Nursing Leadership: Issues involved in the Healthcare System
Every nurse does play vital, essential role in leadership domains being found in the healthcare system as there can be about effective integration towards leadership ways found within the nursing care structures. The need to recognize leadership issue, a challenge that links towards shifting work hours and how patient safety is affected by certain leadership situations found in nursing care. The need to assume SMART objectives ideal for the scenario to better handle nursing leadership issues as the nurse face attempts in understanding theories and policies put in context analysis as well as discussion. The need for nurses and other care providers to understand ways of nursing leadership and avoid issues that hamper leadership effectiveness of the nurse in actual patient care. The need to present and analyze theories that provide support of leadership formation and assessment as HK hospital nurses will have to assume effective leadership roles and responsibilities despite adverse events that are effect of shifting hours incurring overtime hours at work deemed for patient safety and care forming in adequate leadership empowerment and motivation substance giving leadership influence and success of patient care into nursing professionalism.
The topic is about nursing leadership, issues involved in the healthcare system that are being evident at the Hong Kong Hospital, the leadership report will utilize scenario based integration of a particular nurse leadership behavior she have thus, looking into the leadership style and appropriate theories applicable for the type of leadership the nurse possesses as a part of the Hong Kong Hospital team. The particular nursing leadership issue will be focusing towards the presence, discussion as well as recognition as to how this particular nurse can be a successful leader in providing effective patient care upon ensuring patient safety, looking how authoritarian leadership by Nurse Connie will affect ward B nurses in terms of leadership formation. The topic is important into the nursing care team, initializing awareness that effective patient care is to be given by the nurses at all times despite such issues in work hours hindering on leadership skills that is crucial for achieving success into the patient safety. Proper nursing leadership stance implies ideal and rightfully driven nurses effective in their performance reflecting night shifts position that could be daunting in nature.
Nurse Connie is a nurse officer at the Hong Kong Hospital, the area she belongs is in the hospital medical ward B for more than 20 years now. In terms of leadership, nurse Connie is very experienced and hard working person, and wanted to do all the things in the best way but nurse Connie is perfectionist and has a rigid type of personality which can’t be normal at all into the care environment. Thus, nurse Connie likes the ward to always tidy and clean keeping it organized at all times and she behaves tough and is a strong willed nurse for example, she does not care about the hospital ward situation like for instance, when two patients admit at the same time, she asks still the nurse on duty to tidy up the ward and do the bed making despite lack of nurses on duty in the ward, only four nurses and manages forty patients under their responsibility area. Thus, nurse Connie likes that, all nurses in ward B follow her instructions such as the changing of the wound dressing only after doctor’s round, and if the patient request before the situation, nurse Connie just instruct the nurse to follow her instruction, since, nurse Connie thinks it is the best way for the doctor to see the wound condition and does not care about the patients feelings which is not right in terms of giving care to patients and respect is crucial in healthcare. Aside, nurse Connie is reluctant to accept and embrace change and she does not want to hear any other nurse opinion for the matter. Then, nurse Connie want all the nurse in ward B to work over time, because she believes that working over time would represent that nurses are hard working, and dedicated to the job and also, she does not want the nurses to smile or laugh in ward B because she assumes that every nurse should be solemn in realizing their work and roles.
The context will bring about the adopted leadership style of a particular nurse leader, assessing and giving possible ideas on how the nurse can change her leadership behavior towards patients and nurses in ward B, her area of responsibility at Hong Kong Hospital. The leadership issues of being too strict and organized nurse and does not give other nurses rewards sue to the fact that she does not care for the feelings of the person and wanted the idea of over time work where in fact, nursing profession is one tiring work and rest plays a factor for leadership and patient care effectiveness, looking into a resolution of leadership issue through acquiring of certain aspect of transformational leadership. As it can be that, overtime in nurses have been escalated and the HK hospital may possibly cope to a shortage of nurses as little is known of the prevalence, the effects on patient respect and valuing care. Thus, one study have presented that, such logbooks completed by nurses reveal that nurses have worked longer than scheduled of an approximate ratio of forty percent of the overtime hours (Sherman, 2005). Indeed, leadership context have shown that nurses will not report errors because they have fears of being warned and be put into nursing disciplinary action by the nurse leaders, the nurses’ working overtime does fail to give ideal patient care, and that leadership errors will occur due to work overload and the precise leadership analysis are linked in such theory and to its policy manner.
