Leadership in Nursing

AND Nursing and Midwifery council were searched for relevant literature. The author also made several visits to the library for books in order to produce this piece of work. During the authors third year of studies, the author had a clinical placement on a medical ward where she observed that nursing staffs did not know the difference between the various types of urinary catheters. The author also noticed that nursing staffs did not observe aseptic technique when emptying catheter bags. When it was time to empty these bags they don’t even put on gloves nor did they wipe the drainage tape before and after emptying the bag s stated by (Johnson.

J, 2002). Warren et al (2008) stated that hand should be decontaminated and a pair of gloves should be worn before manipulating a patients catheter. Nursing staff on the ward just open the catheter bag, empty it and allow the bag to lay on the floor without hanging it on a stand. The National Institute of Clinical Excellence (NICE, 2004) recommend that all indwelling catheter should be connected to a sterile closed urinary drainage system which should be cared for using aseptic technique in order to avoid infection. There was a patient who had difficulty in passing urine; the patient was in a to of pain.

A bladder scan was carried out which revealed that there was fluid retention in the ladder and the doctor then requested the staff nurse on duty to set up a trolley with all the equipment needed for the patients categorization. The author was working with this staff nurse A, as the staff nurse was bringing out the Catheter from the shelf in the treatment room, the author then asked the staff nurse what was the difference between the male and female catheter and what inform her choice of the catheter she have chosen?

Staff nurse A was unable to explain to the author the rationale behind her choice of catheter and owe the use of a wrong catheter might have an effect on the patient. According to Nasals (2010, up 98) choosing a catheter that is of appropriate length, size and material can help to reduce catheter related problems. The author noticed that there was general lack of knowledge amongst nursing staff on the length of stay of catheters in patients, difference between short and long stay catheters. The author also noticed that on the ward that about 5% of patients on the ward were categorized.

Batik et al (2010) states that about 25% of urinary categorization is unnecessary and that inappropriate categorization s an indicator for poor quality care. The moment a patient don’t pass urine in 24 hours, they are immediately categorized. There was this case of a patient becoming sick on the ward due to catheter infection . According to Woodward (2003,up 14) categorization is the insertion of a tiny flexible tube into the body, usually along the tube through which urine passes out into a bag. According to Nonzero ( 2005, up 34) urinary tract infection occurs when bacteria enter urine and cause clinical problems.

Hospital acquired infection cost the NASH about E 150 million pounds a year (Newman et al, 2004). The author also noticed that while on clinical placement on the ward , the ward manager was not doing enough in tackling the issue of improper catheter care. Mullions (2007, up 40) states that having an effective manager who also have great leadership skill help in the effective running of the ward which can lead to better quality of care for patients. According to Heeler et al (2004) a manager is a person who is reactive rather than a person who is proactive to situations.

A good manager look at every small details of things in other to attain efficiency. Morehouse (2010, up 45) also acknowledged that a good manager always ask staff to do things faster, smarter and in a more cost effective way. Yuk (2010, up 27) reckons that good managers stick to rigidly rules and procedure in other to bring about safety and maintain quality. Following this events in clinical practice the author now want to look at how this poor practice of catheter management and knowledge by nursing staff can be changed in clinical practice using leadership and management theories.

The characteristics of a good leader is that a good leader has to be innovative, experienced in the way to do things , proactive, preventing things from going wrong and always thinking ahead (Daffy & Magic, 2009, up 20). Huston, 2009, up. 56) states that a good leader is one who can motivate the team and a good role model to the team. According to Johnston & Madman- Williams (2009, up. 423) a good leader is able to manage their time, so that they can have time for leadership and equal time for management so that there is time for vision and also time to have a proper look at the way the system work.

Limo- Metcalf at al (2007) acknowledge that a good leader is someone who is able to encourage ND enable an organization growth based on integrity, transparency and value for others. Schilling (2009) suggests that leadership does have an effect on organizational performance, either positively or negatively. Larsen et al (2005) stated that in order for leadership and management to be successful leaders and managers have to develop their own unique style of leadership since effective leadership and management in healthcare system are drivers in patient experience..

There is a difference between management and leadership. Managers plan, organize and control, while leaders communicate vision, titivated, inspire and empower in order to create organizational change. Similarly, Maiden (2002, p. 32) stated that there is a difference between theory and style leadership. Leadership theory represents the reality of things, while style of leadership is the various ways one can implement a theory of leadership ?the way in which something is said or done.

