Challenges Facing Nursing Leaders

Introduction

As the nursing profession has increasingly taken an evidence-based approach to both practice and research in recent years, professionals have identified leadership as a critical topic of interest within the field. As a result, a number of challenges have also been highlighted which consistently present themselves to leaders within the nursing profession. The purpose of this paper is to discuss some of the most pertinent challenges experienced by nursing leaders in today's workforce. Specifically, this paper will discuss managerial issues within an increasingly multidisciplinary field. Next, ensuring high patient and worker satisfaction will be discussed in the context of this changing work environment. A strengths, weaknesses, opportunities, and threats (SWOT) analysis will then be presented related to these two related nursing leadership challenges. Recommendations for the future of nursing will then be discussed. This paper concludes with a brief summary and outline of key points.

Managing an Increasingly Multidisciplinary Field

An abundance of research (e.g., Epstein et al., 2010; Zakrisson et al., 2011) has emerged over the past 10 years highlighting the increasing multidisciplinary nature of the professional nursing field. As more professionals are entering the workforce, the field has become more specialized and nurses now possess very specific skillsets to work with patients of differing needs (Epstein et al., 2010). Furthermore, hospitals are favoring a multidisciplinary approach to patient care because of the holistic nature of this strategy (Epstein et al., 2010).

The benefits of this emphasis on multiple specialists with specific skillsets are fairly intuitive to researchers and practitioners. According to Zakrisson and colleagues (2011), this multidisciplinary care approach increases patient satisfaction and the perception that a team, rather than just one individual is managing their care. Furthermore, a multidisciplinary care approach increases the chances that treatment is delivered in accordance with national nursing guidelines, as more individuals are held accountable for treatment outcomes (Zakrisson et al., 2011). Finally, the utilization of multiple specialists promotes increased patient accessibility to information and support from members of the care team (Zakrisson et al., 2011). These benefits have combined to increase overall patient satisfaction (Epstein et al., 2010).

However, despite the benefits associated with multidisciplinary care, this approach is not without its drawbacks. The greater reliance on multiple care team members elicits the possibility of communication difficulties, which can ultimately impact treatment outcomes in a negative manner (Wright, McDowell, Leese, & McHardy, 2010). Additionally, relying on more individuals to provide care for one patient increases the likelihood of conflict regarding treatment decisions, or discrepancies between members of the care team (Wright et al., 2010). Finally, allowing more professionals access to patient information may also increase the chance of recording errors (Wright et al., 2010). Each of these challenges makes handling the multidisciplinary care team a mixed blessing for nursing leaders.

Vazirani, Hays, Shapiro, and Cowan (2005) examined these communication challenges within the multidisciplinary care environment over a two-year period, specifically focusing on the role of leaders in mediating conflict and communication difficulties. According to these authors, one of the most critical issues for nursing leaders was ensuring effective communication and collaboration between doctors and other members of the care team. The hierarchical roles between doctors and nurses within the hospital setting posed unique challenges for nursing leaders, and effectively managing this hierarchy was found to be a key determinant of patient satisfaction (Vazirani et al., 2005). Interestingly, these researchers found that, through a communication-focused intervention, the barriers between doctors and nurses could be overcome and both patient and worker satisfaction increased.

Brown and colleagues (2011) also conducted a recent study regarding the increasing risk of conflict as a result of multidisciplinary care. Drawing on a phenomenological analysis of more than 120 professional health care team (PHCT) members, these researchers identified several implications for nursing leaders. Key sources of conflict within these multidisciplinary care teams included: role controversies; managing scope of practice; and accountability issues. Additionally, Brown and colleagues (2011) found that a number of consistent barriers to resolving these conflicts existed, including: lack of time; heavy workload; lack of motivation; and fear of confrontation due to emotional discomfort or loss of job status. As can be evidenced, these sources of controversy and the according barriers serve as a basis from which nursing leaders can intervene and help resolve these issues. As with Vazirani and colleagues (2005), Brown and colleagues (2011) found that nursing leaders who had better communication skills, were more open to diverse resolution strategies, showed more respect to workers, and possessed humility were more effective at resolving multidisciplinary care team conflict within the work environment.

