It is it essential that nurse as managers possess the qualities of good leadership to effectively manage contemporary clinical nursing teams. Critically analyse this statement with emphasis on the impact good leadership has on the performance of clinical nursing teams and on patient care.
This assignment will critically analyse the qualities that a nurse, as a leader must possess in order to effectively manage a contemporary nursing team. The assignment will focus on several areas and will include that of the role of the nurse as a leader and skills that the nurse requires as a professional practitioner. The assignment will go on to discuss the meaning of Clinical Governance and the components of this with regard to their involvement within the framework. Personal qualities of a nurse leader will be reflected upon throughout the assignment and the relevance in regards to communication, quality and leadership will be analysed. Finally the impact that effective leadership has on the performance of clinical nursing teams and on patient care will be discussed.
The NHS Next Stage Review (DoH 2008) identified and described a future where the National Health Service (NHS) will deliver a high quality service to everyone and in addition this future will afford the staff the opportunity to focus on quality. To ensure that this is achieved, both existing and new staff will be in receipt of primary education and training in order that their current skills are supported and improved and new skills developed. The NHS affirm that their workforce operate on the most effective basis when they are reflecting the needs of the patients. However, we must consider the vast numbers of patients treated within the NHS on a daily basis and the effect these numbers may have on quality patient care (NHS 2012). It is for this reason to ensure that standards are met and upheld that a set of specific requirements have been outlined by the government and these are the benchmark to which nurses’ work. These requirements are relevant both to those within the healthcare setting and to those whom are receiving care from Health and Social Services The government insist that all organisations must therefore have structures in place which are robust and discernible and that assist and facilitate the planning, delivery, monitoring and promotion of the safety of all, as well as the highest quality of patient care. Within the nursing environment we acknowledge this is represented by Clinical Governance (DoH 2010). The Clinical Governance guidelines acknowledge that the healthcare environment is such that this environment will not only be affected by, but also influenced and sensitive to constant change. It is for this reason that the specified requirements reflect the changes as they occur so as not to stifle innovation (DoH 2010).
‘Clinical Governance’ describes the structures, processes and culture needed to ensure that healthcare organisations - and all individuals within them - can assure the quality of the care they provide and are continuously seeking to improve it (DoH 2013a). In effect this is an inclusive title that consist of the functions that will assist in the maintenance and improvement in the standards of the care afforded to patient within all healthcare practices; as each have a duty to the practice within which they work and provide care, to maintain the quality and safety of care (DoH 2010). Regardless of the area of practice there are processes and structures in place that any organisation must adhere to and in doing so the organisation should have the capability to contribute verification that these standards have not only been achieved but also that they are maintained. When we refer to clinical governance we consider six main areas. The main areas are: Patient Focus, Information Focus, Quality Improvement, Staff Focus, Leadership and Public Health (RCN 2010). These themes are both detailed and fixed within the RCN (2010), ‘Principles of Nursing practice’ by a group of stakeholders which included nurses, patients and other service users. These principles have distinct links with the main areas outlined in Clinical Governance. The links can be suggested as follows: When we consider the importance of individualised focused care based on patient need, this can be linked to patient focus, they go on to describe nurses’ pivotal contribution to communication and we can link this to information focus. The principles provide a foundation for the improvement of quality and indicate also how, as a nurse, we contribute to the quality care of our patients. This demonstrates a link to quality improvement. The principles finally stress the importance of the multi-disciplinary approach to working and leadership skills and this represents a distinct link to staff focus and leadership skills (RCN 2010).
The DHSSPS (2006) have indicated that nurses will always be at the heart of patient care and experience, they go on further to indicate that nurses make up the largest group of health professionals within the National Health Service (DHSSPS 2006). As a result it is clear that nurses have a vital role to play in enhancing the patient experience and thus require many skills that will assist them in doing so (Hughes 2008). Among these vital skills ensure those of leadership and management and these skills and qualities remain critical within our health service in order as professionals we not only effectively manage our teams but more importantly improve the quality of patient care. The NHS Leadership Framework and the launch of the NHS Leadership Academy in 2012 have a focus on developing nurses as leaders. This framework assists in incorporating best practice and leadership principles in order to provide “a consistent approach to leadership development for staff in healthcare irrespective of discipline, role or function, and represents the foundation of leadership behaviour throughout the NHS” (NHS Leadership Council, 2011 accessed http://www.leadershipacademy.nhs.uk/discover/leadership-framework/).
