Leadership Styles in Nursing Setting

Nurses in United Kingdom are encouraged to prioritise people, practise effectively, preserve safety and promote professionalism and trust in nurse practice (NMC, 2018). This can only be achieved when nurses are effective leaders who use good management practices and use reflection in practice to improve patient outcomes (NHS Leadership Academy, 2013). Therefore, the author aims to discuss leadership, management and team working and explore different leadership styles and analyse their impact in a healthcare work setting. Included herewith is this author’s reflection on student nurse placement and lessons learnt.

August 20, 2019

portia zhuwao

STUDENT NUMBER: 1208491

Nursing and Midwifery Council’s Standards for pre-registration nursing programmes (NMC 2018b) sets competency requirements “that is a combination of skills, knowledge and attitudes, values and technical abilities that underpin safe and effective nursing practice and interventions” for pre-registration nurse education for which student nurses are expected to achieve and demonstrate their knowledge before they can be registered as qualified nurses. The competence requirements are: Communication and interpersonal skills; professional values; leadership, management and team working; and nursing practice and decision making. This author’s reflection is based on competence requirement for communication and interpersonal skills.

Nurses are encouraged to reflect on practice as it helps to identify one’s strength and weakness and it is an important part during nurse training (Oelofsen, 2012). Royal College of Nurses (RCN, 2015) also states that nurses should use reflection after undertaking an activity so that it can be improved, developed or to find means of doing it differently in future use so that patients and clients are provided with safe and high-quality care. Johns and Freshwater (2005) state that reflection in nursing practice is a successful way of developing competent nurses. Nurses can critique, develop, monitor and evaluate their clinical methods and practices continually using reflection and thus improve the quality of their patient care (Johns and Freshwater, 2005).

Pseudonyms will be used to maintain patient confidentiality (NMC, 2018). I was placed in a Stroke Unit working with Paul, my mentor, who was the nurse-in-charge. Paul asked me to accompany Mr Kent, the patient, to the eye clinic appointment. The patient needed assistance to transfer from the wheelchair to the optician’s testing chair because of his right sided hemiplegia. Paul was an excellent communicator who clearly explained to me the procedure of safely transferring Mr Kent from the wheelchair to the testing chair. World Health Organisation (2007) stresses the importance of continuity of care when more than one healthcare professional attend to a patient, stating that nurses and indeed all healthcare professionals should employ effective communication methods when sharing patient information.

Paul exhibited transformational leadership as he wanted me to use my initiative, exercise my interpersonal skills and improve my communication skills by sending me to a different department to escort Mr Kent to his eye clinic appointment. Whitehead, Weiss and Tappen, (2010) listed three key leadership styles as transactional, transformational and laissez faire. They described a transformational leader as one who welcomes ideas and inputs from those that they lead. This type of a leader gives guidance and shares information on important decisions and plans for the organisation with his or her team. Although followers of such a leader are often motivated and creative and there is more flexibility, this is a less efficient way of running an organisation (Whitehead, Weiss and Tappen, 2010). Millar (2016) adds that transformational leadership style is key to employees reaching their full potential, job satisfaction and organisational commitment is strengthened. Paul showed qualities of a transformational leader by guiding me during my placement and he helped me stay motivated. He was also an excellent communicator who shared appropriate and valuable information for to use during my placement.

On the other hand, Whitehead, Weiss and Tappen, (2010) state that a transactional leader is one who makes all the decisions and gives out orders. They further state that this may be an efficient leader who gets things done but those that they lead may be less creative and less motivated

On another day, the author witnessed a different leadership style from Karen, who was nurse-in-charge. She briefed staff on what was to be done since the ward was short staffed. Karen exhibited laissez-faire leadership style as she did not check on other nurses to see if they needed support. Because of Karen’s leadership style, there was conflict amongst nurses in our ward. For example, she would not walk around to find out how the nurses were doing and offer support where needed, leaving Sue, the most experienced nurse in the ward to step in and help 3 other nurses new to the ward. Sue had a burn-out and exchanged some words with one of the nurses whom she accused of not doing enough to help her colleagues. This situation could have been avoided had Karen been more pragmatic and visible and stepping in before things went out of control. Whitehead, Weiss and Tappen (2010) describe the laissez faire leader as one who does less planning and decision making and the least effective leadership style. In effect there is lack of leadership leaving followers feeling confused and frustrated as there is no guidance or direction and there are no clear goals to be achieved. Robertson and Barling (2014) concur by adding that laissez-faire leadership style adversely affects staff’s physical wellbeing as it reduces their safety consciousness and their beliefs that safety behaviours are rewarded and supported. Laissez-faire leadership style also negatively affects staffs’ psychological wellbeing because it intensifies role ambiguity, role conflict, and conflict amongst team members and bullying at work and employees’ trust in leaders decreases (Robertson & Barling, 2014). NHS Employers (2019) state that managers who practice supportive leadership and management techniques have a substantial positive impact on employee wellbeing.

