Leading and Managing Nursing Care

CONTEXT

Various authors have defined leadership and management. Although the roles of a manager and a leader are often linked, the two are different in multiple aspects According to Tyczkowski et alc(2015), leadership is defined as the ability to influence others to work towards achieving a particular goal.

As per the view of Herman, Gish & Rosenblum, (2015) leadership can be defined as the action of leading people or group of people. It is the way of influencing the behaviour of others. A leader must possess good communication skills, so that he can engaged in motivating the individuals to perform the task better and achieve their goals and objectives. Authentic leadership can be used in nursing practices, as this will help leaders in developing the self-awareness, values, emotions and transparency in their tenure. In this type of leadership style leaders will make the vision clearer so that it does not create conflict or chaos in workplace setting. In this type of leadership style, leaders try to act according to values so that they can be able to create better relationship with workers. It has also been analysed that if leaders are transparent then this can support them in building trust of nurses on them. Trust can also be created because of the leaders action, so leaders must be honest in their working.

Nursing practice entails four categories of stakeholders. These are managers, leaders, mentors, and followers. Having a deeper understanding of these four terms in the context of nursing practice is essential in informing about the role and commitment of nurses concerning them. Yoder-Wise (2014) defines management as the process of organizing, staffing, planning, and coordinating, directing, and controlling all the activities of a healthcare organization. This reflects the role of managers in nursing practice which is central and cuts across all decision-making functions of a healthcare organization. Managers prepare budgets for the allocation of nursing resources and develop strategies for achieving the mission and vision of the institution.

In the opinion of atton, Zalon, and Ludwick (2018) there are various leadership theories that is being identified in nursing leadership. These type of leaders are motivational and inspirational, they are effective communicators and are engaged in making better relationship with individuals working with them. Clinical leaders must be involved in taking care of community environment, hospital wards, hospital administration staff. Congruent leaders lay focus that nurses and other staff members working with them provides quality of services and are highly motivated and engaged in achieving their goals and objectives.

Discussion

According to Makaroff, Storch, Pauly, and Newton (2014), as enablers for the organisational development (OD) agenda for cultural transformation and redesign that places the pledge of the health care unit constitution at the very heart of leadership practice for world class patient and citizen care. Mentors are the role models which are engaged in developing leadership that is place based so that all level population heath is being supported. Followers, on the other hand, can be perceived in different approaches. Managers and leaders have followers who depend on their guidance and direction to act (Improvement.nhs.uk, 2019). The authors also define an active follower significantly contributes to patient outcomes in healthcare. This is because it is not psychopathy. According to Wigston, S. (2019), although they do what they are told, followers do not do it blindly. They are aware, raise concerns, disagree with their leaders, and can initiate changes where they think it is necessary. Through their voice and responsibility, followers keep their leaders in check and develop a sense of ownership and culture of effective team working.

As per the view of atton, Zalon, and Ludwick (2018) state that the healthcare delivery system is significantly changing across the globe. The dimensions of this change include the quality of nursing care, the role of a nurse, and nursing management. It has been analysed that in order to improve the quality of service in nursing care unit, servant leadership style can be use by clinical nurses. In this leaders have the quality of serving first. They are engaged in analysing needs and demands of nurses working with them and also this type of leaders is involved in providing safe environment to patients who are under their tenure. Servant leaders have various qualities like for example they make use of empathy and patience to deal with other individuals. This also support them in increasing the quality of services that is being provided to patients.

Patton and colleagues (2018), has also interpreted that the other type of leadership style that can be used by clinical nurses is action centred relationship style. In this leaders are engaged in making the objectives clear to the staff members and also they are engaged in making use of open communication so that if any changes occur in nursing care unit, it is being communicated effectively. Initially, nurses worked under the supervision of physicians. Today, nurses are now being tasked with clinical management responsibilities because of the increased demand for medical services (Patton et al. 2018). There is insufficient supply for physicians to offer supervisory functions to the nurses. This has seen the evolution of nurse-managed clinics in the UK.

In accordance with Kirkup and Investigation (2015) Transformational leadership is opposite of transactional as it concerns with inspiring or motivating the people. Departments of these type of leaders have a high reputation so that they can satisfy the nurses and their morale and with that care of patients. this style of leadership does not motivate other people or inspires them to work on improving their performance. This method will be evaluated in a positive way only when the outcome of treating the patients is better. To encourage them the leaders and management make them visible and solve the problems of the team. They don't put away the problems instead they look for the solution of the issue so that problem can never arise again.

According to surveys, there is a big problem in the NHS in the United Kingdom. For instance, a recent report shows how the quality of care for mental illness is not meeting the standards of care in current practice. Morecambe Bay Investigation report published in 2017 shows how people living with mental illness die at a young age compared to those who do not suffer from intellectual disabilities (Kirkup and Investigation 2015). Compared to the international mortality rates, the UK has significantly higher mortality for those patients. Poor motivation by leaders can lead into reducing the quality of service that is being provided by nurses to patients. Also there might occur chances that hospital staff is being overloaded with work and the task assign to them is not clear that is hampering the quality of service.