If I were nurse Connie, I would have to integrate and apply in me ample leadership change as well as transformation in order for me to be fair and unbiased to patients and to my co nurses. Allowing my personality to adopt and properly constitute successful leadership stature for me to assume effective hospital care milieu and allowing my desired work role in ward B for me to be flexible, understanding and supportive to the needs and feelings of patients and have respect to the initiative abilities of the nurses on duty in ward B, having a work synergy that works positively into the care area and the assumption perceiving better leadership roles of myself as a nurse leader. Then, creating in valuable conditions for leadership style effectiveness, and provide awareness of Kanter's theory (Upenieks, 2002) of such organization behavior recognizing that leadership effectiveness does have the ample access to opportunity also resources and leadership power in ward B, as the work setting. Thus, nurse Connie will have access to structure of her leadership behavior as it needs to be empowered and successfully driven which help her achieve an enhanced worth and nursing care achievement. It can be true that, nurse Connie are being charged with creating healthcare domain that provides quality care having creative and cost oriented ways.
Indeed, Nurse Connie will have to be a charismatic as well as transformational nurse officer in ward B, as she needs to expose right avenue for her intellectual stimulation and justifiable care consideration in order for her to positively empower nurses and for the enhancement of patient needs as well as care reality. HK hospital nurses that develop and foster transformational leadership in the presence of nurse Connie will be prevailing old traditions and she will be confidently navigate complex changing hospital care setting. There implies that, some nurses do occupy important position in the nursing unit upon having concerns on the leadership style, as created into initiating structure of nursing practice. Also, indicating that social leadership contribute positively to nurses' reactions to their leadership. Then, from the analysis of nurse Connie leadership style, there appear that she as a nurse, is satisfied if ward B nurses can pay great attention to effective dimensions of leadership ways and clear that nurses with good need for autonomy will prefer another leadership behavior from nurses with enough need for work autonomy and stance. Thus, several nurses were transformational leaders since, they achieved better staff satisfaction and higher work group effectiveness allowing assumption on Bass' (1992), transformational leadership model with Hagberg's (2002) power stage theory respectively. The nurse usage of transformational leadership fairly achieve satisfied nurse level as effectively manifested. The transformational qualities of nurse Connie can be enhanced by means of achieving high leadership stage and by being with more participative health care organizations. In today's health care environment, nurses require leadership skills that provide direction for fresh generation of nurses.
The strength of nurse Connie is her well organized and systematic handling of situations at ward B, she is good in keeping things in order all the time and has knowledge in her field of service while, nurse Connie is weak in terms of having acceptable leadership behavior and quality due to authoritarian trait that she posses and how she communicates to people is a failure due to the fact nurse Connie is not sympathetic to the needs and emotions of patients and nurses at ward B and does not want to be corrected and set goals without freedom of thinking and opinion, nurse Connie believes that overtime is hard work because she also works overtime and does not have the ability to handle stress and develop positive leadership for herself to acquire growth in her area of responsibility and lacks awareness as well as proper nurse mentoring skills. For opportunities, there has to be appropriate leadership as ideal for nurse Connie must be behavioral in nature and for her to be people and relationship oriented. Nurse Connie should promote and facilitate effective process of leadership and to assume teamwork for nurses under her leadership and for her to provide the necessary attitude into the healthcare domain. Thus, several situational factor as well as nursing model can play an opportunity for nurse Connie from within good nursing leadership assume motivational factors have played significant role when nurses enters into the nursing leadership as there has to be serious attention for nurse Connie to develop competent leadership, nurse leaders who are strong in their areas can go beyond merely influencing patient safety as the nurse's central role, nurse Connie have the ideal position to create and drive the patient safety. For a possible threat there is, it can be leadership change failure on the part of nurse Connie for it can hinder effective leadership, challenge for health professionals to enable improvement in the ward care practices (Manojlovich, 2005; Marisa and Anthony, 2001), and enter herself into conflicts with the other ward nurses (Hendel et al., 2005).
