The Importance of Effective Nursing Leadership Today … Research Paper
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Leadership Roles Faced in Today's Society For Nurses
Today, nursing professionals are required to perform a wide range of roles in healthcare, including patient education, advocacy and ultimately leadership responsibilities. Properly performed, nursing leaders can help their healthcare organizations achieve optimal clinical outcomes, but it is reasonable to suggest that many nurses lack the experience or training they need to become effective leaders overnight. As the research will show, there is also a gap in the existing body of nursing scholarship concerning the precise competences that are needed by nursing leaders today. To gain some fresh insights into these issues, this paper reviews the relevant literature concerning the various types of leadership roles that are faced in modern society for nurses, followed by a summary of the research and important findings in the conclusion.
Review and Discussion
Nursing leadership has experienced some fundamental changes over the past century, evolving from the traditional hospital matron role in the late 19th century to clinical leadership to promote improved healthcare outcomes by the late 1990s (Sorensen & Delmar, 2011). According to George and Haag-Heitman (2011), nursing leaders are in a good position to promote improvements in clinical practice by focusing providing their subordinates with the resources and tools they need to perform the responsibilities effectively. Moreover, nursing leaders can also promote accountability for practice amongst their subordinates. For instance, George and Haag-Heitman note that, "[Nursing] managers will play an essential role in helping facilitate direct-care nurses' ownership of their practice outcomes" (p. 258). Likewise, Haycock-Stuart and Kean (2012) point out that, "The contribution of [nursing] leadership is recognized to be central in achieving the change required to meet the policy drive for quality care" (p. 372). It is noteworthy that nursing leaders are increasingly being looked to as the driving force for implementing the changes that will be needed to improve the overall quality of healthcare services.
While the research is consistent in showing that there is no "one-size-fits-all" leadership approach that is most effective all of the time, a growing body of evidence indicates that the most effective nursing leaders today employ a transformational leadership style (Sorensen & Delmar, 2011). In this regard, Sorensen and Delmar (2011) emphasize that, "The transformational leadership style has been compared with the clinical leadership style and is found to prevail in magnet hospitals, a concept whose international recognition has been accompanied by the dissemination of transformational/clinical leadership styles" (2011, p. 422).
Other authorities also cite the need for effective nursing leaders to drive improvements in the quality of clinical care provided, but many also agree that fundamental changes in the existing healthcare delivery framework will be needed to achieve optimal outcomes, especially in community nursing settings. For example, Haycock-Stuart and Kean (2012) emphasize that, "Delivering the quality agenda will require ambitious leadership and strong professional values, supported by a robust and effective governance framework, suggesting change is required in community nursing" (p. 373). Efforts to improve the quality of healthcare services are certainly not novel, but there is a growing body of scholarship that supports the need for nursing professionals to lead the way in improving the healthcare delivery system. As Haycock-Stuart and Kean (2012) conclude, "Senior nursing leadership has a pertinent role in bringing the quality agenda to the fore" (p. 373).
Notwithstanding the compelling need, though, Sorensen and Delmar (2011) also emphasize that, "In spite of several studies of nursing and clinical leadership, it is still unclear how nurses navigate between nursing and leadership roles" (p. 421). While the debate over nature versus nurture continues, it is reasonable to suggest that some nurses manage to make the transition into leadership positions more readily than others, but it is also reasonable to suggest that all nursing leaders need ongoing feedback concerning how well they are performing their responsibilities in order to identify opportunities for improvement and problem areas that require resolution.
One approach that has proven efficacy in helping nursing professionals navigate between the traditional nursing role and leadership roles in peer review using the American Nurses Association (ANA) Guidelines for Peer Review. In this regard, George and Haag-Heitman report that, "Peer review implies that the nursing care delivered by a group of nurses or an individual nurse is evaluated by individuals of the same rank or standing according to established standards of practice" (2011, p. 255). Properly and timely performed, the peer review process can provide nursing professionals with the feedback they need to identify opportunities for improving their practice as well as identifying individual strengths that can be drawn upon for this purpose (George & Haag-Heitman, 2011).