A debate on the current quality of care has dominated the House of Commons Public Administration and Constitutional Affairs Committee after a report was presented by the Parliamentary and Health Service Ombudsman (PHSO). According to the report, NHS failed to investigate the unexpected death of Sam Morrish, three years old, and whose death from sepsis was found to be unavoidable (PHSO, 2015). According to the committee, the NHS is still lagging behind in investigating clinical cases such as these, making the process of quality improvement slow. A report published by the Care Quality Commission (CQC) also reveals that investigative procedures of NHS are not sufficient, and some gaps need to be addressed (CQC, 2015). According to CQC, there is a need for routine open-minded and learning-focused investigative culture if the quality of care is to be enhanced. (See, appendix 2). This type of outcome is only being generated when leaders are not engaged in effective communication with workers, they are also not involved in analysing the problems that is being faced by staff members because of which quality of service is being hampered.

In accordance with Herman, Gish & Rosenblum, (2015) Policymaking is the first step that leads to transforming the healthcare industry. Although nurses can make efforts at the bedside to improve patient outcomes, much of the contribution begins at legislation. It is the statutory laws that guide and govern healthcare. This means that the lack of nursing professional representatives at the policymaking tables has led to inefficient policies that demean nursing practice (Willcox et al. 2018). Leadership at the practice level can significantly transform the quality of care. However, in the boardroom, it is more impactful since the policies established cuts across all aspects of the healthcare delivery system. Regulations that support a high quality of care need to be made. Guidelines that eliminate barriers and challenges to better patient outcomes are required if there is a change to be realized.

As per the view of Ryan, (2019) The leadership at the legislation level in the UK has not involved nursing professionals. It is the nurse at the bedside who understands the challenges of delivering services to the patient. Although nurses make proposals addressing these problems, it is not easy to have them implemented (Ryan 2019). Nursing leadership is required at the top policymaking boardrooms. Having managers who have individually worked at the bedside is the solution to improving the quality of care. Transformational leadership, according to Patton and colleagues (2018), involves empowering the stakeholders in the nursing delivery system to develop interventions that lead to better outcomes. Since leaders have a massive influence on their aides, they need to be role models by demonstrating a culture of inquiry at all cases of illness to be able to identify the exact problem and the most appropriate interventions. This theory is essential in creating positive relationships across an organizational structure that contributes to a high quality of care and patient safety.

In the opinion of McCleskey, (2014) Contingency theory is based on the reality that there is no one ideal action for all situations. Healthcare organizations are faced by gradually changing operational environments. Being successful in maintaining the standards of care requires nurse leaders to change in response to the current situation. Lin, MacLennan, Hunt, and Cox (2015) states that the role of leaders in this theoretical concept is to create an environment where all stakeholders can make informed decisions based on the current state of affairs (McCleskey 2014). Through this approach, all members of the organization become a team and trust themselves in making the right decision.

Transactional Leadership

In the opinion of stanton, (2010) This style of leadership states that leaders of the company use the method of punishment and reward so that they can maintain the discipline in the company. For instance nurses who take many leaves will be given a punishment and those who don't may be allotted a primary spot of parking in the premises. In order to make this method effective management of the hospital must identify the deficiency in their employees so that they can improve them in those selective areas. This type of leadership has a different place in the management of nursing as it helps them to reduce the no. of mistakes and solve their problems.

Teams and team working

Standards of clinical care is high which has made their structure complex which is putting pressure on the staff to provide and deal with the services which are complicated and learn new skills from them. There are many factors which has forced this sector to comply with this approach. It has been proven that if the team works together then the errors or mistakes they commit is less so that they can improve their services and provide more safety to their patients. Teamwork also helps in reducing the issues regarding culture. It helps to break the team according to the hierarchy which gives more leverage to the employees of healthcare and provides them with high level of satisfaction.

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During placement in a primary care unit there was a patient who was under intravenous therapy under the critical care unit who developed an extreme fever. Student nurse noticed that the patient was spiking temperature and went to inform the senior nurse for advice. She advised to administer Tylenol to the patient who is known to have drug allergies with that certain medication. In this situation the student nurse asked the senior nurse whether it was a rational decision as the student noticed the drug allergy (Who, 2019). Then the senior nurse checked his drug chart and noticed that the patient had drug allergy then she informed the doctor. After that doctor came and looked at his health condition and treated him accordingly. This was a good example of how a multidisciplinary team can work together to meet a patient’s holistic needs. Multidisciplinary team like doctors, nurses, other health professionals work together and communicate effectively to improve patient outcomes. In this situation, doctors, nurses and student nurses worked together to help this patient health from deteriorating. Therefore, from this situation student nurse learnt the importance of team working in multidisciplinary team. Multidisciplinary team need to work closely together so that as a team, it becomes easy to identify a mistake before it happens (RCN, 2019).. 

