Theories of Leadership and Management in Nursing

Nursing is an important priority sector in the healthcare system; this is because nurses are involved with the primary care of the patients spending the most time with their patients. This is important because they should be involved in the policy-making and leadership of the healthcare institutions(Finkelman,2012). This paper will focus on leadership and management in nursing and various theories that cover these topics. It will also focus on a literature review regarding a specific theory in leadership and how the leadership and management affect the role of the nurse, impact for patients and healthcare systems. Leadership is a complex issue as it involves diverse aspects of the healthcare system. Various theories have been developed in an attempt to define leadership. According to Lewin,Lippitt&White(1939), autocratic leadership involves leaders who don’t consult other parties during decisionmaking, democratic leadership involve other parties in decisionmaking although the final say is theirs while Laissez-faire leadership decisionmaking lies with the involved parties. Another theory is by Likert(1967) participative leadership where the leader involves the parties in decisionmaking and ensures everyone is involved and there is maximum cooperation. Likert also established the authoritative leadership where the leader uses threats and intimidation to achieve the set goals.

Transformational leadership is a theory coined by Bass and Riggio(2006) which emphasizes that leadership is creating a positive environment while at the same time motivating the workers to achieve the best outcomes. Situational leadership states that before a leader makes decisions he considers the availability of resources, motivation, confidence level and the emotional support of the workers(Hersey and Blanchard,1969). Various theories of leadership use different approaches and they have various applications in nursing. Management is the ability to utilize resources in an institution to ensure the smooth running of the operations. Leadership and management work hand in hand to ensure the success of various divisions in an organization (Tomey,2009). Follet (2003) described management as working together with employees rather than above the employees. Cooperation with the employees yields better results rather than working without involving them. Fayol (1916) described the theory of management as having various aspects and principles including planning, organization, command, coordination and control. Gulick (1937) further elaborates the principles of management to include reporting and budgeting.

Leadership and management play an important role in nursing as the healthcare institutions look up to nurses as leaders and managers at various posts such as nurse practitioners, clinical nurse specialists and in charges in the ward. Nursing is a dynamic profession and involves various policies at the individual level, hospital, community, government and international levels. The nurse is required to have leadership skills to make rational decisions and consult with other key stakeholders (Scully,2015). A leader and a manager are expected to be compassionate while dealing with the subordinates, assertive and able to handle conflict without taking sides. Good skills ensure growth in the nursing profession and easier cooperation at the employee level. Setting goals with the other parties, involving them in decision making, resolving conflict and finding amicable solutions while providing the resources and motivation sums up a good nurse leader and manager.

The Importance of Leadership and Management in Nursing

Transformational leadership theory by Avolio is the theory of management that I will criticize in my paper. This theory comprises of four aspects which involve identifying diverse needs of the nurses and patients in this case nursing leadership. The second aspect is the leader provides motivation that inspires the entire team to achieve the set objectives and goals. The leader involves the team during problem and they make contributions to finding a solution known as intellectual stimulation. Idealized influence refers to transformational leaders acting as the role models whom the rest of the team looks up to. Doody&Doody (2013) states that transformational leadership is a flexible type that is applicable to the nursing field considering the long mismanagement. The role of the nurse under this type of leadership changes drastically to making rational decisions and approaching leaders when faced with challenges.

Transformational leadership involves working together with the employees to ensure that the goals and objectives set are met while ensuring their welfare is met.According to Robbins and Davidhizar (2007) transformational leaders in nursing have been associated with increased patient satisfaction. Choosing this type of leadership considers the key players involved in the health care system mainly the managers, the nurses & other health care workers and the patients. It has been proven that transformational leadership has the ability to equip nurses with skills to make decisions while providing primary care. They are also involved in making health policies which affect the healthcare sector. This type of leadership has maximum benefits and outcome success measures rely on the patient satisfaction.

