Implications of Change in Healthcare Delivery System on nurse leadership
Technology drives most of the healthcare delivery system and the changing technology has resulted in the transforming face of modern healthcare system. The practice of nursing becomes quite dynamic when seen in purview of the technological advancements and their implications (Melnyk et al., 2012). For example, genetics and genomic field has encountered a substantial change as large number of diseases, risk factors, therapies and treatments have genomic elements which are influenced by lifestyle and environmental factors, thus having a greater impact on nursing practice. This compels the nurse leaders know more about genomic and genetics to effectually teach and counsel patients on this matter. This has enabled the nurses to achieve the competency to learn about patients, their family history, their environment, drug reactions and risk factors (Melnyk et al., 2012).
Use of less invasive and far more accurate diagnostic and treatment tools result in lowering of the patient risk and overall cost and enhancing the patient care. This has led the nurses to have more knowledge and understanding of minimally invasive tools and increase their competency level so as to deliver the best to the patients. Electronic Health Records (EHR) and CPOE or Computerized Physician Order Entry are fast growing technologies that that have a significant impact of nursing leadership (Hamric et al., 2013) . Such technological advancements pose heavy challenges for the nurse leaders as nurses are required to capture appropriate information electronically, that too without any certified degree or much extensive training. It is a part of clinical work flows and hence nurses have to work on their levels of readiness to use EHR system (Hamric et al., 2013).
One of the most important leadership skills to be acquired by the nurses is the ability to use technology that is responsible for facilitating nurse-patient relationships, interactions, communications and operational processes (Hamric et al., 2013). Nurses today are becoming an expert in information management so that they know the best way of knowledge acquisition and distribution.
Characteristics, roles, and responsibilities of Leaders and Managers
The two somewhat interchangeable terms ‘leader’ and ‘manager’ are not same. Not every nurse manage is a good nurse leader and people having good nurse leadership may fall short of being an effective nurse manager (Piccolo and Coloquitt, 2006). Nurse manager is an assigned role and is actually a position in the hierarchy of an organization. Nurse manager has decision making authority and can control specific processes. They are expected to carry our specific set of duties that come under their KRAs. A nurse leader, on the other hand, may not be a recognized authority and may not have any position in the organizational hierarchy, yet a nurse leader will possess the power by virtue of his or her capability to influence others, by means of effective interpersonal and communication skills (Piccolo and Coloquitt, 2006). A nurse can exhibit role of a leader at any stage of his practice or career. A nurse leader works productively in her unit and enthusiastically carry out the works and processes towards achieving the unit’s goals. Nurse leader works with every member of the unit cohesively. Let us learn more about their roles and responsibilities (Piccolo and Coloquitt, 2006):
A clinical nurse leader or CNL gets prepared as a generalist at master’s degree level whereas nurse managers (NM) are prepared at BSN or higher level.
CNL works as clinical generalist who manages and provides health care to patients, families and communities. NM provides operational and administrative services to a particular unit or group of units.
CNL manages and coordinates client care for lesser number of patient units or groups while NM does the same for entire unit of patients.
CNL is a health professional who manages specialized patient cohorts, assesses and modifies plan of care, if needed, is responsible for patient and his family’s education, performs comprehensive assessment of patient upon first contact and is responsible for health outcomes of specialized patient cohorts. NM identifies and maintains staff requirements, update core competencies, control budget, develop team skills and expertise, evaluates the quality of nursing practice, plans for training nurses and supply physical structures to treat patients (Hamric et al., 2013).
Ethical Considerations for CNL and NM
Ethical dilemmas faced by the nurse leaders include almost everything, right from having a voice about shortage of staff and how it is impacting the quality of health care to birth complications, birth control, abortion, teen pregnancy, organ transplant and end of life issues. Nurses spend more time with the patients so they know the needs and wants of the patients and their families. They are the ones who understand that the patient and the family are not happy with the treatment, but they cannot opt out of the treatment. Nurse leaders are closely associated experientially so it puts them in the thick of things. Their own values conflict with those of the patients or the physicians sometimes.
