Developing leadership skills at the front line

The health secretary announced in July plans to launch a NHS Leadership Academy. This article explains what progress has been made in setting up the body and enabling it to support nurses and other front line staff to develop the leadership skills needed to transform the NHS into a genuinely patient-centred service, one in which different services work together to provide integrated care.     

Leadership and support for safety

This is the second in a series of seven articles on the National Patient Safety Agency's Seven Steps to Patient Safety (NPSA 2004a). Leadership and support for staff can be achieved by ensuring that patient safety has a clear focus throughout the organisation. This article considers the context in which nurses work and provides examples of what can be done at organisational, directorate and team levels to ensure patient safety.     

Impact of clinical leadership development on the clinical leader, nursing team and care-giving process: a case study

Aim This study explored the dynamics related to a leadership development programme and their impact on the clinical leader, the nursing team and the care‐giving process. Background While there is a growing conviction about the need to invest in transformational leadership in nursing, further insight into the true complexity of leadership development and, more specifically, how leadership can make a difference in nursing and patient outcomes is essential. Method A single instrumental case study was conducted in a unit of a large academic hospital where a Clinical Leadership development Project (CLP) was implemented successfully. We used mixed methods with multiple sources of data to capture the complexity of leadership development. Data were collected through individual interviews, focus groups and observation of participants. A purposive sample of 17 participants representing a wide variety of team members has permitted data saturation. The data were categorized and conceptualized and finally organized into a framework describing leadership development on the unit and its impact on the leader, the nursing team and the care‐giving process. Results Leadership development is an ongoing, interactive process between the clinical leader and the co‐workers. The head nurse became more effective in areas of self‐awareness, communication skills, performance and vision. The nursing team benefited because more effective leadership promoted effective communication, greater responsibility, empowerment and job clarity. Improved clinical leadership seemed also to influence patient‐centred communication, continuity of care and interdisciplinary collaboration. Conclusions The results of the study give more insight into the processes underlying the leader’s progress towards attaining a transformational leadership style and its impact on the team members. The impact of leadership on the care‐giving process, however, remains difficult to describe. Implications for nursing management The interactive nature of leadership development makes CLP a challenge for the leader as well for the team members. Through its impact on the leader and the nursing team, CLP is a valuable instrument for improving work environments of nurses, contributing positively to patient‐centred care.     

Congruent leadership: values in action

Aim(s)  To discuss the significance of an appropriate leadership theory in order to develop an understanding of clinical leadership.
Background  Leadership theories developed from management and related paradigms, particularly transformational leadership, may be ineffective in supporting nurses to gain insights into clinical leadership or to develop and implement clinical leadership skills. Instead, congruent leadership theory, based on a match between the clinical leaders' actions and their values and beliefs about care and nursing, may offer a more firm theoretical foundation on which clinical nurses can build an understanding of and capacity to implement clinical leadership or become clinical leaders.
Evaluation  The information used is drawn from the contemporary literature and a study conducted by the author.
Key issue(s)  Leadership can be better understood when an appropriate theoretical foundation is employed.
Conclusions  With regard to clinical leadership, congruent leadership is proposed as the most appropriate theory.
Implications for nursing management  It is important to recognize that leadership theories based on a management paradigm may not be appropriate for all clinical applications. Education should be aimed specifically at clinical leaders, recognizing that clinical leaders are followed not for their vision or creativity (even if they demonstrate these), but because they translate their values and beliefs about care into action.     

Leadership style and organisational commitment among nursing staff in Saudi Arabia

Aims

To examine how nurse managers’ leadership styles, and nurses’ organisational commitment in Saudi Arabia relate.

Background

Effective leadership is influential in staff retention; however, recruiting and maintaining nurses is an increasing problem in Saudi Arabia.

Methods

Using a survey design, the Multifactor Leadership Questionnaire and the Organisational Commitment Questionnaire were distributed to a sample of 219 nurses and nurse managers from two hospitals in Saudi Arabia.

Results

Transformational leadership was the most dominant leadership style. After controlling for the influence of manager/staff status, nationality and hospitals, transformational leadership was the strongest contributor to organisational commitment. Perceptions of both transformational and transactional leadership styles, increased with age for nurse managers and nursing staff.

Conclusion

Introducing the Full Range of Leadership model to the Saudi nursing workforce could help to prepare Saudi nurses for positions as nurse managers and leaders.

Implications for Nursing Management

The study provides insight into the type of leadership that is best suited to the dynamic and changing health care system in Saudi Arabia. It is possible that transformational leaders could influence and induce positive changes in nursing.     

