Leadership and Management in Nursing Practice

Currently, we have 40 doctors and 700 supportive staffs. These groups of people from various multidisciplinary with different tasks of specializations in their fields, collaboratively working together as a team in order to achieve goals, objectives, vision and mission of the hospital. * This hospital offers clinical services such as laboratory, radiology, accident and emergency department, rehabilitation, pharmacy, dietician, hospital information managements (medical records).

Besides that, we have supports services such as human resources, finance, housekeeping, business development, food beverage, security and wards including intensive care unit ICC), operating theatre (TO) and hemophilia’s unit. 2. Contents: (a) Organizational structure: * Organizational structure is about the lines of authority, communication, and delegation. It can be formal or informal (Stickler 2007) * For example, decentralized nursing departments of my hospital had strong nursing representation in the organizational structure in order to provide quality nursing care.

The director of nursing in my hospital served at the executive level of the organization and reported to the executives officer (Ruder and Monarch 2002) * The modern organization theory said that an organization is an integrated yester with integrated parts (Clan, 2007). Organizational structure is not one of the best due to the complexity and changing circumstances. It supposed to help coordinate resources to achieve organizational goals. The organization hospital needed to be adaptive, creative and robust to solve the any challenges in healthcare. Handy (1985) introduced “role culture” category of organizational cultures could be applied to the organizational culture of health care. It is about distinct policies and procedures that control the organization, and employees operate based on job descriptions. Each job description defines one’s main duties and responsibilities as well as specific educational qualifications and experience needed for advancement to each position. * The bureaucratic nature of this organizational structure leads to feelings of powerlessness, particularly at the lower levels.

This may explain why nurse managers employ intimidation to control employees. (b) Leadership and management in nursing * Difference between leadership and management is ‘Vision”. According to him management consists of primary analysis, problem solving and planning while as adhering consists of vision, values and communication (Warren 2005) * Different between management and leadership is vision stated by Warren (2005). He said that management consists of primary analysis, problem solving and planning, while leadership is about vision, values and communications. Leadership is a process of identifying a goal or target, motivating people and giving support and motivation to reach mutually negotiated goals (Davidson et al, 2006). * Dry Carter’s views had been echoed by Sir Bruce Gogh, the medical director of the NASH in England stated that in order to carry out their tasks, all doctors should roved leadership to the healthcare team to ensure patient safety. * Effective and successful leadership from all staff in the hospital organization is important to the delivery of high quality health care to clients. Excellent leadership concerns, not one very senior position, but people working collectively across a healthcare system and across organizational boundaries. * The style of the manager can also be very important for employees’ acceptance of change and this will result to motivating them to achieve a high quality of care (Bass and Viola, 1994). * Connection between nurse manager’s attitudes towards the existing organizational culture and the leadership model adopted. This is often done intentionally because they want to make a sense of job dissatisfaction among professionals (Loincloth et al, 2000). Kane-Arroba (2006) noted that trustworthiness is a result of character and competence, trust is the actual act of believing in someone and having confidence in them. Level of trust in organization can foretell its success because it is important element connected to employee performance and organizational commitment. Trust in nursing leadership is needed ingredient for all staff nurses o give out their best in their duties. * Landholding et al (2000) revealed that there is a connection between nurse managers’ attitudes towards the existing organizational culture and the leadership model adopted.

The nurse managers who had a clear leadership style that was related mainly to a transformational or transactional leadership model experienced fewer management problems than nurse managers with composite leadership style. However, in cases where the leadership style is unclear, there is a strong perception that nurse managers’ style of leadership is one which enforces hostility and “lordship” style. This style of leadership has seemed to create a sense of job dissatisfaction among professionals. * The employees’ dissatisfaction is a major cause for the staff turnover.

The incidence of high staff turnover is not good as it normally has negative financial implications on the agency concerned (Kane-Arroba 2006). * Nursing is a people-oriented profession which emphasizes on humanism and this probably influences leadership style (Seller et al, 2006). * The style of the manager managing his organization can be an important factor to influence the employees’ willingness to accept change which leads to titivated them to achieve a high quality of care (Bass and Viola, 1994). Nursing leadership is the key to maintaining the essence of nursing in organizational culture where the nursing leader is not just a manager but also a leader of evidence-base care (Bonds, 2003). * The key competence was identified as leadership behavior and specific items in the analysis were transformational leadership, visioning and perseverance. * There are many ways of transforming an employee for increased productivity, but insulting and shouting will certainly not transform an employee positively.