Ensuring Patient and Nurse Satisfaction

Patient satisfaction is always at the top of any care facility's list of priorities (Reid et al., 2010). The degree to which a patient is satisfied with his or her care falls directly in the hands of nursing leaders, who oversee members of the multidisciplinary care team responsible for treatment outcomes (Reid et al., 2010). Patient satisfaction is a result of multiple factors, but is highly related to the interpersonal relationship formed with members of the care team. According to Larrabee and colleagues (2004), patients' perceptions of nurses' level of care for their treatment outcomes is the most important predictor of patient satisfaction. This should come as no surprise to modern nursing professionals who are familiar with the American Nurses Association's (ANA, 2013) code of ethics. Among the most pertinent values and ethics advocated by this organization are compassion, empathy, and respect for patients' human dignity (ANA, 2013). Therefore, it is critical that all members of the multidisciplinary care team display compassion and show that they care about each patient's treatment outcomes.

Unfortunately, the degree to which each nursing professional actually displays this level of compassionate care can be saturated when more people are involved in a patient's care (Marshall, 2011). Within the multidisciplinary care environment, care can often become less intimate and more superficial, and a greater number of professionals are responsible for overseeing a case (Marshall, 2011). This poses a unique challenge to nursing leaders, who must ensure that the multidisciplinary care team still maintains the ANA's (2013) high ethical and moral standards.

Equally important to nurse leaders is ensuring that members of the multidisciplinary care team are satisfied with their worker environment. Dissatisfaction with work can also become a source of conflict within the workplace, and can subsequently reduce patient satisfaction (Vazirani et al., 2005). Nursing leaders are faced with the task of balancing the needs of patients with those of professionals, which may sometimes be in conflict. Professional nursing faces one of the highest rates of attrition of any profession, due to heavy workloads, stress and burnout, role controversies, and compensation factors (Reid et al., 2010).

Andrews, Richard, Robinson, Celano, and Hallaron (2012) recently showed that nursing leadership styles were also a key determinant of worker satisfaction. According to these authors, those nurse leaders who displayed a transformational style of leadership were more likely to have satisfied workers than those who used alternative styles, such as transactional or autocratic leadership (Andrews et al., 2012). A transformational style is one that promotes nursing excellence through motivation and inspiring positive change in workers, rather than through traditional reinforcement and punishment strategies (Andrews et al., 2012).

Similarly, a transformational leadership style seems to most suitably fit with the professional guidelines presented by the ANA more than any other style. The compassion, empathic understanding, and respect for human dignity promoted by the ANA are all characteristics of the transformational leader (Marshall, 2011). Therefore, nursing leadership can have a direct impact on both worker and patient satisfaction, and the effective nurse leader is able to critically reflect upon, and improve, his or her leadership skills.

(SWOT analysis table omitted for preview. Available via download)

SWOT Analysis Summary

The increasing multidisciplinary nature of professional nursing has brought both benefits and consequences to the field. The benefits include increased patient and nurse satisfaction and increased specialization, which have heightened the overall level of nursing care. However, this multidisciplinary nature of professional nursing has presented challenges for leaders, such as interpersonal conflict, communication difficulties, difficulties managing professionals from a range of different sub-diusciplines, increased risk of errors, and potential dissatisfaction by both patients and nurses. These threats to present unique opportunities to conduct new research and overcome modern professional nursing problems. Additionally, these drawbacks highlight the need to adhere to ANA nursing standards and increase focus on leadership skills. Potential threats to modern nursing leaders include a risk of professional divergence due to increased specialization of skills, greater hierarchies within the field, and the ever-present demographic and governmental influences on the field.

Recommendations

Although the increasing multidisciplinary nature of the professional nursing field has brought forth many positive changes to the workplace, there is certainly room for improvement. As can be evidenced from the above research, interventions have proven to be effective in mediating some of the communication difficulties and interpersonal conflict that has challenged nursing leaders. The intervention presented by Vazirani and colleagues (2005) may serve as an efficacious starting point to resolve some of these challenges and better meet patient needs. This intervention specifically emphasized enhancing communication skills of multidisciplinary care team workers, as well as increase collaborative efforts from professionals of varying nursing sub-disciplines. Due to the success of this intervention, focusing on these two outcomes is a highly recommended strategy for managing the increase multidisciplinary nursing field.

Second, an overwhelming abundance of research (e.g., Vazirani et al., 2005; Marshall, 2011) has illustrated the need for more transformational leaders within the nursing field. For decades, nursing education has focused on promoting the clinical skills needed to successfully provide quality care and treat patients' various medical needs (Marshall, 2011). However, recent trends in nursing programs have shown that incorporating leadership skills into the curriculum has produced more efficacious nursing professionals (Marshall, 2011). The multidisciplinary nature of the nursing profession makes this field particularly suited for transformational leaders, due to the emphasis on effective communication, demonstrating respect for all members of the care team, resolving conflicts through empathy and understanding, focusing on collaboration and making patient-centered care a primary goal (Marhsall, 2011). Therefore, installing transformational leadership workshops into the academic and professional nursing environment is another highly recommended strategy for managing the modern workplace. Furthermore, incorporating reflective analysis into these workshops may help students and leaders understand their own strengths and weaknesses and develop the skills they need to become transformational leaders.

