Moral Leadership in Healthcare Environment

With today’s complex and multifaceted healthcare, leadership style is paramount in the wellbeing of an organization.  The type of leadership style can impact the overall organizational outcomes, such as staff retention and the quality of patient care (Sfantu et al., 2017).  Moral leadership, for instance, is one style that every leader should possess.  Studies have shown that moral leadership leads to healthy working environments, improve job satisfaction, increase employee work engagement, and organizational commitment (Engelbrecht & Heine, 2017; Prottas, 2013).

Moral Leadership

According to Spector (2017), the core aspect of moral leadership is “shaping the moral judgment of followers on what is, in fact, good and bad, right and wrong” (p. 2).  Messinger (2013) contends that leaders with moral leadership style have high moral values and principles.  They follow organizational values, policies, and ethical guidelines.  They consistently display high moral standards and instill ethical behaviors in their followers.  They serve as role models to their followers and provide a sense of meaning and purpose in their followers; inspire them to achieve their best potentials; and encourage creativity and innovation (Gu, Tang, & Jiang, 2015; Vinkhuyzen & Karlsson-Vinkhuyzen, 2014). 

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Moral leaders possess several qualities that are conducive to the success of an organization.  One quality that moral leaders have is moral competence, which is the ability to consistently act according to their values and principle and help them to determine behaviors and decision that are right and ethical (Kiel, 2015; T.Y. Kim & Kim, 2013).  Moral competence has four components:  Integrity, compassion, responsibility, and forgiveness.  Having integrity means that moral leaders act according to their values, principles, and beliefs; tell the truth; stand up for their beliefs; and keep promises, meaning their actions are congruent with their words.  These leaders are honest, ethical, fair, and trustworthy.  When leaders act according to their moral values and principles, followers are likely to respect, believe, and trust their leaders (Kiel, 2015; Kim, et al., 2013).  Moral leaders also have compassion.  They care about others, attend to other needs, and support others’ choices (Kim, et al., 2013).  They demonstrate respect for all people and treat them with dignity and show concerns for their followers (Hutchinson, Jackson, Daly, & Usher, 2015).  Moral leaders have a sense of responsibility.  They are responsible or accountable for the choices they make; they admit to their own mistakes; and they feel obligated to serve others.  Finally, moral leaders possess the moral competence of forgiveness.  They are able to accept their own mistakes as well as others.  They are capable of learning and improving from their mistakes (Kim et al., 2013).  Kim et al. (2013) found that leaders with moral competence improved employees’ job performance.  Similarly, Kiel (2015) found in his study that leaders with moral principles, such as integrity, responsibility, compassion, and forgiveness, deliver better financial results.         

Hutchinson et al. (2015) contend that moral leaders have the capability to exercise emotional self-awareness.  They are able to understand and regulate their own emotions when facing challenging situations.  Therefore, their emotions would not interfere with decision-making.  They are able to make decisions based on reason and good judgment (Hutchinson et al., 2015). 

Vinkhuyzen and Karlsson-Vinkhuyzen (2014) illustrate that moral leaders have the capability of self-evaluation, meaning that they can evaluate their own strengths and weaknesses.  They also have the ability to develop better interpersonal relationships.  They openly communicate with their followers, open to new ideas, encourage others’ inputs, and involve them in decision making.  They inspire and motivate their followers to reach their best potentials (Vinkhuyzen et al., 2014).  In addition, moral leaders are unselfish and not motivated by personal gain.  They forgo personal gain to benefit the collective and welfare of the organization.  The leaders’ selfless acts in turn foster employee’s trust in their leaders.  Thus, they work collectively to adhere to that the values of the leaders which align with that of the organization (Schuh, Zhang, & Tian, 2013).  They are also visionary.  They articulate a clear vision for the future and inspire and motivate the followers to achieve that goal.  Finally, moral leaders care for the welfare of mankind and society (Vinkhuyzen et al., 2014).  They believe in fairness, justice, and individual rights (Caldwell, 2016; Messinger, 2013).  Their goal is to serve society for the common good and inspire followers to work towards a better society (Caldwell, 2016; Vinkhuyzen et al., 2014). 