It will only decrease their morale, commitments and trust in the leader * The result of the competency study conducted by Coble and Russell (2003) seemed not to portray nursing leaders as transformational in nature. This result also indicates that there are many ways of transforming an employee for increased productivity. But it is for sure that insulting and shouting will not transform an employee positively. In fact it will only decrease their morale, commitments and trust in their leaders. * Many types of leadership style: Autocratic, democratic, lassie-fairer, transactional and transformational leadership.

The authoritarian leaders always maintain strong control over people in the group with complete ignored the needs and feelings of group members. These types of leaders give orders and expect group members to obey these orders. * Autocratic leadership is commonly use by my team leader during emergency situation in hemophilia’s unit which he gives clear instructions and the group members need to follow his ordered so that patient’s life could be save. * Democratic leadership is use for a group of people who will work together for an extended time, when interpersonal relationships can substantially affect the org of the group. For example, recently my manager purchase new humidification’s (HAD) machine from other company. We never have HAD machine before in my unit in which we only use common hemophilia’s machine. So, my manager demonstrated how to use the HAD machine to all the dialysis staff and explained the advantages of that machine to staff and also patients. He giving chance to dialysis staff and also patients to give feedback about the machine so that he could make final decision to purchase another HAD machine. Transformational leadership concerns not only with compliant behavior room employees, but it also concerns with getting greater performance through the art of stimulating innovative ways of thinking and at the same time transforming the followers’ beliefs and aspirations. Transformational leaders can see the importance of organizational change as they have vision and they can adapt themselves to that vision to support the changes required by the organization (Bass 1985) – Carney (2006) said that leaders need to articulate a vision which can motivate workers to adapt to changing environment. Literature no 7} * Leaders must concise the culture of their organizations and to be able to develop an environment that is healthy and conducive change. {Literature 7} * CEO of my hospital use transformational leadership where he wants to transform the hospital to be the best hospital in Borneo. In order to do so, he tried to ensure that my hospital achieve the Joint Commission International (ICC) reorganization. He called up all the staff in the hospital for meeting in which he spoke clearly about his vision, mission, goal and objective on targeting to get this standard. He shared his accountability, responsibility and power and empowers employees to achieve organizational goals. His leadership style had improved organizational commitment, higher job satisfaction, reduced stress, greater productivity in patient’s safety and greater empowerment (Cummings et al, 2010). * Conflict between nurses and doctors always happen in clinical area. Accommodation style is commonly use to prevent this conflict occur. Accommodation is one way for individuals to move away from the uncomfortable feelings of struggle that conflict inevitably produces.

For example of accommodation situation where was one of the patient complained of fever t home but not having fever in dialysis unit with body temperature 37. Ca. So, a nurse informed the doctor about patient status in which patient has right permeated to use for dialysis. The dialysis nurse suggest to have the blood culture from the right permeated to diagnosed what type of microorganism in patient body so that proper antibiotic medication can be prescribed. But the doctor refused the nurse to do so. He only prescribed paramedical MGM 2 tab stats but did not prescribed any antibiotic for that patient.

After only brief discussion of their differences, the nurse has to accept what the doctor decided o do in order to maintain a friendly nurse -physician relationship and in order to prevent further conflict. * Leadership skills are required in nursing because the nurses are responsible for leading and managing the care environment and so they need to exercise leadership during their interactions with patients and their families and colleagues (Heeler et a’, 2004) * Leadership has a positive impact on employee satisfaction and patient care (Paterson et al, 2010). Knowledgeable and skilled nurse leaders are required within healthcare organizations (Coble and Russell, 2003; Huston, 2008). The organizations should have a life-long learning programmer for their nurses so that the new nurses could have the opportunity to learn a much- needed knowledge and skills in leadership while as the more experienced nurses could continuously do the up-dating of their knowledge on nurse leadership and skills. Another initiative which also could be used to develop leaders and to improve leadership is through providing a warm, safe and supportive organizational culture and working environment.

