Effective leadership and teamwork in nursing, with particular reference to psychiatric (mental health) nursing, within the context of professional practice and client (patient) perspectives
As part of the campaign to deliver effective health and social care, the Government’s modernisation agenda focuses on strengthening nursing leadership and developing inter-professional teamwork. It is proposed that having good quality clinical leadership skills among all health professionals is perceived as vital to the provision of high-quality, effective patient-centred care, as well as for the development and future of the National Health Service (NHS) (Department of Health (DOH), 2000, pp59-71). Nurse leadership has developed significantly over the past decade and now nurses can become nurse consultants, nurse practitioners, and modern matrons or run nurse-led units. It is debated that high calibre nurse leadership can produce more motivated and effectual staff, reduce the risk of errors in drug management, decrease staff turnover and rates of sickness, result in fewer patient complaints and most importantly improve patient care (Williams et al, 2001, pp1-3). This essay will critically analyse effective leadership and teamwork in nursing, especially within a mental health nursing context, with respect to professional practice and patient perspectives.
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As mentioned leadership skills have for a long time been acknowledged as a solution to the provision of good health care. In order to achieve first-rate health care, healthcare personnel especially senior nurses must be able to effectively lead teams, particularly across professional, clinical and organisational boundaries (Taylor, 2007, p30). Two of the key roles of a lead nurse or senior nurse manager are that of supporting staff and overseeing nursing in the provision of patient care (Castledine, 2004, p119).
It is proposed that meeting staff needs improves satisfaction, productivity and efficiency and it is debated that productivity is now an important concept within health and social care sectors. It is suggested that productivity within the healthcare industry is defined by the quality of patient care. Arguably, productivity is not exclusively dependent upon how hard and well individuals work, but about meeting staff needs and support from leaders and colleagues (Moiden, 2003, p19). Debatably, where team leaders or managers are concerned about the needs and objectives of their staff, and are aware of the social and physical conditions that affect their working environments, productivity and efficiency will improve. It is possibly that a lack of working environments that support staff affects the quality of care for patients. It is suggested that it is vital that the nurse manager has leadership skills that allow a team to work together effectively (Moiden, 2003, p19). Nurse leaders should be seen frequently by those they lead as high visibility could ensure that support is obtainable when most needed. Similarly, nurse leaders must ensure that staff skills are used in such a way that patients’ obtain the greatest benefit from their abilities. This can be achieved by the nurse leaders enabling others to act and giving positive responses to work-related performance. This will facilitate motivation, increasing job satisfaction and promoting better patient care (Clegg, 2000), p44).
Within a psychiatric nursing environment whether it is in the community or in a mental health unit teamwork is imperative for both the staff and the service users. In the field of psychiatric nursing, nurses work as a team with other professionals such as psychiatrists, clinical psychologists, occupational therapists and social workers. Therefore, responsibility for the service users is shared across the whole multi-disciplinary team and each service user relates to several team members (Williams, 2005, p39). Arguably, the team approach to patient care within mental health nursing has advantages in terms of reducing dependency on team members, and reducing levels of burnout. It is debated that teamwork is vital in order to provide a safe and therapeutic environment that respects the service user’s dignity while promoting independence and preparation for life in society. The team approach can be supportive and creative but it is not without its problems (Machin, 1998, p17).
Onyett et al (1997) studied a sample of four hundred and forty-five team members across various disciplines working in fifty-seven Community Mental Health Teams (CMHTs). Emotional exhaustion, low personal accomplishment, depersonalisation, job satisfaction and sick leave was examined in relation to the perceived clarity of the role of the team, personal role clarity, identification with one’s profession and the team, caseload size, composition and the frequency with which users were seen. Excessive emotional exhaustion was reported, predominantly among consultant psychiatrists, social workers, nurses and psychologists. High job satisfaction, high individual achievement and “low depersonalisation” were also found. Job satisfaction was associated with “team role clarity” and identification with the team. Caseload size, assemblage and the frequency with which service users were seen were not associated with job satisfaction or burnout. Important disparities were found between disciplines on all variables except sick leave. Therefore, on the evidence presented it could be argued that team membership has different implications for different disciplines. Debatably, greater attention is needed to the composition, training and leadership of CMHTs rather than hope that the disciplines will spontaneously work effectively together. It is important to note that the research used here of evidence of effectiveness of teamwork has various limitations. Firstly, the small sample size makes it not viable to relate the findings to all CMHTs in the United Kingdom. Secondly, the questions asked in the study might be seen to be leading questions and this makes the study unreliable. Thirdly, this study does not take into account the personal views of the members of the team. The individual views on the effectiveness of multi-disciplinary teamwork from the nurses, occupational therapists and social workers could make this research more valid as relationships and issues of skill mix between the disciplines could have been explored within the context of patient care.