Leadership development in the English National Health Service: A counter narrative to inform policy

Objectives

To examine the current approach to leadership development in the English National Health Service (NHS) and consider its implications for nursing.To stimulate debate about the nature of leadership development in a range of health care settings.

Background

Good leadership is central to the provision of high quality nursing care. This has focussed attention on the leadership development of nurses and other health care staff. It has been a key policy concern in the English NHS of late and fostered the growth of leadership development programmes founded on competency based approaches.

Design

This is a policy review informed by the concept of episteme.

Data sources

Relevant policy documents and related literature.

Review methods

Using Foucault's concept of episteme, leadership development policy is examined in context and a ‘counter narrative’ developed to demonstrate that current approaches are rooted in competency based accounts which constitute a limited, yet dominant narrative.

Conclusion

Leadership takes many forms and varies hugely according to task and context. Acknowledging this in the form of a counter narrative offers a contribution to more constructive policy development in the English NHS and more widely. A more nuanced debate about leadership development and greater diversity in the provision of development programmes and activities is required. Leadership development has been advocated as being crucial to the advancement of nursing. Detailed analysis of its nature and function is essential if it is to meet the needs of nurse leaders.     

Charge nurse leadership development and evaluation

OBJECTIVE: To describe the development and evaluation of a permanent charge nurse role and report outcomes of this leadership model over 4 years. BACKGROUND: A permanent charge nurse role was developed to improve continuity of care and develop emerging nurse leaders. An evaluation model was constructed to measure program outcomes. Kouzes and Posner's Leadership Model served as the theoretical framework. METHODS: The permanent charge nurse role was developed, training planned, and the evaluation framework established. Measurements included two survey instruments, an investigator-developed End-of-Shift Report, and institutional patient satisfaction data. Survey instruments included Kouzes and Posner's Leadership Practice Inventory (LPI), concurrently measuring self (charge) and other (staff) perceptions of charge leadership. The McClosky Mueller Satisfaction Scale (MMSS) measured charge and staff nurse job satisfaction. Data were collected at baseline, post-implementation, and additional time periods. RESULTS: Charge RNs reported significantly more favorable perceptions of leadership abilities than staff. The Shift Report successfully tracked both system and charge management issues. Patient satisfaction data did not yield data due to vendor changes. Job satisfaction results showed charge nurses reported higher satisfaction with schedule, praise and recognition, control and responsibility, than staff nurses. CONCLUSIONS: Using data to evaluate charge nurse leadership guides continued program improvements.     

Clinical leadership in contemporary clinical practice: implications for nursing in Australia

BACKGROUND: Leadership in the clinical practice environment is important to ensure both optimal patient outcomes and successive generations of motivated and enthusiastic clinicians. AIM: The present paper seeks to define and describe clinical leadership and identify the facilitators and barriers to clinical leadership. We also describe strategies to develop clinical leaders in Australia. Key drivers to the development of nursing leaders are strategies that recognize and value clinical expertise. These include models of care that highlight the importance of the nursing role; evidence-based practice and measurement of clinical outcomes; strategies to empower clinicians and mechanisms to ensure participation in clinical decision-making. KEY ISSUES: Significant barriers to clinical leadership are organizational structures that preclude nurses from clinical decision making; the national shortage of nurses; fiscal constraints; absence of well evaluated models of care and trends towards less skilled clinicians. CONCLUSIONS: Systematic, strategic initiatives are required to nurture and develop clinical leaders. These strategies need to be collegial collaborations between the academic and health care sectors in order to provide a united voice for advancing the nursing profession.     

How can leadership influence the quality ofcare in a health-care organization?

Objective:This study focuses on how leadership could influence the quality of care in a health-care organization.Methods:The concept of leadership and quality are analyzed.In addition,issues concerning how leadership can influence quality of care through the effect on the organizational culture and the engagement of both nurses and patients are discussed.Results:Leadership is the pivotal factor in the improvement of quality through the effect on the organizational culture and the engagement of both nurses and patients.Conclusions:Leadership can influence the quality of care directly and indirectly.The organization and the leaders should know the importance of effective leadership to a better work environment,facilitate the implementation of the new mode of nursing,and provide best services to the patients.     

