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Nursing Leadership
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Table of Contents
Introduction
Leadership as a concept which conjures up a variety of
images, thoughts and actions has been explicitly discussed in literature. Among
various definitions for the term ‘leadership’ that have been defined in
literature, most common expressions suggest that leadership is the art of
influencing beliefs, behaviours, attitudes and feelings of other people in a manner
that they begin to willingly strive towards the achievement of group goals. The
concept of leadership has significantly evolved in its approach over time and
had developed to include aspects of having a vision, developing trust and
empowering others (Sørensen et
al, 2011).
Reflecting on this concept, the main aim of this paper
is to examine leadership, its styles and influences in the healthcare domain
with a specific emphasis on the aged care and disability healthcare sector. The
paper begins with defining the concept of leadership and critically discussing
the evolution of leadership styles from heroic concepts. This is followed by
identification of appropriate leadership theories which might be applied to the
healthcare domain. Diversity in the western healthcare system has been
discussed with specific implications for individual and community decision
making. Lastly, various types of leaderships have been discussed in terms of
their applicability to the domain of aged care and disability healthcare and
practical examples have been presented in order to support arguments.
Leadership
in Healthcare
Although the concept of leadership has been
extensively discussed in management as well as organizational literature,
comparatively less attention has been paid to nursing leadership or leadership
in healthcare. In accordance with available viewpoints, leadership in
healthcare might be defined as a process of developing administrative
competence, clinical expertise, business skills and a thorough understanding of
principles which govern leadership. Nurse educators and executives believe that
the concept of leadership as applicable to nursing is different from general
leadership as it emphasises the influence and improvement of practice
environment. In other words, leadership in the healthcare domain has its roots
in actual clinical practice (Sandstrom et al, 2011).
Common expressions used to describe leadership in healthcare include empowering
others, developing appropriate healthcare knowledge, facilitating learning,
assisting others and working with others to achieve success. Literature on
nursing leadership also suggests that contrary to organizational scenarios
where leader-follower relationships might be clearly defined, every healthcare
professional might be a leader in some context. For example, a staff nurse
might be a leader for patients/clients that she/he is responsible for. Alternately,
a ward manager might be a leader for all healthcare team members (Curtis et al, 2011).
Looking at the historical evolution of leadership, it
might be suggested that the modern day leadership concepts in healthcare and
otherwise have been developed from Galton’s Great Man Theory in the 1990s. The
‘Great Man Theory’ or ‘Heroic Leadership’ advocated that certain individuals
(such as those with a family history of traditional healing) possessed inherent
qualities required to lead others and achieve success. People followed
traditional healers and their practices without questioning them (Cummings et al, 2010). This theory eventually gave rise to ‘Trait Theories’
during the 1920s. These theories attempted to identify traits of leaders and
were based on the belief that leaders would certainly possess some universal
qualities which others don’t. The ‘behavioural approach’ came around much later
and focussed on actual work responsibilities of good leaders as opposed to
their traits and qualities. As leadership approaches further evolved, the
aspect of situation became important. It was fashioned that leaders were
required to alter their style in context of the presenting situation. For
example, a nurse leader might have to be autocratic in order to deal with a
difficult patient. Alternately, participative approach might work better for
others. Refinement of the situational approach led to the development of
contingency approach which focussed on identification of particular situational
variables which might influence leadership styles. The contingency or
transactional approach finally gave way to the transformational approach of
leadership that is best known today (Richardson & Storr, 2010).
Transformation leadership derives its strength from
five different pillars of strength namely living one’s ideals, inspiring motivation,
stimulating others, coaching each individual for development and commanding respect,
trust and faith (Cummings et
al, 2010).
Theories
of Leadership
While any of the leadership approaches as discussed
above might be able to guide nursing professionals in leading, transformational
leadership has been strongly advocated as the most appropriate choice. Transformational
leadership is a process where leaders take actions so as to increase the
awareness of their associates. Transformational leaders strive to provide their
associates with a sense of purpose and take the initiative of building
organizations that are high performing. Transformational leaders live by their
values and ideals and discuss the importance of trust in an organization. They
tend to inspire others by being enthusiastic and optimistic in nature. They
articulate a compelling vision of future possibilities and re-examine critical
assumptions at every step. They seek differing perspectives and encourage
thinking that is non-traditional in nature. They encourage individuals to look
at problems from a variety of perspectives and suggest new ways of problem
solving. Transformational leaders spend time coaching others and helping them
take on leadership responsibilities in the future. They instil pride in others
and reassure others at every step (Brady Germain & Cummings, 2010).
Transformational leadership in the domain of
healthcare has been particularly related with the aspect of having a vision,
building trust, empowering others and sharing a bond with followers. Literature
presents evidence to the fact that transformational leadership in healthcare facilitates
innovative nursing practice and serves to increase quality of care offered by
nursing and other healthcare professionals. Transformational leadership in the
domain of healthcare helps in boosting confidence and capability of the
healthcare staff (Kelly, 2011).
In addition
to transformational leadership, the situational approach might be of particular
importance in healthcare. Fiedler’s Contingency model advocates that no single
leadership style might be labelled as best for a professional and situations
would have a heavy influence on leadership style requirements. In this context,
a healthcare professional faced with difficult patients who do not tend to
listen and stay committed to their treatment plan might have to adopt an
autocratic or dictator type of leadership style to benefit her patients (Vogelsmeier & Scott-Cawiezell, 2011).
