“Leadership is a prerequisite for effective management without leadership skills one cannot be an effective manager” Tappen (1985). For the purpose of this assignment the types and characteristics of leadership will be discussed. The author will briefly review the theories of leadership. Particular emphasis will be placed on the difference between transactional and transformational leadership and how it is relevant in modern nursing. The author will also explore why nursing leadership and management is vital in today’s healthcare environment and how changes in healthcare have influenced leadership and management in modern nursing.
Tappen (2001) identifies the difference between management and leadership as follows: There is a close relationship between the concepts of leadership and management. Management is a formal specifically designated position within an organization. Each department and clinical area has a manager who is responsible for the organization of that specific area. Tappen (2001) states “leadership is an unofficially achieved position that may be assumed by more than one person at any one time. Tappen suggests that management is an assigned role, leadership is an attained one”. The literature also acknowledges the concept that all people have untapped leadership potential (Tichy1997).
It is also acknowledged in the literature reviewed and it highlights that that there is confusion regarding the difference between leadership and management (Carney 1999). It is suggested that they are one and the same thing but the management role is task orientated, while the leadership role is team orientated.
None the less both concepts are pivotal in the delivery of health care. Watson (cited by Beech 2002) identifies a useful distinction between management and leadership, using the 7Sframework: managers rely on strategy, structures and systems . Leaders use an approach involving style , staff, skill and shared goals.
To be effective leaders and managers in the nursing profession, nurse professionals must have adequate nursing knowledge, self awareness, the ability to communicate clearly and effectively and the ability to mobilize, empower and be enthusiastic about leadership activities (Tappen 1995). Burns (cited by Marquis and Huston 2000) state that there are two styles of management leaders, relevant to nursing; transactional and transformational leaders. Other styles noted in the literature include autocratic, bureaucratic, democratic, laissez faire, and employee controlled (McAdoo 2003).Theories of leadership include the trait approach, the behavioural approach, contingency leadership and charismatic leaders. The author will now focus on transformational and transactional leadership.
Transformational leadership identified by Tappen (2000) is the ability to motivate others to achieve high standards and long term goals. Transformational leaders have characteristics of being change agents, courteous, believing in people and having the ability to deal with complexity, uncertainty and being life long learners. They have a strong belief in themselves , being aware of personal strengths and weakness and have a strong belief in the success of the organization. They create an empowering culture. Carney (1999) states “the empowered nurse will deliver many benefits to an organization”. Nurse empowerment will ensure that healthcare is planned and delivered in an effective manner. Communication skills, strong values and beliefs and mutual respect are evident in the transformational leader. Transformational leadership is a key factor in optimising team performance in the delivery of quality patient care. The transformational leader provides direction for the team while enabling other team members to act. The need for effective team leadership is documented in the literature. Ovretveit (cited by Beech 2002) argues that team problems are caused by inadequate team leadership rather than any other factors. Transformational leaders are proactive and create visionary organizations. They use skills of problem solving and focus on results. An environment for success and quality is encouraged and the development of key personnel is also encouraged rather than control personnel, respect for staff is also a focus of transformational leaders. They understand that elitist attitudes are unethical and so stunt development of both organizations and personnel (Miller 1996).
The transactional leader does not possess the previously names qualities. The characteristics of a transactional leader include the following principles; the transactional leader is more like the traditional manager, responsible for the day to day management of tasks. They focus on achieving the task at hand and maintaining the status quo. They are in a caretaker role and have no vision for the future and shared values are not identified . The transactional leader expects staff to carry out work in exchange for payment. The transactional manager can positively or negatively influenence organisational structure.
Transactional leadership best describes nursing leadership in the past (Carney1999). In the history of Irish nursing transactional nursing has been predominant (McCarthy 1998). This type of leadership was effective but it impeded the development of nurses in their management role. Lack of nursing leadership at the development of health policy has resulted in inadequate consultation with regard to nursing The health care environment is both complex and dynamic involving a variety of team members from a multidisciplinary background. Leaders are required to ensure that health care is delivered by nurses with effectiveness and efficiency. The quality of the health care delivered in the Irish health care setting is primarily determined by the quality of the nursing services. By having effective and efficient nursing workforce, it will lead to a better quality of health service.
Leaders are key to the delivery of quality care in an organization and need to be valued in their role. Kelley and Joel (1995) note that there are stumbling blocks to the development of the leadership role. This is due to the divisiveness within the profession. Other inhibitors include the lack of cohesiveness within nursing, lack of agreement on professional goals, lack of planned leadership development, and lack of internal support systems. Other issues for nurse leaders include the flattening of organization structures, the stressful nature of the work the nature of nursing practice, shift work and working conditions ( McAdoo 2003).
Healthcare organizations are undergoing enormous changes. Health policies for example “The Health Strategy. Quality and Fairness (2001) and the Commission on Health Funding (1989), The Management Development Strategy (1996) have a major influence on the delivery of health care. Nurse managers and leaders are being affected by these changes. One of the goals of the Health Strategy is high performance. The Management Development Strategy (1996) established the Office of Health Management. It influences the recruitment and selection of nursing personnel and the decentralization of decision making. It promotes individual performance appraisal and leadership and management development. The implications of these have major influence on nursing management resources and the leadership skills required.
In Ireland the national budget for healthcare has risen dramatically since 1997 from 15.3% to 21.4% GDP (Foley and Murtagh 2003). As there is increasing pressure on resources and the need for prioritisation and accountability, the involvement of competent nurse managers is required. 28,000 Nurses are employed in the Irish health service; the largest group of healthcare professionals. McCarthy (1998) purposes that ” leadership in Irish nursing requires an transformational approach.” Professional managers are needed who are knowledgeable, skilful and competent and critical thinkers, to ensure that the changes implemented have a positive impact on the quality of patient care.