Baggier & Woolworth (2002) says that organizations should aim for a leadership style that allows for high levels of work performance, with few disruptions, in a wide variety of situational circumstances, in an efficient manner Leadership style. There are different types of leadership styles. According to Baggier & Woolworth ( 2002) an Autocratic leader is one who set aims , objectives and end goal without engaging or allowing others to be involved in the decision making process. ). Bureaucratic leadership on the other hand occurs when a leader rigidly adheres to rules, regulations, and policies.

Participative or democratic leaders allow staff to participate in decision-making and actively seek out the participation of those involved. This type of leadership allows team members to feel more committed to the oils they were involved with formulating (Baggier & Woolworth, (2002). Laissez fairer leadership leaves employees to their own devices in meeting goals, and is a highly risky form of leadership. Bothersome, Baggier & Woolworth (2002) advocates that situational leadership style is a more effective form of leadership.

This is where the leader switches between the other types of leadership styles depending upon the situation at hand and upon the competence of the followers. In order to reduce catheter infection on the ward a good manager will ensure that correct nursing practice is adhere to on the ward by staff members. A manager can achieve this by employing democratic style of leadership where by the manager calls a meeting of all staff member and discussing with the staff the need to improve the management of patients catheter on the ward and the ways to achieve that.

The manager will then schedule with the agreement of the other staff members educational training for all members of staff. Managers have to ensure that quality care is delivered and facilitated, and that patients and career receive the best possible experience of the service that can be provided while working within guidelines and standards. The manager has the responsibility to ensure that policies and procedures are cascaded to all staff and that staff are trained and supported in following them (Marquis an& Huston, 2009).

Gould (2006) states education is central to infection control and the development of clinical effectiveness. In order to develop a clinically effective service, nurses must first have the skills that will enable them to search for, and identify, evidence. This may involve conducting a literature search or critically appraising the evidence they obtain. As the ward is the best environment to learn about alnico practice, the role of ward-based infection control education is vital.

It is imperative to teach the basic principles of urinary catheter infection control. Another type of leadership style the ward manager could adopt to bring about change on the ward in the correct management and knowledge of urinary catheter by nursing staff is transformational leadership style. A transformational leader has the ability to recognize the importance to take on a challenging situation and make a difference (Baggier & Woolworth, 2009). This leadership style brings about respect ND faith in the employee.

In order for a manager to be a transformational leader, the ward manager need to participate in patient care whenever they can as this brings about respect and trust of staff for the manage. R By being a transformational leader, the ward manager is innovative in problem solving. By being a transformational leader, the ward manager is able share value and ethical principles. The ward manager can do this by arranging a staff meeting where she discusses with employee, the problem on the ward (poor Catheter management) then share with staff the trust policy on catheter management and ways to improve practice on the ward.

De Guest et al. , (2008) states that a transformational leader is able to provide challenging goals. While communicating a vision for the future. According to Awaited (2009) transformational leadership style is positively associated with higher employee satisfaction and better performance. These, in turn, correlate positively with higher patient satisfaction. De Guest et al. , 2008 also acknowledges that transformational leadership style is very well suited to today’s fast-changing health care environment where adaptation is extremely important.

Cook ( 2009, up. 59) states that in order to facilitate change on the ward using transformational style of leadership, the ward manger needs to use action learning, which involves putting staff member into small groups, that meet once in a while to discuss the problems on the ward, sharing different ideas and staff members doing research, studying and feeding back to the group ways to archive better practice. The effects of such leadership will radiate to better outcomes for both nurses and patients.

Hyatt (2003) explains that transformational leadership helps in the building of interpersonal processes which encourages empowerment between the leaders the followers. Empowered nurses are able to believe in their own ability to create adapt to change. Transformational leadership is about team work. The ward managers ability to bring all employee together to work as a team, setting clear boundaries and support for employee make her a good transformational leader. Hyatt, (2003) explains that when using a team approach to leadership, it is important to set boundaries, goals, accountability, and supports for team members.

Welfare (2009, up 97) states that a transformational leadership is seen as empowering, but the nurse manager must balance the use of power in a democratic fashion to avoid the appearance of abuse of power. The ward manager can demonstrate good transformational leadership by setting clear goals and giving feedbacks to employee. According to Robbins et al (2007) motivation is the process of initiating and directing behavior based on the persistence effort to satisfy an individual needs or goals.

