Characteristics and Roles of Nursing Leadership
Leadership means believing in and respecting human dignity. It means listening, inspiring and encouraging, being attentive, and upholding a rewarding culture. It means comprehensive management that constantly focuses on quality. Great nurse leaders, be they upper-level executives, administrative directors, or managers—I consider these roles complementary—instill within their staffs a common vision in which high-quality patient care is key. Nursing leadership should be customer-oriented. Genuine customer orientation means considering patients holistically rather than solely in terms of their illnesses.
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. ne 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. 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. 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. 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 role. 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.
It is clear that leadership is considered to be fundamental to nursing, and that nurses are now expected to act as leaders across a wide variety of settings (Richardson, 2010). If nurses are expected to undertake such roles it is important that they are adequately trained and prepared for this (Sanderson, 2011). Studies have found that many undergraduate nursing courses now view organisation and management to be fundamental parts of autonomous nursing practice, and it is widely part of the curriculum (Richardson, 2010, Sanderson, 2011). However it is unclear what is actually taught, and much of the content appears to be focused on the transition period from student to qualified nurse (Sanderson, 2011). However it seems that current expectations of leadership within the NHS are not suitable to be taught as isolated elements within the curriculum, and should instead be embraced throughout training and beyond (Richardson, 2010, Sanderson, 2011). The development of leadership skills should also be continued through a nurse’s career to continually promote the importance of leadership, and to develop newly-qualified nurses into role models for others (Jackson, 2009). In collective leadership there are both individual and collective levels of accountability and responsibility (Cummings, 2008). There is a strong emphasis on regular reflective practice which has been shown to improve the standard of care given by nurses, and strives to make continuous improvement a habit of all within the organisation (Cummings, 2008, Cummings, 2010). This is in contrast to a command and control style of leadership, which displaces responsibility onto individuals and leads to a culture of fear of failure rather than a desire to improve (Feather, 2009). Leadership comes from both the leaders themselves and from the relationships among them and with other members of staff. Key to leadership is also the idea of followership – that everyone supports each other to deliver high quality care and that the success of the organisation is the responsibility of all (Hutchinson, 2012). It is important to recognise that good leadership does not happen by chance, and that collective leadership is the result of consciously and purposefully identifying the skills and behaviours needed at an individual and organisational level to create the desired culture (Hutchinson, 2012). This is in contrast to more traditional leadership development work, which has focused on developing individual capacity whilst neglecting the need for developing collective capability (Cummings, 208, Cummings, 2010). This style of leadership has been linked to poorer patient outcomes, decreased levels of job satisfaction, and higher levels of staff turnover (Sorensen, 2008). The challenge of recruiting and retaining leaders at all levels must be recognised, as there is need for clinical leadership at every level (Cummings, 2010).
To conclude, effective leadership is a key element in organisational success. Effective leaders along with their team members, work together in order to achieve organisational goals. Leaders develop certain leadership attributes that enable leaders to influence others to follow them. Nursing leadership is an indispensable part of health care system. It plays a vital role in promoting health and delivery of quality client care. Nursing leadership is client oriented as it works for the best interests of their clients. Nurse leaders exercise power to influence clients, their families and other healthcare professionals in order to achieve positive health outcomes. Change is inevitable in health care. New changes can be introduced successfully with the effective use of power. The focus of care remains clients. The nurse leaders should communicate the change with their colleagues and clients and persuade them to allow this change. The nurses are obliged to protect the rights of clients and ensure optimal delivery of health care services. The changes are made to improve the quality of care and client safety.
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The Mid Staffordshire NHS Foundation Trust Public Inquiry (2013) Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry: executive summary. London: Stationery Office (Chair: R Francis).
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Sandstrom, B. (2011). Promoting the implementation of evidence-based practice: a literature review focusing on the role of nursing leadership. Worldviews on Evidence-Based Nursing, 8(4), pp.212-223.
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Swearingen, S. (2009). A journey to leadership: dsigning a nursing leadership development program. The Journal of Continuing Education in Nursing, 40(3), pp.113-114.