Posted on December 20, 2017
Mahoney (2001) points out the importance of developing future leaders among nurses. Leadership qualities are often required in nurses’ work, especially when they treat people who work in the top-management sector. According to Curtis, DeVries, and Sheerin (2011), everyone who is responsible for assistance, and everyone who is considered an authority (for example, medics who treat patients) is a leader. Leaders among nurses are involved in development of treatment methods; they improve treatment and provide new approaches (Cook, 2001). Along with this, we consider leadership not a specific skill or a group of skills, but an example of proper behavior (Cook, 2001). Leadership also includes an example of perfect performance. Main goal of every leader is not to just control others, but to organize and plan all actions of other employees, as well as to create all necessary conditions for them to benefit from work (Jooste, 2004).
Many experts defined leadership in different ways, but some features are common for a lot of different definitions. Most authors agree that leadership includes influence; it develops within groups, it depends on a particular goal, and it is present on every level (Faugier & Woolnough, 2002). There are a few different types of leadership. For example, there is an autocratic type of leadership that excludes any participation in decision-making (Curtis, DeVries, and Sheering, 2011). At the same time, bureaucratic type of leadership implies strict adherence to established system of rules and regulations. Another type of leadership allows other employees to search for a best decision, considering different solutions, and making employees participate in planning and in success of the overall work (Fradd, 2004). Another type of leadership is called laissez-faire leadership, and it gives employees almost total freedom in decision-making and goal setting. This type is described by Faugier & Woolnough (2002) as the most risky one. The most flexible type of leadership is situational leadership, where a leader switches among different styles, depending on a situation and a particular goal.
We considered the basis of a leadership theory and common types of leadership. Moiden (2002) states that theory is used to describe reality, while various types of leadership are different ways to implement such a theory. Every organization has to consider different approaches and choose a style that corresponds to particular goals. Choosing a necessary style, an organization must look for a best performance in various conditions. Here the point is to provide highest efficiency in any circumstances (Moiden, 2002). We also have to highlight the key difference between leadership and management. Leaders provide motivation, proper vision, and inspiration, while managers provide control and planning (Faugier & Woolnough, 2002).
Transformational Leadership VS Transactional Leadership
According to Outhwaite (2003), transactional type of leadership requires certain skills which can improve everyday routine and increase its efficiency. The main goal of transformational leadership is to ensure that all members of team cooperate and benefit from innovations. Good leader is able to assess everyone’s potential and interests of any particular employee, sorting tasks and involving members of a team depending on their individual skills. In turn, such an approach helps the leader develop his or her leadership abilities, which creates necessary environment for the further development of their careers. According to Outhwaite (2003), leaders must be able to determine obstacles and possible conflicts, in order to solve any problems at the very beginning. Leader should be close to the team, participating in the process, and staying in touch with all members of the team. When a leader is an important part of the team, he or she serves as an example, and is able to estimate all difficulties, goals, and perspectives. Thus, a real leader must be responsible and qualified.
While the goal of transactional leaders is to provide effective everyday work, transformational leaders must help employees unleash and develop their full potential. This type of leader should create the necessary direction and motivate everyone to focus on necessary tasks. According to Cook (2001), transformational leader must influence others, giving them understanding of most important goals. Faugier & Woolnough (2002) point out the importance of articulating and developing necessary vision among different members of a team. While transactional leaders should provide efficient management, transformational leaders, must be able to increase possibilities of employees, and so provide better conditions for the entire project.
De Geest et al. (2003) describe feature of transformational management on the example of Magnet hospitals. They illustrate how development of leadership positions improved the level of treatment among employees, as well as patients. These hospitals provided a number of innovations, creating the atmosphere of trust, providing highest ethical standards, and estimating all possibilities of development in future (De Geest et al., 2003). Authors note that leadership skills are mostly important today, when directions of health care change all the time, due to technological innovations and increase in demand among patients. Authors state that such a type of leadership provides much higher level of satisfaction among employees, therefore creating necessary motivation and increasing performance. In turn, such changes provide higher level of satisfaction among patients. According to De Geest et al. (2003), leaders have to implement democratic, efficient, and supportive methods, to provide non-stop development, and guarantee benefits for both patients and employees.
