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Leadership and Change in Healthcare Management

Executive Summary

The system of caring is undergoing several changes in modern society. But the need for leadership in this sector is well recognized for further growth and development. Nursing is one of the most essential professions in the healthcare industry. The paper outlines the essence of leadership and change in healthcare management focusing on Patient safety, Understanding organizations, Health care management, Leading Change, and Quality assurance. It also links the aspects such as shortages of nursing, use of technology, skills, and evidence-based nursing to patient care.

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Leadership plays a main role in the nursing profession as it is one of the most important elements in creating quality professional practice environments. The need of the healthcare industry is strong, consistent, and knowledgeable leaders, who are visible, inspire others and support professional nursing practice. It is only under such a leadership wing can new nurses start their professional life.

Transformational leadership is also essential for new nurses as it encourages change and is a need for the dynamic healthcare system of the 21st century. The lack of proper leadership has also increased and influenced the shortage of nurses. Though nurses have made their way to decision-making and legislation, the shortage is still a major problem faced by the healthcare industry. This not only increases the stress on the existing staff but also leads to problems such as medication errors, diagnostic errors, health challenges, job burnout, and dissatisfaction. This in turn compromises patient safety.

Technology is another important aspect that is being discussed in the healthcare sector. Computerization and information technologies are in turn going to improve the nursing practice and patient education. It may also help to ease the stress on the existing staff, reduce medication errors and increase retention. Nursing education is also using this advanced technology to train the new nurses and is encouraging the use of mobile computers in hospital settings. Nurses being the patient educator, the use of advanced technology can help them to attain success in this field. The use of these technologies aid in efficiently storing vast amounts of data and also helps to reduce errors.

The use of evidence-based nursing for taking clinical decisions, creative thinking, and good communication also plays important role in nursing practice. Studies have proven beyond doubt that communication skills play a major role in easy and proper information flow between patients, physicians, and family members. There is a great deal of importance given to delivering clear messages that people can easily understand and act on. Any kind of confusing communication may lead to misunderstanding and serious errors. There is a mounting demand for nurses with these skills to treat patients with multifaceted care needs.

Nursing is a profession that needs to take care of patients with utmost care together with the use and knowledge of the latest technologies. All the efforts focus on creating the best environment for the recovery process of patients. The fast-changing healthcare sector calls for more and more people to enter the nursing faculty and also provide strong leadership to sustain and grow the healthcare industry. The modern nursing staff is expected to play various roles of leaders, coordinators, teachers, and practitioners. These aspects can help to create a risk-free environment for the patients and also help to increase the quality of patient care.

Introduction

Leadership and change is common factor for all sector in the 21st century and healthcare is not an exception. The growth and development of the healthcare industry are strongly linked to strong leadership and constant change. The most important aspect is that there is a correlation between the quality of patient care, staff morale, and effective nursing leadership in this industry (Manley, 1997). Effective nursing leadership is the most important factor influencing nursing management and the maintenance of quality assurance in nursing care.

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Truly professional nursing is an art that has a strong link to applied science. Besides, nursing is a self-motivated profession and art of science with a growing body of knowledge. It is a profession that truly focuses on supporting human beings of their wellness/illness continuum. Nursing involves the promotion, maintenance, and restoration of health in various clients. This is a profession that helps every individual that approaches the healthcare industry in gaining, regaining, and supporting good health. This paper aims to provide a model of leadership in nursing. It also outlines factors that influence nursing management, patient safety, understanding organizations, healthcare management, leading change, and quality assurance.

Leadership and Nursing

Leadership is about knowing how to make visions become reality. This definition remains constant whether it is nursing, medical, or healthcare leadership. The vision of nursing is linked with patients being treated with dignity and respect at all times. Additionally, the systems are designed in such a way to benefit the individual needs and where the work performed by nurses is valued and respected.

From a nursing perspective, the three aspects or the main visions that aid nursing achieve success are the development of patient-centered care measures that are a part of performance management and the clinical governance agenda; leadership based on personal growth and development principles, and; new clinical career and competency framework for nursing (Kitson, 2001). Order to achieve these visions will require a paradigm shift in the philosophy, priorities, policies, and power relationships of the health service.

It is important to understand that the main leadership qualities that nurses need to develop include the following – to be the providers of quality care, propagate teamwork, articulate communicator, counselor, risk-taker, role models and be visionary. It is only with effective nursing leadership that nursing practice and effective health care policies can be shaped and influenced in the future (Antrobus and Kitson, 1999).

Researchers have identified the need for transformational leadership in the healthcare industry. Transformational leadership links ideals of leaders and followers (Sullivan and Decker, 2001) and unites them to aim for a better future, and also promote good leadership. Transformational leadership is especially helpful for new nurses and is an encouragement for them as this leadership helps to bring about change that fits into the exceptionally dynamic system of healthcare.