However, nurse Connie may require leadership skills beyond what they have at present since it is not known if the future leadership needs of nursing will be met with the transformational model. There provides development and encouragement of her leadership assimilation. The path analysis are to be used to develop structural model of nurse Connie leadership influence in ward B upon having consideration behavior of such inverted effect on ward B nurses and effective performance as nurse Connie’s initiating leadership behavior will be having a positive effect on other nurses if she herself will change accordingly.
Furthermore, the behavior of nurse Connie do affect the satisfaction of overtime nurses in ward B as some factors that might contribute to research approach do include the lack of supervisory presence at night, the changes in work environment at night, increased job responsibility on the night shift as well as social isolation at night, resulting into problems of communication within the health care team. There can be that nurse Connie say her relationship with other nurses is important factor in job satisfaction and to remain in the work field. Nursing care policy is a must and there should include the providing of positive leadership, promoting transformational leadership boosting nurse Connie and other nurses’ morale and satisfaction at work. Several studies indicate that overtime work does adverse effects on performance of nurses as well as healthcare providers, despite concerns of HK nurses about the ability to provide quality care when working overtime.
Halfer (2004), have provided recommendations that, “nurse leaders do conduct an inventory of their work units that looks at the nursing team’s age profile and such nursing issues found. Ideally, it is important that nurses are being held to leadership expectation, health policies and its dominant factor for patient safety assimilation yet, several nurses as leaders in health force will have to consider individual needs and differences of leadership styles involving contexts of motivation as well as leadership interaction as well as communication as there can be truth that issue awareness for nursing care will possibly promote solid leadership stature that allows nurses to keep grounded despite pressure into the actual work (Hart, 2006).
Thus, the presence of a flexible scheduling are being at the core stance and are being valued by almost all nurses, HK nurses too is for flexible scheduling to keep them away from negative leadership issues that will affect patient care domain. The healthcare may expect ample nurses turnover in today’s time for example, if nurses’ expectations and needs are not being met according to their principles (Clausing, Kurtz, Prendeville and Walt, 2003; Howe and Strauss, 2000). Furthermore, it is essential too, to assure that leadership communication is being understood by nurses and that reducing patient care errors coming in along with leadership failure, these are perceived into the work ethics among nursing leadership and its formation such as for instance, nurses does seek work and life balance and less to accept overtime or schedule changes just to accommodate the needs of nursing care work (Greene, 2005) and the available leadership approach seen in the actual work (Weston, 2001). Then, understanding is a must in determining nurses’ needs which is critical for having effective leadership and that such presence of diversity will lead to leadership synergy upon bringing nurses into SMART success as well as into much stable points of performance (Hobbs et al., 2005).
There have been leadership strategies that work well in the nursing workforce into the leadership nature and the flexing of leadership style as critical for nursing leadership to accrue success. Then, there can be few programs for nurses in leadership roles to better understand and utilize leadership concepts such as engaging and motivating, develop human capacity, building communities, manage of nursing change. The creation of healthy work environments to empower and engage nurses requires a new breed of leader with a variety of new skills. Nurse Connie will need to create and sustain environments that support excellence in leadership formation as well as better level of care, ample need to promote leadership approaches being grounded in care principles as well as quality patient care. For one, situational theories do suggest that the traits required of nurses’ differ according to varying situations.