 Out of these qualities, integrity is one quality that every leader should possess.  Integrity is one of the core values in nursing practice.  A leader with integrity promotes an ethical organizational culture (Ridge, 2015).  A leader who has integrity is honest, sincere, and trustworthy.  This leader consistently behaves according to high moral values and principles.  He or she will stand up for he or she believes in.  This leader also tells the truth and openly communicate with their followers.  He or she respects his or her followers by listening and accepting their opinions.  As a result, followers reciprocate respect, trust, and loyal to their leader (Engelbreacht & Heine, 2017; Martin et al., 2013).  A leader who is honest and trustworthy promotes a healthy working relationship with his or her followers (Engelbreacht & Heine, 2017).    Engelbreacht and Heine (2017) found that leaders with a high level of integrity improve work engagement.  Employees with a high level of work engagement are more satisfied, enjoy their work, and are more involved in their work (Engelbreacht & Heine, 2017).  Similarly, Prottas (2013) illustrates a positive relationship between the manager’s behavior integrity and job satisfaction and organizational commitment.  A manager who exhibits low behavior integrity had a negative effect on job satisfaction and organizational outcomes.  Therefore, it is paramount for leaders to have a high level of integrity in order to foster a positive work environment.  

A Moral Leader at Current Work Environment

 At my current hospital, the Emergency Department is very a stressful and chaotic environment.  The nurse to patient ratio is one to thirteen.  The place is extremely crowded in which the admitted patients have no admitted beds.  Patients are staying in the hallway.  This causes an unsafe environment for staffs and patients.  Nurses are stressed out; have low morale; and not satisfied where they work.  Therefore, many nursing staffs started to call out and left the department.  The nursing turnover rate is extremely high.  Nurses have voiced their concerns in the past, however, nursing leadership did not make any changes.  Because of the stressful environment, I had two different managers and nursing directors for the past three years.  They did not make any changes; the Emergency Department remains to be an unsafe and stressful environment.

Last year, the hospital hired a new nursing director for the Emergency Department.  She possesses the qualities of a moral leader, such as integrity, trustworthy, compassion, and understanding (Kim et al., 2013; Messinger, 2013).  She acts according to her principles and values.  She tells the truth and communicates honestly and openly with her staff.  She listens and accepts her staff members’ inputs.  For example, on the day when she introduced herself to the department, she held a meeting; voiced her concerns and the changes she would make for the Emergency Department.  She respected everyone, listened, and accepted her staff members’ different viewpoints on how to improve the department.  She planned to create a healthy working environment for both staff members and patients.  She stated that treating patients like our family members and providing safe and optimal care to patients is our mission.  The nursing director instills her staffs with a sense of purpose and meaning.  She stands up on what she believes in.  Her actions are consistent with her words.  Unlike other nursing directors who introduced themselves and seldom stopped by the department, this nursing director is different.  She puts effort into her work.  I notice that she always comes before her shift starts and consistently staying late at work.  She is always in the Emergency Department.  She notices how busy her nursing staffs are, she will help out by answering call bells, walking the patients to the bathroom, putting IVs in, and transferring the patients to other departments.  She is very compassionate about her job and patient care.  She sets an example of what an effective and a moral leader should be.  She emphasizes the importance of teamwork. 

The nursing director understands the needs and concerns of her staff members.  In order to decompress the number of patients in the Emergency Department, the nursing director created a department where the admitted patients can stay while waiting for the admitted beds.  She hired more nurses to reduce the patient load.  She holds daily huddles on every shift to address any concerns.  She checks on her staffs regularly.  For instance, she asked me how I’m doing and any concerns and needs that I could address to improve the department.  The nursing director appreciates the staff’s hard work by treating them with lunch, ice cream, and pizza parties.  Staff notices how the nursing director is making a difference.  She promotes a positive and healthy atmosphere for her staff.  Nurses have less patient load, instead of having thirteen patients, they now have seven to eight patients.  Nurses appreciate the nursing director for listening to their needs and concerns and transforming the Emergency Department into a better working environment.  As a result, they respect and trust her.  The nursing director’s actions have improved nurse morale, job satisfaction, and nurse retention.

The nursing director is exemplary of what a moral leader should stand for.  She leads her department and staff members with integrity, respect, understanding, responsibility, and compassion.  She has transformed the Emergency Department into a positive and healthy working environment.

Initiative at Current Work Environment

In healthcare, it is important for nurse leadership to foster a healthy working environment.  Moral leaders who attend to their staffs’ needs and concerns.  They respect all people regardless of their cultural backgrounds.  Their qualities can induce a positive organizational culture.  Nurse leaders should uphold the moral and ethical standards of behavior in the working environment.  They should encourage employees to report any unethical behaviors that might jeopardize patient’s care.  Furthermore, leaders should promote a safe working environment for their staffs.  They should stop workplace violence against staff (Ridge, 2015).  

