Nursing Leadership and Management

The health care delivery system is changing rapidly with respect to policy, medical practices, medical treatments, medical technology, and more. In the context of these changes, the nursing profession is being redefined in significant ways. This is especially true in relation to nursing leadership and management. To demonstrate the point, the following report presents a seven-part discussion. Emphasis is placed on subtopics such as the implications of change in the health care delivery system, roles and characteristics of managers and leaders, transformational leadership in relation to IOM recommendations, and other related issues.

The Implications of Change in the Health Care Delivery System on Nurse Leadership

With respect to the implications of change in the health care delivery system on nursing leadership, a paradigm shift is occurring. Just ten to twenty years ago, the roles and responsibilities of nurses were primarily defined in terms of support functions for physicians and other medical professionals. Today, however, nurses fulfill a vast array of critical health care delivery functions involving direct patient care, complex research, and more (IOM, 2011). For these functions to be fulfilled properly, nurses must recognize themselves as far more than just supporters. Nurses must see themselves as leaders. As such, nurses need to understand leadership theory and practical application in terms of the characteristics, roles, and responsibilities of leaders and managers.

Characteristics, Roles, and Responsibilities of Leaders and Managers

In today’s health care, leaders and managers share many characteristics in common. Foremost, in the diverse and complex healthcare delivery setting, they must have great communication skills. In a work environment where multitasking is the name of the game, they must also be able to manage time effectively. And perhaps most importantly of all, managers and leaders must be able to influence others through demonstration of integrity and trustworthiness, humility, and values (Smith, 2011; DiMattia, 2013).

As for roles and responsibilities, leaders and managers are responsible for overseeing the workplace behaviors and actions of other people. However, the basic functions of a manager and leader are different. Fundamentally, a manager plans, organizes, and controls. In other words, managers make sure the workplace environment is functioning according to specific standards. The leader, on the other hand, is more concerned about possibilities for the future. Leaders, in so many words, focus on creating shared vision throughout the organization. Summarily, managers maintain the system and set job and performance expectations. Leaders focus their efforts and energies on inspiring and influencing others for the purpose of creating a better future.

Management and Leadership Qualities

In addressing the topic of management and leadership qualities, a few similarities exist. Management and leadership both require knowledge of the healthcare industry. Both disciplinary areas also require an understanding of the law and regulatory framework, financial issues (e.g., budgeting, resource allocation, and so forth), and business rules and policymaking. Management and leadership are also concerned with topics like teamwork, collaboration, motivation of staff in relation to innovation and productivity, organizational change, and organizational culture (DiMattia, 2013). Perhaps the best way to differentiate management and leadership is to think of management as a matter of systemic thinking and regulated behavior. Management, in other words, is more of a scientific discipline based on rules and principles. Leadership, by contrast, is more of an art as it requires intuition, feeling, and other intangible qualities.

The Importance of Transformational Leadership Today and the Relationship to the Recommendations of the Institute of Medicine

To understand the importance of transformational leadership today, one must first understand the meaning of transformational leadership itself. Fundamentally, transformational leadership is all about leaders treating staff and subordinates like real human beings. In this respect, transformational leadership is perhaps best understood as being concerned with the building and maintenance of relationships in the organization. For this reason, the importance of transformational leadership in today’s complex and demanding healthcare system environment concerns the need for collaboration, teamwork, and synergy.

The first IOM recommendation calls for the removal of the scope of practice barriers (IOM, n.d.). In other words, the IOM wants nurses to be able to exercise the full spectrum of their knowledge and skills without bureaucratic encumbrances. Therein, one discovers the relationship to transformational leadership. Transformational leadership is all about finding ways to help people reach their fullest potential. In this way, transformational leaders are forward-looking visionaries; they look for ways to break down barriers in order to support the needs, ambitions, and aspirations of their team members.

