Leadership is essential to the successful management in the field of nursing. However, nursing leaders and employees have different views on the type of leadership style to be adapted for best results. Owing to the challenges in the nursing leadership, re-evaluation of current managerial tactics is necessary. A nurse leader must master delegation because it constitutes a critical portion of the effective leadership and success in the patient care. Since we live in a multi-cultural nation; good leaders should consider all aspects of a person including cultural diversity. Time management skills, self-efficacy and assertive communication are the other significant qualities of nurse leaders. All the attributes of a nurse leader influence the quality of care provided to the patients.
One of the nursing leadership approaches is transformational style. A transformational leader is the one who employs good and qualitative styles associated with improvement in patient care. This style inspires the others to develop and implement leadership qualities. It comprises charisma, self-confidence, inspiration, intellectual stimulation and individual consideration. The transformational leader motivates the other nurses; he is sensitive to the needs of his subordinates and communicates effectively. This style of leadership increases the staff satisfaction leading to an overall reduction of nurse turnover and an increase in patient satisfaction (Smith, 2011). Though transformational leadership promotes nursing excellence, the difference in the interpretation of the nursing styles between the nurse leader and the staff is often associated with decreased satisfaction with the leadership (Andrews, 2012).
Several studies have been done to establish a relationship between managerial competencies, personal characteristics and leadership style of the nursing leaders. Managerial competencies refer to the ability of the nursing leaders to manage the other nurses well. The managerial competencies of nurse leaders consist of characteristics like visionary leadership, conflict resolution, effective communication, problem solving abilities and teamwork. The issues requiring apt management by nursing leaders include conflict resolution and addressing the laziness of employees. A leader must, therefore, have qualities or competencies that help in problem solving and conflict resolution. A leader who is a great manager is the one who is long-sighted. A leader must be a person who considers the future and not just the present. The leader must know that future healthcare depends on the present health care. Another important attribute of a nurse leader is delegation. Delegation of work by the leaders increases the satisfaction amongst the employees and nurses working under them. All these characteristics and attributes positively correlate with the patient care both in the short- and the long-terms (Lorber & Savic, 2000).
There is no dearth of knowledge regarding the appropriate leadership styles for nursing fields. However, inappropriate leadership styles are used by the nursing leaders in many healthcare set-ups. Therefore, a uniform and unique healthcare model for all institutions must be formed so that the country can properly facilitate the reforms needed in the healthcare system or sector. The country must also facilitate the competency evaluation and consistent monitoring of the leader’s work so that the results can be seen and appreciated. The leaders that do not furnish appropriate results may be denied their leadership roles (Lorber & Savic, 2000).
The definition of leadership is multi-faceted. All sectors in the society, from the business to the financial sector and even the nursing or the healthcare sector require good leadership for greater productivity. According to Giltinane (2013), leadership in the working environment is of utmost significance. Direct involvement of the leadership is advised because leaders motivate the employees to go beyond the call of duty. The leader’s role is to ‘elicit effective performance from others.’ The leader influences and guides others towards positive results and productivity. They empower the employees and, therefore, increase organizational loyalty, job satisfaction and reduce sickness levels. The direct involvement of nursing leaders in the actual work of taking care of patients encourages the other nurses to work and to take care of the patients in a better way. Hence, the nursing leader must have personality traits, emotional intelligence and apt cognitive responses that are able to inspire others to work harder and better in their work stations. Thus, a positive productivity is associated with good leadership styles. Effective leadership also requires trust between the leader and the staff. Therefore, the leader should treat them fairly and acknowledge individual achievements. A good leader shows interest in the working of the staff, listens to their problems and helps them in decision making (Giltinane, 2013).
The leader is a person who can inspire those behind him. This means that the followers should be able to agree with their leader, and the leader should be able to make them see the things the way he sees them. Overall, there should be an agreement between the leader and the followers regarding the goal(s). A respectful leader is the one who inspires the subordinate(s) to achieve the positive and effective results of the laid plans (Boyle & Kochinda, 2004). The registered nurses are trained to use techniques of the goal-oriented path to delegate more effectively to the patient care tasks. Delegation is an entry level skill and is the ability to be able to assign duties well to the respective people. Lack of delegation skills is a potential cause for negative and adverse outcome(s) resulting from ineffective supervision (Boyle & Kochinda, 2004).