Nurse leaders are required to be represented at planning and policy development and strategy planning at national level. This is important when competing in an environment where resources are reduced. As the largest group of healthcare professionals, nurses need to influence the development of health policy. The Commission on Nursing (1998) addresses the changing role of the nurse and introduced significant changes in the management and leadership structures in the healthcare setting. One of the many terms of reference for the Commission was the evolving role of nurses in overall management of nursing services and in the area of professional development.
Recommendations and implementations of the Commission was the development of the Chief Nursing Officer in the Department of Health and Children with support from recruitment of nurses and midwives from the health sector (Department of Health 1998). The development of Nurse Planning Development Units and the development of management and leadership education programmes promotes the development of future leaders and managers in the nursing profession. The establishment of the National Council for Professional Development, as recommended by the Commission On Nursing also focuses on professional and clinical leadership, staff development, resource management and facilitating communication. (Department of Health 1998).
McCarthy (1998) stresses that leadership is one of the most important competencies of nursing management and requires strengthening and development. Resulting from the Commission on Nursing , nurse managers are involved at three levels , executive , middle and first line managers , with specific competencies required for each level. These competencies are outlined by the Office of Health Management (2000)and are as follows: The executive management level provides strategic and clinical leadership, establishes policies systems and structures ; leads on vision, values and process and focuses on the corporate agenda .The middle management role must have a defined management role. The competencies required include an empowering and enabling leadership style, setting and monitoring of performance standards , negotiation skills , a proactive approach to planning, and effective coordination of resources. The first line management competencies include planning and organization , building and leading teams , and leading on clinical practice and service quality. (Office of Health Management 2000)
Autonomy and accountability for decision-making are principle factors in the delivery of healthcare in the current healthcare environment (Carney 1999). In relation to autonomy, as the largest group of healthcare professionals, nurses require a strong voice in terms of influencing health policy and general management issues. Autonomy is also evident in the role of clinical nurse specialist and advanced nurse practitioners and in primary nursing.
A principle theme of the Health Strategy (1994) and (2001) is accountability. Health care professionals will need to work effectively and efficiently in a more accountable culture. This will require nurse leaders and managers to develop new skills and working practices through clinical and shared governance, networking and mentoring. The devolution of decision-making is required so that junior colleagues can solve problems locally and feel confident in their working practices (Department of Health and Children 1996). They need to be reflective practitioners who have skills of critical thinking. Future nurse leaders and managers need to have adequate nursing knowledge, self-awareness, and the ability to communicate effectively. They also require the ability to empower other healthcare personnel. The competence and creativity of managers and leaders at all levels in health care will be fundamental to the effective implementation of the health strategy (Department of Health and Children. 1996).
Shared governance is a system that shares power, control and decision making with the professional nursing staff with a clinical decision making framework. The flattening of organizational structures within the health service means that there is a need to increase job satisfaction by empowering staff without necessarily changing roles. The aim of participating in shared governance is to enhance work performance, job satisfaction, patient satisfaction and improve staff turnover rates within an organization (Halligan 2000).The key principle is the decentralization of power which results in the empowerment of staff in the practice area. Accountability is another key element of shared governance.
Networking as defined by Kelley and Joel (1995) gives visibility to nurses. It provides advice, information and guidance and provides contact with other nursing personnel. It can break down communication barriers within organizations. Mentoring as defined by the Office of health Management (2000) is career management tool used by organizations to nurture and develop staff. Staff mentors provide a useful role in introducing the nurse to the management role. The literature propose that transformational leadership will allow this process of innovation and change (Carney1999)
Considering nurse shortages and the financial difficulties of the health service presently, transformational leadership could be effective in retention and recruitment of nursing personnel. Organizations cannot afford to support non productive employees. No longer will the concept of accidental managers be possible. A transformational leader will develop nursing personnel to achieve their full potential and create a quality health care environment. The literature stress that clinical nurse managers and leaders have a vital role to play in creating the conditions conducive to staff retention (Department of Health 2002).
Leaders influence others by what they say, how they say it and what they do (Miller 1996). The author’s employing authority is proactive in providing a leadership and management programme for all nursing personnel. The L.E.O. Programme (Leading an Empowered Organization) is offered to all nursing personnel. The aim for the nursing personnel is to enable them to create a strong leadership environment and the development of management skills to deal with the changes evident in the current health care environment.
In conclusion, the literature addresses the concept that in the Irish healthcare context nursing is over managed and under led (McCarthy 1998) resulting from the traditional type of education, but leadership is developing through education, shared governance, mentoring and networking. Transformational leaders need to be autonomous, knowledgeable skilful, competent and accountable in their nursing practice. Future nurse leaders and managers need to be able to empower enable and create a vision because of the dynamic changing healthcare environment. Nurses need to be able to achieve order out of chaos (Carney 1999).Accountability and autonomy are major concepts in the role of future nurse leaders and managers. Marquis and Huston note that for managers and leaders to function at their greatest potential the two must be integrated (cited by McAdoo 2003). The integration of leadership skills and the ability to perform management functions is necessary if an individual is to become an effective manager in the current health care environment in Ireland.
The Development of the Health Strategy initiatives and the implementation of the recommendations of the Commission on Nursing (1998) and the Office of Health Management will enhance the development of future nurse leaders and managers in the nursing profession. By adopting a transformational leadership style, nurse managers and leaders will enhance staff morale, improve recruitment and retention and improve the delivery of quality patient care.
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