role of an authoritative father, the nurse acted as a comforting mother with the patient taking the role of a child. In this regard, the nurse and the patient had no say and they only followed orders. Today, physicians and nurses collaborate to ensure that the patient gets the most effective healthcare services. The patient is allowed autonomy to decide the kind of care he or she wants something that reflects a change in management and leadership styles. All the players value the input of one another and they come to collaboration without any side dominating the others. For this kind of change to occur, nurses ought to be in the forefront to lead change with the aim of advancing health. According to Hallock (2019), the best way to equip nurse leaders and managers is by allowing them opportunities for higher levels of education. Moreover, the nurse ought to practice on a full scale to ensure that the education they have gained is not in vain. Additionally, Hallock (2019) believes that it is high time that nurses partnered with physicians and other health professionals in redesigning healthcare. At the end of it, the nursing leadership and management field will experience a revolution considering that nursing leaders have what it takes to change the healthcare landscape.
References
Bowers, D., & Goodyear, C. (2019). Healthcare then and now: Impact on nursing leadership. Nursing Management , 50(9), 26–29.
Hallock, A. B. (2019). A case for leadership development in nursing practice. Nephrology Nursing Journal, 46(3), 325–328.
Lee, E., Daugherty, J., & Hamelin, T. (2019). Reimagine Health Care Leadership, Challenges and Opportunities in the 21st Century. Journal of PeriAnesthesia Nursing , 34(1), 27–38. Machon, M., Cundy, D., & Case, H. (2019). Innovation in nursing leadership: A skill that can be learned. Nursing Administration Quarterly , 43(3), 267–273.
Stefanacci, R. G., & Riddle, A. (2019). Nursing leadership in LTC. Geriatric Nursing , 40(3), 329–332.