A good nursing leader must learn the skill of delegation through educational and practical experience. Thus, a nursing leader can’t live without the delegation power, and every success of a registered nurse will depend on their power to effectively delegate duties well. Delegation has the major role in leadership and has the determination of how the leaders perform their duties. The results in positive or negative outcomes in patients measure the level of delegation in nurses. Therefore, a successful leader is the one who possesses the qualities to delegate duties well to the subordinate staff (Dunham-Taylor, 2000).
Confidence is the value of self-belief that a nurse should possess to be able to delegate patient care tasks. Research shows that demographic variables, registered nurses leadership skills and confidence in delegation are related to the outcomes of patient care in a community teaching hospital. The level of confidence is vital in the process of delegating duties among the registered nurses. The low level of confidence affects the delegation of tasks by the nurses adversely and may result in poor patient outcomes. Therefore, the level of confidence in the nurse leaders directly influences to the productivity in the health centers (Saccomano & Pinto-Zipp, 2011).
In a recent study, it was hypothesized that registered nurses who demonstrated a supportive leadership style will report more confidence in delegating patient care tasks than the ones with either directive or participative styles. The hypothesis failed to hold from the research conducted and thus, the level of confidence was not justified as a measure to alter the delegating process. The level of confidence was then correlated to the delegation of duties by the nurses. In a healthcare setting, some departments help to develop the delegating skills while others do not. Therefore, the skill may or may not develop in the leader. Also, the level of confidence in the nurses will help in increasing the productivity level as they are aware of what they are doing and are not undertaking a trial process. If the nurses undertake their duty with confidence, their productivity levels are bound to increase (Saccomano & Pinto-Zipp, 2011).
The nurses serve the patients with very distinct cultural beliefs. Some of the issues that face the nurses due to such occurrences include the language barrier in cases where the nurse is serving a patient from a different ethnicity or with communication problems. Secondly, there can be the cases of prejudice. They may serve the patients with their belief about the patient or what they think rather than taking keen interest in the problem faced by the patient. Thirdly, they could be ethnocentric. The issue is more problematic where a nurse is serving patients from a country that has different ethnicities, religion and/or cultural beliefs. The nurse may serve in favor of some ethnic groups, religions or communities. In the case, a hospital is not in the position of solving the issue of biasness, the simple acts of favoring one group of patients and not-favoring the other group(s) may settle an institutional trend. This type of trends may lead to the loss of nurses as well as the healthcare organization(s). Therefore, much needs to be done about the issue of cultural competence in nursing students and faculty. Psychological empowerment is considered as the best option to enhance the cultural competence. Nurses should be trained on how to give equal treatment to the patients of different backgrounds. They should have the capacity of understanding that every patient is as important as the others and the services and resources should be allocated equitably and not by bias of issues such as ethnicity, religion or race. A perception is very powerful and can lead to justice in any service. The decisions of nurses should be autonomous with a professional basis in the decision making process. This can be installed by bringing in such study fields in nursing schools as well as seminars in places of work. The nurses should be empowered by the knowledge and not pressure (Dreher, & MacNaughton, 2002; Lipson & Desantis, 2007). A nursing leader has several roles in a culturally diverse healthcare system. In any hospital setting with culturally diverse nursing workforce, the nurse leader should be fair and unbiased towards all the staff members irrespective of their background. Leadership directly affects the staff retention, level of motivation and quality of the care provided. Therefore, a good leader should be able to generate and maintain a diverse workforce for the provision of culturally relevant care.
According to Skim and Miller’s theoretical framework (1999),(I could not find this reference??) there is a given process of achieving a sensitive process of changing the perception of a nurse or healthcare provider. The process involves the steps mentioned below:
• Understanding cultural diversity: Learning different cultural practices from other countries from where the practitioner might get clients.
• Increasing cultural awareness: It involves teaching the nurses to be mild on cultural decisions and not acting in the favor of some patients at the expense of others.
• Minimizing cultural sensitivity by uniting the community: This means that the patients work together with the medical practitioners in improving health standards. They communicate well and try to understand each other.
• Eradicate cultural competence behavior in the individual(s): In cases of cultural differences, the different cultures may be competing on usage of health resources. Nurses are not supposed to be a part of this fight. Therefore, they should remain neutral.
Such a process has the capacity of making a nurse act more professionally and avoiding being biased (Dreher, & MacNaughton, 2002).