Nurse Managers too face ethical dilemmas when it comes to carrying out their roles and responsibilities (Hamric et al., 2013). Ethical problems facing nurse managers include issues associated with patient care, team and staff and the organization, among which issues related to patient care is of primary concern. Employee relations is another concern for the NM. There is always an ethical conflict between the administrative and professional roles of nurse manager where their professional role focuses on providing the best quality health care to patients whereas their administrative role emphasizes on providing economically effective services to patients (Piccolo and Coloquitt, 2006).
Both CNL and NM take care of the nurses in moral distress, particularly in acute health care settings.
Importance of Transformational Leadership and its relationship to IOM
Transformational leadership happens when the leaders get involved with their team members towards achieving mutual goals. Their work purposes become fused. Such kind of the leadership elevates or inspires the followers and thus has a transforming effect on both the leader and followers (Nielsen et al., 2009). Transformational leadership is important for a health care setting as it leads to future-oriented work place, an open minded team which is committed to planning and a dynamic work environment full of least number of conflicts.
A transformational leader creates a learning organization where appropriate acquisition and management of knowledge makes one of the important attributes of high performance, dynamic organization. The leader is skilled in creation, acquisition and communication of knowledge and modifying the behaviour of the followers to reflect the new learning. Transformational leadership aims at continuous organizational learning that plays a critical role in the growth and development of security and safety in a health care organization. According to the report Crossing the Quality Chasm: A New Health System for the 21st Century by IOM, a substantial growth in acquisition and proper management of knowledge in a health care organization is one of the four characteristics of high quality health care facility, having the other three as medical devices, drugs and technologies (Nielsen et al., 2009). This is possible only through transformational leadership.
Errors in Transformational Leadership
The following errors may occur in transformational leadership (Bass and Riggio, 2006):
1. The enthusiastic leader may keep unrealistic timelines for the team to change or get adapted to change or sanction unrealistic budgets for the work. To avert this, the leader must practically think about each and every follower and his/her work conditions and the skills he/she possesses.
2. Communication issues is another error that may result in failure of transformational leadership. When the leader fails to communicate regularly with the followers, they start thinking that they are no longer needed or important and hence become less serious about work. To avoid this, leader should give continuous feedback to the followers to keep them enthusiastic.
3. Followers resist change, even if they have their favourite leaders. The nurse leader must properly communicate the vision and objectives and make them realize that it is important for them too, to achieve those objectives (Hutchinson and Jackson, 2013).
4. Adapting to change may jeopardize the interests of patients. Many times matching up to the technological advancements has led the nurse followers ignore the actual interests of the patient.
5. Transformational leaders should be proactive and not hyperactive. Sometimes, the nurse manager reacts too quickly to some change, without thinking the repercussions. The leader must make robust plan even if he/she needs to decide quickly (Hutchinson and Jackson, 2013).
Competencies
The two competencies are communication and relationship management and professionalism. Both the competencies are important for a nurse manager or nurse leader in a health care setting. Communication and relationship management is needed to communicate concisely with the internal (nurses and staff) and external people (patients, families, external stakeholders) and have a long lasting relationships with them. Professionalism is important in nursing as this helps in aligning and keeping parallel the ethical and professional standards including patient and community responsibility.
References
Bass, B. M., & Riggio, R. E. (2006). Transformational leadership. Psychology Press.
Hamric, A. B., Hanson, C. M., Tracy, M. F., & O'Grady, E. T. (2013). Advanced practice nursing: An integrative approach. Elsevier Health Sciences.
Hutchinson, M., & Jackson, D. (2013). Transformational leadership in nursing: towards a more critical interpretation. Nursing Inquiry, 20(1), 11-22.
Melnyk, B. M., Fineout-Overholt, E., Gallagher-Ford, L., & Kaplan, L. (2012). The state of evidence-based practice in US nurses: Critical implications for nurse leaders and educators. Journal of Nursing Administration, 42(9), 410-417.
Nielsen, K., Yarker, J., Randall, R., & Munir, F. (2009). The mediating effects of team and self-efficacy on the relationship between transformational leadership, and job satisfaction and psychological well-being in healthcare professionals: A cross-sectional questionnaire survey. International journal of nursing studies, 46(9), 1236-1244.
Piccolo, R. F., & Colquitt, J. A. (2006). Transformational leadership and job behaviors: The mediating role of core job characteristics. Academy of Management journal, 49(2), 327-340.
