In an ever-changing healthcare practice, nursing has become so challenging and dynamic a career. Thus, the profession calls for leaders that are an inspiration to the others as well as engaging role models as the nurse leaders are an integral part of healthcare transformation. Nurse leaders’ practices are enhanced by the Deliberative Nursing Process theory that permits them to devise valuable plans for care in nursing. Nurses can modify the nursing care plan in cases where complications arise with patients (Porter-O'Grady & Malloch, 2015). Thus, this paper will explore the nursing concepts, characteristics of nurse leaders, the antecedent and consequences, and empirical referents used in determining leadership in nursing. Also, the hypothetical and real-life situations related to nurse leaders will be elaborated as borderline, contrary, and model cases while theoretical application of leadership in nursing will be discussed in detail.
Roles of Nurse Leaders
Leadership in nursing can be discussed in two categories the Clinical Nurse Leader and the Executive Nurse Leader. The Clinical Nurse Leader’s title was recommended by the American Association of Colleges of Nursing to tackle issues pertaining to patient’s quality of care, safety, and general issues concerning the healthcare system. Their roles include supervising and delegating healthcare as the organization offers it at the clinical stage. They are also tasked with designing, evaluating and implementing patient care (Pihlainen, Kivine & Lammintakanen, 2016). Nurse Executives, on the other hand, are responsible for administrative as well as managerial duties. They are responsible for spearheading the organization towards the realization of the smooth operation of all its resources to achieve improved healthcare services.
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Literature Review
Nursing is believed by many to be a calling to duty. Scully (2015) states that nursing and leadership have a commonality in between them and this involve both to be compassionate and caring. The writer further points out that, leaders have more responsibilities other than having a vision, delegating, and directing; they have to motivate each of their team members to achieve the pinnacle of the potential. Furthermore, leaders have to manipulate the feelings, attitudes, behavior, and beliefs of their team in order to command their genuine respect and appreciation. This way they manage to create a culture of trust that will propel the accomplishment of the mission and vision of the organization.
In nursing, leadership is enhanced by the Deliberative Nursing Process theory that emphasizes the reciprocal connection between nurses and patients. The theory was postulated by Ida Orlando and elaborates that nurses have authority to take action to practices that relate to nursing without waiting for doctors’ orders (Vaismoradi, Griffiths, Turunen, & Jordan, 2016). The theory further states that orders from the doctors are directed towards the patients and thus, nurses were necessary to assist the patients in implementing the doctors’ orders. But nurses are leaders in their domain since they are in charge of the patients and thus have to help them in interpreting events.
For many years, nurses have been the shadow of doctors and physicians, but circumstances have changed through time, and today they are up against numerous opportunities and challenges. These changes are mainly due to organizations undergoing changes constantly and hence a need for flexibility in leadership (Fischer, 2016). Hence, an adaptive type of leadership is called for where responsibilities are shared with the aim of achieving a common good. This type of leadership, Fischer (2016) refers to as Transformational leadership. He writes that the leadership style inspires team members and advocates for creative ideas and higher moral standards in administering to patients. Therefore, the team members work in the accomplishment of the interests of the organization rather than personal interests.
Nurse Leaders are therefore tasked advocating for not only patients but also their profession including nurses under their supervision. Boamah, Laschinger, Wong, and Clarke, (2018) in their article on the effect of transformational leadership ascertain that these leaders in nursing need to take appropriate action to ensure the advocacy is attained. Some of the actions include the promotion of a conducive work atmosphere and balanced allocation of the organization’s resources. Moreover, they have to advocate for quality care of patients using safety practices as they are the critical determinants of successful results.
There are so many challenges that the Nurse Leaders face, but the primary challenge is meeting the requirements of their nursing staff while accomplishing the organization’s mission and vision. Other setbacks that they meet in their duties include adequate training for their team members and ensuring that all units are uniformly staffed. Since they report directly to the managers, they have to make sure that the data they pass over is accurate and detailed so that the staffing issues can be solved directly and timely. Furthermore, nurses are said to experience burnouts frequently and thus need constant motivation and support to keep them occupied in their duties (Cherry, & Jacob, 2016). Therefore, the Nurse Leaders have to facilitate meetings, team, and capacity building events to maintain the team’s morale at an all high level.
Strong leadership in nursing is critical as this profession involves situations that exert pressure on the nurses and require decisive decision making. The Nurse Leader’s position is crucial as it nurtures the aspect of nurses working together as a unit (Weng, Huang, Chen, & Chang, 2015). With incredible interpersonal skills, Nurse Leaders communicate with management, doctors, patients, other staff, and the patient’s families hence bridge any differences and forge a cohesive bond between these stakeholders. Furthermore, they encourage the staff under them to engage in safe practices and thereby forging an environment for the growth of both the staff and the organization.
Essential Attributes of the Nurse Leader
Nurse Leader needs exceptional skills and proficiency in communication as they are at a position where they interact with people across all levels. They need to communicate accurately to pass relevant information to the management for the implementation and operation of the organization (Weng et al., 2015). Most importantly, they have to resolve some of the issues that arise between the nurses and communication skills come in handy in such situations. Furthermore, the skills are essential especially in explaining technical medical jargon with patients or their relatives. Therefore, excellent communication skills help them to facilitate cooperation between senior executives, support staff, and primary care providers.