Transformational leadership considers interpersonal relations between the leader and other employees, which is why we must mention empowerment (Hyett, 2003). Empowerment gives nurses confidence and will to act efficiently in any circumstances. Implementing a team approach, leaders must be able to create strict boundaries and formulate clear goals. The team must be supported on every stage of the process. At the same time, Welford (2002) notes that a nurse manager must be able to create a balance between the use of power and democratic methods, in order to avoid abuse of power. Hyett (2003) focuses on the atmosphere of trust and respect, defining it as the key feature of transformational leadership.
Clinical Governance VS Shared Governance
Generally, clinical governance is a relatively new approach, which implies the National Health Service’s control over the quality of service, as well as provides new standards of treatment. Moiden (2002) writes about the creation of necessary environment to improve clinical service. Modern standards of UK government imply new types of leadership that are able to support diversity among employees, building a strong community at the same time. Scott and Caress (2005) note that development of leadership approaches is necessary for professional development of staff. Shared governance is one of methods used to realize such a goal (Hyett, 2003). First of all, this method implies empowerment of all staff, making them able to work on common goals and participate in decision making process. Rycroft et al. (2004) call it multi-professional care. Scott and Caress (2005) note that this approach helps to decentralize management, motivating staff to work together, and increasing responsibilities. This method provides much better results than a classical system of hierarchy. It increases motivation and satisfaction of staff, which makes employees want to make significant contribution, using their creativity and improving their most useful skills.
Skills and Knowledge of a Nurse Leader
Obviously, leaders must have necessary knowledge of management. They have to create proper atmosphere within a team, as well as understand necessary details about finances and economics. Mahoney (2001) notes that leaders must also have knowledge of evidence-based outcomes. However, according to Mahoney (2001), this list of skills is not complete, since every nurse leader also must be competent, and creative. Leaders must easily collaborate with other workers and stay up to date about all changes in standards of treatment. Not only have they to be aware of the latest medical trends, but also to implement these standards and make sure that they are applied efficiently. Moiden (2003) notes that leaders must be able to understand needs of staff, creating necessary conditions for work, in order to increase productivity.
Strong leadership is based on three main things, such as influence, authority, and power (Jooste, 2004). Taking into account modern tendencies in management, we can conclude that a leader must use influence more, trying to use less power. A leader must be able to find common ground in every situation, negotiating with staff, motivating and persuading them. Author highlights three necessary methods that help improve communication between workers and a leader, such as instructions, caring relationships, and modelling, which is supporting a point with examples. De Geest et al. (2004) sorts necessary skills, and creates a list of five necessary practices for leaders, including modelling, inspiring, motivating to act in a certain way, challenging, and encouraging. A leader must be able to correctly assess contributions, creating the atmosphere of competition among employees, therefore encouraging them and increasing performance. Mahoney (2001) states that such an approach helps the leader to focus not only on leadership issues, but on the whole team as well.
Practice Settings
Hyett (2003) notes that most health visitors have no necessary mechanisms of self-control, which could help them make decisions and take them out of a self-led environment. In such conditions, nurses don’t initiate changes, since such initiatives don’t find support. As a result, most active nurses lose their confidence and don’t feel able to support their colleagues. Fradd (2004) states that such problems are the most important issue in a context of motivation, noting that the lack of motivation directly affects the quality of medical care. Often managers don’t pay necessary attention to self-esteem of staff, focusing only on a range of medical services, and so increasing dependence, and decreasing motivation. Hyett (2003) states that such conditions may be the reason for workers to leave their job, or even change their line of work. Every time when a nurse leaves a position, an organization faces the need to find new employee, and so spend extra time on training. In turn, it means additional costs on training and recruitment.