Seabrook and Breton (2002) agreed with these views and they indicated that leadership and organizational ultra were the main contributing cause for the increased nurse turnover. * Provide a warm, safe and supportive organizational culture and work environment can help to develop leaders and improve leadership. Leadership and organizational culture were the main factors to increased nurse turnover. * Ritter(2011) also shared the above view and he concluded that a healthy work environment has a positive effect on nurse retention. The goal of any healthcare organization should be geared towards influencing the quality of patient care as a result of having good nursing leadership. Keen et l (2001) was in full agreement with this concept as they also stated that the hospital practice environment has a significant effect on patient outcomes. This concept is therefore emphasizing the need to promote greater nursing expertise through increased staff ability and a new level of competence. This also implies that junior nurses should be given the opportunities to acquire and maintain high quality nursing standards. The results of the study conducted by Amok NAS Au-Young (2002) showed that organizational climate and supportive leadership were correlated with empowerment among nursing staff. Consistent with this view, Patrick and Lashings (2006), also pointed out that healthcare organizations which provide professional development opportunities for staff and at the same time giving them rewards for good efforts and contributions will contribute to a supportive and empowering environment. Empowerment is another strategy which could be used to develop potential leaders. In nursing, delegation of tasks and projects to staff is a form of empowerment. This would provide opportunities for learning, sharing ideas and working collectively (Curtis and Redmond, 2009). It is difficult to develop empowerment in working environment because there are few barriers that could prevent its success. However, if the managers could identify and eliminate these barriers then the strategies could be implemented through empowerment process. Healthcare organizations that provide professional development opportunities for staff and reward their efforts and contributions with positive feedback will help to support and empower work environment (Patrick and Lashings, 2006). * Curtis and Redmond (2009) also mentioned about delegating tasks and project to staff gives the chance for learning, sharing ideas and working electively. * Mentoring is a strategy to develop leaders and leadership said Galilean (2003). This strategy normally uses a more senior, experienced and specialized nurses as mentors for the junior nurses. Marquis and Huston (2009) pointed out that the mentors played a significant role acclimating nurses to management roles. * Connors et al (2000) added that mentoring could give positive outcome on professional development of staff. The goal of any healthcare organization should be geared towards influencing the quality of patient care is actually as a result of having good nursing leadership. Keen et al (2001) was in full agreement with this concept as they also stated that the hospital practice environment has a significant effect on patient outcomes.

This concept is therefore emphasizing the need to promote greater nursing expertise through increased staff ability and a new level of competence. This also implies that junior nurses should be given the opportunities to acquire and maintain high quality nursing standards.. (c) Recommendations: * Human resource management is the process of acquiring and retaining the process of acquiring and retaining the organization’s human resource. A further study is also recommended to describe the level job satisfaction experienced by staff nurses and its relationship to quality of health care. Effective leadership training should be instituted for prospective nurse managers before appointments are made to management and administrative positions. This means that higher learning institutions in the country, such as public and private universities, should develop curriculums and programmed to train professional nursing administrators. * Factors such as trained leaders and administrators, interest and revisionism’s should be considered in appointing nurse managers instead of traditional long service in conflict management for staff nurses and nurse managers is needed. Organization should either to develop in-house programmed to meet the needs of nursing leaders or send nurses to externally facilitated programs. This program could give them much needed knowledge and skills in leadership for those nurses who do not have any appropriate leadership or management qualifications. Besides that, they can provide on-going education and updates for those nursing leaders who already have a leadership or management qualification. D) Conclusion: * Leadership is an important component of nursing practice in the many aspects of nurses’ role because nurses are responsible for leading and managing the care environment and must exercise leadership during interactions with patients and their families and college. * Staff nurses preferred more proactive, articulate, and independent leaders who will “fight” the interest of nursing. * The nurse managers needed to go beyond just being managers to becoming transformational leaders aimed at propelling their staff to provide quality , evidence- based practice.