Nursing Leadership - Essay Example

Nursing Leadership Introduction In today’s world of competence, leadership is an important aspect behind the success of each and every organization. The increasing complexity of work in recent years, the need for higher levels of productivity and commitment all combine to perform in ways different than in the past. The health care industry is also not any different. It is found that there is a correlation between the quality of patient care, staff morale and effective nursing leadership (Manley 1997). Effective leadership plays a very important role in nursing as it directly influences the retention of nurses and the quality nursing care. Recent years have seen a dramatic reduction in the numbers of nurse and one of the main problems pointed out by many is the lack of effective leadership. Because of this shortage the remaining nurses often experienced substantial increases in their workload. This reduction contributed to the perception that nursing leadership and the involvement of nurses in decision making were not valued (Heather, 2005). The focus of this paper is to highlight some of the reasons for the lack of leadership and its impact on the nursing profession and also reflects on some of the basic leadership theories. Leadership is about knowing how to make visions become reality. Each and every organization requires effective leadership because all of them are affected by their contexts, philosophies, governance structures, value systems, and the legal ground rules under which they operate. This remains constant whether it is nursing, medical or healthcare leadership. From a nursing perspective the three key foundation stones that helped nursing achieve the vision of a patient centred health service are development of patient centred care measures as part of performance management and the clinical governance agenda; leadership based on personal growth and development principles and; new clinical career and competency framework for nursing (Kitson, 2001). Achieving these visions will require a paradigm shift in the philosophy, priorities, policies, and power relationships of the health service. While a fall in the number of nursing leaders may be attributed to the current nursing shortage, studies have noted that there is also a significant deficiency in the number of nursing leaders. Even at major research and teaching hospitals, chief financial officers are worried about the scarcity of nursing staff (Singhapattanapong, 2002). According to another study of 980 nurse leaders in the United States and Canada, in about 2-3 years, approximately 20% of nurse leaders and 35% of nursing employees will have retired. By the year 2020 it is predicted that the situation would be worst. By then, 75% of current nurse leaders say they plan to retire, with more than 50% of their nursing employees also retiring. Further, the study also suggested that it will be necessary to bolster recruitment and hiring efforts and retention of nurse leaders and nursing employees (Rigoli, 2006). Though this is a study in United States and Canada, similar situation can be expected all around the world. Today, with the increasing pressure on the nursing staff, it is estimated that first-year retention rates for new graduate nurses is only between 40% and 65%. In terms of numbers as many as 6 out of 10 new nursing grads leave nursing practice within one year of graduation (Rosebrough, 2005). One of the main reasons for them to leave the profession is the workplace violence they experience particularly in the initial years of their practice and this can be easily linked to the lack of good leadership. There are several studies that show that leadership is positively correlated with nurses job satisfaction and commitment towards institutional goals. However the challenge in the health care sector particularly for leaders is to be able to build and sustain a long-term vision, to build teams and increase commitment to effect organizational change. The main job of the leader will have therefore to focus on motivating, inspiring and empowering their workers (Zurn et al., 2005). There is a need for nursing leadership to exert that influence and by nurturing both leadership as well as clinical skills. The nursing profession trains new nurses on operating the latest technology and complex medical equipment. However, once at the bedside they rarely get the opportunity to apply even basic leadership principles. Nursing as a profession does a disservice to new nurses by not developing their leadership capabilities (Valentine, 2002). Central to the theme of nurses as leaders is the fact that effective leaders are also proficient clinically. Nurses can incorporate leadership fundamentals while developing competency in their profession. In exploring the Synergy model Kerfoot (2001) contends, "A leader cannot provide direct care. The leaders’ obligation is to create the environment in which good people can provide good care". Many leadership studies and professional opinions, disagree with this statement. In the United Kingdom, a "lack of consensus on nursing leadership has led to leadership development programmes for nurses which have emphasized the development of corporate and political skills, often to the detriment of nursing knowledge" (Antrobus and Kitson, 1999). The fact is that while nurses provide the majority of care and spend the majority of time with a patient, they are clearly not at the same power-level/structure as physicians or administrators. Few nurses have input on major decisions affecting an organization. What nurses can do is propose improvements to the existing status quo. They can submit new scheduling options, take the lead in presenting in service training or consult on retention and recruitment issues. It is incumbent on nurse leaders to orient nursing education to emerging health delivery systems. In the United States, acute care hospitals have influenced the content of nursing education. Many of nursings heuristic methods, especially its models of clinical education, assumed that acute care hospitals would always be at the center (Donley, 2005). The leadership initiative for nursing education enhances the leadership skills of nurse educators, clinicians and nursing students. It is essential to enhance the leadership skills of academic and clinical nursing educators responsible for developing the next generation of nurses. Additionally it is also important to strengthen the leadership competencies of nurse