NMC (2018b) states that nurses should be able to resolve conflict by using robust negotiation techniques and effective communication strategies to realise best outcomes, while at the same time respecting the human rights and dignity of all concerned. In addition to this, nurses should know when to turn to a third party and the process of making referrals for advocacy, mediation or arbitration. Learning from the above placement scenarios, this author hopes, in future when a conflict situation arises, to be able to resolve it by improving on confidence in negotiations, interpersonal relationships and communication through attending university lectures, and carrying out own research on these topics and observing others.

Daly et al. (2014) describe workplace culture as a set of long-lasting common core values, beliefs, behaviours and attitudes that are passed on from one generation of staff to another. Thew (2019) contend that workplace culture reflects the quality of leadership and management style and this can either have positive or negative effects on employees’ well-being. Blyton & Jenkins (2007) concur by stating that a positive work culture leads to a sense of cooperation and collaboration among team members, positive team spirit, effective communication, and a reflection of greater shared knowledge among team members. Numerous cases of poor-quality care and degrading treatment, and inadequate patient safety have been reported in the media including the cases of Mid Staffordshire NHS Foundation Trust (Francis Report, 2013), Baby P (CQC, 2009) and Shipman Inquiry (2003).  This required a cultural change by learning from the above errors and mistakes. Francis Report (2013) made recommendations for quality improvement among other things instead of adopting a blame culture. The conflict in the second scenario could be avoided by having high levels of staff engagement which is beneficial to the patients, staff and the NHS (SPF Guidance, 2014)

In the United Kingdom, regulatory bodies such as NMC and NICE provide healthcare industries with guidelines for their practices (General Medical Council (GMC, 2017). Thus, most hospitals design their policies from these guidelines to provide their staff with safe standards of practice. For example, in the first scenario, my mentor specifically told me not make important decisions about Mr Kent without consulting him. It is therefore important for all healthcare staff to follow laid down policies and procedures to minimise complaints and achieve excellent outcomes for patient care (NHS England, 2015)

Bayral and Yener (2015) state that possessing leadership qualities is not an option for nurses but is an integral part of the healthcare system. Mintz-Binder, Lewis, and Fitzpatrick (2011) add that leadership is a critical factor that empowers nurses to make well informed clinical decisions which are based on researched evidence and has a bearing on safety and quality of care. Bayral and Yener (2015) state that good leadership and management in a healthcare setting is key in helping an organisation achieve success and productivity by making sure that staff remain motivated and are not stressed and do not suffer from burn-out as what happened to nurse Sue in the second scenario. To be an effective nurse leader, one must uphold professional standards of nursing set out in NMC Code (2018). A nurse leader should have knowledge of health care systems, should be visionary, strategic thinker, excellent planner, work effectively in teams, contribute to policy development, and manage change (Mintz-Binder, Lewis, and Fitzpatrick, 2011). Delmatoff and Lazarus (2014) suggest that, to be effective, a nurse leader should be good at resource management, communication and negotiation and should put more effort in motivating and influencing others. In addition, Wilson (2013) concurred that all healthcare staff can add to the leadership process and indeed demonstrate leadership skills, attributes, knowledge and behaviours while working with patients and other staff to improve quality and safety of healthcare services.

The terms leadership and management are often used interchangeably but these are different concepts. Fowler (2016) separates the nurse’s management responsibilities from leadership responsibilities. He states that management function of a nurse includes things that must be done such as determining staffing levels, approving annual leaves, financial budgets, clinical activity reports, health and safety, ordering supplies and building maintenance. In addition, Gopee and Galloway (2017) describe management as consisting of planning, organising, controlling, directing and monitoring systems and resources including staff and financial budgets to achieve the organisation’s aims and objectives.

