Leadership in nursing has many facets, and can incorporate establishing a clear objective or target, organizing nursing activities effectively and providing motivation for others to achieve the organizational goals (Porter-O’Grady, 2003). On a daily basis, leadership in nursing could also require a senior nurse to coordinate the activities of the nurses on staff, as well as any support staff. The operation and efficiency of any hospital can depend on how effective it senior nurses are at managing shifts, employee morale and a host of problems and issues that can crop up on a regular basis. Thus, the management functions of a nurse leader are a key part of the required skill set. However, management is not in and of itself leadership. Management is about controlling the goals and tasks to ensure they are done correctly and in a timely manner. Leadership is about judgment, perceptions and the underlying management philosophy of the individual who is leading. The following will examine the qualities of an effective leader in the nursing field.
Leadership Characteristics
Speaking in broad generalizations, effective leaders are often judged to be visionaries who bring effective strategies to bear in the workplace, as well as a drive to lead their staff toward a particular objective (Mahoney, 2001). A key characteristic of effective leadership is that the leader is able to create group camaraderie, ensure general effectiveness of the group and solve problems quickly and efficiently. In addition, leaders should be able to motivate workers with inspiring and passionate commitment to the job at hand. In order to gain the trust and support of the team members under his or her authority, a senior nurse must bring all of these qualities to bear in the management of clinical practices. Furthermore, an effective leadership style in a nursing situation means that the leader will be in the position to ensure that the highest professional standards are adhered to in the workplace. This will encourage the development of the nursing staff and ensure that new nurses grow into competent and reliable practitioners. In short, leadership requires leaders who act as a driving force and an inspirational role model for other nurses might themselves someday become leaders (Bondas, 2006).
It should be noted that leadership priorities for senior nurses usually involve the following: delegation, conflict resolution decision-making behaving with integrity. As a leader, a nurse must also nurture others by being constantly aware of team dynamics and the emotional tone of the staff from day-to-day. These key elements are essential to maintaining a connection between the leader and the developing staff members. One of the best ways to achieve this is for the leader to work with the staff in a supportive and mentoring role.
Certainly, a truly successful and effective leader should attempt to develop and improve the staff under them. In fact, research has demonstrated that this kind of one-on-one supervisory interaction is pivotal when it comes to clinical instruction (Saarikoski & Leino-Kilpi, 2002). Further research has suggested that mentoring makes the learning process more effective by making it easier for the nurse leader to assess the performance and knowledge of the staff in a real-world setting (Hughes, 2004).
All of this is in keeping with the concept of "show, rather than tell." Whenever people are performing a task that incorporates both physical and intellectual activity, it is often best for a leader to demonstrate that task and then provide support as the staff member (in this case a nurse) completes the task. Furthermore, this kind of ongoing learning through support and/or mentoring will ensure that best practices are carried out in a way that will motivate the staff and empower them. It is vital for nurse leaders to create a supportive and dynamic environment in which staff members are motivated to adhere to best practice models.
There are number of specific things that nurses acting as leaders can do to ensure effectiveness in those they are leading (Borbasi & Gaston, 2002):
Providing access to positive role models
Putting in place effective mechanisms for clinical supervision and mentoring
Ensuring that the staff have opportunities for career growth
Putting in place a potential leadership successor
Placing a high value on competence in the clinical setting
Adaptability to Change
Any nurse leader must have the ability to quickly respond to the frequent changes that can take place in the healthcare setting. This can include shifts in national or local policies or changes in what the organization itself expects. Certainly, over the last few years the role of the nurse in hospitals and other clinical settings has changed significantly. There has been greater specialization, as well as a greater emphasis on accountability and patient outcome. Some of these changes have been positive, while others could be viewed as negative. Certainly, healthcare consumers have come to expect much higher standards of care and professionalism. This is especially the case when it comes to nursing care. For this reason, nurse leaders must be flexible enough to quickly respond to any changes that are introduced to the work environment. They also have to support other staff members so that the change can be as positive as possible. This latter point can be particularly daunting, but it is essential for an effective nurse leader to be able to help his or her staff shift their thinking about a new change so that it can be seen as not only essential, but doable.
