Discuss about the Clinical Leadership in Contemporary Nursing.
The paper deals with the role of leader in the work place change. A leader plays a vital role in successful change of the workplace and the organisation. Since leaders have direct authority with people a successful change depends on them. Leaders support people undergoing change to execute the workplace change in their span of influence (Grossman & Valiga, 2016). This is same with the leaders in every organisation. For this paper, role of leader in workplace change is discussed in reference to nursing practice. The role of nurse leaders is equivalent to navigating a perfect storm. The nursing profession strives to build a workplace that demonstrates a culture of safety for care users and their family. Simultaneously, it handles different forms of crisis in the workplace. It also refers to handling workforce issues that involves nursing faculty and nurses. The issues culminates in a situation where the resources, people, the whole system and the organisation seems to have potential threat (Yen et al., 2016).
The metaphor “perfect storm” is appropriate in nursing profession due to depth of challenges faced by the nurse leaders. Neither of the challenges is the quality of the nursing workplace. According to Jackson and Daly, (2010) workplace change is essential because a quality of the work environment is the key to achieve optimal workplace outcomes. This determines the retention of nurses. A healthy workplace in any organisation refers to one where the staff are experiencing the job satisfaction and are contributing towards the organisational goals. The staff in the healthy work environment achieves personal goals and experience fulfilment. However, in healthcare organisation, it was identified ages back that negotiating the workplace is traumatic and complicated experience. Therefore, the health care workforce in a current period can be called as chaotic situation. The status of the healthcare workforce currently indicates further deterioration if serious system reforms are not taken (Yen et al., 2016).
The role of leader in the workplace change comes into play because of the rich literature indicating multifactorial nature of the difficulties faced by the nurses, which sometimes also include inter-professional conflict. The importance on retention of the nursing staff and influencing the job satisfaction, worker wellbeing and staff morale is associated with the workplace difficulties. The leader must play an important role in the workplace change because an unhealthy environment is not only affecting the nurses negatively but is also carrying serious financial implications for the health care organisation. This is also associated with the suboptimal patient outcomes (Huber, 2013). The importance of the role of leader in changing the workplace is the outcome of the question: How can a patient be given a therapeutic environment when the caring staff are simultaneously experiencing the workplace environment as noxious and harmful?
When the literature is convincingly highlighting the adversities in nursing workplace, several researchers contemplate the “role of leaders and leadership”. Different researchers and theorists have constructed this concept in different ways. However, it is generally accepted that the influence of the leader is due to direct authority with people. It occurs as a result of the interconnectedness between people and also includes strong relational and interpersonal aspects (Anonson et al., 2014). As per Mannix et al. (2013) the panacea to the organisational difficulties and poor management which is endemic in many clinical environment is effective clinical leadership. The role of the leaders in changing the workplace is assisted and influenced by many resources. Based on literature review the elements that direct the leaders to promote healthy environment for nurse in the workplace includes setting standards such as authentic leadership, true collaboration, skilled communication, appropriate staffing, decision-making, and meaningful recognition. These elements determine the change in the workplace initiated by the leader (Yoon et al., 2016). The role of leader is to be passionate, dynamic, solution-focused and act as driving force of the organisation. Only leaders with these qualities are admired and regarded as source of inspiration by future nurse leaders (Mannix et al., 2013).
Bamford et al. (2013) recognised that a leader must establish authentic leadership as primary standard to make positive changes in the workplace and foster a healthy work culture. An authentic leader recognises that the follower trust is crucial. Therefore, such leader also acknowledges that authentic leadership is gateway to positive emotions such as optimism and hope which play a vital role in accomplishing the desired leadership outcomes. Banks et al. (2016) describes that the authentic leader is one who have attained high level of authenticity and have realisation of personal beliefs and values. Authentic leader transparently interacts with others while acting upon those values and beliefs. The concept of authentic leadership is compatible with the transformational leadership according to Cheng et al. (2016). It is the personal beliefs and principles that shapes the actions and behaviours of authentic leaders. However, the unanswered question in this aspect is how can a leader initiate a change in the complex environment of healthcare and lead authentically when the they are compelled to act against their personal beliefs and principles. This dilemma is due to healthcare environment that is highly regulated, and is rapidly changing.
The study executed by Lin et al. (2015) suggested that for effective leadership outcomes a nurse leader must adopt transformational leadership. The results of the transactional leadership are short lived and such leader intervenes when something goes wrong in the organisation. On the other hand transformational leadership offers longevity in the relationship between the “senior nurses and junior colleagues.” This leadership has positive effect on the teambuilding and communication. Transformational leaders play a role in shaping goals and values of other staff to benefit the nursing profession and the organisation. As per Lin et al. (2015), transformational leaders are those who provide opportunities to career pathways by mentoring and clinical supervision and access to effective role models. The role of transformational leaders is to involve in intentional succession planning and create work environment that values clinical competence. Transformational leaders strive to promote work environment that is the centre of excellence (Hutchinson & Jackson, 2013).