It can be noted that it is easy for new nurses to identify and compare the new and old policies and procedures and provide suggestions for improvement. Sofarelli and Brown (1998) favor the transformational leadership style and find it empowering. By using transformational leadership, managers can encourage new nurses to submit feedback on how well unit-specific procedures are carried out and implemented. The main purpose of this is to actively listen and institute relevant suggestions that not only promote client outcomes but also again help to build a base of leadership with the new nurse. Transformational leadership provides new nurses with a method of taking an active and participatory role in policy within a new nurse’s jurisdiction and power.

Nursing Shortage and Its Impact on Healthcare Industry

While a fall in the number of nursing leaders may be attributed to the current nursing shortage, studies have also proven beyond doubt that there is also a significant deficiency in the number of nursing leaders. Nursing research and teaching hospitals are concerned about the scarcity of nursing staff (Singhapattanapong, 2002). If we look at the healthcare industry, it is growing fast when compared to other industries. However, with the increase in population, an increased number of healthcare professionals are needed to care for them especially in the case of epidemics and disasters. Though this is a global concern, it is a serious problem in the United States healthcare sector.

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Of late, nurses are in a distinct position to influence healthcare policy and legislation. Therefore, there is a need for nursing leadership to exert that influence by nurturing both leadership as well as clinical skills. However, once at the bedside, they rarely get the opportunity to apply even basic leadership principles. In addition to leadership skills, the nursing profession trains new nurses on operating the latest technology and complex medical equipment. It is suggested that nursing as a profession does a disservice to new nurses if their leadership capabilities are not explored (Valentine, 2002).

The growing healthcare industry needs more and more nursing staff to support this industry. In thousands of hospitals in the United States and around the world, there is a severe shortage of nursing staff. It is only through good leadership that this shortage can be solved. Due to this shortage, the existing nursing staff is under the pressure of working overtime that seriously affects their personal life. If these nurses face an emotional challenge due to working overtime, they do not perform to their full potential and there are instances when many of them opt to quit this industry. Therefore, the shortage of nursing staff itself triggers the further reduction in their numbers.

In recent years studies have noted that many of the healthcare setups are concerned about patient safety. For instance, a study conducted by Aiken and his associates showed that trends in hospital use and staffing patterns have brought together so many problems especially related to hazardous conditions for patients. The study exposed the fact that high patient perception levels, together with an increase in admission and discharge cycles and shortage of nurses pose serious challenges for the delivery of safe and effective nursing care (Aiken, et al., 1996). The work pressure on existing nurses is such that they will have to work on an average of twelve to even sixteen hours.

Besides, nurses who are serving specialized units such as surgery, dialysis, and intensive care are often required to be available to work extra hours other than their regular shifts that may be randomly scheduled. In emergency units, twenty-four-hour shifts are becoming more common (Rogers, et al., 2004). In a study by Gold (1992), it was found that nurses who worked rotating shifts were more sleep deprived and more likely to fall asleep while they are at work as a result they were nearly twice as likely to make a medication error when compared with other nurses who predominantly worked day shifts. A good healthcare system needs to be evolved to overcome these problems.

Further growth of the healthcare industry calls for more and more people to join this service industry through good education. Increased numbers of healthcare professionals are needed not only to care for elderly patients but also to replace retiring professionals. According to national statistics, the average age of nurses is rising whereas the rate of those entering the profession has slowed over the past decades. This is another reason for nursing shortages that the average age of nurses is 45 years. Additionally, the image of the profession, work environment issues especially the high-stress situations, and leadership shortage also add to the problem. In addition, issues such as job burnout and dissatisfaction with the current working nurses also add to these problems.

Technology and Quality Care

As technology has entered all other fields it has entered the nursing field also. Computerization is very common in most health care institutions and therefore nurses need to have good computer knowledge. Nursing Informatics is a recently developed field that combines nursing skills with computer expertise. This field is the modern technology that aids with documenting and communicating the service or care provided. Today, in most hospitals the records have less information, and most of it is stored in computers which is a different situation from the 80s and 90s. It is often seen nurses in the hospital work with mobile computers in the patients’ rooms. Therefore, recent years have seen several advancements using the latest technologies.

Technological advancement in all fields including the healthcare sector helps the customers to get better information about the quality and cost of their care. Among the healthcare sector, there is obvious competition to provide customers with the best value. According to the existing estimates, approximately 15% of GDP is spent on healthcare alone in the United States, which is the highest in the world (WHO, 2006).

As technology is playing a major role in all emerging fields, nursing is also growing in terms of technology. It is quite evident that the use of computer and information technologies in healthcare increase at a faster rate and this is, in turn, going to improve the nursing practice and patient education. The use of these technologies can also help in storing a vast amount of data systematically and reducing errors. With the increase in stress due to the shortage of nurses, the working staff will be handling more patients and many times it is possible that errors occur in medication. The use of a computerized charting system can help the nurses in managing the data.

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Nursing Skills and Patient Care

The Science of Nursing involves Evidence-Based Nursing and Nursing Informatics. Evidence-Based Nursing (EBN) is the method using which nurses make clinical decisions. When using EBN nurses use the best sources of research evidence, their clinical expertise, and patient preferences to solve problems. The clinical problems they identify as the driving force for clinical change improve health care quality. According to the definition given by Lindberg (2004), “EBN is the clinical decision making based on the best available scientific evidence, together with clinical nursing expertise and taking into account patient preferences and available resources”.