Nurse leaders need to ensure that they and their staff are included in organizational decision-making, particularly with regard to those issues that relate to patient care, such as workforce hiring and planning, policy development clinical environment governance and staff training. As difficult as it can sometimes be, experts believe that senior nurses have to find ways to ensure that they are viewed as equals in the team so that their opinions on the above matters are taken into account (Sorensen et al, 2008). Finally, they need to ensure that the workplace has systems in place to support positive outcomes for the patients and to represent the views and interests of the nurses themselves.
Leadership Activities
When acting as a leader, a nurse should try to help other staff develop new abilities and skills by making sure they can apply the theories they've learned to ask for practice in a safe and controlled (not to mention supervised) environment. In this area, the leader's activities work hand-in-hand with developmental objectives (through the use of practice-based learning) to produce experienced and capable practitioners.
As mentioned before, leadership in a nursing environment involves providing support through supervision, mentorship and practical opportunities. In addition to the benefits mentioned above, supportive leadership has been demonstrated to minimize the negatives of a work environment and prevent emotional exhaustion on the job. Because of this, it is especially useful for nursing supervisors to offer emotional support to their staff and to provide clear and unambiguous feedback about their performance. Positive feedback improves and employee's self-esteem and ultimately their effectiveness as a worker (Bakker et al, 2000). Nurse leaders also need to encourage their staff to critically reflect on their own work so they can look for areas where they either have (or can) improve.
Stress can be a common occurrence in any hospital ward, with tensions often cropping up between the professionals involved. The resolution of such tensions and the establishment of positive working relationships between the various members of the team is one of the principal tests of any nurse's capabilities as a leader. In part, such tensions have increased in recent years because of the fact that nurses are (more and more) being required to make autonomous decisions about patient care. This must by definition result in a revision of the relationship between nurses and doctors, as well as with other professionals.
Senior nurses in a hospital ward also have a little play in creating and maintaining an organizational staff development and support program. The purpose of such a program is to minimize stress, sickness, absenteeism and burnout among the nursing staff. Certainly, nurses in a supervisory position have the opportunity to exert a considerable influence on their employee's professional and personal outcomes. As one researcher has pointed out, a senior nurse can serve as a buffer against the negative effects produced by a difficult and stressful work environment by providing leadership that fully supports the nursing staff (Bakker et al, 2000).
It's important to keep in mind though that individuals have different motivations. For this reason, a nurse leader has to focus on the specific needs of individual nurses and applied motivational approaches that will work in each case. Also, while attempting to motivate and encourage members of the staff who might be a bit worn down, nurse leaders also have to maintain the motivation of those nurses who already feel motivated in their work. One of the keys to motivating staff is by providing them with a vision and a goal, and then inspiring the staff to reach for that goal.
As the above indicates, leadership should be the principal force driving the work environment, since it helps determine staff effectiveness and motivation. As a part of this, a number of experts argued that nurse leaders should constantly attempt to use their position and influence to improve current practices (West-Burnham, 1997). This process should include a cooperative effort by the team to establish goals so that there is an overall feeling of mutual ownership and responsibility.
The Specifics of Mentorship
Since people are motivated in different ways, there are a number of different strategies that nurse leaders can use in this process. One of the most important and effective of these can be mentorship. Structured mentorship fosters an ongoing development process in which the nurses acquire additional knowledge and master new skills. Consistency is an important part of this process, which means that nurse leaders should include time in every shift in which they are engaged in mentoring in some form. In order to ensure that this is done every day, it's often best to create a log of such activities. The log can simply focus on certain specific tasks, documenting that mentorship was provided at a certain time in a specific area of work. It should include the following:
The task being performed
Any weaknesses or strengths demonstrated by the staff member
Interventions by the nurse leader
Future goals for improvement.
Nurse leaders should keep in mind that mentoring does not equate to micromanaging. Micromanaging is a very negative approach to management and one that is best avoided, since it negates any feelings of self-confidence the mentee might have. In fact, the aforementioned logs should be used as mentoring tools, not management tools. Such laws are intended to refresh the mentor's memory about how the staff member did edit a particular task at a given time. It also begins as a reflective tool when carrying out more comprehensive discussions later.