Jackson and Daly (2010) suggested that the high level and exceptional skills is required in healthcare leadership which is controlled by various external and internal factors of the organisation. Thus in order to meet the demands imposed by the organisational forces carrying risks is important although complicated. Mauno et al. (2016) argued that without resources and support from the organisation it is difficult for the leader to enact their role to initiate change in the turbulent environment of the healthcare. Otherwise, the leaders my feel that they are not supported by the higher authorities in the organization and the followers. To them it appears difficult to sustain essential changes in the workplace. When the stakes are high the leadership is a “risky business” according to Jackson and Daly, (2010). However, a successful leader is aware of this risky business and special skills required to manage the complexities and tensions in nuanced ways. Thus, they emerge successful even in politically charged environment. There is a rich body of literature available bragging about the difficulties faced by the leaders in large organisations and several suggestions on how to avoid failure in changing workplace to gain positive outcomes. Despite the suggestions, several leaders have failed to change the workplace and eliminate issues such as staff retention or burnout and low job satisfaction among nurses.
Effective leaders play a role where they do not distance themselves or stand back from the quality of the work environment (Huber, 2013). Even in the presence of such effective leaders, harmful actions have occurred in several health care organisations. It may be due to ineffective management, turning blind eye to them or blissful ignorance of such adversities. As per the literature, interpersonal skills and relationship is central to nurse leaders. Inspite of which, unhealthy and abusive factors in the workplace remain unaddressed. Frameworks such as NAMC (Nursing and Midwifery Council) and NAMB in Australia and similar other framework proposed by the American Association of Critical Care Nurses (AACN) are existing to promote positive work environment (Jackson & Daly, (2010). However, a “large scale systemic change” remains elusive.
The role of leader is to create a hopeful work environment, as factors such as optimism, positive expectation, and hope are vital to healthy work setting (Mannix et al., 2013). In addition, effective leader require undaunted courage, personal insight, fortitude and strength, as they are responsible for driving necessary change. These skills are required to maintain standards and productivity of the organisation. These skills help to promote the wellbeing of the staff and care users. Jackson and Daly, (2010) suggest that the leaders in the healthcare environment in order to facilitate change must ask certain question while exploring and recognising the complexity. The questions include- “Are we doing enough to prepare the next generation of professional and clinical leaders in nursing in contemporary healthcare systems?” “What are the barriers and facilitators to enacting effective leadership in the workplace?” “Are we producing graduates who are empowered to lead in the workplace?” “How do we facilitate change to help leaders become more progressive and effective?” and so on.
Several researchers have considered these issues. The recent commission of “inquiry into acute care services” in New South Wales recognised the essential role of preparing medical graduates for leadership roles. It have recognised the role of “effective health sector leadership” (Mauno et al., 2016). The role of leaders is to focus on improving the work environment. They must lay greater emphasis on enhancing the working conditions for nurses. The role of leaders is to collaborate with the staff and the managers to address the challenges in the workplace. For example if a workplace has a culture of bullying then the role of leaders is to mitigate such behaviour by developing appropriate interventions. This ensures that the nurse’s leaders are able to recognise the behaviours that led to bullying. This calls for their immediate response when observing such behaviour in the work place. As per the literature, bullying behaviours mostly emanate from the senior levels (Johnson & Rea, 2009). Therefore, in such situations the role of leaders is to reflect on their personal conduct. This may assist the leaders in the development of the personal insights, which will enhance the workplace as suggested by Anonson et al. (2014).
It is also suggested in the plethora of literature that leaders must reflect on the quality of the workplace knowing the existing difficulties faced by the nurses. The leaders must consider innovative ways by which they can contribute to the creation to a toxic and detrimental working environment or a healthy, optimal one. Bamford et al. (2013) argued that it is the role of leader to set standards for the workplace behaviour. It is for the leaders to establish a “civil workplace” where each and every staff will be treated with respect, and dignity. It will be a place where the issues of the nurses and conflicts will be dealt in a healthy and open manner (Jackson & Daly, 2010). Since these are global issues it is imperative for the leaders to “think globally and act locally” to evoke a strategic response suggested Twigg and McCullough (2014). Nurse leaders demonstrating resilience can handle stress due to changing workplace demand. They are capable of thinking strategically, reframe thinking as per situational demand, which enable them to set changes in the workplace that are achievable, and are imperative (Frankel & PGCMS, 2017). Senior nurses according to Arnold and Boggs, (2015) find way of involving in decision-making in the organisation on issues that influence the heath care. These include workforce planning, developing policy, and clinical governance. Therefore, the senior nurses and leaders must develop a constructive process to design workplace that is underpinned by the good patient outcomes.