Nurse managers at various positions such as nurse practitioners practice leadership which requires various skills such as honesty and respect towards other nurses and patients. In my organization, transformational leadership plays an important role in promoting teamwork and collaboration between the nurses and the providing care to the patients. The nurse leaders utilize the transformational leadership which emphasizes on individual consideration of the needs of the team members. A leader is expected to treat and understand that various individuals are different in terms of their beliefs towards their nursing profession and character. Emotional intelligence is important when a leader is dealing with the nurses at the decisionmaking level and even when resolving conflict (Cavazotte,2012). Individual consideration requires the nurse leader to communicate to the team members regarding certain goals and objectives, for example, reducing hospital-related infections to maybe two from eight in a span of four months. Good communication skills involve passing information in the right tone and listening to feedback from the nurses (Riley,2015). Communication ensures any upcoming issues are addressed and the nurses and patients can approach the leader. The nurse satisfaction is ensured when there is a healthy work environment leading to good patient outcomes and a productive healthcare system. The nurse leader ensures that when addressing the team members, he/she treats them with respect especially when addressing a mistake that has been done. Shouting at nurses’ breeds resent towards the leader and therefore unhealthy work relations. The goals achieved should be appreciated and motivated by small tokens. Hutchinson &Jackson (2013) state that when the nurses are treated as equal and no one is favoured the competition is healthy as they work towards achieving a common goal together rather than against each other. A leader who uses the transformational leadership involves the team members when making decisions. The nurse leader understands that policies in the healthcare system cannot be made by a few individuals and work but rather with brainstorming new ideas are added and those with less value are not given priority. Johansen & O’Brien (2016) decision making in nursing is a complex issue that needs to involve all the parties. Patient-centred care involves ensuring the policies protect and safeguard the welfare of patients and reduce their hospitalization stay.

Critique of Transformational Leadership in Nursing

Transformational leadership in the healthcare sector has seen improved job satisfaction among various cadres and achievement of personal and organizational goals (Vandenberghe, Stordeur&Dhoore,2014). Intellectual stimulation refers to a transformational leader who uses creativity and introduces new ideas to the team so as to improve the healthcare sector. The nurse manager, for example, appreciates that technology is a new everchanging idea that can be used to transform healthcare by reducing time wastage and prompt diagnosis. The team members whose leader uses intellectual stimulation are motivated to make extra efforts since they are aware of new methods to achieve a common goal. According to Smothers et.al (2016) when the nurse manager is intellectually stimulating the team members are empowered. The nurse manager is open to ideas that the nurses could be having on how to improve patient outcomes for example assessment of a high-risk patient who is likely to fall on admission. This encourages innovation and creativity which promotes healthy competition and aspiration to achieve more. This leads to nurses using the latest evidence-based care and learning new knowledge which in turn benefits the patients since the nurses are giving the best of primary care. The healthcare system, in turn, experiences a positive turn over as the patient outcomes improve.

Inspirational motivation in transformational leadership refers to the ability to inspire motivation and confidence to achieve set goals. Motivation refers to the intrinsic drive to work and reach towards a certain goal. Motivation can be intrinsic or extrinsic. The key drive is always intrinsic motivation but when a leader motivates the team members by words of affirmation and praise leads to improved efforts. In nursing, the nurse leader uses motivation to encourage the team members to improve on various areas that have been previously poor for example pressure ulcers in orthopedic patients. Andersen et.al (2016) states that when a transformational leader shares a vision with the team members, the process inspires motivation as they work together towards a common goal. Motivation leads to increased job satisfaction for the nurses as they work as a team towards for example catheter-associated urinary tract infection prevention. This results in patient satisfaction as they receive evidenced-based care which is towards reducing comorbidities that may occur during hospitalization.

Human beings learn by association where they relate what someone they admire is doing and they also do the same. Transformational leadership involves idealized influence where the leader is a role model to the team members through their leadership skills. According to Mittal and Dhar (2015), the high moral standards and assertiveness lead the followers to admire the leader as they portray values. The nurse leader who communicates on expectations at the same time considering individual needs and available resources acts as a good role model to the nurses. The leader is an advocate for the patient’s rights and goes out of their way to consult with physicians regarding their care earns respect from the other nurses. The nurses emulate their leader by advocating for the rights of the patients and standing their ground during the conflict. Maragh (2011) the nurse leader is the agent of positive change and the role model to the junior nurses. Nurses who are new in the practice emulate strong visionary leaders who are optimistic and flexible to change. The nurses who have a good role model make rational decisions regarding their patient’s primary care which results in optimum outcomes.

Choice of Transformational Leadership in Nursing

Some authors disagree with transformational leadership as it promotes employee burnout. Cheng et.al (2016) states that transformational leadership emphasizes motivation and achieving goals and outcomes which keeps employees hopeful leading to overstretching their capacity to perform. Nurses are prone to burnout due to their heavy workload and most times shortage of nursing staff. Emphasizing on their performance and achieving organization goals may cause a situation that is catastrophic. Nurse burnouts have been associated with poor patient outcomes (Nansupawat et.al,2015). The nurse is also at risk of emotional and mental exhaustion. Research has shown that musculoskeletal disorders among nurses have been associated with working for long hours indicating physical risks of burnout.