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Leadership has been defined by Koontz and Weihrich (2005 p 347) as “the art or process of influencing people so that they will strive willingly and enthusiastically toward the achievement of group goals. This is further supported by Cook (2001) who suggests that leadership is not simply an array of skills and tasks, alternatively it should be an attitude that will inform behaviour, whereas management is a system of action intended, to provide order and consistency to quality care, (Sullivan and Garland 2010). Although leadership and management are closely linked we must recognise that they are not the same. We must consider that there’s undoubtedly a distinction between both, there is also however a correlation between high quality management and leadership (Kerridge and Ryder, 2013). Leaders recognise the need to make improvements or set goals and when this is so the manager will take over the day to day function in order that this is implemented (Murphy 2009). When this is the case this will result in better outcomes such as higher quality care, increased productivity and therefore result in higher Clinical Governance scores and thus fewer patient complaints. Leadership combined with management within nursing should therefore ensure that high success and quality of care is delivered and maintained, Vaughan and Pilmoor (1989) support this with the suggestion that both management and quality are a defined level of competence which is expected to be demonstrated and achieved by all nurses at all times. Contrary to this Sullivan and Decker (2009) outline that the skills required of a good clinical nurse are different to those that are necessary to lead a ward. This is supported further by Mathena (2002) and Acree (2006) when they suggest that nurses often have expanded roles and responsibilities and thus face competing priorities within their work within which they do not have enough support, resources or knowledge.
There is not only an assumption but also an expectation that nurses will lead patient care, if this is so then nurses must be fully appreciative and receptive to what is expected of them (NMC 2010). The meaning of quality in association with the healthcare environment must therefore be considered and this in itself can be complex in this instance as there remain many differing views on this. WHO (2000) define quality as “quality is a process of meeting the needs and expectations of patients and health staff. Understanding the terms management, leadership and quality care assists in providing an essential overview as to what is expected of the nurse and in addition the challenges that the nurse will face when leading a team while delivering and maintaining quality care. The healthcare environment is one that reflects constant change and with changes comes new challenges with which the nurse must work (Jooste, 2004).
According to Bass (1985), there exist two styles of leadership; transactional, which describes the relationship that exists between the leader and the employee as one where the employee will comply in return for reward, and transformational, the focus of which is concerned with more that compliance; in order to achieve greater performance a transformational leader will promote innovative thinking and guide beliefs and develop aspirations. A transformational leader will recognise the importance of organisational change and with skilled communication ensure that change is effectively adopted via a shared vision.
Barr and Dowding (2008) state that “effective leadership is crucial to the delivery of quality care by the NHS, particularly in the current economic climate”, this is stated as resources are stretched and budgets are restricted. On the other hand, the Healthcare Commission in 2009 have suggested that a lack of leadership can also contribute to poor quality and unsafe care. The Francis Report (Francis 2013) indicated this and as a result patients received poor quality care. The Francis Report (2013) continuously outlined that a lack of leadership was a vital factor that contributed to the poor care attributed to some of the wards. Turnbull (2011) outlines that there is a risk in ignoring the responsibility of the individual and goes on to suggest that by doing so, good practice may be destroyed by a single person who feels they do not have the capability to practice leadership or furthermore, who leaves a task undone or ignored as they believed someone else to be in charge. It is for this reason that Turnbull (2011) suggests a more collaborative approach and a less formal model to be implemented, one that will allow leadership to be practiced across all shifts. He goes on to suggest that this model could then be extended to management practices. This supports the point outlined by Baker et al (2012) who suggests that every member of a team of healthcare professionals has some reporting and management functions as part of their role and responsibilities. Baker et al (2012) suggests further that newly promoted nurse managers are rarely given formal training from which they will carry out their new role and often expected to carry out the role without their needs being identified or seen as a priority. It is therefore assumed that those in this role will gain the skills they require when working within the role. In order that this happens, good role model needs to be in place. It could subsequently be said that if on the job learning was effective then a more competent and confident workforce would be in place.
There are a varied amount of qualities a nurse leader requires to lead clinical nursing team to enhance patients care (Oliver 2006). Communication, working within a team, adapting to change and delegation skills are all significant attributes and vital for effective practice and the development of patient care (RCN 2009).
As a nurse communicating with patients about their care is cornerstone when providing good quality care (McEwen and Kraszewski 2010), in addition nurses are at the centre of the communication process, they assess record and report on treatment and care, handle information sensitively and confidentially, deal with complaints effectively, and are conscientious in reporting the things they are concerned about. A descriptive study that had the purpose of evaluating attributes that nurses felt were important in order to be an effective leader was conducted by Feltner et al in 2008. Nurses outlined that communication skills were the most important attribute. The study found that when communication was effective so too was the perception of leadership.
As a nurse leader they have to use clear and accurate means of communication to guide their staff in dealing with complaints, misunderstandings and working as an effective team. When communicating the leader must consider being an active listener and listen to concerns of staff, patients and relatives. When the nurse leader adopts the active listening strategy they can respond appropriately, which will enhance the care of the patient by giving suitable care required. Furthermore the nurse leader must make themselves approachable so their staff and patients can point out concerns and fears they may have; this is when the nurse leader can facilitate any issues. It is known that bad communication between health professionals and patients can have devastating effects. This was evident in the Mid Staffordshire Hospital’s practice, documented in the Francis report (2013) where poor communication between nurses and management resulted in a number of deaths caused by neglect and poor communication; these could have been avoided if concerns were noted and if nurses and other health care workers addressed their own concerns instead of ignoring them.