The role of leader is to enhance workplace change through learning opportunities and using communication kills (Yen et al., 2016). This learning occurs when there is change in the skills, attitudes, behaviour and knowledge of each individual. The rationale behind this workplace learning is to develop staff’s ability to adjust to the changes in the workplace and to the work demands. It means the role of leaders is to be emotionally tuned with the staff and nurture others (Twigg & McCullough, 2014). However, workplace learning is not given much attention due to busy schedule of the caregivers and the chaotic circumstances they handle throughout the day. Hence, the role of leader is to influence positive learning in workplace by means of activities other than formal education. This in turn influences the work performance. The leaders can influence learning in the workplace by facilitating reflective practice as suggested by Yen et al. (2016). By presenting new information to the staff such as reinforcement of standards, new policies and procedures or by presenting audit data one can trigger change in care activities. This will lead to performance change. Leaders with the help of managers should support the new staff by giving supportive learning experiences.
Yen et al., (2016) suggested that the leaders must develop a “hospital-generated generic framework” of skills and competencies that must be adopted by each nurse mangers to the requirement of the workplace. It will help set performance goals for each staff in relation to “generic and unit specific skills”. It will help in monitoring progress towards their accomplishments incrementally over time. Here the strategy is to create managerial obligation for nurse managers to create order and create accountability and predictability. The significance of this system is that it will lead to dynamic process of development by creating open communicating system between the staff and the nurse managers. It will also create open communication between the nurse managers and the nurse leader. Based on the performance feedback the nurse leaders can design and redesign the plans and priorities. Thus, the role of leaders is not only to acknowledge own learning needs but also to engage other persons and model their learning behaviours (Arnold & Boggs, 2015). Learning culture help in orientation of the new staff as well as professional development of the managers at all levels.
The role of leaders in changing the workplace must include innovation in the allocation and the structure of work. In addition, the leaders must ensure that the profession has existence of opportunities for building relationship with significant others. The staff must feel that the efforts will be justified which means the workplace should be changed in a way that will have a presence of “expectance of performance”. These concerns are central to what determines or ensures job satisfaction and staff retention (Mauno et al., 2016). According to Frankel & PGCMS, (2017) considering improvement of skills, allocation of work and mentoring relationship will provide a strong base for team and individual learning. This is essential for creating a culture of safety in the health care workplace. This is also called as strategic leadership. By recognising, the unique set of needs of the nurses as everyone will not perform at the same level, a successful leader will support staff in a way in which they can be useful to the organisation. Hence, the role of leaders is to develop motivational strategies keeping in view that each nurse responds differently to the wok stress and pressure. It will foster the development of confidence among the demotivated staff. Helping the demotivated staff in developing a vision of future, directly effects the staff morale and motivation (Yen et al., 2016).
In reference to mentoring it can be said that the leader plays a role of supporter, teacher, assessor, facilitator supervisor and role model (Hafteinsdottir et al., 2016). Creating confidence and providing supportive environment is central to face the workplace challenges. Since poor performance is not only observed by others and is also felt by the staff members themselves, there is a need of identifying underperformance and devising efficient interventions to ensure patient safety. In such situation, the nurse managers must uptake leadership role in helping the staff in identifying gaps in the professional knowledge in reference to policies and procedures of the hospital. The nurse managers must first show the nurses how to perform the task and provide support to complete their responsibilities. After every shift the senior nurses should invest 30 minutes in mentoring activity and create a log as evidence or documentation of activities taught or coached and future goals (Grossman & Valiga, 2016). This is not a management tool but a mentorship tool. This refers to the role of a democratic leadership (McKeown & Carey, 2015). Staff can only be motivated by the culture of continual learning through best practice methods and support. In this process, the leader provides the new staff with opportunities to take initiative. It will give them the confidence in problem solving or making decisions. The act of role modelling is the traditional expectation of the nurses when learning from the experienced person. Through role modelling the nurse leaders can transmit values, skills, behaviour and attributes to the junior staff. It is important for the new staff to develop professional identity, emotional intelligence and deeper understanding of managing stress. This refers to role of transformational leaders where the nurse leader serve as a model to provide professional socialisation to less experienced one (Hutchinson & Jackson, 2013). In conclusion, employing diverse management strategies will help in collective learning from the practice opportunities, which leads to nurse empowerment. Such empowered nurses will eagerly participate in evidence-based practice and deliver high quality care to the patients.
The paper has discussed the role of nurse leader in changing the workplace to create a skilled and competent staff. Irrespective of the personal leadership style the nurses leader play a vital role in optimising the workplace environment and are challenged to do so. The workplace in health sector is complex. This is a place of healing and caring for the patients and their families. However, for the nurses and the physicians it is a workplace. In order to improve the workplace of the health sector into healthy work environment then the leader must implement a strategic change. Since these are global issues it is imperative for the leaders to “think globally and act locally” to evoke a strategic response. Conclusively, the nurse leader should recognise that their leadership has great impact on the staff. The nurse leaders must acknowledge their role and positively influence the workplace so that juniors are inspired to develop similar professional skills and maintain positive environment.
References
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