Increased attention to the analysis and development of nursing concepts in the recent decade can be explained by the researchers’ aim to clarify any issues and inconsistencies that in the past were accepted as correct or common. Because some nursing concepts, including those regarded as essential, were defined by unclear terminology and explained through inconsistent definitions and theories. The selected nursing concept is leadership, which is a multi-dimensional concept that comprises a range of qualities and definitions. It relates to the leadership nursing theory, which was created to guide, motivate, and inspire the nursing professionals to “promote the values of the National Health Service, to empower and create a consistent focus on the needs of the patients being served” (Giltinane, 2014, p. 35). This paper will be divided in the following sections to examine the concept of nursing leadership: concept definition, literature review, defining attributes of the concept, its antecedents and consequences, empirical referents, a model case, and alternative cases of the concept.
According to the broad definition provided by Weihrich and Koontz (as cited in Curtis, de Vries, & Sheerin, 2011), leadership is the influence, that is, a process of influencing other people in order for them to be motivated. Another definition given by Cook (as cited in Giltinane, 2014) described leadership in clinical practice as the direct involvement in clinical care at the same time with a constant influence on others in order to improve the quality of care provided to patients. Therefore, the role of the nursing leader is facilitating effective performance from other members of the medical staff. Such facilitation is associated with influencing the development of shared nursing values, expectations about enhancing nurses’ performance, and overall effectiveness of the provided care.
The traditional approach towards leadership implies that leaders possess different personality characteristics compared to their followers. As described by Grimm (2010), a leader has particular personality traits such as ethical fitness, courage, confidence, motivation, and ability to put important activities as a priority. It is important to mention that although leaders, especially in the sphere of nursing, predominantly possess necessary traits by nature; skills and competencies can be developed and advanced through education and professional practice. Another way of exhibiting leadership competencies in the nursing environment is employing the Leadership Framework (developed by the NHS Leadership Academy), which helps the medical staff with understanding their stages of development as leaders, and supports them in recognizing their potential leadership qualities.
To examine the nature of the leadership concept, it is first important to mention that the concept of leadership influenced the development of research and theory. Depending on the approach researchers took, nursing leadership theories were differentiated into different categories. For instance, Spector (2006) differentiated leadership theories into four approaches, such as:
- The trait approach (examined personal traits that facilitate good leadership skills);
- The contingency approach (concerned with the interaction between a leader and the behavior he or she exhibits in a specific situation);
- The behavior approach (similar to the trait approach in that it examines personal behaviors that facilitate effective leadership skills);
- The leader-member exchange approach (concerned with the relationship between the leader and his or her followers).
The above-mentioned leadership theories can all be beneficial in helping nurses develop effective leadership skills; although, many researchers and theorists distinguished transformational leadership as the best choice for developing and advancing leadership in the nursing profession. According to Curtis et al. (2011), transformational leadership is an approach that is grounded on one’s vision, ability to build trust from followers and inspire them, create strong bonds, and motivate others to reach set goals.
Although researchers from the sphere of nursing gave specific definitions of leadership in the context of nursing, there is a lack of cohesive terminology as to the notion of “nursing leadership.” However, Dunham and Fisher (1990) defined nursing leadership as “administrative competence, adequate education, business skills, clinical expertise and an understanding of leadership principles” (p. 1). Such definition of nursing leadership suggests that there is an emphasis on nurses understanding their responsibilities when it comes to improving the practice environment and enhance the quality of care provided to patients. Therefore, a general definition of leadership is included in the specific nursing leadership explanation, although there is more attention put on the medical practice rather than the relationship between leaders and followers or the development of new skills. Another approach towards defining nurse leadership was developed by La Monica (as cited in Curtis et al., 2011), who stated that any nurse professional that recognizes his or her responsibilities and understands the need for carrying out a set goal is a leader. Therefore, such an approach to nursing leadership suggests that any nursing professional that provides help to others is a leader. For example, a nursing manager is a leader to the members of the medical staff while a staff member is a leader for patients he or she treats.
Researchers also explored characteristics of an effective leader to get a better understanding how leaders affect the process of providing high-quality care to patients or developing team skills. For example, as described by Frankel (2011), an effective leader possesses a strategic framework for directing his or her team to meet the future goal. Furthermore, an effective leader should be familiar with how to solve problems, how to maintain the efficiency of the nursing staff, as well as how to correctly identify his or her group to develop a unique approach towards leading the group. Leaders, especially in the sphere of nursing practice, set an example for others, they motivate people to perform better and have of focus on implementing a solution, which will be the most suitable for patients with different issues or conditions. Frankel (2011) also mentioned a specific characteristic of a nursing leader, described by the phrase “don’t just tell me – show me” (p. 3). This phrase illustrates the importance of leaders giving clear instructions in supervising their teams. A leader should first show the followers how a goal can be achieved, and then should support and guide them in completing the assigned task.
Lastly, it is crucial to mention political context as one of the driving forces for leadership. Due to the constant changes in the healthcare environment, leaders should possess adapting skills to change and improve nursing roles when necessary. For instance, senior nurses are greatly challenged by becoming involved in the process of decision-making as to the changing policies, planning of the nursing workflow, and maintaining corporate and clinical governance in a healthcare facility. Sorensen, Iedema, and Severinsson (2008) underlined the importance of senior nurses becoming integrated into the nursing team to be respected and accepted by the staff as equal stakeholders. When such integration occurs, senior nurses can build strong leader – team relationships, which will facilitate the process of decision-making as to adapting to the changes in the nursing environment.