Leadership Theories Ideal for the scenario assessment
Porter-O’Grady (1997, p. 18), have observed that, “leadership issue from places in health system play a role, the system require better policy and leadership stature” and have open up the process of thinking about leadership by noting how the changing healthcare system required transformational leadership characteristics (Porter-O’Grady, 1997; 1999). Aside, he observed that knowledge will change the needs of hierarchy from the leadership viewpoint, and Nurse Connie will have to be aware of her actions in delivering service to patients as well as handling nurses. Connie’s leadership and knowledge being associated with nursing care have strong instance, “entering the profession with leadership values from transformational approach from within possible strong leadership" (Porter-O’Grady, 1997, p. 17). Furthermore, nurse Connie should decide appropriate times to respect nurses on duty in ward B, choosing in applicable care as found form the building blocks of leadership, effectively give rewards to nurses from a corresponding patient satisfaction of care given, ideas from Porter-O’Grady (1999, p. 41).
Critique with summary
There can be perception of influence and decision making of nurse Connie and how her bad behavior affects the ward B area in her interrelations with the ward patients and nurses as her colleagues, as nurse Connie is authority based and the one leadership theory assuming her behavior towards patients and nurses can be about trait-attitude theory from within there implies to personal leadership characteristics as nurse Connie looks and talks like a perfectionist and meticulous nurse officer at ward B wherein she embrace limited change into the area and often considers the situation and feelings of patients and to the nurses as well and have a dominant type of personality in which she does not recognize respect towards her team in general. Also, theories of contingency, situational approach is present as nurse Connie is strict with the organization and atmosphere at ward B and nurses does not have freedom to move themselves as she is too bossy in executing things in actual set up. The effective leadership style appropriate for nurse Connie will be depending on the situation, the success in handling patients and other nurses pays a lot of change motivation for nurse Connie to adopt, as she could utilize path goal leadership approach, and the need for her to reward nurses performance and recognizable skills as well as focus on achieving definite goal for ward B to maintain effective leadership paradigm and vigor, nurse Connie can be supportive to patients and participative, good listener to the needs of other nurses especially when it comes to emotional stability from within proper delegation of work time schedules and ideal work hours, theories in lieu to Hershey and Blanchard views. Nurse Connie needs to accept turn of leadership direction and beliefs, transactional/transformational style have to be seen and forget being too authoritative leader which is not healthy in healthcare service as she needs to influence patients’ perception towards care and the need to foster a directional sense for ward B nurses to be satisfied at work and reduce shortage or turn over possibilities. Nurse Connie should motivate ward B nurses and patients to perform at their complete potentialities and put aside self interests in order to have good health care delivery and effective leadership stature. Moiden (2002), implies reality theory as ward B nurses should aim for leadership style that allows for high levels of work performance in a variety of situational manner (Moiden, 2002; Faugier and Woolnough, 2002). The empowered nurses believe in their own ability to create and adapt to change and supports for team members (Hyett, 2003), transformational leadership is empowering, but nurse Connie must balance the use of power into democratic fashion to avoid the appearance of abuse of power (Welford, 2002) as the respect and trust of ward B nurses by nurse leader Connie is essential.
In addition, nurse leader Connie should have knowledge of management, communication, teamwork skills and evidence-based outcomes (Mahoney, 2001). Personal qualities desirable in nurse leader Connie includes competence and collaboration. Thus, nurse leader Connie should be aware of changing environment and make changes proactively as nurses who show concern for the needs and objectives of staff members and are cognizant of the conditions affecting the work environment will encourage productivity (Moiden, 2003) and that, further use of transformational leadership allows nurse leader Connie to enhance good leadership. The need to awaken nurse Connie’s leadership creativity allowing to fit in the role of emotional intelligence of nurse Connie as she learns to interact and communicate well with other ward B nurses to avoid points of tension and conflict in the healthcare workplace and achieve a free flowing leadership status that helps in the patients achieve what they want to happen, the nurses and the rest of the nursing care to astound a peaceful and healthy health care work environment, as nurse Connie’s emotional intelligence play critical role in enabling and supporting awakened creativity as there concerns how she enable and promote ward B nurses creativity in certain ways
Conflict in ward B between nurse leader Connie and other nurses in the same vicinity can point to the equality of work role, as they have all equal rights coming from the nursing profession as nurses at ward B will have shared transformational leadership qualities, as well as ideas of successful environment and visions of the nursing practice and nurse Connie will have to strive excellence, value integrity, demonstrate perseverance as well as motivate others with inspiration and share the path for self-discovery as conflict among ward B nurses and nurse leader Connie can be from, challenges to nurse value systems in moral and ethical beliefs, patient care workloads that exceed nurses' capabilities in which nurse leader Connie must take into consideration.
