Nursing Leadership and Management
Nursing leadership implies influencing other caregivers to improve the quality of care and services offered to patients. In nursing, leadership and management require one to have the ability to set a vision for their colleagues and spearhead efforts towards achieving a common goal. Nursing education courses are essential because they prepare nurses for leadership roles that allow optical patient outcomes.
Leadership in Nursing
Leadership in nursing implies the ability to influence other nurses to improve the quality of care delivered to patients. Just like all organizations, leadership is influences productivity. Leadership in nursing requires the leader to have the ability to set a clear vision for the other nurses. Also, the nurse leader should motivate other nurses towards achieving the team goal by motivating the staff and creating a friendly working environment.
A nurse leader sets the vision and creates a strategic plan towards achieving the vision. For instance, a nurse leader can set the vision to be engaging socially with patients to increase contact with patients. A strategic plan for such a vision can include teaching the nurses on the importance of a close nurse-patient relationship. Also, it is the role of the nurse leader to create a work-friendly environment for all the staff. The nurse leader can create such a situation by ensuring all the nurses get along and advocating for the rights of other nurses.
A nurse leader should practice shared decision-making. Typically, successful leaders engage with their followers and learn their needs. An authoritarian leader cannot lead a productive team because the followers are not motivated. A nurse leader should not only engage other nurses but also spearhead actions meant to improve the quality of services as well as advocating for the rights or nurses.
In nursing leadership, it is essential to promote ethical principles because they help nurses to make the right decision when facing a dilemma. In line with Barkhordari et al. (2017), “One of the most powerful methods to promote ethics in health care and the nursing practice is to role model ethical performance on the managerial level.” Thus, when nurse leaders practice ethical principles, other nurses learn by example.
Ethics in nursing leadership
The ethics in nursing are justice, beneficence, autonomy, fidelity, and nonmaleficence. Beneficence requires nurses to show kindness and charity to patients. Autonomy reminds the nurses that patients have a right to decide on their health. Fidelity implies that nurses must be faithful to the professional promises they made to provide quality care for patients. Nonmaleficence binds nurses from harming patients knowingly.
Issues in nursing ethical principles impact on the rights of patients. The range of ethical problems that nurses encounter along with their level of stress should be considered on how it impacts their ability to provide ethical care for their patients (Ulrich et al., 2016). According to Barkhordari et al. (2017), ethical leaders must strive to model and support ethical performance and at the same time be sensitive to moral issues and enhance nurse’s performance by fostering respect for human dignity; thus, they can play an essential role in promoting patient safety, increase the capacity to discuss and act upon ethics in daily activities, and support the ethical competence of nurses. Therefore, it is the roles of nurse leaders to ensure that nurses can adhere to ethical principles as well as uphold quality services.
Unethical leadership harms patient care. When nurses do not exercise ethics in nursing, the patients become withdrawn and cannot, therefore, interact freely with nurses. According to Barkhordari et al. (2017), disappointment and lack of confidence, commitment, and motivation are among the side effects of leaders’ unethical behavior that influence both patients and organizational efficacy negatively. Poor patient-nurse relations result in poor service delivery, which impacts directly on the health of patients.
Appropriate leadership behavior and skills
Nurse leaders are expected to uphold nursing ethical principles. There is the expectation that nurses should ethically treat patients and put ethics first in their professional performance. Across the world, nurses are guided to use professional codes that emphasize their obligation to respect, protect and defend the fundamental rights of the people involved in nursing and health care (Barkhordari et al., 2017). Therefore, in upholding nursing ethics, nurse leaders must maintain a pleasant working environment to improve the quality of services.
Description of the scenario
In the scenario, an 86-year-old male patient has been repeatedly admitted to the hospital for the past six months. The patient is struggling with depression and loneliness and does not have a support system. He admits to not eating healthy or monitoring his blood glucose levels. He has type II diabetes that is uncontrolled. He requires further teaching, referrals to grief support groups/counseling, scheduled follow-up care, and he should be seen by the physician for a possible prescription for an anti-depressant. The charge nurse wants to discharge him to free up his bed because he will most likely be readmitted shortly anyways.
Evaluation of the scenario
The action taken by the charge nurse is wrong because of the lack of empathy. Prescribing medication for a patient when the cause of their illness is different is illegal. Since the old man is suffering from depression, the right action is to refer the man to a therapist or an elderly care resident where they can receive maximum attention. Discharging the patient, as the charge nurse suggests will harm the patient. The patient will succumb to depression due to loneliness, and thus, it is not advisable to discharge the patient without getting a solution to their emotional problems.
Plan and Implementation to improve scenario outcome
Seeing the condition of the patient, the proper action to take is to advocate the state of the patient to the charge nurse. “Communication with elderly patients can be problematic as they can feel uncomfortable about asking questions, and it can be difficult to find the appropriate teaching levels” (Bergh et al., 2015). Therefore, it is vital to Give him further teaching, referrals to grief support groups/counseling, scheduled follow-up care for him, and make the physician aware of his depression. Another initiative for improving people’s health, mentioned by the managers, was the “Senior-Health” project: an effort to reach out to seniors by offering conversations on health and lifestyle and a contact phone number. According to managers, having a nursing-responsible-nurse or responsible-physician has improved continuity and security, and facilitated patients’ knowledge and understanding about self-care management” (Bergh et al., 2015). Also, “DSME/S is cost-effective by reducing hospital admissions and readmissions (10–12), as well as estimated lifetime health care costs related to a lower risk for complications” (Powers et al., 2016). Therefore, referring the patient to support groups and scheduling follow-up care reduces the rate of hospital admissions.