On the other hand, Drenkard (2011) states that nurse’s leadership style is a function of personality traits such as charisma, high ethical standards, influence, inspiration, intellectual stimulation and the ability to treat each person equally but differently. Fowler (2016) adds that the nurse’s leadership role includes being innovative, providing a vision and direction for their teams, communication and making their teams more enthusiastic about their work.  Hersey and Campbell (2004) state that a leader aims to influence the actions of his or her followers, who may either be his or her seniors, subordinates or colleagues. Huber (2018) also adds that leadership is about influencing others to think and act in a certain way. However, Gopee and Galloway (2017) explain that although management and leadership are different concepts, there is always an overlap in their application. NHS Leadership Academy (2014) states that effective managers apply both concepts concurrently and are committed to the overall goal achievement of the organisation.

Sherman (2018) states that a nurse leader’s role is to help staff to be effective and maximise productivity. She therefore advocates for nurse leaders to adopt a servant leadership mindset to achieve this. From the description given above, my mentor was a leader who supporting me during my placement as he gave me guidance, intellectual stimulation, inspiration and influence.

Healthcare institutions are under pressure to achieve performance targets. Most nurse leaders are therefore perceived by their subordinates as more concerned about costs and performance standards than on staff welfare and patient care leading to conflict, high staff turnover, disengagement and staff burnout (Fowler, 2016). Greenleaf and Spears (2002) state that servant leaders perceive themselves as servants who are effective leaders because they attend to the needs of their subordinates.

Quinn (2017) concur and states that a servant leader aims to encourage those who work for them by motivating and empowering them. Staff are likely to become more engaged and do more for the organisation if the nurse servant leader shows that he or she is concerned about their welfare and is ready to help them solve problems. The characteristics of a servant leader include; empathy, listening, awareness, healing, foresight, persuasion, conceptualisation, stewardship, commitment to the growth of people, and building community (Quinn, 2017).

Therefore, effective leaders should employ different leadership styles depending upon the situation they face in different circumstances (Bolden et. al. 2003). Factors such as environment, organisational structure, and task to be carried out as well as the needs, maturity and nature of followers and internal group dynamics call for different leadership styles for the leader to be effective (Shankman, Allen & Haber-Curran, 2015).

NHS Leadership Academy Model (2013) was formulated in order to help health care workers to develop leadership skills regardless of the role and care settings in which one works in. The model also states that the nurse’s leadership behaviour or style has an impact on overall patient experience, the quality of care provided and reputation of the organisation.

NHS Leadership Academy Model (2013) explains that the leader’s behaviour also affects the working climate and culture and team effectiveness. This calls upon leaders to take stock of their personal qualities in order to identify areas of strengths or weaknesses and develop one’s self accordingly. The way a leader behaves is affected by factors such as determination, self-confidence, self-knowledge, self-awareness, self-control, resilience and personal reflection (NHS Leadership Academy Model, 2013).

Reflecting on my time while on placement, I realised that I needed to improve my people and personal development and my communication skills especially when escorting a patient for continuity of care. Nurses and all healthcare professionals are expected to communicate effectively in order to provide high standard of care which is safe to all patients (Institute for Healthcare Communication, (IHC 2011). Therefore, I have included communication skills improvement as part of my personal development plan for the next twelve months.

NMC Standards (2018) require all nurses to use excellent communication skills which are safe, effective, sympathetic and respectful to support person-centred care. Further, nurses should communicate effectively, most importantly to those service users with disability and other healthcare professionals in order to acquire necessary information to make reasonable adjustments to provide equal access to the health services. In the first scenario, Mr Kent was wheelchair bound and needed support. I successfully managed to help him attend his eye-clinic appointment all due to excellent communication between my mentor and myself.

I hope to gain more confidence to communicate effectively at all levels with both patients and other healthcare professionals in twelve months-time at the end of the adult nursing course. I also hope to improve my interpersonal skills, that is to be more assertive and improve negotiation and conflict resolution skills. To achieve this, I have created a personal development plan shown in Appendix 1.

In conclusion, there are different leadership styles which impact differently on healthcare work settings. I now realise the importance of reflection in practise and am now aware of my strengths’ and weaknesses and limitations and have identified areas that need improvement. In the first scenario, my mentor commended me for not taking risks by avoiding making decisions or taking actions without correct information or training which I take as a strength. I hope to improve on my communication and interpersonal skills by attending university lectures, carrying out my own personal research and observing other nurses in practice. I believe that my confidence, negotiation skills and conflict resolution techniques will thus be improved and that I will no longer succumb to peer pressure.

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APPENDIX 1