Delegation

Dyess, Sherman, Pratt, and Chiang-Hanisko (2016) state that healthcare managers often find themselves dealing with complicated tasks. As previously identified, effective leaders do not work in isolation. They build a reliable team that can perform different tasks. Delegation is not only efficient in saving time for activities but also builds trust among the subordinates towards their leaders (NMC, 2019). For instance, at the time of placement, the senior nurse assigned a task to a student nurse to do a bladder scan on a patient who was suffering from urine retention. The student nurse was not confident enough to do the scanning but with the nurse help and support student nurse managed to complete the task. Leader should always ensure that one can complete the task before delegating (RCN, 2017). When leaders delegate, they show their juniors that they are capable of delivering as expected. This pressures the subordinates to work hard to meet the standards. Without bladder scan the task would not be completed, which show the hospital management was good enough as the equipment and resources were available (Kings Fund, 2011).

Technological advancements have digitized the healthcare delivery system from the traditional paper-based recordkeeping to electronic patient records (EPR). Health informatics has also been introduced in practice. These innovations have impacted the quality of care in different ways. Digital data is more efficient in handling compared to the paper records. At first, paper records took more time to capture and obtain when the reference was necessary. According to Honeyman, Dunn, and McKenna (2016), having chunks of files made it difficult to relocate a patient’s file record. These led to delays. For instance, when a patient under treatment developed complications that needed emergency interventions, it was difficult to retrieve their files. With digital data, it is only a few clicks in the clinical management systems, and the data is navigated.

Coiera (2015) notes that healthcare organizations currently use integrated information systems that serve all purposes of the organization. For instance, the Computerized Patient Record System (CPRS) is a typical digital database that stores patient data of healthcare organizations. In the same system, therapeutic, surgical, and financial departments can navigate into one system and share patient records from one end to another. For instance, when a physician wants information from the laboratory unit, it is shared directly through the computer system. This has created efficiency in healthcare operations by saving time, costs, and reducing medical errors that arise from inaccurate paper records. Patient safety and quality of care have thus been enhanced.

In the opinion of Dyess and et.al., 2016 responsibility must be delegated so that workload of each employee is reduced. When leaders are involved in delegating authority it creates trust of sub-ordinates on leaders. This can also support the health care unit in achieving their goals and objectives on time as responsibility is being delegated and handled properly. Delegation of responsibility can also create sense of responsibility among workers which is really necessary for their growth.

Digital Data

The impact of health informatics in quality of care has been incredibly impressive. The only absolute potential for improving patient outcomes is through technology. Coiera (2015) asks whether with the current few innovations showing positive results, it is possibly right that technology has not been fully exploited to create new processes for delivering healthcare services. Some of the practical innovations include the Bar Code Medication Administration (BCMA) used for identifying patients to avoid confusion and the Vista Chemotherapy Management (VCM) system used in the oncology services. According to (Coiera 2015), the gap in the exploitation of technology is the lack of educational programs on informatics in the curriculum and clinical settings. When equipped with this knowledge, nurses will be in a position to explore the opportunities in information technology to improve the quality of services (Johnston 2017). Data analytics must be used to provide solution to problem. These analytics solutions can give a business a view of customer behaviours or consumer trends, and allow them to cater their products or services to meet those needs more effectively. An example would be in the management of patient flow and ward capacity in hospitals during the notoriously busy winter months. (See, appendix 1).

Gap in clinical practice / Action Plan (SMART GOAL PLAN)

Gap analysis in services provided by NHS

There are various gaps that has Not making use of updated digital technology. It has also been analysed that in NHS there is No involvement of leaders in workplace practices. They are also involved in providing Low quality of services (Porter-O'Grady and Malloch, 2014). It has also been analysed that there is No training taking place in unit. So these gaps needs to be overcome by NHS (Yoder-Wise and Grant, 2014).

Action Plan: Gap has been analysed and its way to improve is Gap analysis Making use of updated technology. NHS must have engaged in making use of automation and AI so that quality of service can be improved. They must make use of Improved leadership. Leaders must have engaged in making use style like transactional and transformational (Porter-O'Grady and Malloch, 2014).

CONCLUSION

Healthcare needs are fast changing. According to Cherry and Jacob (2016), nursing practitioners are under significant pressure to respond to the complexities being presented daily. Quality of care has become a necessity in practice. Compensation models have shifted to paying for high-quality care other than traditional quantitative care. These changes have influenced the need for both effective management and leadership in healthcare. In the United Kingdom, quality issues are evident based on the recently published reports. Investigations have revealed that a significant percentage of deaths could be avoided. Leadership approach is the only possible strategy to ensure that patient safety and outcomes are improved. Multidisciplinary teams in healthcare are capable of addressing the current issues. By introducing a culture of inquiry, leaders will achieve evidence-based practice that leads to the identification of the problems. From situational and quantum leadership theories to information technology, managers and leaders can form successful teams that work together to deliver high qualit