For conclusion, there is about leadership theories and styles explaining nurse Connie’s behavior and how it range from such analysis of strength and others and discussing leadership in transformation/transactional from wherein emotional intelligence and conflicts are known. Proving simple ways to ensure that leadership should be enacted and executed well esp. in health care and how such ideas are related into an organized manner. The understanding of good leadership for nurse Connie to apply, how different types of leaders might affect shifting work hours in nursing that, includes health care effects that nurses’ might have on work stress as well as the wellbeing of nurses as there can be leadership assurance relating to its domains and the care assumed Lastly, the issues of leadership have to be in positive drive from within the context of nursing care that leads to generalized notion that theories and leadership actions for nurses must be well tailored to address nursing leadership complexities into the work milieu. There is focus on change can be directly applicable to nursing. These nurses are in a unique position of evaluating end results of both new and old policies and procedures. Using transformational leadership, nurses can motivate other nurses to submit feedback on how well unit specific procedures are carried out and implemented. For recommendations, it can be good for nurse Connie to provide strong yet flexible leadership applicable for ward B nurses as the ideal leadership should need to:
- Influence ward B nurses in a constructive way and give them the proper handling and treatment from Nurse Connie along with impetus management of the care area, making a rewarding performance through leadership integrity
- Valuing of transformational leadership for active work role and empowerment
- Sharing of power with the other nurses and enables patients to have rights and the keeping of positive transformation at ward B
- Delegating fair as well as reasonable nursing schedules of work and balanced authority for success
- Encourage ward B nurses to excel through her mode of leadership in providing successful patient services
In reflection, I believe that I am good and effective health provider as I will learn to integrate SMART (Specific, Measurable, Achievable, Realistic and Timely) objectives is useful for myself to always remain grounded into my leadership nature and embrace change into formulation of active patient respect of feelings and to change whatever thinking I have about overtime work of the other nurses and it will be in proper leadership context and nursing care cognition, helping myself strengthen and refine such leadership skills. The nursing leadership mandates the use of SMART ways from within levels of adaptability avenue in the nursing care path. Connie’s leadership do enhance well designed and thought about decision making, helping meet patient needs and to determine the best nursing leadership actions that will assists ward B nurses in meeting balanced work life. Thus, like me nurse Connie can be a good critical thinker from within reality based deliberation to validate the accuracy of research as well as reliability of resource. Transformational leadership assumes learning that is within my leadership ways appropriate for effective nursing care, regardless of every patient situation within dynamic SMART adaptation, allowing other nurses to focus on leadership factors that are relevant and significant to shifting work hours along well planned of action. The likelihood of leadership success, following the SMART motivated approach, monitor adherence to patient care and the providing of constructive feedback to nurses in actual care, and not be affected by pressing events, I myself, will create objectives achievable and relevant by engaging health care team in leadership selection ideal for execution, identify leadership ways tactics that are achievable within nurses’ schedule, adequate nurse staffing and other resources and for me to provide ongoing leadership communication upon motivating nurses at all times and make the transformation time bound for example, setting dates to evaluate success of patient care and leadership in my field of care pathway. For a personal reflection, my involvement into this leadership issue is by being a researcher, a reflector of the situation pertaining to nurse Connie situation and her behavior towards ward B nurses and patients, a nursing leadership study needs a researcher as I was able to amiably bring in active awareness to healthcare community, the team and the nurses to have ideals on leadership appropriately executed and provide readers with enough knowledge that leadership is one core factor into delivering a positive patient care complete with values and principles geared for true service of humankind. The one leadership plan is to have awareness campaign for Hong Kong nurses to embrace from and exercise more alternative options in patient care esp. those nurses assigned to ward areas, as it can be a reality that ward work is tiresome and stressful due to number of patients to serve and other underlying factors to arise thereunto.
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