Leading And Management Care

Introduction

Quality healthcare is an essential factor in determining how individuals view their quality of life (Gibbs, 2011). Various issues and challenges affect the health care system. These are: patients have long waiting times which reduces the quality of health care provided ; high burden of medical knowledge (Emmerson et al., 2007); the burden of avertible medical errors (Mah'd Alloubani et al., 2014); understaffed health institutions; an aging population which takes up a great fraction of the health budget (NHS, 2013); patients being more in control of the choice of medical staff to attend to them (Doherty & Carino, 2015); demand for high quality medical service at an affordable cost (Gibbs, 2011) among others. With these issues and challenges in the health sector, there is need for an effective clinical leadership in place that is responsible for leading and managing the activities and staff of a health care institution (NHS, 2013). This essay will therefore reflect on leadership in the context of nursing. It will expound on leadership within the National Health Service (NHS) and the potential barriers that could arise. The essay will also include the leadership style preffered by the writer, a SWOT anaylsysis as well as SMART goals to identify strengths and weaknesses of the writer.

Leadership in Nursing

Leadership in nursing is fundamental in ensuring a safe, efficient and cost-effective patient care. Having nurse leaders that demonstrate resillience in the current health care environment is of great importance (WHO, 2020). Therefore, there is a need for the nurses to get leadership education and leadership development programs to be effected in the health institutions to cater for the challenge of lack of time due to high demand for health care services (Clausen et al, 2019). Leadership in nursing is a complex concept which involves processes such as advocating for patients to achieve better health outcomes, coordinating care, planning, providing support and direction, collaboration and effective communication (Xu, 2017). By demonstrating such skills followers are provided with clear guidance on operation of activities. Nurses, as part of an interprofessional team, are expected to take on the role of leadership, especially in the current climate of health care service which is high paced with major technological advance and high Leadership in nursing is a complex concept which involves processes such as advocating for patients to achieve better health outcomes, coordinating care, planning, providing support and direction, collaboration and effective communication (Xu, 2017). By demonstrating such skills followers are provided with clear guidance on operation of activities. Nurses, as part of an interprofessional team, are expected to take on the role of leadership, especially in the current climate of health care service which is high paced with major technological advance and high patient acuity (WHO, 2020). Lastly, studies on nursing leadership suggest that there is a direct correlation between effective leadership and better patient outcomes (Alvinius, 2017, pp. 253). . .

Leaders facilitate the collective objective of an organization or group by influencing others to achieve a common target. It is the lack of good leadership and poor communication that are the leading causes of poor health services (WHO, 2020). A study by Ghiasipour, et al (2017) demonstrated that inadequate leadership causes increase in health care costs, reduces efficiency and effectiveness which in turn leads to poor patient outcome and dissatisfaction among staff. Xu, (2017) studied that there is a correlation between improved patient outcome and mortality and infection rate if staff are treated with respect and compassion. This treatment trickles down to better patient satisfaction, better Care Quality Commission (CQC) performance and lower turnover.

The role of the nurse leader within a multidisciplinary team (MDT) is very crucial because the training of nurses incorporates sciences from various disciplines, the nurse usually works closely with the patient and they understand the condition of the patient, they also work hand in hand with the medical professions and they follow professional instructions and protocols to the letter (Tariman & Szubski, 2015) the nurse leader within a MDT will require extra training for the additional roles in order to be aware of their limitations and abilities. The nurse leader should be represented even in MDT meetings to table the concerns that affect their department involving the care of the patient and collectively brainstorm ways of improving patient care (Taberna et al, 2020)

Leadership Theories

There exist various types of leadership theories, of which the most prominent ones within the healthcare context are: Transformational and Transactional leadership theories (Van Hecke et al., 2019).

The transformational leadership style, when adopted, has shown to boost job satisfaction, decrease absenteeism and increase retention (Swanwick & McKimm, 2017). Transformational leaders are inspiring, thoughtful thinkers and visionary in nature. They inspire a continuous vision and encourage the flow of fresh ideas, and they believe in a leader who practices what they say (Thibault et al., 2019). This leadership styles mentors’ others by considering individual goals and objectives and the organization’s at large (Xu, 2017). Adopting this leadership style by nurse leaders improves the organizational outcomes and impacts positively on the staff engagement. Hutchinson and Jackson (2012) demonstrate transformational leadership style as being a human-capital-enhancing system of management style, whereby followers are inspired to do more whilst performing beyond own expectations. Despite of the strengths, this model of leadership, from literature, has certain theoretical limitations such as manipulation of followers by these leaders, difficulty in the training of the theory and self-gratification done by these leaders (Hutchison and Jackson, 2012).

Transactional leadership style on the other hand is more task oriented and is often intermittent and involves setting short term- goals. In its essence, the transactional style employs a reward system in exchange for completing a task (Swanwick & McKimm, 2017). It enables followers to be motivated with effective communication in relation to goal setting and positive feedback upon successful completion of a task. Nonetheless, criticisms of this approach in nursing can impede on the holistic care of patients if only the motivation surrounds around completion of task (Murray, 2017).

Transformational leadership style is more preferred by the writer as it is the most dominant one in nursing and is considered to be the gold standard of leadership (Swanwick & McKimm, 2017). This style of leadership has shown to be influential on safety culture as well as staff satisfaction therefore leading to improved patient outcome. Similarly, it places emphasis on nurses and nursing whilst creating relations with followers. These leaders also transform into effective mentors and role models, further there are a set of core values in which they adhere to such as integrity (Murray, 2017). Lastly, Transformational leaders are instrumental in identifying common long term- goals, individually as well as collectively. More importantly this type of leaders includes their followers in the responsibilities by taking a democratic approach (Xu, 2017).