Graham, Ziegert&Capitano (2015) states that transformational leadership encourages the use of unethical behaviors to the employees so as to ensure the goals are achieved. Unethical behaviors include pressurizing the team members to achieve the desired goals within a short time frame. Nurse leaders may be under duress by the health institution and engage in policies which pressurize the nurses to perform. This causes nurse burnout as earlier illustrated and low retention of nurses as they seek a better work environment. This type of leadership underestimates the human limits of how much can be achieved within a time frame. The patients are on the losing end as they are no longer the centre of care but the goals to be achieved is what matters most. This leads to a healthcare system that is focused on how well it performs rather than how well the patient service is.

Transformational leadership has been praised for creating a healthy work environment for the employees while ensuring they are up to the task for their duties. The leader ensures that the individual needs of the employees are met while communicating the expectations and goals of that should be met. The nurse leader understands the nursing process, activities and listens to the needs of the nurses to ensure that they articulate them and they are addressed. The nurses address their concerns as they are with the patients for the longest periods. A healthy work environment is not only important for one’s emotional health but also mental health leading to optimum patient outcomes (Kelly & Todd,2017).

Transformational leadership is associated with high levels of productivity. Productivity refers to the ability to have maximum output in comparison to input. In nursing productivity refers to improved patient outcomes as compared to previous hospital audits, for example, decreased surgical wound infections due to observing aseptic techniques and close monitoring. Productivity is ensured by the nurse leader effective communication on the institution’s goals and objectives. The nurse leader also acts as a good role model in terms of participative decision making and advocating for patient’s rights. Ritcher et.al (2015) states that research has proven transformational leadership has positive effects on productivity.

The disadvantage of transformational leadership is it mainly emphasizes traits which are mainly one’s character rather than be instilled in someone. The leader who chooses to use this theory of leadership may have to actually change his personality and character or try to fit in. This may not work for long since one’s behaviour can only be hidden for so long. Nurse leader has to decide if this will work for him/her if not applying it and changing creates confusion to the team members. Deinert et.al (2015) motivation is strongly related to one’s personality.

Literature Review on Transformational Leadership in Nursing

The other disadvantage is it limits the leader who might not have the four aspects of transformational leadership and yet displays strong aspects of leadership. The four aspects of transformational leadership are positive but don’t entirely cover a leadership aspect. Nursing is a dynamic field and some aspects of it require the nurses to be intrinsically motivated. Depending on the nurse leader to always provide motivation towards meeting personal and institutional goals is quite impossible. Yucel, McMilan&Richard (2014) states that transformational leadership lacks clarity in terms of the four aspects surrounding it.

Conclusion

Leadership and management are key areas of any organization and this together with other factors determine its success. However, leaders should always remember that they are dealing with team members whose needs should be prioritized so as to achieve the goals and objectives. The paper has covered various leadership theories which include Lewin’s style, participative style and transformational leadership. Management theories include the principles of management which have been defined by Fayol and Gulick. In the essay, I chose transformation leadership theory as my choice to describe leadership in nursing. This type of leadership involves idealized influence, motivation, intellectual stimulation and inspirational motivation. However, some authors disagree with this since motivation may cause the nurses to experience burnout and it may propagate unethical habits in a bid to achieve the goals.

The strengths of transformational leadership include the ability to create a healthy work environment and increased productivity. The challenges are this type of leadership is mainly relying on one’s character and personality and leadership comprise of other factors except for the four aspects that are emphasized in the transformational leadership. Finally acknowledging that nurse leaders play a crucial role in the healthcare sector and they should be recognized and supported. Every nurse leader should ensure excellence in the healthcare sector while maintaining the professional standards. Leadership in nursing is a key priority in the healthcare system.

References

Andersen, L.B., Bjørnholt, B., Bro, L.L. and Holm-Petersen, C., 2016. Leadership and motivation: a qualitative study of transformational leadership and public service motivation. International Review of Administrative Sciences, p.0020852316654747.

Bass, B.M. and Riggio, R.E., 2006. Transformational leadership. Psychology Press.