The second IOM recommendation calls for the role of nurses to be changed in relation to collaboration and teamwork with physicians and other medical professionals (IOM, n.d.). Transformational leadership concerns itself with getting all stakeholders on the same page as team members. Most fundamentally, transformational leaders achieve these purposes with exemplary behavior. Thus, an effective transformational leader can serve as an enabler of the second IOM recommendation.

IOM recommendation number three takes aim at providing nurses with a landing spot after they have completed advanced degrees, education, and/or training (IOM, n.d.). All too often, however, nurses do not find positions suitable for their new qualifications and skills. For this situation to improve, significant institutional changes are necessary. Most critically, more placement programs need to be established. Also, far more residency programs must be created. These types of innovations and advancements require profound institutional changes. Therefore, the right type of leadership is needed. Specifically, leaders must be able to prepare organizations for change, implement changes, and institutionalize the changes. Once again, the transformational leader fits the bill.

IOM recommendations four and five basically call for more nurses in healthcare with higher qualifications (IOM, n.d.). Adding more nurses with baccalaureate degrees, master’s degrees, and even doctorates require a unified and concerted effort in the health care industry. Nurses will need significant support for their education and learning needs. To support these ends, health care institutions must be flexible, adaptable, and resourceful. Conveniently, these three characteristics also describe the transformational leader. In other words, the transformational leader is perfectly suited for advancing IOM recommendations four and five.

IOM recommendation six emphasizes the need for nurses to engage in lifelong learning (IOM, n.d.). Along related lines, IOM recommendation seven is based on the recognition that nurses need to champion the reins of change. In this respect, transformational leaders are skilled when it comes to inspiring and motivating team members to pursue professional growth and development. Finally, IOM recommendation eight calls for the building of an information system infrastructure to support the management of the professional health care workforce (IOM, n.d.). The development and implementation of a system of this type of capability and complexity requires visionary leadership - i.e., of a transformational nature. Summarily, transformational leadership is essential for supporting and achieving the ambitious goals of the IOM.

Five Transformational Leadership Errors and Strategies to Overcome Each One

Transformational leadership is not always successful. When it fails, it is often related to one of the following errors: i) building the organization around people (not institutions), ii) not properly accounting for failures, iii) tunnel vision, iv) failing to learn from mistakes, and v) improper/inappropriate use of influence. Fortunately, strategies exist to help rectify each of these potential errors.

As for the first potential error, building an organization around people creates unnecessary dependencies and vulnerabilities (Knapp, 2012). In other words, when power and responsibilities are concentrated in the hands of certain (or even a few) individuals, the organization becomes brittle and susceptible to lost capability and/or functionality in the case of personnel losses and/or turnover. As a strategy to offset these risks, the organization should be built according to shared (i.e., overlapping) responsibility structures (Knapp, 2012). In this way, the loss of any single individual in the organization does not imply disruption in business processes, loss of capability, and/or any other type of operational decline.

As suggested in the Knapp (2012) article entitled, "FIVE Leadership Mistakes of the Galactic Empire," a leader like Darth Vader is a negative transformational leader. As such, he exerts a significant influence on his subjects. However, he does so with absolute intolerance for failure. Some transformational leaders make the same type of mistake, although, unlike Darth Vader, they do not kill their subordinates in the process. In other words, transformational leaders tend to adhere to a formula that stresses the importance of proactive measures to achieve a shared vision. Yet, a more complete leadership equation recognizes failure as a potential way to improve motivation and performance. A complementary strategy would, therefore, involve the encouragement of risk-taking without fear of repercussions for failure.

As a related error, transformational leaders may not encourage others to learn by their mistakes (Knapp, 2012). As common historical lore goes, Thomas Edison did not view his thousands of unsuccessful attempts to build a light bulb in a negative light, no pun intended. He learned from his mistakes and, thereby, figured out the right way to make a light bulb. As a strategy for transformational leaders, mistakes should be viewed as opportunities to learn.

