Leadership in Professional Nursing

Every day, a set team of nurses and nursing managers set out to ensure the health and well-being of their patients. To achieve this goal, a nurse manager must adhere to a specific style of nursing leadership. There are many different styles of leadership in the healthcare field. Bass and Barnes (1985) stated that the two most common are transformational and transactional (as cited in Frankel, 2008, p. 24). This paper will define leadership, the two different styles, how each are executed, as well as pros and cons of each. Review of Professional Nursing Literature Stogdill (1950) defines leadership as the process of influencing the activities of an organized group in its efforts toward goal-setting and goal achievement (as cited in Frankel, 2008, p. 24). The use of leadership behaviors is significantly correlated with job satisfaction, productivity, and organizational commitment. When a group faces a task, the leadership set before them directly affects the outcome. In order to obtain a positive outcome, a leader must be able to direct a group or individual toward the achievement of a common goal. Inspiring action and a shared vision greatly increase the chances of a positive employee outcome. As the nation continues to focus on issues of health, rather than just treatment of disease, nurses will increasingly play leadership roles (Mittelman, 2010, p. 10). The first type of leadership is transformational. The main focus of transformational leadership is to conjoin nurse managers and nurses to strive to meet a united goal. Leaders transform followers by increasing their awareness of task importance and value, getting them to focus first on team or organizational goals rather than their own interests, and activating their higher-order needs. It is vital to allow young nurses the opportunity to form their own opinions and receive feedback. These young nurses are trying to find their place within the work force and will not benefit from being criticized on many things at once. Job dissatisfaction is due to managers not giving due recognition and support, not being able to follow through on problems and not helping but criticizing in a crisis (Loke, 2001). The boss must be careful and narrow down the areas in which improvement is needed and explain why the improvements are needed. When utilizing this method, Sutton suggested that they (bosses) consciously break out of the power bubble by asking for direct input and feedback (as cited in Flora, 2010, p. 50). By doing this, nurses are allowed to hold a functioning role in the development of policies. Bass (1985), found that â€Å"the transformational leadership factors were more highly correlated with perceived group effectiveness and job satisfaction, and contributed more to individual performance and motivation, than transactional leaders† (as cited in Frankel, 2008, p. 23). This type of leader is often found empowering their employees and giving them a sense self worth within the company. Steers (1977) found â€Å"commitment improves work performance and reduces absenteeism and turnover which are costly to organizations (as cited in Loke, 2001). Transactional leadership is built on reciprocity, the ways in which leaders and followers influence one another, and the idea that the relationship between leader and their followers develops from the exchange of some reward, such as performance rating’s, pay, recognition, or praise (Marturano, 2004). This style of leadership does not promote a close relationship amongst the boss and the employee, but has proven to be practical in certain situations. According to Frankel (2008), â€Å"transitional leadership is short-lived, episodic, and task based† (p. 23). Based on this, the employees’ attraction is geared towards a more selfish transaction, rather than the common good of the group. Many employees find themselves working past this type of hierarchy to acquire the exchange they are seeking. Application of Clinical Example Mark, the nurse manager of a fifty-two bed intensive care unit, was attending a budget meeting with the nurse managers from other departments, as well as other various administrators. Right now, many hospitals all over the nation are being forced to make budget cuts because of the economic recession the country is suffering from, and Mark’s hospital is no exception. In the meeting, in order to save money, the CEO forbids all of the managers to allow any overtime. Mark knows that times arise when his nurses simply are not able to clock out on time, but he must enforce the rules passed down to him. Mark quietly accepts the decision made by administration without any contest. Over the next couple of days, Mark holds several staff meetings to inform his employees that no overtime will be permitted and that anyone who either clocks in early or clocks out late must end their next shift early to adjust their time. Subsequently, any employee who has accumulated overtime at the end of the pay period will be suspended. The nurses of the ICU respond less than favorably, arguing that clocking out early from a shift would not only cause additional stress for the nurse, but also would almost certainly lead to negative patient outcomes. Many of the nurses voiced their concern that they were putting their license in jeopardy. Mark’s only response was â€Å"this is the way it has to be,† leaving them feeling let down that their manager didn’t stand up and do more to protect them. Over the next few weeks, Mark could tell that the overall productivity, quality of care, and employee morale that had once been excellent had fallen dramatically. Because of the added stress from the nurses feeling rushed throughout their shift, there was an increase in documented medication administration errors, a decrease in the quality of clinical skills, and abandonment of patient and family teaching. Looking back at the different types of leadership, Mark could have possibly changed the outcome of this situation by understanding the style of each. Leadership is not just about picking that or this strategy or goal; it’s equally about standing up publicly and saying this is what we are going to do and why we are doing it (Grayson, 2010, p. 6). First, Mark could instill a sense of empowerment by encouraging the staff to come up with alternate ways to save money. Secondly, he could have stood up to the administration and taken some heat by demonstrating how it’s not always possible to clock out on time. Lastly, he should stand behind his staff, and don’t give up until the situation is resolved. Enabling others to act is a leadership behavior that infuses others with energy and confidence. Developing relationships is based on mutual trust and providing subordinates with discretion and make their own decisions (Loke, 2001). Conclusion Despite these contextual influences, the expectations of leaders are that they will promote change within their organization and thereby shape its modus operandi and culture (McIntosh & Tolson, 2008). Understanding the different styles of leadership is vital in keeping up with the constant evolution of healthcare. One must be able to not only manage, but also inspire employees to achieve goals. Former president John Quincy Adams was once quoted as saying, â€Å"If your actions inspire others to dream more, learn more, do more, and become more, you are a leader. † By following these simple guidelines, nurse managers are able to generate a more satisfying work environment, enhance employee performance, and increase patient outcome.