Cavazotte, F., Moreno, V. and Hickmann, M., 2012. Effects of leader intelligence, personality and emotional intelligence on transformational leadership and managerial performance. The Leadership Quarterly, 23(3), pp.443-455.

Cheng, C., Bartram, T., Karimi, L. and Leggat, S., 2016. Transformational leadership and social identity as predictors of team climate, perceived quality of care, burnout and turnover intention among nurses. Personnel Review, 45(6), pp.1200-1216.

Deinert, A., Homan, A.C., Boer, D., Voelpel, S.C. and Gutermann, D., 2015. Transformational leadership sub-dimensions and their link to leaders’ personality and performance. The Leadership Quarterly, 26(6), pp.1095-1120.

Doody, O. and Doody, C.M., 2012. Transformational leadership in nursing practice. British Journal of Nursing, 21(20), pp.1212-1218.

Fayol, H., 1916. General principles of management. Classics of organization theory, 2(15), pp.57-69.

Finkelman, A.W. and Finkelman, A.W., 2012. Leadership and management for nurses: Core competencies for quality care. Pearson.

Follett, M.P., 2003. Mary Parker Follett prophet of management. Beard Books.

Graham, K.A., Ziegert, J.C. and Capitano, J., 2015. The effect of leadership style, framing, and promotion regulatory focus on unethical pro-organizational behavior. Journal of business ethics, 126(3), pp.423-436.

Gulick, L., 1937. Notes on the Theory of Organization. Classics of organization theory, 3.

Hersey, P. and Blanchard, K.H., 1969. Life cycle theory of leadership. Training & Development Journal.

Hutchinson, M. and Jackson, D., 2013. Transformational leadership in nursing: towards a more critical interpretation. Nursing inquiry, 20(1), pp.11-22.

Johansen, M.L. and O’brien, J.L., 2016, January. Decision making in nursing practice: a concept analysis. In Nursing Forum (Vol. 51, No. 1, pp. 40-48).

Kelly, L. and Todd, M., 2017. Compassion fatigue and the healthy work environment. AACN advanced critical care, 28(4), pp.351-358.

Lewin, K., Lippitt, R. and White, R.K., 1939. Patterns of aggressive behavior in experimentally created “social climates”. The Journal of social psychology, 10(2), pp.269-299.

Likert, R., 1967. The human organization: its management and values.

Maragh, K.A., 2011. The nurse leader as change agent and role model: Thoughts of a new nurse manager. Nurse Leader, 9(3), pp.39-42.

Mittal, S. and Dhar, R.L., 2015. Transformational leadership and employee creativity: mediating role of creative self-efficacy and moderating role of knowledge sharing. Management Decision, 53(5), pp.894-910.

Nantsupawat, A., Srisuphan, W., Kunaviktikul, W., Wichaikhum, O.A., Aungsuroch, Y. and Aiken, L.H., 2011. Impact of nurse work environment and staffing on hospital nurse and quality of care in Thailand. Journal of Nursing Scholarship, 43(4), pp.426-432.

Richter, A., von Thiele Schwarz, U., Lornudd, C., Lundmark, R., Mosson, R. and Hasson, H., 2015. iLead—a transformational leadership intervention to train healthcare managers’ implementation leadership. Implementation Science, 11(1), p.108.

Riley, J.B., 2015. Communication in nursing. Elsevier Health Sciences.

Robbins, B. and Davidhizar, R., 2007. Transformational leadership in health care today. The Health Care Manager, 26(3), pp.234-239.

Scully, N.J., 2015. Leadership in nursing: The importance of recognising inherent values and attributes to secure a positive future for the profession. Collegian, 22(4), pp.439-444.

Smothers, J., Doleh, R., Celuch, K., Peluchette, J. and Valadares, K., 2016. TALK NERDY TO ME: THE ROLE OF INTELLECTUAL STIMULATION IN THE SUPERVISOR-EMPLOYEE RELATIONSHIP. Journal of Health & Human Services Administration, 38(4).

Tomey, A.M., 2009. Nursing management and leadership. USA: Mosby Elsevier.

Vandenberghe, C., Stordeur, S. and D’hoore, W., 2014. Transactional and transformational leadership in nursing: Structural validity and substantive relationships. European Journal of Psychological Assessment, 18(1), p.16.

Yucel, I., McMillan, A. and Richard, O.C., 2014. Does CEO transformational leadership influence top executive normative commitment?. Journal of Business Research, 67(6), pp.1170-1177.