When a leader acts as a mentor, they need to make certain that staff members feel free to ask questions and offer their own ideas and opinions. Furthermore, the staff member should be encouraged to show their own initiative, since this will help to promote self-confidence when it comes to their own skills and decision making process. The fundamental purpose of mentoring is to create a work environment in which role models encourage professional growth in others (Murray and Main, 2005).
Models for Leadership
When it comes to leadership in nursing, there are three principal models that should be considered. These are the transactional, transformational and Three Circle models (Burns, 1978). It should be noted that transactional leadership has a fairly short-lived effect. This is probably because it is based on specific tasks and usually only occurs when the transactional leader sees something has gone wrong and intervenes with negative feedback. This approach to leadership is useful when a short-term narrowly focused project has to be completed as quickly as possible.
However, on a hospital ward it is usually more effective to employ a leadership model that relies on a long-term relationship between the senior nurses and those they are leading. While the transformational approach can be more complex, it is also more positive and has a longer-term effect on teambuilding and workplace communication than the transactional approach. A leader using a transformational model attempts to adjust the objectives and fuse of their staff in order to accomplish the overall goals of both the employer and the nursing profession itself. Research has demonstrated that the transformational leadership approach contributes greatly to the perception that groups are more effective and that the workers have greater job satisfaction. In fact, the performance and motivation of workers in a transformational leadership environment is demonstrably superior to that of those being led by transactional leaders.
The three Circle model as described by Adair (2002) is a strategic leadership approach in which the three circles in question represent the needs of the team as a whole, the individual and the specific task. While Adair points out that expertise and knowledge in the nursing profession is not sufficient to be a leader, he also recognizes that leadership is not possible without these qualities. Thus, leaders as individuals have to maintain awareness of all of these needs so that they can be smoothly and effectively balanced where the three circles overlap. Each circle must always be considered in regard to how it relates to the other two circles (Adair, 2003). Because the opinions of those doing the work must be taken into account in this model, the three Circle model could be considered at least partially democratic in nature. Certainly, the individuals concerned need to be involved in those aspects of the decision-making process that relate to their specific work.
Professional Socialization
Among the many advantages to supervised learning (mentoring) in a work environment is that it helps to encourage a greater sense of responsibility and motivation, a better understanding of the relationships between nurses and patients and enhanced emotional intelligence (Allan et al, 2008). Certainly, ongoing educational activities and developmental practices do a lot to improve the standard of care in any healthcare situation. An important aspect of this is that it helps to improve socialization in the work environment for new workers and nurses. Nurse leaders who want to be effective in their job will try to create opportunities providing professional and personal self-development for their staff, particularly those who are new to this profession. This is because a new nurses introductory socialization is the time during which he or she develops their understanding about the role they play, their attitudes about their role and their opinions about professionalism in the workplace. Senior nurses can provide role models during this period and can transmit traditional professional values to the next generation of nurses.
Improved Patient Outcomes
The ultimate goal for any healthcare provider should be to provide the best quality patient care possible. Effective nurse leaders can do a lot to make sure this is the case. They can offer encouragement to their staff and help them better appreciate the needs of their patients. In the end, the introduction of such strategies will result in greater satisfaction among the patients, an improved patient/nurse relationship and quicker/easier patient recoveries. Nurses empowered in this way are much more likely to ensure that best practices are observed in patient care. Such nurses are well motivated, committed an understanding of the organizations objectives. This allows them to provide high quality patient care with maximum efficiency
In conclusion, the above essay has examined the vital role that nurse leaders play in developing and nurturing the staff that they help manage. As has been made clear, the leadership model and approach that is used, as well as the behavior and attitudes of the leader, can have an enormous effect on the staff in any health care setting. Senior nurses (were principally the leaders) have to recognize the significance of this role and understand that the nurses there managing depend on them in their efforts to develop their own nursing abilities and professional skills.
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