Leadership vs. Management: Preferred Qualities in Nursing Personnel

Though the skills inherent to effective leaders and managers often overlap, it is imperative to an organization's overall efficaciousness to possess both management and leadership.  Leadership is most generally defined as "the ability to define a vision and guide individuals and groups toward that vision while maintaining group-promoting teamwork, commitment, and effectiveness" (Knodel, "Nurse," 2009, p. 2), while management, typically enveloping leadership skills,  differs in its emphasis on technical and administrative skills.  While the term management may imply leadership, not all managers are (effective) leaders, and likewise, not all leaders possess effective management skills.  This paper will juxtapose the approaches of the leader and the manager to the shortage of nursing staff in a given facility--not the overall workforce; and in order to accentuate the differences between the two, both the manager's leadership skills and the leader's management skills will be tenuous.  Following this comparison will be an alternative approach curtailed to a nursing philosophy that enlists both leadership and management skills in order to more efficiently and effectively overcome the problem.

The "Nurse Staffing Strategy" report, released March 2013 at the American Organization of Nurse Executives conference, will be utilized to draw the specifics of the staff shortage example to be used in this paper.  According to the findings of the survey, 57% reported workloads were distributed unevenly the previous year, 77% reported their organization had 12-hour nursing shifts, 56% noted that their hospitals disregard required rest periods, 65% claimed their hospitals have no policy limiting total cumulative days of extended shifts, 63% blamed the necessity for overtime on vacancies affecting the work schedule.  The same survey has 96% reporting feeling somnolent when their shifts begin.  Thusly, the staffing shortage of this paper will be due to burnout as a direct product of these organizational impediments.

For this issue, the manager's administrative and quality of care skills, above all else, will be put to the test.  Though the problem is largely administrative, it unquestionably affects nurse performance--not to mention presence--and therefore quality of care.  Because quality of care skills include competence in enhancing performance through gathering, interpreting, and analysis of quality data, it is in this instance even more in demand.  It would be expected of the manager to approach the matter empirically, otherwise stated, through the examination of the extent of the problem of his/her own facility, a comparison of her issue with research conducted on facilities with similar issues, and a conclusion of the best course of action based on the findings of research reviewed, adjustments for differentials.  The manager would then take administrative measures in an attempt to solve the issue, such presenting an organized portfolio of her findings,  through the appropriate channels.  The portfolio would include a breakdown of the problem and its source, future consequences of the problem's dismissal, steps that can be taken to dilute the current issue as well as prevent it in the future, and the research supporting his/her case.  

Though there is managerial merit in the steps above, they do little to educate staff to deal with issues themselves.  When, in her work, Notes on Nursing: what it is, and what it is not, Florence Nightingale sagaciously instructs those in charge to "provide for [the] right thing to be always done," in contrast to always doing it themselves, she goes on to say that "It is the invariable sign of the bad nurse and manager when her excuse that such a person was neglected or such a thing left undone, is, that she was 'out of the way'" (58).  Nightingale's use of the phrase, "out of the way" is more than appropriate for the circumstance under discussion as nurses being 'out of the way' is exactly what the problem is.  Should the problem recur once the manager is permanently out of the way (as a result of relocation, retirement, etc.), being that there was no educational leadership to ensure that it does not recur, the remaining nurses will find themselves in the same situation.  

An effective leader would ensure the prevention of recurrence by instilling the vision of proper scheduling, implementing measures that prohibit abuse of extended shifts, and ergo preventing burnouts and mistakes that occur from inattentiveness to detail as a consequence of fatigue.  The leader would further organize a team effort that both instructs the members of the staff on the details of preventive measurements and  accomplishes the task at hand.  Team building instills communication; this is both something a leader encourages, and an imperative for discovering the dissatisfaction in the workplace in the first place.  "Workload and staffing" is the second most cited reason for turnover in nursing ("Attracting and Retaining," 1999), and effective leadership's encouragement of voicing opinions can be a great assist in decreasing such high turnover rates.  But even the efforts of nurses whose leadership is top-notch can fall short of the goal without the proper managerial skills and core competencies in training.

This is why managerial nurses should adopt a philosophy that encourages staff solidarity, establishes direction, initiate and encourage vision, and engenders strategies to attain such visions.  A leader does not have to be a manager, but the manager should certainly be a leader.  Kowalski's "Five C's" (2003), ideal for the role model, combined with four more: communication, collaboration, control (that is, control over day-to-day operations and administrative actions), and creativity--which has been linked to increased job satisfaction (Sellgren, "Leadership," 2008)--would provide an ideal framework for the fusing the two roles and responsibilities of manager/leader.  A Manager with this methodology and skills would be able to overcome the issue through team effort  and knowledge of administrative procedure and would be able to prevent it by acting as a role model whose methods educate his/her staff on how to solve the problem in his/her absence.

References

Knodel, Linda . "Nurse to Nurse Nursing Management - McGraw-Hill Nursing Books : Book." McGraw-Hill Professional - Online bookstore. n.p., 18 Nov. 2009. http://www.mhprofessional.com/product.php?isbn=0071601538&promocode=WTGOOG&fromgoogle=yes.

Kowalski, K., & Yoder-Wise, P. S. (2003). Five C's of leadership. Nurse Leader, 1(5), 26-31.

Nightingale, Florence. Notes on nursing: what it is, and what it is not. Commemorative ed. Philadelphia: Lippincott, 1992.

"Nurse Staffing Plans & Ratios." American Nurses Association. n.p., n.d. http://www.nursingworld.org/MainMenuCategories/Policy-Advocacy/State/Legislative-Agenda-Reports/State-StaffingPlansRatios.

Sellgren, Stina Fransson, Goran Ekvall, and Goran Tomson. "Leadership Behavior of Nurse Managers in Relation to Job Satisfaction and Work Climate." Journal of Nursing Management 16.5 (2008): 578-587. Wiley Online Library.

William M. Mercer Inc. (1999) "Attracting and Retaining Registered Nurses - Survey Results." Chicago, IL. American Association of Colleges of Nursing. n.p., n.d. http://www.aacn.nche.edu/publications/position/tri-council-shortage.