LEADERSHIP IN NURSING - BY NURSE RABI'U H. MUSA

LEADERSHIP IN NURSING
Rabi'u Hassan Musa
INTRODUCTION:
The successful organization has one major attribute that sets it apart from unsuccessful organization; that is the dynamic and effective leadership.
Leadership has probably been written about, formally researched and informally discussed more than any other single topic. Leadership still remains an unexplainable phenomenon.

Nursing is a major component of health care delivery system and nursing services are necessary for every client seeking care of any type including health promotion, diagnosis, treatment and rehabilitation. So, the nurses must be good leaders and managers to provide quality care to the patients.

ETYMOLOGY
The word leadership was first known to be used in 1765. 
Etymologically, the term leadership was traced to “a prehistoric West and North Germaniclaithjan,” which was derived from laitho, meaning way or journey, from which comes the English word load, then, “lead which means cause to go along one’s way.”

DEFINITION OF LEADERSHIP:
Roughly, Leadership can be defined as the process of moving individual or groups in some direction through mostly non coercive means. A leader is a person who influence and guides direction, opinion and course of action.
1. According to Gerdener (1990), he defined leadership as “process of persuasion and by which an individual (or leadership team) induces a group to pursue objectives held by the leader or shared by the leader and his or her followers”
2. Tourengeau (2003), used a broader definition, stating that “leaders are those who challenge the process, inspire a shared vision, enable others to act, model the way and encourage the heart”.
3. According to Encyclopedia of social science, leadership refers to the relation between an individual and group around some common interest and behaving in a manner directed or determined by the leader.
4. According ti Heinz weihrich and k. Harold, leadership is defined as influence; that is a process of influencing people to do what they will strive willingly and enthusiastically toward the achievement of group goal.

DEFINITION OF NURSING LEADERSHIP
1. NURSING LEADERSHIP refers to actions taken and the role assumed by the nurse practitioner in the performance of his or her duty – the delivery of quality patient care.
2. NURSING LEADERSHIP is a combination of personality traits, administrative skills and talents which enable a nurse to excel in the profession
3. ACCORDING TO RUTH TAPPEN, SALLY WEISS AND DIANE WHITEHEAD, nurse leaders can inspire others to work together in a pursuit of a shared goal. Nurse leaders can establish these goals while maintaining a balance between legal concerns, ethical demands and patient care.
4. PETER O'GRADY 2003, believed that, nursing Leadership can be defined as a multifaceted process of identifying a goal or target, motivating other people to act, and providing support and motivation to achieve mutually negotiated goals.

FACTORS OF LEADERSHIP
There are 4 factors of leadership, thus the process of leadership is a function of leader, followers and situation. The interaction or the communication is also very important in the process of leadership. The 4 factors are:
1. Leader
2. Followers
3. Situation, and
4. Communication.

ACCORDING TO MC GREGOR: L =F (E,F,S) where 'L' stands for Leadership, ‘F’ for followers and e,f,s are situational characteristics. 
The situational characteristics are: 
a. The leaders’ characteristics, his/her knowledge and skills, 
b. The follower’s characteristics, their attitude,  and needs, 
c. Organisational characteristics, nature of task performed and other factors.

IN NURSING, THE MOST COMMON CONCEPTUALIZATION OF LEADERSHIP includes 4 elements as central to the definition: leadership.
a. Is a process
b. Entails influence
c. Occurs within a group setting or context, and
d. Involves achieving goals that reflect a common vision.