Research and analysis of such a multi-faceted concept as nursing leadership did not distinguish a specific approach towards defining its attributes. Because of the variety of definitions, theories, and ideas about nursing leadership, it is impossible to distinguish nursing leadership attributes that will apply to all leaders and all situations. However, research “Attributes of clinical leadership in contemporary nursing: An integrated review” conducted by Mannix, Wilkes, and Daly (2013) managed to distinguish some leadership attributes that unified some approaches, presented in the previous studies.
The first attribute of leadership in the clinical environment is associated with the focus on the team or followers. Stemming from the team focuses leadership theories, this attribute of leadership is regarded as one of the most important components of effectiveness and success. Team-focused nursing leadership is effective in improving the performance of the staff, promoting collaboration between different teams and team members, and increasing the effectiveness of separate individuals in achieving the set goal. The second attribute of clinical leadership is the clinical focus, or if put in the context of the nursing environment, nursing focus. This attribute implies that a leader has a clear focus on employing all knowledge and skills in order to achieve a goal of improving patients’ health outcomes. By focusing on the nursing practice, a leader will manage to improve goal-oriented instruction and better guide followers in their learning and development. Characteristics of the nursing-focused approach include systematic thinking, evidence-based rationale, and expert knowledge (Mannix et al., 2013). The third attribute pertaining to nursing leadership is the personal qualities focus. Focus on personal qualities in leadership has been proven to be of high importance, both for leaders and team members. Recognizing personal attributes like, for example, self-control, awareness, and determination may help leaders guide his or her followers effectively as well as may help followers comply with the instructions given by the leaders.
Antecedent and Consequence
According to Hodgston and Scanlan (2013), antecedents are events that occur previous to the emergence of the concept. The most significant antecedent of the nursing leadership concept is the requirement of a leader and a follower or a group of followers. Thus, the leadership relationship cannot occur without the existence of the leader and his or her followers. The act of leading the nursing staff towards a set goal begins with the team selecting a leader or the leader selecting the followers to establish a relationship between them. Leader – follower relationships are supported by the availability of a common interest or a goal that facilitates effective communication and promotes respect. For this reason, healthcare facilities should recognize the importance of leadership and should believe in its beneficial outcomes.
Consequences of nursing leadership happen after the concept (Hodgston & Scanlan, 2013). The experience of effective nursing leadership will allow the leader develop new skills of guiding followers towards a set goal while the team members can learn how to interact within a group and work cooperatively to achieve the objective of increasing the quality of health care. Not only team members and leaders benefit from effective interaction but also the healthcare facility, and consequently, patients can improve their outcomes. Thus, leadership empowers and motivates leaders and their followers. As a result, motivation can enhance employees’ performance and professional development.
Empirical referents are indicators of the concept’s occurrence (Hodgston & Scanlan, 2013). Two of the empirical referents of nursing leadership is mutual respect between team members and their leaders and the common vision, which results in tangible changes in the provision of health care. There is a range of tools that can assess the strive to achieve a common goal and the level of respect within the professional environment.
John Brown, a nursing practitioner, has a set goal of achieving success in the sphere of administration and leadership. As a first step towards achieving his goal, he decides to facilitate meetings of the staff in which team members will discuss issues they deal with on a daily basis to solve the problems cooperatively. Other team members recognized John as their leader and began to come to him for some advice, help, or guidance in some issues.
This model case shows all three attributes of leadership: team focus, nursing focus, and personal qualities of the leader and his followers. The leader and the team members exhibited willingness and respect; the leader focused on improving the healthcare outcomes and used personal qualities of his followers to resolve performance-related issues. The antecedent of the model case is John’s desire to develop his leadership while the consequence is him being recognized as a leader of a small group of employees. The empirical referent of this model case is that employees now consult John on some performance-related questions and value his opinion.
Jane wants to pursue the career in nursing administration, for which she needs a record of effective leadership experience. She decides to offer help to some employees and show them how to properly perform certain tasks. However, instead of facilitating interaction with other employees and creating a group of employees that will engage in conversation and help each other, she interfered with nurses’ work and caused conflict. Although the attribute of focus on nursing is present in this case (Jane wanted to improve the effectiveness of the provided care), the prospective leader did not have a team focus and disregarded personal characteristics of the nursing staff.
Mark always wanted to achieve success in the sphere of nursing leadership; he decided to encourage group meetings to discuss issues that arise in the professional practice of the nursing staff. However, when Mark proposed to conduct the meetings, the rest of the staff did not think that it was a good idea. Therefore, Mark did not have an outlet for his leadership ambitions and had to look for other ways of facilitating team interaction.
The fast pace of nursing practice development calls for leaders that will be able to adapt to changes, facilitate group interaction, and lead followers towards reaching an objective of improving patient outcomes and the quality of provided care. Exploring the concept of leadership in nursing gave a better understanding of how it was studied by researchers, how it influences the professional practice, as well as how it is implemented in the sphere of nursing. Going forward, the nursing practice will need more effective leaders that will possess the necessary leadership attributes to approach the provision of health care with innovation and a ‘clear vision.’
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