Given the chronic shortages of qualified nursing leaders in the United States and many other Western nations today, it is also vitally important to provide nursing professionals with the training they need to perform their responsibilities properly, including forging personal relationships with other nursing leaders and staff. For example, Galletta, Portoghese, Battistelli and Leiter (2012) point out that, "The quality of working relationships that employees develop at the unit-level, influences employee attitudes with implications for both employee outcomes and unit performance" (p. 1772).
To the extent that relationships between nursing leaders and subordinates are healthy will likely be the extent to which the nursing unit achieves optimal clinical outcomes while simultaneously minimizing unplanned nursing turnover rates (Galleta et al., 2012). This point is also made by Sherman and Pross (2010) who maintain that nursing leaders that forge healthy relationships with other supervisors and nursing staff provide the framework that is needed to achieve improved patient care. In this regard, Sherman and Pross (2010) note that, "The establishment of a healthy work environment requires strong nursing leadership at all levels of the organization, but especially at the point of care or unit level where most front line staff work and patient care is delivered" (p. 1).
These observations are highly congruent with the following key elements that have been identified by the Nursing Organizations Alliance as being integral components of a healthful practice/work environment:
A collaborative practice culture;
A communication rich culture;
A culture of accountability;
The presence of adequate numbers of qualified nurses;
The presence of expert, competent, credible, visible leadership;
Shared decision making at all levels;
The encouragement of professional practice and continued growth/development;
Recognition of the value of nursing's contribution; and,
Recognition by nurses for their meaningful contributions to practice (Sherman & Pross, 2010, p. 4).
Some of the traditional roles that are performed by nursing leaders have been significantly expanded and amplified in recent years in response to increased calls for accountability and cost efficiencies. For instance, Bolton (2015) emphasizes that, "Those institutions that have succeeded have done so in collaboration with their nursing professionals. They have not approached the issue in terms of replacing physicians but of collaborating with physicians" (p. 23). This type of close collaboration between healthcare practitioners can have a synergistic effect on improving healthcare outcomes and staff morale provided that nursing leaders understand this expanded role (Bolton, 2015).
It is also important to note that nursing leaders at all levels can play an important part in ongoing efforts to improve clinical care. In this regard, Bolton (2015) adds that, "Top facilities are also likely to have not just a chief nursing officer (CNO) but untitled nurse leaders who continually contribute to advancing the profession and the work of healthcare improvement" (p. 24). Some salient examples of these different types of expanded nursing leadership roles include nurses who are responsible for minimizing hospital lengths of stay and patient safety coordinators who are tasked with preventing nosocomial conditions as well as medication errors and falls (Bolton, 2015). In this regard, Bolton (2015) emphasizes that, "Having exemplary, highly skilled and educated nurses on staff leads to decreases in the number of hospital acquired conditions -- including falls, pressure ulcers, and infections. Solid evidence supports this assertion" (p. 24).
While some fortunate nursing professionals possess the innate leadership traits required to serve in these various capacities while forging strong health relationships with other supervisors and staff, many nurses lack the experience and training they need to be effective leaders. In some cases, nursing willingly and even aggressively seek out leadership positions, but in many cases they are promoted or otherwise assigned to these positions irrespective of their readiness. Consistent with the so-called "Peter Principle" that holds that people tend to assume additional responsibilities and ever higher positions of leadership until they reach a point where they are no longer effective, nurses who transition into leadership roles may find they lack the knowledge and skills they need in their new role.
Today, nursing professionals form an integral part of the healthcare delivery system in countries around the world, and many are assuming new roles in their capacity as nursing leaders. These nursing professionals are increasingly expected to help drive the changes that are needed in order to provide optimally effective healthcare services today. The research also showed, though, that far too many nurses who accept positions of leadership lack the formal training… [END OF PREVIEW]
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