As nurses lead patients through their care it is vital that a nurse, when communicating with patients avoid the use of medical jargon as patients and families may not fully understand what care or procedure is being given. It is therefore essential for the nurse to effectively communicate with patient in a language in which they understand or to get a member of the medical team to do this. When patients understand the concepts of their care they will be more willing to understand their health problem and be more compliant with their treatment therefore adapt the actions and follow additional instructions (Victorian project council 2006).
The findings indicated in the Francis report outline poor communication from a range of all nursing levels, and it is as a result that it has been suggested that change will be brought about as to the way in which nurses and managers work together and how the nursing care is standardised (DoH 2013b). In order for a nurse leader to adapt to change they have to update their knowledge and training, as nursing is an evidence based profession, which is updated regularly (Hughes 2008). While working in a constantly changing environment the nurse leader has to portray skills to enhance quality of patient care (Mclean, 2011). The priority of any ward managers role is change management, where they are required to lead their team through structural organisation, moving teams, changing roles and working differently, which can mean leading change is not simple, but an essential skill for a nurse manager (Mclean, 2011). Consequently, some team members may not perceive change as a positive experience (Sullivan and Garland, 2010), this is only human nature as people want to visualise a future state and understand what it will be like. If the person cannot balance the benefits this will impact on a busy working environment and jeopardise quality in the care patients will receive. It is therefore the role of the nurse leader to share this vision. Within this vision staff, patients and relatives have to be informed as change can directly influence these situations and bring on resistance to change (McClean, 2011). For this to be successful communication is a key element in order that this is achieved, in addition the nurse leader therefore has to demonstrate this by imparting information and not omitting anything that will surprise their staff or patients, and allow time for discussion when change impacts their care or working environment. This will enhance patients care as they will feel safe and secure and are more knowledgeable in their future care (Stonehouse, 2012). Adapting to change the nurse leader must consider theoretical models to assist them. Lewin's (1951) 3 stage theory is a theoretical model that is frequently used by nurses. The three different stages are freezing, moving and refreezing. Lewis’s theory assists us to work through any process of change. Unfreezing is the stage that recognises that a process needs to change in order to improve and advance the care in an identified area. Moving is the stage where the change actually takes place and re-freezing is the stage where these new changes are incorporated to be a new process within the current practice. As healthcare systems are subject to constant change the ability of leaders to be competent in helping and guiding their teams in order that they progress cannot be emphasised enough. Anderson (2010) is of the opinion that in order to engage staff an effective leader will involve them in effecting and implementing change.
Lord Darzi (2008) said: ‘Leadership is not just about individuals, but teams.’ Teamwork can be related as two or more people working together to achieve the same goal (Williams 2011). Effective nurse leaders have to organise the staff within the team to collaborate and work together. This can be seen as a difficult task and takes commitment within the NHS, as there are a varied personalities, thoughts and values (Makely, 2005). The leader must recognise each individual’s skills within a team whether it be the nursing, medical or the whole multi-disciplinary team (MDT). These skills are fundamental to enhancing patient care, where these unique contributions within the team get the patient treated effectively and appropriately. In order to manage a nursing team professionally the nursing leader should always work with their staff to achieve goals and achievements and not penalise them when these have not been met. Working with staff to complete tasks quickly and to an optimum level rather than criticise when it has not been possible as it results in low staff morale and will not encourage staff to complete tasks to a better standard. An open and encouraging environment promotes self-learning with confidence making for a more knowledgeable and a less stressful place to work in (Doyle, 2008).
It is also important for the leader to know their team when delegating tasks. Delegation is the means by which leaders share tasks with or transfer responsibilities to others in their team but still remain accountable and responsible for the task (NMC2008). When delegating the leader has a duty to consider the patient and make sure it is in the patients’ interest. When nurses are under workload related pressure they must consider delegation within the team. When delegating the nurse must communicate clearly so the delegatee understands the instructions, has relevant training so they are able to carry out the procedure, and are aware of the outcomes to be able to report back to the nurse. This will therefore enhance the quality care to the patient as delegating tasks allows the nurse to develop the skills of others, boosts confidence of the team and frees up the more experienced nurse to attend more complex patient needs (Wheeler, 2007), therefore making delegation an essential task of management to achieve ‘organisational effectiveness’ (Wheeler 2007).
In conclusion the nurse leader has a fundamental role within the health care environment in safeguarding that high quality care is given to patients from nursing teams. This role can be affected by way of positive leadership styles and qualities as well as working knowledge of those in their team alongside a continuous developing skill base where all members of the team are encouraged and supported by way of professional development. It must be recognised the pivotal role team work and effective communication plays in the delivery of a consistent and high quality standard of patient care, all the while considering the negative implications this may have should this process of common practice be ignored as noted within the Francis report. The guidelines outlined within Clinical Governance will continue to assist the nurse leader to adapt to the ever changing healthcare environment while at the same time being innovative regarding this change, thus producing a safe, effective and quality nursing environment.
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