The nature of the nursing career is too demanding and hence demands the leader to be a critical thinker. Critical thinking is vital as the position involves interaction with diverse personalities throughout their delivering of service (Porter-O'Grady & Malloch, 2015). Through the interactions, they have to be decisive and forge collaborations as well as make decisions on matters that are complex and require immediate attention. Critical thinking is a valuable attribute for the Nurse Leaders as they will command respect from the nurses based on how they handle different situations. Lack of self-confidence or failure to make critical decisions when called for might make them seem weak hence fail to influence the beliefs, attitude, and behavior of the staff in achieving the organization’s goals.
They must have empathy and be able to relate with the challenges that the nurses are going through since at one point they also went through the same challenges. Therefore, they should be able to work in close proximity with trainees and through the process, assist them to cultivate emotional intelligence (Porter-O'Grady & Malloch, 2015). It is this kind of support that assists the trainees to handle stressors that they encounter during their routine practice. They not only need to help their peers to overcome the challenges but manage additional counterproductive effects that may lead to poor teamwork and emotional fatigue.
Antecedent and Consequences of Leadership in Nursing
The antecedent to Nurse Leaders involves nurses acting like robots; waiting for directives from doctors on necessary actions to take. They were legally bound to wait for orders from physicians that led to an increase in patient death or preventable conditions developing into complications (Vaismoradi et al., 2016). Consequent empowering of the nurses has led to the decrease of patient deaths and improvement of services related to safety practice in the health sector. Vaismoradi et al., further deduce that the introduction of leadership in nursing has fostered cohesion and the spirit of team workmanship that has subsequently led to notable successes in patient care.
Empirical Referents of Leadership in Nursing
First, patient safety for a long time has been used to determine the superiority of care offered by the nurses. Cherry and Jacob (2016) state that results from patients indicated that some critical aspects in nursing comprised damage to the membrane of mucosal, fluid hydration, and the lack of pressure ulcers. The researchers concluded that the results together with others not listed are measurable through nursing interventions and hence a pointer to the importance of Nurse Leaders. Secondly, improved patient status has likewise been used to determine the significance of leadership in nursing. Patients’ improved status is determined by how well they perform tasks needed in their daily life.
Case Studies of Situations Depicting Leadership in Nursing
Model Case
Mary a newly appointed Nurse Leader at Military Memorial Hospital notices one of the nurses attending to patients without washing her hands. She politely summons the nurse to her office later on and enlightens the nurse on the importance of washing hands before attending to patients. The nurse agrees with her and vows never to repeat the mistake in future.
Borderline Case
Because members of her team are all engaged with another patient, Nurse Mary hangs Mr. Martin’s blood contrary to nursing practice that dictates that a second nurse must crosscheck the hanging. The patient later develops complications, and it is discovered that the blood was meant for another patient called Mrs. Martin. If she had consulted with the Nurse Leader, she might have advised seeking the assistance of another nurse from a different unit.
Contrary Case
During a board meeting, directors are faced with a situation where nurses working in a specific unit have isolated themselves in groups due to a misunderstanding between them. The meeting established that some of the causes comprised low esteem and job satisfaction, poor communication, and lack of leadership. Therefore, patient care is in complete disarray and patients are incredibly dissatisfied healthcare services.
Theoretical Applications of Leadership in Nursing
Deliberative Nursing Process theory assumes that patients will feel helpless if they need assistance in their medical requirements when they cannot manage to attend to themselves, yet they are not assisted. Vaismoradi et al., (2016) state that it is only through close interaction with the nurse that the patient can ask for assistance. Therefore, nurses provide patients with motherly care and nurture them to eliminate the feeling of helplessness. Hence, with leadership in nursing, nurses can be directed on how to communicate with patients to identify their areas of need and assist them accordingly.
Conclusion
It is evident that leadership in nursing has played a significant part in the development and growth of the healthcare industry. Based on the theory of deliberative process, nurses have interacted more with patients and through observation and analysis managed to assist the patient. Furthermore, they have managed to understand the patients better, even though; they face numerous challenges including burnouts that call for inspiration from time to time. Nurse leaders have proved to be a bridge connecting and supporting multidisciplinary collaborations. Therefore, they should be empowered by ensuring that they acquire the necessary skills relevant to their profession.
References
Boamah, S. A., Laschinger, H. K. S., Wong, C., & Clarke, S. (2018). Effect of transformational leadership on job satisfaction and patient safety outcomes. Nursing outlook , 66 (2), 180-189.
Cherry, B., & Jacob, S. R. (2016). Contemporary nursing: Issues, trends, & management . Elsevier Health Sciences: Amsterdam.
Fischer, S. A. (2016). Transformational leadership in nursing: a concept analysis. Journal of Advanced Nursing , 72 (11), 2644-2653.
Pihlainen, V., Kivinen, T., & Lammintakanen, J. (2016). Management and leadership competence in hospitals: a systematic literature review. Leadership in Health Services , 29 (1), 95-110.
Porter-O'Grady, T., & Malloch, K. (2015). Leadership in nursing practice . Jones & Bartlett Publishers: Massachusetts.
Scully, N. J. (2015). Leadership in nursing: The importance of recognizing inherent values and attributes to secure a positive future for the profession. Collegian , 22 (4), 439-444.
Vaismoradi, M., Griffiths, P., Turunen, H., & Jordan, S. (2016). Transformational leadership in nursing and medication safety education: a discussion paper. Journal of nursing management , 24 (7), 970-980.
Weng, R. H., Huang, C. Y., Chen, L. M., & Chang, L. Y. (2015). Exploring the impact of transformational leadership on nurse innovation behavior: A cross ‐ sectional study. Journal of Nursing Management , 23 (4), 427-439.