As creators and champions of a shared vision, transformational leaders can fall into the trap of being singularly minded (Knapp, 2012). In other words, the transformational leader can suffer from a type of symbolic tunnel vision whereby he/she is so focused on a specific goal that other possible outcomes are ignored. As a strategy to offset this tendency, leaders in the health care environment need to be open to alternatives. During the planning stages of a change initiative, for example, the inclusion of alternative goals and objectives should be a mandatory part of the process. With this type of requirement, a broader and more inclusive perspective can be advanced when it comes to critical the goals, objectives, and decisions for supporting improved health care delivery.

Transformational leaders can use their power of influence in ways that are improper and/or inappropriate (Knapp, 2012). For example, a transformational leader might use his/her charismatic capabilities to promote personal agendas and/or narrowly focused objectives that do not support the strategic purposes of the organization. As a strategy to address this problem, health care organizations can institute a formal change management model. By doing so, the behaviors and activities of leaders can be assessed according to objective and measurable criteria, not the emotions of staff members and other followers.

Two of the Competencies needed to be an Effective Leader: How Each one is Relevant to Nursing

According to the NCHL, the competencies for effective leadership fall under three broad categories: transformation, execution, and people (NCHL 2010). Within the people category, self-development refers to the ongoing pursuit and improvement of knowledge, skill, and expertise. Self-development is, therefore, relevant to nursing because nursing, by common observation, is: i) a knowledge and skill-based vocation, ii) a successful career in nursing requires cross-disciplinary knowledge, skill, and expertise, iii) a successful career in nursing requires a commitment to lifelong learning,

Under the transformation category, analytical thinking refers to the ability to break a subject or issue into its constituent and essential parts. This competency is relevant to nursing in two major ways. Number one, many problems and challenges in the context of health care settings require systematic comparisons – diagnoses, treatment decisions, and so forth. Number two, analytical thinking is critical to understanding temporal relationships, causal relationships, and conditional logic (NCHL 2010). In sum, nursing, and leadership in nursing, require analytical thinking on a continuous basis.

Content that should be Included in a Nurse Manager and Leadership Development Program

As for content that should be included in a nurse manager and leadership program, the NCHL competencies should be a core component. Within the three domains, the NCHL lists 26 leadership competencies (NCHL 2010). The transformation competencies support the nurse manager and/or leader in championing a vision for the future. These competencies also support the important capabilities of motivating followers, innovative thinking, and change. The execution competencies support the objective of getting things done - i.e., implementing real solutions based on the shared vision. Lastly, the people category is supported by competencies for advancing teamwork, collaboration, and synergy in the workplace – three essential elements of a functional health care setting. In addition to the NCHL competencies, a nurse manager and leadership development program should also address the array of topics related to transformational leadership and management methods that support the IOM recommendations.

References

DiMattia, E. (2013 January 14). Leadership vs. management: Focus on leadership and management. Retrieved from http://lj.libraryjournal.com/2013/01/opinion/focus-on-leadership-and-management/leadership-vs-management-focus-on-leadership-and-management/.

IOM-Institute of Medicine. (2011). The future of nursing: Leading change, advancing health. Washington, DC: The National Academies Press.

IOM-Institute of Medicine. (n.d.). The future of nursing: Leading change, advancing health report recommendations. Washington, DC: The National Academies Press.

Knapp, A. (2012 February 13). FIVE leadership mistakes of the Galactic Empire. Retrieved from <http://www.forbes.com/sites/alexknapp/2012/01/13/fiveleadership-mistakes-of-the-galactic-empire/

NCHL-National Center for Healthcare Leadership. (2010). Health leadership competency model summary. Retrieved from <http://www.nchl.org/Documents/NavLink/Competency_Model-summary_uid31020101024281.pdf

Smith, M.A. (September 2011). Are you a transformational leader? Nursing Management, 42(9), 44-50. doi: 10.1097/01.NUMA.0000403279.04379.6a