Goal setting motivational theory is about setting specific, difficult and goal feedback which lead to higher performance by employee. Work motivation can be increased y having a specific goal. Having a goal specific behavior leads to higher performance. That is, work motivation can be increased with goal specific directed behavior. However, feedback is essential in the achievement of specific and difficult goals because feedback helps identify difference between what they have done and what still need to be done (Robbins et al, 2007, IPPP).

In order to gain the performance benefits of specific goals, feedback helps shape the individuals behavior. Better still, self-generated feedback is a greater motivator as it allows the individual to monitor their progress.. A transformational leader treat employee as individuals by listening to them solving their problems as best as they can . Awaited (2003) cites definitions of transactional and transformational leadership as posited by Bass in 1990. Transactional leadership involves the skills required in the effective day to day running of a team.

However, transformational leadership involves how an integrated team works together and the innovativeness of their approach to the work (Awaited, 2003). For example, a leader can empower team members by allowing individuals to lead certain aspects of a project based on their areas of expertise. This will encourage the development of individual leadership skills. In addition, leaders should explore barriers and identify conflicts when they arise, and then work collaboratively with the team to resolve these (Awaited, 2003).

Furthermore, the leader should remain a part of the team, sharing in the work, thus remaining close to operations and being able to understand the employee’s perspective (Awaited, 2003). Transactional leadership style is about the providing day-to-day care, while transformational leadership is more focused on processes that motivate lowers to One group of authors described the use of transformational leadership by Magnet hospitals (De Guest, Classless, Lingering, & Schubert, 2003). Reform to their full potential by influencing change and providing a sense of direction (Cook, 2001). The ability of a leader to articulate a shared vision is an important aspect of transformational leadership (Baggier & Woolworth, 2002). Transactional leadership is most concerned with managing predictability and order, while transformational leaders recognize the importance of challenging the status quo (Baggier & Woolworth, 2009.

Clinical or Shared Governance Clinical governance is a new way of working in which National Health Service (NASH) organizations are accountable for continuous quality improvement, safeguarding standards of care, and creating an environment for clinical excellence (Maiden, 2002). Requirements of several recent UK government policies require that new forms of leadership better reflecting the diversity of the workforce and the community be developed (Scott & Caress, 2005). Leadership needs to be strengthened and needs to involve all staff in clinical leadership.

Shared governance is one method of allowing for this. This form of leadership empowers all staff for decision making processes, and allows staff to work together to develop multi-professional care (Scott & Caress, 2005). Shared governance is a decentralized style of management in which all team members have responsibility and managers are facilitative, rather than using a hierarchical management style where managers are controlling and staff are not involved in decision-making (Scott & Caress, 2005).

Scott and Caress (2005) contend that this type of leadership will lead to increased morale and bob satisfaction, increased motivation and staff contribution, encouragement of creativity, and increased sense of worth. You can get expert help with your essays right now. Find out more… Knowledge, Attitudes, and Skills of an Effective Nurse Leader A clinical nursing leader is one who is involved in direct patient care and who continuously improves care by influencing others (Cook, 2001 Leadership is not merely a series of skills or tasks; rather, it is an attitude that informs behavior (Cook, 2001).

Several important functions of a nurse leader are: acting as a role model, collaboration to provide optimum care, provision f information and support, providing care based on theory and research, and being an advocate for patients and the health care organization (Mahoney, 2001 In addition, nurse leaders should have knowledge of management, communication, and teamwork skills, as well as some background in health economics, finance, and evidence-based outcomes (Mahoney, 2001 Personal qualities desirable in a nurse leader include competence, confidence, courage, collaboration, and creativity.

Nurse leaders should be aware of the changing environment and make changes proactively. Leaders who show concern for he needs and objectives of staff members and are cognizant of the conditions affecting the work environment will encourage productivity (Maiden, 2003). In doing this, it is important that a philosophy of productivity is established. According to Joist (2004), three things that are essential to leadership are authority, power, and influence. Effective leaders of today should use more influence and less authority and power.

It is more important to be able to motivate, persuade, appreciate, and negotiate than to merely wield power. The author cites three categories of influence for nurse leaders to use in creating a opportune care environment. These include modeling by example, building caring relationships, and mentoring by instruction (Joist, 2004). In addition, Joist lists five practices fundamental to good leadership including inspiring a shared vision, enabling others to act, challenging processes, modeling, and encouraging.