FEATURES OF LEADERSHIP
1. Leadership is a continuous process of influencing behaviour
2. There is a relationship between leader and his followers
3. Leaders try to influence the behaviour of individuals or group of individuals to achieve the intended goals
4. The followers work willingly and enthusiastically to achieve those goals
5. It provides an experience of help to follower to attain common goals
6. It is exercised in a particular situation at a given point of time and under specific set of circumstances 
7. Leadership is part of management, but not the whole of it

DIFFERENCESM BETWEEN EADERSHIP AND MANAGEMENT
Lead means to guide on a way especially by going in advance; to direct on a course or in a direction. 
Manage means to handle or direct with a degree of skill; to make and keep complaint. Lead subordinates and manage the work of subordinates.
Nurse Manager need to have both leadership and managerial skills due to dramatic and rapid change in nursing. They must strive for the integration of leadership characteristics throughout every phase of the management process. 
Leadership is a synthesis and management is analysis.
Analysis is defined as the procedure by which we break down an intellectual or substantial whole in to parts or components. 
Synthesis is defined as the opposite procedure, to combine separate elements or components in order to form a coherent whole.
Leadership has long term impact but Management has short term goals
Leadership is a part of management:
Leadership is a wider term
LEADERSHIP is concerned with influencing subordinated with the intention of climbing up in the next level; MANAGEMENT is the process of getting the work done or executing the plan.

BACKGROUND AND CLASSICAL STUDIES OF LEADERSHIP.
There are number of studies and a considerable body of knowledge on leadership. These includes
1. The Lowa leadership studies
2. The Ohio State leadership studies
3. The early Michigan leadership studies

THEORIES OF LEADERSHIP
The oldest view of leadership is considered at birth right. Kings and Queens ascended to thrones because of custom. Kings begot kings and became king leader. Individuals in formal leadership roles were accepted without question. This is similar to great man’s theory which states that “the great leaders are born with the ability to lead, influence and directs others”.

Some of the theories of leadership are:
1. Great man theory or charismatic theory
2. Trait theory
3. Behavioural theory
4. Situational theory or contingency theory
5. New theory of leadership, and
6. Path – goal theory of leadership to mention but a few

Leadership for the health care professionals.
One of the difficulties of looking at leadership for health care professionals is that, most theories were not developed within a healthcare context. Usually these theories were developed in a business context and were then applied to healthcare. Also, the bulk of published research on healthcare leadership has very little evidence of any impact of improved patient care or organizational outcomes.

NURSING AS COMPARED WITH OTHERS DISCIPLINE IN HEALTH CARE HAS ESTABLISHED LITERATURE ON LEADERSHIP;
a. CONVEY (1987) has been one of the most influential writers on leadership for healthcare professionals. He outlines a process of increasing maturity within leadership which moves from dependence towards a state of interdependence
b. BEVERLY ALIMO-METCALF is a key writer on transformational leadership in the healthcare and has developed tools for assessing transformational leadership 
c. THE LEADERSHIP THEORIES ND FRAMEWORK USED IN NURSING LITERATURE ARE;Bass and Avolio’s transformational and transactional leadership, Kouzes and Posner’s leadership practices, Hersey and Blanchard’s situational leadership model, Path goal theory, consideration and initiation and Kanter’s Organizational Empowerment Theory. 
d. Promoting Action on Research Implementation in Health Services (PARIHS) was also used to frame the research design.

LEADERSHIP STYLE
Leadership is practiced by leadership style, which is the total pattern of leaders’ action in relation to followers. It represents their philosophy, skills and attitude in practice.

MEANING OF LEADERSHIP STYLE
Leadership style is a form of cross situational behavioural consistency. It refers to the manner in which a leader interacts with his or her subordinates.
Leadership style is the manner and approach of providing direction, implementing plans and motivating people. They are behavioural models used by leaders when working with others.

TYPES OF LEADERSHIP STYLE
There are various types of leadership styles as;
1. According to dimensions of leadership
2. According to the way authority is exercised


1. According to dimensions of leadership:
The leadership styles depict the way in which leader:
a. Attempts to influence the behaviour of subordinates (Goal attainment function)
b. Makes decisions regarding the direction of the group (adaptation function), and
c. His or her balance between the goal attainment function and the maintenance function of the group

a. Leaders approach to influence
This is further subdivided in to
i. Transformational leadership
ii. Transactional leadership


i.  Transformational leadership:
In transformational leadership in contrast, the leaders are more visionary and inspirational in approach. They tend to communicate a clear and acceptable vision and goals, with which employees can identify and tend to engender intense emotion in their followers.