Another essential strategy is to educate the charge nurse on why her action of wanting to discharge the patient prematurely is wrong and is not setting a good example of effective leadership. The charge nurse should understand that such patients require more care than medicine prescriptions to better their health.
BSN Nursing Classes related to leadership, ethics in nursing, and the scenario
BSN nursing classes educate new nurses on how to practice ethically and prepare new nurses for leadership roles. The several nursing practice ethics that can be applied to the scenario are beneficence, justice, and nonmaleficence. Beneficence is doing good for the patient, which would include giving him resources for his depression and grieving and properly educating him about caring for his diabetes. Nonmaleficence is doing no harm, which could be prevented by not prematurely sending the patient home. Justice is fairness, which would include fairly and justly distributing care instead of discharging a patient because his bed is needed for new admission. These principles will reinforce the argument that the charge nurse’s decision is not ethical and is cause for change.
Applying and analyzing ethical theories is also an important strategy. Essentially, it is crucial to investigate the actions of the charge nurse and to determine a more ethical response and course of action to best care for the elderly population of patients.
In transcultural nursing, they are identifying biases in the nursing field. In this specific instance, the charge nurse may have biases or set beliefs about the elderly population. It is imperative nurses are sensitive to individual patients and their needs and preferences so that every patient receives respect and quality care.
Another strategy is psychological inquiry and application identifying biases in the nursing field. In this specific instance, the charge nurse may have biases or set beliefs about the elderly population. It is imperative nurses are sensitive to individual patients and their needs and preferences so that every patient receives respect and quality care.
Evaluation of leadership
The leadership portrayed in the scenario is authoritarian. Today’s healthcare environment is driven by discordant demands to provide high quality care and to manage costs with diminishing resources” (Ulrich et al., 2016). Thus, the charge nurse feels the need to discharge the patient to free the bed for another patient. A change in nurses’ patient education can be achieved when managers indeed use nurses’ ideas and support the process of change, thus making creative discursive practice that changes the social method” (Bergh et al., 2015). The charge nurse should consider the view of other nurses before discharging the patient prematurely.
Leadership styles
As stated earlier, the leadership portrayed in the scenario is authoritarian. Authoritarian leadership style in nursing is when the nurse manager makes decisions and gives orders to team members. Team members are expected to follow what they are asked, and their input is not considered. This style of leadership fails to promote trust, communication, and teamwork.
The best leadership style to use in the scenario is the affiliative leadership style. An affiliative leadership style in nursing is when the leader is great at making relationships and motivating team members. Affiliative leadership is useful when there is a need to bring a team together, rebuild broken trust, and team harmony. In line with De Zulueta (2015), health care professionals and their leaders need to find adaptive ways to contain anxiety and to develop and sustain self- and other-awareness and emotional resilience to maintain a compassionate practice. Valuing emotions more than goals will benefit the patient in this scenario because he needs additional compassion, care, and teaching.
Conclusion
Leadership is a part of nursing at all levels from new graduates to experienced nurse managers. Facilitating changes and improvements in nursing care are essential to effective leadership. Making ethical decisions as a leader is imperative in providing quality patient care.
References
Barkhordari-Sharifabad, M., Ashktorab, T., &Atashzadeh-Shoorideh, F. (2017). Obstacles and problems of ethical leadership from the perspective of nursing leaders: a qualitative content analysis. Journal of medical ethics and history of medicine, 10, 1.
Bergh, A. L., Friberg, F., Persson, E., &Dahlborg-Lyckhage, E. (2015). Registered Nurses’ Patient Education in Everyday Primary Care Practice: Managers’ Discourses. Global qualitative nursing research, 2, 2333393615599168. doi:10.1177/2333393615599168
De Zulueta P. C. (2015). Developing compassionate leadership in health care: an integrative review. Journal of healthcare leadership, 8, 1–10. doi:10.2147/JHL.S93724 Haddad, L. & Geiger, R. (2019). Nursing Ethical Considerations. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK526054/
Powers, M. A., Bardsley, J., Cypress, M., Duker, P., Funnell, M. M., Fischl, A. H., … Vivian, E. (2016). Diabetes Self-management Education and Support in Type 2 Diabetes: A Joint Position Statement of the American Diabetes Association, the American Association of Diabetes Educators, and the Academy of Nutrition and Dietetics. Clinical diabetes : a publication of the American Diabetes Association, 34(2), 70–80. doi:10.2337/diaclin.34.2.70
Ulrich, C. M., Taylor, C., Soeken, K., O’Donnell, P., Farrar, A., Danis, M., & Grady, C. (2016). Everyday ethics: ethical issues and stress in nursing practice. Journal of advanced nursing, 66(11), 2510–2519. doi:10.1111/j.1365-2648.2010.05425.x