Creative thinking is an important link in the teaching-learning process, as it is a very important aspect that enhances problem-solving in nursing practice (Kalischuk and Thorpe, 2002). Recognizing this need, several health care units have initiated programs that consist of arts and creativity. Researchers have found that due to the unique links with patients, nurses play a vital role in bringing creative arts into patient care (Lane, 2005).

The importance of communication skills for professional nursing practice is well recognized. When communications are good, information flows smoothly, delivering clear messages that people can easily understand and act on. When it is not, confusion leads to misunderstanding, inaction, or wrong actions. Any mistakes in communication among the nursing staff can lead to serious problems. There is a growing demand for nurses with skills to treat patients with multifaceted care needs. The traditions in which people communicate have deep effects on those who are around them.

Peplau (1952) redefined nursing as an interpersonal, interpretive practice (Tilley, 1999). Peplau created one of the first statements of principles for the study of nursing as a communicative practice. It is important that nurses need to take action based on the meaning of events to them, based on their instant understanding of the environment and performances that emerge in a particular rapport.

However, the patient may act based on his illness to him. “The interaction between nurse and patient is fruitful when a method of communication that identifies and uses common meanings is at work in the situation” (Peplau, 1952). The impact of this outlook of nursing has been deep over the past several decades and there has been a revolution in research and theory on communication processes in health care.

In recent years it is noted that there are a lot of studies going into nursing and communication skills. Therefore, it is vital for practitioners to understand the main tendencies and topics in the learning of communication, to integrate this information within professional practice. Communication is an influential life-changing activity and a varying outcome can come out from the method of caring for others depending on the way communication is managed. Indeed, health care and communication go hand in hand.

Conclusion

It can be said that nursing is a profession that involves taking care of patients with utmost care using the latest technologies. All the efforts focus on creating the best environment for the recovery process of patients. Nursing faculty needs to make use of their critical thinking, creativity, problem-solving, and effective communication skills. Nurses also need to be understanding of cultural diversity while they are delivering therapeutic care.

Modern nurses need to be leaders, coordinators, teachers, and practitioners. They also need to cope with the fast-changing trends in the healthcare industry as there are several responsibilities that they have to specialize in to be successful in this profession. With the increasing demand for nursing staff all over the world, more and more people must get trained and get into this noble profession. In simple terms, this is the only profession in which the focus is on helping individuals, families, and communities in achieving, re-achieving, and maintaining optimal health.

References

Aiken, L.H., Sochalski, J. and Anderson, G.F. (1996) Downsizing the Hospital Workforce, Health Affairs 15, no. 4, pp 88–92.

Antrobus, S. and Kitson, A., (1999). Nursing Leadership: Influencing and shaping health policy and nursing practice. Journal of Advanced Nursing 29, 746-753.

Gold, D.R., Rogacz, S, Bock, N, et al. (1992) Rotating shift work, sleep, and accidents related to sleepiness in hospital nurses. Am J Public Health. 82 pp. 1011-1014.

Kitson, A. (2001) Nursing leadership: bringing caring back to the future. Quality in Health Care 10: ii 79-84.

Kirkness, A. and Grochulski, A. (2001) Living with an Implantable cardioverter-defibrillator, Royal North Shore Hospital and Community services.

Landrigan, C.P. et al, (2004) Effect of Reducing Interns’ Work Hours on Serious Medical Errors in Intensive Care Units, The New England journal of medicine, 351: pp. 1838-1848.

Lane, M.R. (2005) Creativity and spirituality in nursing: implementing art in healing. Holist Nurs Pract. 19(3):122-125.

Manley, K. (1997) A conceptual framework for advanced practice: an action research project operationalizing and advanced practitioner/consultant nurse role. Journal of Clinical Nursing. 6, 179-190.

Peplau H. (1952) Interpersonal Relations in Nursing. Putnam, New York. pp 283–284.

Rogers, A.E. et al., (2004) The Working Hours of Hospital Staff Nurses And Patient Safety, Health Affairs, Vol 23, No 4, pp 202-212.

Singhapattanapong, S. (2002). The nurse shortage hurts UCLA Medical Center. UCLA Daily Bruin, p.1.

Sofarelli M.. & Brown, R. (1998). The need for nursing leadership in uncertain times. Journal of Nursing Management, 6(4), 201-207.

Sullivan, E.J. & Decker, P.J. (2001). Effective Leadership and Management in Nursing (5th ed.). Upper Saddle River, NJ: Prentice-Hall.

Tilley S. (1999) Altschul’s legacy in mediating British and American psychiatric nursing discourses: common sense and the ‘absence’ of the accountable practitioner. Journal of Psychiatric and Mental Health Nursing 6: pp 283–285.

Valentine, S.O. (2002) Nursing Leadership and the New Nurse. Journal of Undergraduate Nursing Scholarship Vol. 4, No. 1, Fall 2002.

World Health Organization (WHO), (2006) Working Together for Health. Web.

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