Essay: Nursing Leadership One of the More Challenging

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¶ … Nursing Leadership

One of the more challenging aspects of healthcare in general and nursing in particular is the inevitability of change and the need for using evidence-based practices to promote optimal clinical outcomes. For this purpose, effective nursing leadership is required in order to ensure that organizational goals are met while ensuring that clinicians and patients alike receive the information they need to make informed decisions. This paper provides a review of the relevant peer-reviewed literature concerning five current issues of interest to nursing leadership theorists and practitioners alike, followed by a summary of the research and important findings concerning these issues in the conclusion.

Review and Analysis

A definitive definition of leadership and how it would be an ideal model of leadership for the clinical environment

Although definitions of leadership in general and clinical leadership in particular vary (Curtis, de Vries & Sheerin 2011), Taylor (2009) suggests that a working definition is: "Leadership is seen in terms of unifying people around values and then constructing the social world for others around those values and helping people to get through change" (p. 40). This somewhat nebulous definition of clinical leadership is due in large part to a paucity of nursing leadership literature. For instance, according to Stanley (2008), nursing leadership development is currently based largely on business and management theories that have been superimposed on nursing rather than specifically tailored for the purpose.

From a strictly pragmatic perspective, it is reasonable to posit that leadership in nursing is no different from leadership in any other enterprise, and this perspective has been used to superimpose various organizational leadership theories onto nursing leadership. For instance, Stanley (2008) also notes that several popular leadership theories have been applied to nursing, including (a) transformational leadership, (b) transactional leadership, (c) authentic leadership, (d) contingency theory, (e) servant leadership as well as other theories, with transformational leadership being the most prominent. In this regard, Stanley (2008, p. 520) notes that, "Of these [leadership theories], the most commonly sited as a theory capable of supporting nurses' insights into clinical leadership is transformational leadership." Definitions vary from country to country. For instance, in the United Kingdom, Giltinane (2013, p. 35) promoting the values of the National Health Service is included in the definitive definition of leadership. An ideal model of leadership for a clinical environment would be congruent with the definition provided by Doody and Doody (2012, p. 1212) that states effective nursing leadership is the process by which consumer healthcare demands are satisfied.

Explanation of 'cognitive dissonance' and why it may create conflict during a period of change

It is reasonable to suggest that everyone has experienced some degree of cognitive dissonance, but many people may not be able to accurately define the experience (Hawkins & Weiss 2012). The gap between personal expectations and personal realities varies in ways that are similar to concepts of self-esteem, which Fontenot et al. (2012) point out also plays a role in dissonance. According to these researchers, dissonance takes place in those instances where individuals experience a deficiency between their expectations of themselves and their behavior. Furthermore, dissonance is exacerbated to the point where burnout and stress can result when behaviors do not live up to normative expectations (Fontenot et al. 2012).

Although most people have experienced some degree of cognitive dissonance, many people have problems identifying when it occurs and how it can be mitigated or resolved (Wetcher-Hendricks 2005). One way to determine when cognitive dissonance is taking place is when two thoughts or priorities conflict to the extent that feelings of uneasiness are experienced (Wetcher-Hendricks 2005). These feelings of uneasiness can also result from people being compelled to make choices they would rather avoid, and it is important to resolve these feelings in healthy ways in order to avoid the negative health care outcomes that are associated with the condition (Wetcher-Hendricks 2005). In sum, there are four pre-existing conditions that are required in order for cognitive dissonance to take place as follows:

1. Individuals must realize that they have a choice in the matter;

2. Individuals must make a commitment to the behavior even though it contradicts their thoughts (dissonance occurs only when individuals engage in the behavior but not if they just think about it);

3. Prior to engaging in a behavior, individuals must be aware of the negative consequences of that behavior; and,

4. Individuals must be unable to justify their actions (Wetcher-Hendricks 2005).

Discuss how an effective clinical leader might manage the conflict

There is growing recognition that change is an inevitable and ongoing process in every organizational setting, especially healthcare (Edwards, Throndson and Girardin 2012). Just as nursing leadership has relied on business management theories to formulate a profession-specific definition and conceptualization of clinical leadership, there remains a dearth of timely and relevant research concerning how effective clinical leaders can best manage conflicts (Edwards et al. 2012). The inevitability of conflicts in the workplace is also cited by Janss, Rispens and Jehn (2012, p. 838) who report that although there can be any number of positive outcomes realized through the change process, in general, the change process is regarded as being a negative social process that can adversely affect the change management process (Jenss et al. 2012).

An important point made by Doody and Doody (2012) is that there is no "one-size-fits-all" clinical leadership style that is best suited for all situations. Moreover, Doody and Doody (2012) argue in favor of nature rather than nurture in maintaining that truly effective leaders must possess the "right stuff" in the form of charisma that can help mediate change. There is a virtual consensus that in order to effect meaningful change in any organizational setting, leaders must motivate their subordinates to follow them in the change process by emphasizing the "what's-in-it-for-them" aspects as well as the imperative for achieving organizational goals (Ellis and Abbott 2013). In healthcare settings, it is important for clinical leaders to ensure that all stakeholders are apprised of the change initiative, why it is needed and what they will be expected to do to facilitate its implementation (Ellis & Abbott 2013). Although change is inevitable in all organizational settings, the need for timely communication is especially pronounced in healthcare (Ellis & Abott 2013).

A definition of congruent leadership and whether being a 'congruent leader' would make a person a better manager

The definition of congruent leadership in nursing provided by Stanley (2008, p. 522) states that, "Congruent leadership can be seen when the activities, actions and deeds of the leader are matched by and driven by a leader's values and beliefs about (in this case) care and nursing." Although effective congruent leaders recognize where they need to lead others, this recognition is not the reason they are effective leaders and their subordinates follow them (Stanley 2008). Rather, effective congruent leadership relies on innate beliefs, principles and values that are discernible by followers to the extent that they are motivated and inspired to greater performance heights (Stanley 2008).

As noted above, the leadership theories that have been developed from business management theories, especially transformational leadership, may lack the robustness needed to provide nurses with the tools and methods they need to develop and implement their clinical leadership skills (Stanley 2008). By contrast, congruent leadership theory is founded on the concept that a better theoretical framework in which clinical leaders can improve their understanding and ability to implement clinical leadership skills is encouraging a match between their actions and their innate beliefs and values concerning health care and nursing (Stanley 2008). This conceptualization of congruent leadership helps to overcome many of the limitations that are associated with traditional management paradigms that may not be appropriate for all clinical applications (Stanley 2008). Based on his analysis of the appropriateness of traditional management paradigms, Stanley (2008) concludes that the congruent leadership model provides a superior method for nursing leaders to develop their skills set for clinical leadership. While congruent leaders are typically situated in many positions in organizations' structures, most are not assigned to managerial roles (Stanley 2008), suggesting that congruent leaders do not necessarily make better managers.

Effective leaders facilitate creativity in those around them in order to motivate those people

Although many truly effective leaders adopt dramatically different leadership styles, they share a common attribute in being able to inspire their followers to perform longer, harder and more creatively than they thought possible. Organizations that are lucky enough to have these types of leaders have a competitive advantage over those that do not because these effective leaders create energy and synergy in situations where it did not exist or was lacking. In this regard, Doody and Doody (2012) suggest that, "Leaders should move out of the realm of pure staff motivation, adopting inspirational leadership as it infuses an intrinsic drive fuelled by a higher purpose, creating enthusiasm and passion, driving staff independently to achieve the goals of the organisation." While these are laudable goals in any organizational environment, many nursing leaders may be challenged… [END OF PREVIEW]

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