For example, a leader may challenge others to act by recognizing contributions and by fostering collaboration. Recognizing contributions also serves to encourage employees in their work. Team leadership moves the focus away from the leader towards the team as a whole (Joist, 2004). Applications to Practice Settings Hyatt described several barriers to health visitors taking on a leadership role (2003). For example, health visitors usually work in a self-led environment, yet there may be no mechanism for self control or decision-making at the point of service?thus stifling innovation (Hyatt, 2003).

Furthermore, if nurses who do try to initiate change are not supported, they lose confidence and assertiveness and may feel disemboweled and unable to support one another (Hyatt, 2003). Management often focuses on the volume of services provided, leading to loss elf-esteem and dependence?causing workers to become disruptive, or to leave the organization (Hyatt, 2003). Focus group data from a study of implementing change in a nursing home suggests that nurses want a leader with drive, enthusiasm, and credibility?not mere superiority (Rectory-Malone, et al. 2004). Further, focus group members identified qualities desired in a leader facilitating change. This person should have knowledge of the collaborative project, should have status with the team, should be able to manage others, take a positive approach to management, and possess good management skills (Rectory-Malone, t al. , 2004). Applications to the Wider Health and Social Context Nurse leaders function at all levels of nursing from the ward through top nursing management.

Over time, the function of leadership has changed from one of authority and power to one of being powerful without being overpowering Store, 2004). Boundaries between upper, middle, and lower level leaders are becoming blurred, and responsibilities are becoming less static and more flexible in nature. In other words, there is a trend toward decentralization of responsibility and authority from upper to the lower levels of health care delivery Store, 2004).

An ongoing program of political leadership at the Royal College of Nursing describes a multi-step model for political influencing (Thomas, Billing & Settling, 2004). Some steps include: identifying the issue to be changed, turning the issue into a proposal for change, find and speak with supporters and stakeholders to develop a collective voice, identification of desired policy change outcomes, and construction of messages to get the issue across (Thomas et al. , 2004).

Education for Leadership In order for nursing practice to improve, an investment must be made in educating nurses to be effective leaders (Cook, 2001). Cook contends that leadership should be introduced in initial nursing preparation curricula, and mentoring should be available for aspiring nurse leaders (2001). For example, the use of evidence-based practice requires nurses to be able to evaluate evidence and formulate solutions based upon the best available evidence (Cook, 2001).

In order for these things to occur, it is important that nurses have educational preparation for leadership during training to prepare them to have greater understanding and control of events that may occur during work situations Maiden, 2002). The NASH has adopted the Leading an Empowered Organization (LEO) project in order to encourage the use of transformational leadership (Maiden, 2002). By doing so, the goal is to enable professionals to empower themselves and others through responsibility, authority, and accountability.

The program also aims to help professionals develop autonomy, take risks, solve problems, and articulate responsibility (Maiden, 2002). Strategies such as the Leading and Empowered Organization (LEO) programmer and the RCA Clinical Leaders Programmer are designed to produce leaders in nursing who are aware f the benefits of transformational leadership (Baggier & Woolworth, 2002). Challenges and Opportunities to Stimulate Change The health care environment is constantly changing and producing new challenges that the nurse leader must work within (Joist, 2004).

Leadership involves enabling people to produce extraordinary things while being faced with challenge and change (Joist, 2004). While management in the past took a direct, hierarchical approach to leadership, the time has come for a better leadership style that includes encouragement, listening, and facilitating (Hyatt, 2003). Hyatt (2003, p. 31 ) cites Yoder-Wise (1999) as defining leadership as “the ability to create new systems and methods to accomplish a desired vision”.

Today, the belief is that anyone can be a leader?leadership is a learnable set of skills and practices (Hyatt, 2003). All nurses must display leadership skills such as adaptability, self-confidence, and judgment in the provision of health care (Hyatt, 2003). The expectation is that nurses lead care, and that they be able to move between leading and following frequently (Hyatt, 2003). Empowering Patients to Participate in the Decision-Making Process Only when health care revises are well-led will they be well-organized in meeting the needs of patients (Farad, 2004).

Nurses have considerable influence on the patient’s experience as patient involvement in care is most often nurse-led (Farad, 2004). Today, patients are more aware of their own health care needs and better informed about treatments and practice. This requires nurses to be better equipped with analytical and assertiveness skills (Welfare, 2002). Transformational leadership is ideal for today’s nursing practice as it seeks to satisfy needs, and involves both he leader and the follower in meeting needs (Welfare, 2002).