Valuing 'voices from below'

The publication of Commission for Health Improvement (CHI) reports in recent years have revealed that employees attempted to blow the whistle on abuse, corruption or malpractice but were largely ignored by senior members of staff. The CHI report into the North Lakeland National Health Service (NHS) Trust (November 2000), for instance, states that an initial failure among management to listen to the concerns of student nurses led to the sustained abuse of patients. To protect patients from incompetent and unethical practitioners and improve standards of care, an environment needs to be created where health care professionals feel able to express legitimate concerns openly and honestly to senior staff, safe in the knowledge that senior managers will take their concerns seriously and act accordingly. The government has pledged to create an 'open culture' in the NHS to encourage staff with genuine concerns to speak out. This can only be achieved if the current leadership culture characterized by conflict avoidance, blame and hierarchical control is replaced with openness and accountability. To produce the desired changes in culture and attitudes, the NHS needs strong leaders capable of challenging the existing social equilibrium.     

The hidden treasure in nursing leadership: informal leaders

downey m., parslow s. & smart m. (2011) Journal of Nursing Management 19 , 517–521
The hidden treasure in nursing leadership: informal leaders Aim The goal of the present article was to generate awareness of characteristics of informal leaders in healthcare with the emphasis on nurses in acute care settings. There is limited research or literature regarding informal leaders in nursing and how they positively impact nursing management, the organization and, ultimately, patient care. Identification of nurses with leadership characteristics is important so that leadership development and mentoring can occur within the nursing profession. Background More than ever, nursing needs energetic, committed and dedicated leaders to meet the challenges of the healthcare climate and the nursing shortage. This requires nurse leaders to consider all avenues to ensure the ongoing profitability and viability of their healthcare facility. Key issues This paper discusses clinical nurses as informal leaders; characteristics of the informal nurse leader, the role they play, how they impact their unit and how they shape the organization. Implication for nursing management Informal nurse leaders are an underutilized asset in health care. If identified early, these nurses can be developed and empowered to impact unit performance, efficiency and environmental culture in a positive manner.     

Learning for clinical leadership

Clinical leadership has been acclaimed widely as a major factor influencing the quality of patient care but research has revealed a paucity of preparation for this significant role. Leadership literature has rarely addressed clinical leadership specifically or referred to the difficulties in characterizing effective clinical leaders. The research informing this paper focused on clinical leadership and identified five attributes of effective clinical leaders: creativity, highlighting, influencing, respecting, and supporting. Effective clinical leaders adopted a transformational leadership style and improved care, through others, by including transformational (soft) knowledge as an integral part of their effective practice repertoire. Phronesis is introduced as practical wisdom that is gained through immersion in relevant experience, and as an essential element of preparation for clinical nursing leadership practice. It is argued, that learning to transform care requires opportunities to work within an environment that engenders and supports aspiring leaders. The paper describes the research process, elucidates the attributes through illustrative examples from the research data, and discusses an emergent educational strategy for the development of these attributes by clinicians in their practice environments. The paper also describes the application of this research through an interdisciplinary programme for staff leading teams in both health and social services sectors.     

Leadership practices and staff nurses' intent to stay: a systematic review

cowden t., cummings g. & profetto-mcgrath j (2011) Journal of Nursing Management 19 , 461–477
Leadership practices and staff nurses’ intent to stay: a systematic review Aim The aim of the present study was to describe the findings of a systematic review of the literature that examined the relationship between managers’ leadership practices and staff nurses’ intent to stay in their current position. Background The nursing shortage demands that managers focus on the retention of staff nurses. Understanding the relationship between leadership practices and nurses’ intent to stay is fundamental to retaining nurses in the workforce. Methods Published English language articles on leadership practices and staff nurses’ intent to stay were retrieved from computerized databases and a manual search. Data extraction and quality assessments were completed for the final 23 research articles. Results Relational leadership practices influence staff nurses’ intentions to remain in their current position. Conclusion This study supports a positive relationship between transformational leadership, supportive work environments and staff nurses’ intentions to remain in their current positions. Incorporating relational leadership theory into management practices will influence nurse retention. Advancing current conceptual models will increase knowledge of intent to stay. Clarifying the distinction between the concepts intent to stay and intent to leave is needed to establish a clear theoretical foundation for further intent to stay research. Implications for Nurse Managers Nurse managers and leaders who practice relational leadership and ensure quality workplace environments are more likely to retain their staff. The findings of the present study support the claim that leadership practices influence staff nurse retention and builds on intent to stay knowledge.     