Finally, reinforcing adherence to the ANA's (2013) current ethical and moral guidelines is essential for modern nursing leaders. Although the nursing profession has evolved considerably since the pioneering days of Florence Nightingale, the code of ethics that have guided the field have remained relatively unchanged. Throughout the history of nursing, the ANA, as well as other leading worldwide nursing organizations, have advocated for empathy, compassion, patient-centered care, respect for human dignity, and other intuitive professional standards. However, the degree to which these standards have actually been followed in an applied setting may leave some room to be desired. Nursing leaders must continually reinforce the ANA's professional standards and ensure that each member of the multidisciplinary care team is acting in a way that reflects these values. Doing so is the most certain strategy for ensuring both patient and nurse satisfaction, and preventing some of the common conflicts that occur within the day-to-day work environment (Marshall, 2011). Therefore, it is recommended that modern nurse leaders closely monitor the degree to which they and their staff are adhering to these guidelines.

Conclusion

The purpose of this paper was to explore modern challenges faced by nurse leaders. Specifically, this paper focused on the challenges of managing the increasing multidisciplinary work environment found in the field. Additionally, this paper discussed the continual need to ensure both patient and nurse satisfaction. A SWOT analysis was presented to help conceptualize the strengths, weaknesses, opportunities, and threats associated with the multidisciplinary workplace. Finally, recommendations were presented to help mediate these challenges, including steps to enhance communication and collaboration amongst multidisciplinary care team workers, emphasizing a transformational leadership style for nurse leaders, and ensuring that all members of the care team adhere to the ANA's professional standards.

Based on the evidence presented in this paper, it is clear that the multidisciplinary nature of professional nursing is a mixed blessing for nurse leaders. However, this change is likely inevitable, and the most effective strategy for these leaders is to adapt. By accomplishing the three objectives presented in this paper, it is believed that many of the challenges that commonly occur in the day-to-day work environment can be prevented.

References

American Nurses Association (2013). Code of Ethics with Interpretive Statements. Retrieved from http://nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurses/Code-of-Ethics.pdf. Accessed 5 December 2013.

Andrews, D. R., Richard, D. C. S., Robinson, P., Celano, P. & Hallaron, J. (2012). The influence of staff nurse perception of leadership style on satisfaction with leadership: a cross-sectional survey of pediatric nurses. International Journal of Nursing Studies, 49(9), 1103-1111.

Brown, J., Lewis, L., Ellis, K., Stewart, M., Freeman, T. R. & Kasperski, M. J. (2011). Conflicton interprofessional primary care teams - can it be resolved? Journal of Interprofessional Care, 25(1), 4-10.

Epstein, S., Geniteau, E., Christin, P., Hermouet, P., Mok, E., Fournier, J., ... (2010). Role of a clinical nurse specialist within a paediatric multidisciplinary weight-management programme team. Journal of Clinical Nursing, 19(17-18), 2649-2651.

Marshall, E. (2011). Transformational Leadership in Nursing. New York: Springer.

Reid, R. J., Coleman, K., Johnson, E. A., Fishman, P. A., Hsu, C., Soman, M. P., ... (2010). The group health medical home at year two: cost savings, higher patient satisfaction, and less burnout for providers. Health Affairs, 29(5), 835-843.

Vazirani, S., Hays, R. D., Shapiro, M. F. & Cowan, M. (2005). Effect of a multidisciplinary intervention on communication and collaboration among physicians and nurses. American Journal of Critical Care, 14(1), 71-77.

Wright, W., McDowell, J. R. S., Leese, G. & McHardy, K. C. (2010). A scoping exercise of work-based learning and assessment in multidisciplinary health care in Scotland. The Journal of Practice Teaching and Learning, 10(2), 28-42.

Zakrisson, A.-B., Engfeldt, P., Hagglund, D., Odencrants, S., Hasselgren, M., Arne, M. & Theander, K. (2011). Nurse-led multidisciplinary programme for patients with COPD in primary health care: a controlled trial. Primary Care Respiratory Journal, 20(4), 427-433.