ii. Transactional leadership
In transactional leadership, the leader views the leader-follower relationship as a process of exchange. They tend to gain compliance by offering rewards for performance and compliance or by offering threatening punishment for non-performance and noncompliance.


b.  Leaders approach to decision making and problem solving
This is further subdivided in to
i. Autocratic or directive leadership
ii. Participative style of leadership

i. Autocratic or directive leadership
In this type of leadership behaviour, the leader considers his or her in a position of authority and expects the subordinates to follow him or her. The subordinates made aware of what to do, but not why. The leader sets the goal and expects them to be accepted along with his or her methods of achieving them.

ii. Participative style of leadership
It compromise between authoritarian and democratic styles of leadership. In this type of leadership, the leader presents own analysis of problems and proposals for action to members of the work group, inviting their criticism and comments.


c. Leaders balance between the influence and maintenance function
These styles of leadership represent extreme forms. Most leaders tends to exhibit behaviours from both styles.  It involves:
i. Task type of leadership
ii. Socio-emotional leaders or relationship building type of leadership style 
iii. Combination of task and socio-emotional leadership style.

i. Task type leadership style
In this type of leadership, the leaders are generally concerned with completion of task, accomplishment of goals, and the general effectiveness of the work group. They also emphasize deadliness, structure task, set and maintain definite standards for performance, enforce standardized procedures and generally insure that subordinates work up to capacity.

ii. Socio-emotional leaders or relationship building type of leadership style
In this type of leadership, leaders are generally more supportive and accepting the subordinates. They tend to look out or show concern for the welfare of the subordinates.

iii. Combination ofbtask and socio-emotional leadership style.
This style is difficult in that it involves the use of high level of interpersonal or emotional intelligence skills. The combination leader works to accomplish group goals by making you effective and recognizing your value.

2.  According to the way authority is exercised.
Depending on the way in which leaders exercised their authority, several studies in economics, psychology and management identify 2 major leadership styles:
i. Autocratic leadership style, and
ii. Democratic or creative leadership style.

i. Actocratic leadership style 
Autocratic leaders allow for only a minimal team participation in the decision making process and sometimes even ignore the opinions of their subordinates.

ii. Democratic or creative leadership style
The democratic leaders delegate authority to their subordinates. The leaders informs subordinates about overall purpose and goal of organization and allows them to participate in decision making ad solving the problems. The leader values the individual characteristics and abilities of each subordinate.
Leadership styles exhibited by nurses
Below are literarily the leadership styles exhibited by nurses.

1. Relationally focused leadership style
This includes transformational leadership, individualized consideration and resonance leadership.

a. Transformational leadership
The leader motivate others to do more than they originally intended and often more than they thought possible.

b. Indivisualized consideration
The leadership focuses on understanding the needs of each follower and works continuously to get them to develop to their full potential.

c. Resonant leadership style 
It is that leadership style that inspires, coaches, develops and includes others even in the face of adversity. This type of style is based on the emotional intelligence of the leaders.


2. Task focusedb(non-relationally focuded) leadership styles
Initiating structures refers to the degree to which leaders articulate clear role expectations, create well defined communication channels and focused on task and attaining goals. The task focused styles are primarily management by exception, laissez faire, transactional leadership, dissonant leadership styles and instrumental leadership.

a. Active management by exception
It focuses on monitoring task execution for any problems that might arise and correcting those problems to maintain current performance level.

b. Laissez faire style
Also known as permissive, free-rein, anarchic, and ultra-liberal style of leadership. They are conceptualized as passive avoidance of issues, decision making and accountability

c. Passive avoidance relationship
The leader tends to react only after problems have become serious to take corrective action, and often avoids making any decision at all.

d. Transactional leadership
It emphasizes the transaction or exchange that take place among leaders, colleagues and followers to accomplish work.

e. Dissonant leadership style 
This is characterized by pacesetting and commanding styles that undermine the emotional foundations required to support and promote staff success.

f. Instrumental leadership style
It focuses on strategic and task oriented developmental function of leaders.