According to statistics based on focus groups, most nurses describe leaders as enthusiasts, who can easily show them necessary direction, inspire them, and support them with necessary advice. Rycroft-Malone et al. (2004) claims that nurses don’t want a leader who will speak from the position of power; a real leader must have enough knowledge, and be able to collaborate with others, working on the same goals, managing them, and demonstrating his or her developed skills.
Social Context
Nurse leaders participate in every stage of work, providing effective management. We can see how leadership changed through time, moving towards smart management, and excluding the role of overpowering. According to Jooste (2004), now difference between lower, middle, and top management slowly disappears, because leaders of each level are no more limited in their tasks. Now each leader must be flexible and able to act in unexpected situations. This fact leads to wider responsibilities, and so to new standards of health care.
Large et al. (2005) consider a leadership program of the Royal College of Nursing. This program of political leadership includes several steps. First of all, leaders should be able to estimate the most important issues, creating a proposal for change. They must involve more participants in discussion, talking to both supporters and opponents of each project. Leaders must build communication and deliver effective messages, creating healthy environment for collaboration between different parts of an organization.
Education
Cook (2001) points out the importance of investment in education. We must teach nurses how to be a leader. Cook insists on including leadership into the basic nursing curricula, also noting that such a type of education must be available not only during training, but also during their careers. Such an approach is wide, and we can consider its benefits on the example of evidence evaluation. Nurses must be able to analyze evidences and make decisions based on the strongest evidence. To make it possible, we need to provide nurses with necessary knowledge, as well as to train them. They must be able to adapt to unexpected circumstances, and make decisions fast and effectively. According to Moiden (2002), we must provide nurses with understanding of possible situations, and with necessary knowledge, so they could find solutions for unexpected issues.
To support the use of transformational leadership, NHS created the Leading an Empowered Organization. They hope that such incentives will help nurses develop and realize their authority and responsibility. This program defines the goal as an ability to take risks, solve unexpected problems, and develop autonomy. Along with the Leading an Empowered Organization, another program was created to help nurses discover their leadership qualities. It’s the RCN Clinical Leaders Program (Faugier & Woolnough, 2002).
New Challenges and Opportunities
Jooste (2004) states that health care constantly produces new challenges and changes the environment for nurses. They must be able to react to unexpected events immediately, take the initiative and make important decisions. This all is impossible with the old hierarchic approach to leadership. New approaches make it possible to introduce new methods of motivation, creating necessary conditions for talking, listening, and encouraging. Hyett (2003) describes leadership as an ability to develop new methods and introduce new systems, in order to provide understanding of a desired vision. Now we are saying that everyone can be a leader, since all a future leader needs is a number of certain skills and practices. First of all, nurse leaders must be flexible, confident, and have necessary knowledge (Hyett, 2003).
Empowering Patients
Fradd (2004) states that only those organizations that have good leaders are able to satisfy patients. Most patients assess medical care depending on the nurse’s behavior, so this profession is one of the most important medical professions in the context of individual trust. A patient can be more or less involved in care, and in this case everything depends on the nurse. Many patients understand features of their disease, or at least want to be as informed about it, as possible. Thus, patients must be involved in discussions, getting necessary information about features of their treatment. Patients need to talk to nurses, and nurses have to be able to argue with patients, as well as to reassure them, and give them necessary information in an understandable way. According to Outhwaite (2003), nurses must be able to protect interests of the patient, in case if a doctor places his own opinion above patient’s opinion. According to Welford (2002), transformational leadership is a method that allows followers participate in important process along with a leader. This method also provides a flexible structure of management, which helps both the leader and followers adapt to fast changes. Mahoney (2001) states that getting rid of hierarchical structures, organizations are able to form strong teams, where all experts and professions collaborate, and so increase performance of the entire organization. As a result, both patients and nurses are satisfied, and this result helps add value for customers and for staff as well.
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