educators and administrators to enable them to be instruments of change in their home institutions. Promoting effective working relationships between nurse educators and employers who depend on nursing programs to produce a workforce prepared for the leadership challenges of the new century is essential. Last but not the least it is also important to assist educators to produce nursing graduates with the leadership skills demanded by the new health care system (Leadership Initiative for Nursing Education: Case Studies, 2002). As leaders, nurses must learn how to strategically identify and work with decision makers; understand where the power lies in the workplace, communities, and state- and federal level organizations; and understand who controls the resources for health care services. In their four- stage framework of political development, Cohen et al. (1996) described a continuum of policy awareness through which a nurse may travel. The stages range from the novice coming to an understanding that political action is important to the expert level of providing leadership in the policy arena (Wilson, 2002). It is critical for today’s nurses to learn how to exert legislative power, seek out policy and decision-making leadership positions, and build alliances and coalitions with consumers, nursing organizations, and health care provider groups. Many nursing schools and universities offer classes and courses on health policy for nurses in upper division coursework, but the audience is usually limited to those enrolled in formal graduate-level or doctoral-level study. Some nursing schools do offer lectures and courses in leadership with a focus on the policy-making and legislative processes. Creating a partnership between education and practice allows for practical application of theory (Ferguson and Drenkard, 2003). Nursing requires strong, consistent and knowledgeable leaders, who are visible, inspire others and support professional nursing practice. The shortage of good leaders among nurses is a major problem faced by the health care industry. Leadership plays a pivotal role in the lives of nurses. It is an essential element for quality professional practice environments where nurses can provide quality nursing care. Effective nursing leadership is the only way in which nursing practice and effective health care policies can be shaped and influenced (Antrobus and Kitson, 1999). This is the only way to reduce the shortage of nursing staff. Leadership is a shared responsibility. It is essential that nurses in all domains of practice and at all levels must maximize their leadership potential. To support distinction in professional practice, humanism must be restored to the work environment to help nurses feel safe, respected and valued. Nurses have the responsibility to their clients to demand practice environments that have the organizational and human support allocations necessary for safe, competent and ethical nursing care. Developing and supporting quality professional practice environments is a responsibility shared by practitioners, employers, governments, regulatory bodies, professional associations, educational institutions, unions and the public (Canadian Nurses Association, 2002). In conclusion, it can be said that leadership is very essential especially among the nurses as this is the one of the main profession that involves the care of people throughout the continuum of life and provides an essential service to humankind. Practicing as a Nurse can be both emotionally challenging and rewarding. Today, due to various reasons mentioned in this paper nursing is facing shortage and this shortage adversely affects the welfare of patients. Therefore, it is important that staff nurses must be willing to assume additional roles while providing exceptional job performance. Good leadership plays important role in nursing as retention of nurses and the quality nursing care is directly linked with this aspect. References Antrobus, S. and Kitson, A., (1999). Nursing Leadership: Influencing and shaping health policy and nursing practice. Journal of Advanced Nursing 29, 746-753. Canadian Nurses Association, (2002) Nursing Leadership. Position Statement. Retrieved on 7 December 2007 from http://www.cna-nurses.ca/CNA/documents/pdf/publications/PS59_Nursing_Leadership_June_2002_e.pdf Cohen, S. S., Mason, D. J., Kovner, C., Levitt, J. K., Pulcini, J., and Sochalski, J. (1996). Stages of nursing’s political development: Where we’ve been and where we ought to go. Nursing Outlook, 44(6), 259-266. Donley, S.R. (2005) Challenges for Nursing in the 21st Century. Nurs Econ. 2005;23(6):312-318. Ferguson, S.L. and Drenkard, K.N. (2003) Developing Nurse Leaders in Health Policy: An Education and Practice Partnership. Policy, Politics, & Nursing Practice Vol. 4 No. 3, August 2003, 180-184. Heather, M. (2005) Nursing Leadership. Nurses Association of British Columbia. Retrieved on 7 December 2007from http://findarticles.com/p/articles/mi_qa3916/is_200502/ai_n11826276 Kitson, A. (2001) Nursing leadership: bringing caring back to the future. Quality in Health Care 10: ii 79-84. Kerfoot, K. (2001). The Leader as Synergist. MEDSURG Nursing, 10(2), 101-103. Leadership Initiative for Nursing Education: Case Studies, (2002). Retrieved on 7 December 2007 from http://www.futurehealth.ucsf.edu/pdf_files/2001_LINE_Case_Study.pdf Manley, K. (1997) A conceptual framework for advanced practice: an action research project operationalizing and advanced practitioner/consultant nurse role. Journal of Clinical Nursing. 6, 179-190. Rigoli, E. (2006) Few Health Facilities Prepared for Shortage of Nurse Leaders, ERE Media, Inc. Retrieved on 11 December 2007 from http://www.ere.net/inside-recruiting/news/few-health-facilities-prepared-for-shortage-179782.asp Rosebrough, C. (2005) Healthcare Management: Challenges and Issues, Retrieved on 11 December 2007 from http://crosebrough.typepad.com/ Singhapattanapong, S. (2002). Nurse shortage hurts UCLA Medical Center. UCLA Daily Bruin, 2002, March 11 p.1. Valentine, S.O. (2002) Nursing Leadership and the New Nurse. Journal of Undergraduate Nursing Scholarship Vol. 4, No. 1, Fall 2002. Wilson, D. (2002). Testing a theory of political development by comparing the political action of nurses and non-nurses. Nursing Outlook, 59, 30-34. Zurn, P., Dolea, C. and Stilwell, B. (2005) Issue paper 4: Nurse retention and recruitment: developing a motivated workforce. International Council of Nurses, Geneva ISBN: 92-95040-24-4. Read More