In a study conducted in Australia, there was much effect of diversity on medical practices as well as medical practitioners and patients. Biases were noted in the nursing practice, and the patients with chronic diseases were very much affected in terms of the provided healthcare. Therefore, medical professionals need training on how to be of higher importance to such patients. The patients include diabetics, cardiovascular patients and others chronic disease patients. These patients need medical training on how to manage the illnesses and conditions when the medical practitioners are not around. The healthcare of these patients may be adversely affected if they are subjected to bias. Hence, the medical practitioners are needed to ensure a diverse cultural understanding of the community they are dealing with (Pardue & Morgan, 2008).
Another study was done in three different first world countries viz. the USA, Canada, and Switzerland. In all the three countries, the research gave a positive report about the diversifying services in the medical sector. Such diversities included overcoming language barriers. One of the best examples of the study was in the USA, in a clinic where physicians were facing a little challenge with language problems with some of their patients. They were not in a position to communicate perfectly with other patients other than the ENL speakers (ENL- English Native Language). The researchers brought interpreters of other languages and communication flow was improved. The result was evident from the customer satisfaction analysis. It proven that the services were appreciated 140% of the previous level of appreciation, an implication that diversifying cultural practices, such as teaching nurses different languages is of utmost significance to service improvement process in hospitals as well as clinics and also medical practices at homes (Pardue & Morgan, 2008).
Cultural diversity has been discussed as a way of improving the services of nurses and medical practitioners. It is of high importance to consider communication. To get better services, a nurse or any other practitioner must be in a position of understanding the language of the patient quite vividly, implying that the practitioner will be able to know the problem faced by his or her patient. For example, if a French speaking patient who does not communicate in fluent English is assigned to an American nurse, a communication breakdown is expected since most American health workers are trained in English (Flores, 2006).
In order to come up with a better understanding, medical practitioners should have cultural diversities. They should understand several languages and, therefore, be able to serve patients better. There is also a possibility of working with interpreters. It is, however, not only a matter of spoken language; the dumb might also need to be served in a hospital. They communicate using sign language. Interpreters of such signs should be available to ensure communication between the patient and the nurse (Gerrish, Chau, Sobowale & Briks, 2004).
Patients and medical practitioners need to work together interactively. Hence, there should be a clear understanding of communication from both sides. The nurses need psychological preparations that are of importance to them during the process of providing medical services to patients. Language barrier and other issues due to culture should be dealt with; they are a barrier to communication as well as efficient medical services. Patients with chronic diseases need attention and well stated instructions, since in the absence of doctors and medical practitioners they are supposed to nurse themselves. The process of treating them, therefore, needs to be communicated well to them, to avoid misunderstanding due to cultural differences including the language barrier (Flores, 2006).
References
Andrews, D. R. (2012). The influence of staff nurse perception of leadership style on satisfaction with leadership: A cross-sectional survey of pediatric nurses. International Journal of Nursing Studies, 49(28), 1103-1111.
Boyle, D. K., & Kochinda, C. (2004). Enhancing collaborative communication of nurse and physician leadership in two intensive care units. Journal of Nursing Administration, 34(2), 60-70.
Dunham-Taylor, J. (2000). Nurse executive transformational leadership found in participative organizations. Journal of Nursing Administration, 30(5), 241-250.
Dreher, M., & MacNaughton, N. (2002). Cultural competence in nursing: Foundation or fallacy? Nursing Outlook, 50(5), 181-186.
Flores, G. (2006). Language barriers to healthcare in the United States. The New England Journal of Medicine, 355(3), 229-231.
Gerrish, K., Chau, R., Sobowale, A. & Briks, E. (2004). Bridging the language barrier: the use of interpreters in primary care nursing. Health and Social Care in the Community, 12(5), 407-413.
Giltinane, C. L. (2013). Leadership styles and theories. Art and Science, 27(41), 35-39.
Lipson, J, G. & Desantis, L. A. (2007). Current approaches to integrating elements of cultural competence in nursing education. Journal of Trans-cultural Nursing, 18(1), 10S-20S.
Lorber, M., & Savic, B. S. (2000). Perceptions of managerial competencies, Styles and characteristics among professionals in nursing. Public Health, 52(198), 199-204.
Pardue, K. T., & Morgan, P. (2008). Millennials considered: A new generation, new approaches, and implications for nursing education. Nursing Education Perspectives, 29(2), 74-79.
Saccomano, S. J., & Pinto-Zipp, G. (2011). Registered nurse leadership style and confidence in delegation. Journal of Nursing Management, 19, 522-533.
Smith, M. A. (2011). Are you a transformational leader? Nursing Management, 42(9), 44-50.