Teamwork appears to be more effective in enabling first-class patient care within hospital based mental health units. Flockhart and Moore (2002, p96) assessed the effectiveness of teamwork on patient care at the psychiatric intensive care unit that is part of the Maudsley NHS Trust in South London. The unit admits some of the most challenging patients who cannot be safely managed on general wards. Many patients suffer from paranoid schizophrenia or bipolar affective disorder and can be violent or aggressive, suicidal, harming themselves or be abusing various substances. Patients are only admitted on the unit for clinical reasons, not for safety. The main ethos of the unit is to help the service users achieve their maximum level of functioning so that they can be cared for with the fewest possible restrictions. It is important therefore that in this unit and in others like it in the United Kingdom the nurses need to be good team workers and be able to deal with issues calmly. Patient involvement and collaborative working has been addressed by joint care planning with the family and other key disciplines such as social workers, probation officers and various psychiatric and psychology therapists and this had led to rapid improvements in patients’ mental state and behaviour. The collaborative teamwork that focuses on the patients’ safety has improved team communication and effectiveness. Arguably, this particular unit has an efficient team that has empowered and enabled the staff to provide the best and most effective care for the service users. This is because the team is organised, supported and valued by each of the other members and the skill mix is ideal for improving patients’ mental health.
It is also important to note that this unit has one dedicated team leader or co-ordinator that provides a consistent approach that meets all the needs of the service users and staff. Routine physical proximity appears to contribute to constructive working relationships and this has been illustrated by the effective interprofessional working relationships observed in this unit. Debatably, in contrast, within a community setting each discipline will have its own team leader or manager and this might lead to inconsistencies, differences and confusion in policy and decision making.
In reviewing the literature for this essay the author would like to propose the following recommendations. Debatably, more evidence based research is needed on how effective leadership leads to enhanced practice and improved patient care, especially within mental health nursing. There appears to be some literature on the effectiveness of teamwork within the mental nursing profession. Arguably, this is because the provisions needed by mental health service users are wide and varied and historically multi-disciplinary teams have always been the solution to providing care and support for service users whether that care was deemed to be of good quality or of inferior quality. However, there is room for more evidence-based literature on the effectiveness of teamwork within mental health nursing. Similarly, it is suggested that there is a need for more evidence-based literature on the effectiveness of teamwork in nursing in general. Correspondingly, there is little or no evidence-based literature that expounds service user’s perspectives about how efficient teamwork improves their care.
From the evidence presented it can be said that many factors lead to better team performance and arguably, one of the most significant is that of team leadership. Good quality leadership skills are the solution to enabling teams to provide high quality effective patient care. Effective team leadership improves satisfaction among team members and patients and improves productivity. In order to be effective as a leader the team leader must be visible and approachable. Team working within a hospital setting is generally more effective in delivering good quality patient care than that often achieved within a community setting where multi-disciplinary teams are involved. The stress on team members in CMHTs is related to the standard of leadership as well as the composition and training of the team. Experience in the Maudsley NHS Trust illustrates the importance of good team working and leadership in determining the quality of outcomes for patients. Evidence in the literature studied is presented from the perspective of staff in healthcare teams while there is little or no evidence of the views of service users on the subjects of leadership and teamwork.
Castledine, G (2004) Nursing leadership must keep its roots in nursing, British Journal of Nursing, 12, 2, 119.
Clegg, A (2000) Leadership: improving the quality of patient care, Nursing Standard, 14, 30, 43-45.
Department of Health (2000) The NHS Plan. A Plan for Investment. A Plan for Reform. London, HMSO.
Flockhart, G and Moore, S (2002) Teamwork is the key, Nursing Standard, 17, 3, 96.
Machin, T (1998) Teamwork in community mental health, British Journal of Community Nursing, 3, 1, 17-24.
Moiden, N (2003) A framework for leadership, Nursing Management, 9, 10, 19-23.
Onyett, S, Pillinger, T and Muijen, M (1997) Job satisfaction and burnout among members of community mental health teams, Journal of Mental Health, 6, 1, 56-66.
Taylor, V (2007) Leadership for service improvement, Nursing Management, 13, 9, 30-35.
Williams, T, Taylor, S and Petts, S (2001) Assessing leadership development training, Nursing Times, 97, 42, 1-3, www.nursingtimes.net, date accessed 11/02/2007.
Williams, C (2005) Assertive outreach: the team approach, Mental Health Practice, 9, 2, 38-40.
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