On similar lines, the Hersey-Blanchard Model of
Leadership advocates that development levels of subordinates significantly
influence the kind of leadership style that might be adopted. The theory is
specifically based on three aspects namely task behaviour, relationship
behaviour and maturity. Task behaviour refers to the extent to which a leader
might engage in properly defining and spelling out responsibilities to
followers. Relationship behaviour refers to the extent to which a leader might
engage in two way communications and maturity refers to the willingness or
ability of a subordinate to accept responsibility from the leader (Dzau & Gilliss, 2013).
Diversity
in Healthcare
Australia
In Australia, healthcare is provided both by
government as well as private providers. National health policy is administered
by federal ministry for health while specific elements are handled by state
governments. Universal healthcare system in Australia is known as Medicare and
is funded by the Universal Healthcare Scheme. Medicare coexists with private
healthcare service delivery (Smith et al, 2010).
United
States and Canada
Healthcare systems in Unites States and Canada are an
amalgamation of public, private and mixed healthcare systems. Public services
are available through Canada Health Act and are funded by public taxation. They
are governed by a universal administration system and service delivery includes
private professional, private for profit, private non profit and public facilities.
Private services include provision of
dental, vision, and alternate medicine and OTC drugs. These are governed by
private insurance providers and out of pocket payments. Mixed goods and
services include home care, prescription drugs and institutional care. These
services are funded both by public taxation and private insurance providers and
are usually administered by targeted public services (Bakker et al, 2010).
Healthcare system both in Canada as well as in United
States is highly decentralised. Provinces and territories are responsible for
handling their single payer systems for universal medical services. The federal
government however does retain jurisdiction over certain aspects of healthcare (Bakker et al, 2010).
Looking at the above discussion, it might be suggested
that a participative style of leadership is followed in Australia, U.S and
Canada where federal government is responsible for policy making and healthcare
is provided both by private and government providers. This helps in better
empowering the community as well as individuals (Sandstrom et al, 2011).
United
Kingdom
Department of health in UK is responsible for creating
and updating health policy while the delivery of care is the responsibility of
trusts. 10 strategic health authorities in the UK are responsible for
disbursing funds on a regional basis and managing healthcare. These 10 health
authorities are linked with NHS. NHS in the country is divided into primary and
secondary healthcare. Delivering primary care is the responsibility of primary
care trusts and they contract with general practitioners, dentists, surgeons
and opticians. Secondary care is the responsibility of secondary trusts and
they are responsible for ensuring that acute care is delivered in hospitals in
an effective manner. 209 especially dedicated secondary care hospital trusts
oversee care provision in 1600 NHS care centres and hospitals (Mills et al, 2012).
Looking at the above structure, it might be suggested
that the style of healthcare leadership is more autocratic in nature and the
resulting level of individual empowerment is limited (Mills et al, 2012).
Discussion
In the present day context, it might be most
appropriate for nurse leaders to endorse servant leadership style while caring
for the disabled and the elderly. This leadership style would encourage them to
adapt better to change and take control of their own life. The leadership style
focuses on building relationships with others and fostering development of
individual skills. A servant leader would serve to listen, commit to growth of
the others, persuade and organize. Citing a practical example of this form of
leadership, it might be appropriate to cite the case of a 64 year old woman who
was recently diagnosed with diabetes. She had been suffering from arthritis for
the past 10 years and was diagnosed with CHF 5 years ago. Working to transform
her life, the nursing professional counselled her and her husband on aspects
like medication management, administration of insulin, diet management and
physical activity. The goal here was to develop individual abilities to
transform lives (MacPhee et
al, 2012).
Alternately, participative leadership style might have
to be utilised in certain situations. This leadership style involves
collaborating with patients, with other staff members and various sections of
the community in order to figure out the best possible alternatives. An example
might be cited from the manner in which care plans are devised for elderly
individuals admitted to various healthcare settings. Care plans are made by
gathering patient perspectives, support available in the community and
healthcare personnel who would be required to stay in touch with these elderly
individuals (Smith et al,
2010).
In rare cases, the autocratic style of leadership
might have to be utilised by nurse leaders. This might be attributed to the
fact that elderly or disabled persons in some cases might completely refuse to
listen to nurse leaders or comply with their medication requirements. Under
these circumstances, autocratic style of leadership would be most appropriate. This
is especially true with nurse leaders who are employed in the mental healthcare
unit. Complexities of the environment sometimes force nurse leaders to be
autocratic in nature (Sørensen et al, 2011).
Conclusion
Looking at the above discussion, it might be concluded
that leadership in nursing is an amalgamation of developing administrative
competence, clinical expertise, business skills and a thorough understanding of
principles which govern leadership. History of leadership also suggests that
its roots are instilled in the great man theory or heroic leadership. While
leadership development might be mapped with the help of several stages,
transformational leadership is most appropriate in today’s context. However a
mix of transformational, participative and autocratic leadership might have to
be utilised while caring for the elderly and disabled persons.
References
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Brady Germain,
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Cummings, G.
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