Real Life Practice

In practice, the ability to be a good team player was demonstrated when I was looking after 4 patients in a ward. I was requested by another member of the nursing team to complete a dressing change and the nursing notes for an extra patient who was not under my care. This was because that nurse was occupied by the preparation of multiple Intravenous (IV) antibiotics, which was time consuming and impeded on the changing of the wound dressing. I volunteered to help look after that patient. My decision was informed by the core message of transformational leadership in which it emphasized on the importance of common goals of the collective as well as creating relations with team members in a democratic way. Deciding to help enabled the attaining of the common goal of the nursing team, ultimately leading to better patient outcome. The patient would have their wound dressing changed and the nurse could complete the preparation and administration of the IV-antibiotics without any delay.

My weakness was demonstrated when I displayed lack of confidence during handover. I was in charge of the handing over of four patients and got nervous despite knowing what needed to be done and had good knowledge about my patients. This was my first time and I felt like I was thrown in to that too soon. I started the handover and quickly started to forget about important elements and the nurse I was working under had to intervene and took over. A study by Kukulu et al., (2012), showed that there were high levels of low self confidence in beginner nursing students which decreases with each year of study. There is an argument that students struggling with clinical handover has been attributed to lack of simulation and similar educational environment, in which students would gain communication and confidence skills in the early stages. Creating workshops and video sessions, as well as receiving feedback from colleagues has shown to improve such skills (Palese et al. 2019).

Conclusion

An effective leadership style when adopted increases staff morale, reduces health care costs and results in better patient outcome. Even though there are challenges within the health service that can cause adverse effects and impede on staff retention, leadership can be utilized in any different capacities by all members of staff to yield the best results. By recognizing own strengths and weakness one is able to implement necessary action to tackle issues at hand in a SMART format.

Take a deeper dive into Leadership Theory and Practice with our additional resources.

Recommendation

I would have to implement my SMART plan to overcome my weakness. Coupling experience with carrying out clinical handover, the easier it will become. More time in clinical practice will enable me to feel confident enough to handover a group of patients, thus taking that important skill into my career as a newly qualified nurse.

REFERENCES

• Alvinius, A. (2017) Contemporary leadership challenges. Croatia: InTech
• Clausen, C., Purden, M., Emed, J., Sol Bruno, F., and Frunchak, V. (2019) ‘Toward Resilient Nurse leaders: The Leadership-In-Action Program in Nursing (LEAP-IN)’, Nursing Leadership, 32(3). .
• Costello, J. 1994. The role of the nurse in the multidisciplinary team. Reviews in Clinical Gerontology, 4(2), 169-176. doi:10.1017/S0959259800003762 Doherty, D. and Carino, R., 2015. Critical risks facing the healthcare industry. Philadelphia: ACE Group.
• Emmerson, C., Frayne, C. and Goodman, A., 2007. Pressures in UK Healthcare: Challenges for the NHS. London: KKS Printing Ghiasipour, M., Mosadeghrad, A., Arab, M., and Jaafaripooyan, E. (2017) ‘Leadership challenges in health care organizations: The case of Iranian hospitals’, Medical journal of the Islamic republic of Iran (MJIRI) 31(96).
• Gibbs, V., 2011. An investigation into the challenges facing the future provision of continuing professional development for allied health professionals in a changing healthcare environment. Radiography, 17(2), pp.152-157. Henwood, S. (2014) Practical leadership in Nursing and Health care: A multi-professional approach. Taylor and Francis group. .
• Hutchinson, M. and Jackson, D. (2012) ‘Transformational leadership in nursing: towards a more critical interpretation’, Nursing Inquiry 20, pp. 11-22. Kline, R. (2019) ‘Leadership in the NHS’, BMJ. 3. Pp. 129-132
• Kukulu, K., Korukcu, O., Ozdemir, Y., Bezci, A and Calik, C. (2012) ‘Self-confidence, gender and academic achievement of undergraduate nursing students’, Journal of psychiatric and mental health nursing, 20, pp. 330-335. Mah'd Alloubani, A., Almatari, M. and Almukhtar, M.M., 2014. Effects of leadership styles on quality of services in healthcare. European Scientific Journal, 10(18). Murray, C. (2017) ‘Leadership styles in nursing’, Nursing Standard. NHS (2019) The NHS long term plan – a summary. Available at : https://www.longtermplan.nhs.uk/wp-content/uploads/2019/01/the-nhs-long-term-plan-summary.pdf
• Palese, A., Grasetti, L., Destrebecq, A., Mansutti, I., Dimonte, V., Altini, P., Bevilacqua, A., Brungnolli, A., Dal Ponte, A., De Biasio, L., Fasci, A., Grosso, S., Mantovan, F., Margnolli, O., Nicotera, R., Randon, G., Tollini, M., Canzan, F., Saiani, L., Zannini, L., Terzoni, S. and Gonella, S. (2019) ‘Nursing student’s involvement in shit-to-shift handovers: Findings from a national study’, Nursing Education Today. 75 pp. 13-21.
• Swanwick, T. and McKimm, J., 2017. ABC of clinical leadership. John Wiley & Sons. Taberna, M., Moncayo, F.G., Jané-Salas, E., Antonio, M., Arribas, L., Vilajosana, E., Torres, E.P. and Mesía, R., 2020. The multidisciplinary team (MDT) approach and quality of care. Frontiers in Oncology, 10.
• Tariman, J.D. and Szubski, K.L., 2015. The Evolving Role of the Nurse During the Cancer Treatment Decision-Making Process: A Literature Review. Clinical Journal of Oncology Nursing, 19(5).
• Thibault, T., Gulseren, D.B. and Kelloway, E.K., 2019. The benefits of transformational leadership and transformational leadership training on health and safety outcomes. In Increasing Occupational Health and Safety in Workplaces. Edward Elgar Publishing.