Registered nurse leadership style and confidence in delegation

Saccomano S.J. & Pinto- Zipp G. (2011) Journal of Nursing Management 19 , 522–533
Registered nurse leadership style and confidence in delegation Background and aims Leadership and confidence in delegation are two important explanatory constructs of nursing practice. The relationship between these constructs, however, is not clearly understood. To be successful in their roles as leaders, regardless of their experience, registered nurses (RNs) need to understand how to best delegate. The present study explored and described the relationship between RN leadership styles, demographic variables and confidence in delegation in a community teaching hospital. Methods Utilizing a cross-sectional survey design, RNs employed in one acute care hospital completed questionnaires that measured leadership style [Path-Goal Leadership Questionnaire (PGLQ)] and confidence in delegating patient care tasks [Confidence and Intent to Delegate Scale (CIDS)]. Results Contrary to expectations, the data did not confirm a relationship between confidence in delegating tasks to unlicensed assistive personnel (UAPs) and leadership style. Nurses who were diploma or associate degree prepared were initially less confident in delegating tasks to UAPs as compared with RNs holding a bachelor’s degree or higher. Further, after 5 years of clinical nursing experience, nurses with less educational experience reported more confidence in delegating tasks as compared with RNs with more educational experience. Conclusions The lack of a relationship between leadership style and confidence in delegating patient care tasks were discussed in terms of the PGLQ classification criteria and hospital unit differences. As suggested by the significant two-way interaction between educational preparation and clinical nursing experience, changes in the nurse’s confidence in delegating patient care tasks to UAPs was a dynamic changing variable that resulted from the interplay between amount of educational preparation and years of clinical nursing experience in this population of nurses. Clearly, generalizability of these findings to nurses outside the US is questionable, thus nurse managers must be familiar with the Nurse Practice Act in their country in order to ensure proper delegation of tasks to appropriate assistive personnel. Implications for nurse managers It is imperative that nurse managers provide nurses with the educational opportunities necessary to develop delegation and supervision strategies to adapt to the changing RN role while adhering to differences in scope of practice. Globally, RNs are caring for increasing numbers of acutely ill patients with scarce resources ensuring an adequately trained RN/UAP team can help support optimal patient care.     

Men at Work (In a Female-Dominated Profession)

ABSTRACT:

There is a movement away from the leadership of an organisation being dominated by those who are in formal positions of authority and an acknowledgement that staff members at all levels of experience and qualification can be leaders within their own area of expertise. This article will outline four key leadership behaviours that frontline veterinary nurses may use to practise and develop leadership skills, potentially benefitting their own professional development, the practice team, the individual and ultimately the veterinary nursing profession.     

Developing and testing a new measure of staff nurse clinical leadership: the clinical leadership survey

Patrick A., Laschinger H.K.S., Wong C. & Finegan J. (2011) Journal of Nursing Management 19 , 449–460
Developing and testing a new measure of staff nurse clinical leadership: the clinical leadership survey Aim To test the psychometric properties of a newly developed measure of staff nurse clinical leadership derived from Kouzes and Posner’s model of transformational leadership. Background While nurses have been recognized for their essential role in keeping patients safe, there has been little empirical research that has examined clinical leadership at the staff nurse level. Methods A non-experimental survey design was used to test the psychometric properties of the clinical leadership survey (CLS). Four hundred and eighty registered nurses (RNs) providing direct patient care in Ontario acute care hospitals returned useable questionnaires. Results Confirmatory factor analysis provided preliminary evidence for the construct validity for the new measure of staff nurse clinical leadership. Structural empowerment fully mediated the relationship between nursing leadership and staff nurse clinical leadership. Conclusion The results provide encouraging evidence for the construct validity of the CLS. Implications for nursing management Nursing administrators must create empowering work environments to ensure staff nurses have access to work structures which enable them to enact clinical leadership behaviours while providing direct patient care.     

Transformation: are nurse leaders in critical care ready?

Aim The aim was to determine whether nursing leaders met the criteria for transformational and/or transactional leadership. Background Many changes have occurred in South Africa and are reflected in the health-care systems. As a result, it has become crucial to source leaders who are able to manage the change process effectively so as to ensure the success and survival of our health-care organizations. Methods The 45-item Multifactor Leadership Questionnaire (Rater) was completed by 41 respondents out of a population of 121. A proportional stratified simple random sampling technique was used to select the raters of seven leaders. Results Most nursing leaders role-modelled the culture of the organisation but did not stimulate their followers intellectually and did not demonstrate innovative motivation or individual consideration. Consequently, their followers may exhibit a lack of commitment to collective goals, with detrimental effects on the health-care organisation as a whole. Conclusions and implications for nursing managers Nursing leaders should be trained to become transformational leaders so as to encourage their followers to become innovative and motivated to render high quality nursing care.