Workplace violence against staff is prevalent in the emergency department (Stene, Larson, Levy, & Dohlman, 2015).  This often happens in my Emergency Department.  The stressful, overcrowding, and long wait times have prompted violence against staff.  For example, a nurse lost her child while she was working because the patient got angry and kicked the nurses’ abdomen.  The nurse was devastated and quit her job.  This causes a dangerous working environment.  Another instance, a frustrated and angry patient held a knife to a nurse’ throat.  Fortunately, the security guards got hold of the patient and the nurse was safe.  Staff voiced their concerns to their nursing director.  The nursing director listened to their concerns and feared for her staff safety during the huddle.  I remembered what she said.  She stated that our goal is to promote a safe and optimal care to patients, however, when our own safety is threatened, it would impede our work productivity and quality of patient care.  She feels responsible for the safety of her staff members.  She initiated a new plan to safeguard the well-being of her staff.  She implemented a plan by installing a metal detector, having police officers, security guards at the entrance and exit of the Emergency Department.  Visitors and staff who enter and exit the Emergency Department have to go through the metal detector, their bags and belongings have to be checked by the police officers to ensure safety.  With this new implementation, staff members feel safe.  The nursing director also initiated a safety committee for nurses who are interested in improving a safe work environment.  This includes how to stop workplace bullying among coworkers and workplace violence against staff from patients, visitors, and families.  Many nurses join the committee because they are interested in promoting a healthy work environment.  They respect and trust the nursing director.  Her actions are always consistent with her words.  Having a moral leader at my current practice promote a healthy working environment, where nurse satisfaction and retention increased. 

Nursing managers, administrators, and other nursing leaders should implement moral leadership style in leading the multifaceted health care organizations.  Organizations place a great emphasis on developing an ethical culture.  It is important for these moral leaders to possess the qualities of integrity, responsibility, compassion, and forgiveness to positively impact the success of an organizations by promoting a healthy work environment and improving organizational outcomes, such as job satisfaction and staff retention (Engelbrecht & Heine, 2017; Prottas, 2013, Sfantu et al., 2017).  Education and training programs should be initiated in the healthcare organizations to teach these leaders the importance of moral leadership.  In addition, further research can be conducted on how moral leadership impacts nurse satisfaction and work outcome.

References

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Engelbrecht, A.S., & Heine, G. (2017). Integrity, ethical leadership, trust, and work engagement. Leadership & Organization Development Journal, 38(3), 368-379. doi:10.1108/LODJ-11-2015-0237

Gu, Q., Tang, T.L.P., & Jiang, W. (2015). Does moral leadership enhance employee creativity? Employee identification with leader and leader-member exchange (LMX) in the Chinese context. Journal of Business Ethics, 126, 513-529. doi:10.1007/s10551-013-1967-9

Hutchinson, M., Jackson, D., Daly, J., & Usher, K. (2015). Distilling the antecedents and enabling dynamics of leader moral courage: A framework to guide action. Issues in Mental Health Nursing, 36(5), 326-335. doi:10.3109/01612840.2015.1017627

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Martin, G.S., Keating, M.A., Resick, C.J., Szabo, E., Kwan, H.K., & Peng C. (2013). The meaning of leader integrity: A comparative study across Anglo, Asian, and Germanic cultures. The Leadership Quarterly, 24(3), 445-461. Retrieved from https://doi.org/10. 1016/ j.leaqua.2013.02.004

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Prottas, D.J. (2013). Relationships among employee perception of their manager’s behavioral integrity, moral distress, and employee attitudes and well-being. Journal of Business Ethics, 113(1), 51-60. doi:10.1007/s10551-012-1280-z

Ridge, R.A. (2015). Putting the I in the integrity. Nursing Management, 46(4), 52-54. doi: 10.1097/01.NUMA.0000462381.26593.91

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Sfantou, D.F., Laliotis, A., Patelarou, A.E., Sifaki-Pistolla, D., Matalliotakis, M., & Patelarou, E. (2017). Importance of leadership style towards quality of care measures in healthcare settings: A systematic review. Healthcare, 5(4), 1-17. doi:10.3390/healthcare5040073

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Vinkhuyzen, O.M., & Karlsson-Vinkhuyzen, S. I. (2014).  The role of moral leadership for sustainable production and consumption. Journal of Cleaner Production, 63, 102-113. Retrieved from https://doi.org/10.1016/j.jclepro.2013.06.045