EFFECTIVE LEADERSHIP
Need for effective leadership in nursing
Effective leadership is vital to provide guidance for solving complex problems related to nursing care delivery. It is critical in delivering high quality care, ensuring patient safety and facilitating positive staff development. It is needed in every level of nursing and there is no substitute for it. Leadership in nursing is required for making decisions. Delegating appropriately, resolving conflict and acting with integrity.


IMPORTANCE OF EFFECTIVE LEADERSHIP
1. Nurse leaders manager can handle the situation effectively
2. The work output and quality of work can be improved
3. The nurse job satisfaction and morale can be increased and the problem like absenteeism, turnover and shortage can be highly reduced
4. There will be healthy work environments
5. Positive outcome for organizations, patients and health care providers
6. Leadership is important to bring effective for effecting changes and achieving high standards of patient care

LEADERSHIP STYLES AND THEIR OUTCOMES 
The under listed outcomes have been documented in relation to either relationally or non-relationally styles of leadership

1. Staff satisfaction with work, role and pay: this includes job satisfaction, satisfaction with their leader, satisfaction with job mobility options, job security, financial rewards and time to spend with patients
2. Staff relationship with work: which involves organizational commitment, nurses’ intent to stay, nurses intent to leave, actual retention, decrease in turnover, staff health and wellbeing, and job tension
3. Healthy work enviroment: This also includes nurse’s empowerment, culture and climate, role clarity, team work, and other characteristics that involves innovation, cohesion, nursing group collaboration, conflict management and nursing models of care.
4. Organizational productivity and effectiveness


CHARACTERISTICS/QUALITY OF AN EFFECTIVE LEADER
A leader is a person who influences a group of people towards the achievement of a goal and has a deep-rooted commitment to the goal that he/she will strive to achieve even if nobody follows him/her.

A mnemonic of the definition would be 3P’s viz: Person, People and purpose.
A person is the leader, peoples are the followers and purpose is the goal.
Affective leadership requires a good leader. An effective leader is a catalyst in facilitating. Effective interactions among man power, material and time.

The nursing administrator, supervisor, the head nurse and nursing staff in a team nursing all are the leaders. As la Monica, 1994 stated that “anytime a person is recognized authority and has followers who count on this persons’ expertise to carry out their objectives, the person is a leader”. She further suggests that a person is a leader if they provide assistance to others. Therefore, a student nurse is a leader to patients and clients, a staff nurse is also a leader to patients and clients and ward manager is a leader to all team members.


QUALITIES OF EFFECTIVE LEADER
1. Temperament (nature of person)
2. Personality characteristics, and
3. Managerial competencies
4. Interpersonal relationships
5. Credibility and forward thinking
6. Professionalism, and
7. Advocacy

SUMMARY
Regardless of the style of leadership selected, the nurse managers should be aware of the effect of the style adopted in hospital, unit or educational institution staff and on the level of work performance. In view of the above it is sometimes desirable to inculcate 2 or more styles of leadership for an effective leading of the organization, which intern can be interchanged when the need arises.

CONCLUSION
Conclusively, we come to realize different types of leadership styles and the importance of effective leadership in nursing. Effective leadership is of utmost importance in nursing profession, in that nurses deals with human lives, whereas, poorly organized leadership can lead to loss of lives and poor attainment of our goals.


THANK YOU PRESENTER NURSE RABI'U HASSAN MUSA


DON'T FORGET TO SUBSCRIBE. DROP YOUR COMMENTS BELOW!!

Comments

Popular posts from this blog

Yes, I had sex with my patient but ‘no penetration’, Dr Tijjani Faruk confessed

WHICH WAY FORWARD - GRADUATE NURSES WERE DISGRACED TODAY OUT OF THE SCREENING HALL AT UNIVERSITY OF BENIN FOR NOT HAVING RN AND RM

DEPARTMENT OF NURSING BUK GETS FULL ACCREDITATION BY NURSING AND MIDWIFERY COUNCIL OF NIGERIA