Notes On... Nursing Leadership
Description
NOTES ON... NURSING LEADERSHIP
Unlock the secrets to effective nursing leadership with this essential guide
In the ever-evolving landscape of healthcare, leadership capability is a vital skill for nurses, however, leadership development and application within the field is rarely addressed during training. This essential resource ensures nurses are equipped with the guidance needed to develop as effective and resilient leaders within the workplace.
Centred on the clinical nurse's perspective, this text serves as a practical guide to applying nursing leadership concepts and provides a timely and authoritative overview of what it means to be a nurse leader in the health service. Throughout the text, the authors provide vignettes that share their personal experiences, highlight the value of applying nursing leadership, describe the different components of leadership, and more.
Notes On... Nursing Leadership is a must-read for undergraduate and trainee nurses looking for a concise introductory text that links current key debates and thinking in leadership to nursing practice.
It is also an invaluable resource for qualified and practicing nurses wanting to develop their leadership skills, broaden their leadership potential, or inspire and support other nurses in their approach to leadership.
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Persons
Alison H. James, DAHP, MA, PGCE, BA, DIP HE, RGN, BA, SFHEA, is a Reader in the School of Healthcare Sciences at Cardiff University, Wales, UK, where she teaches and researches in healthcare leadership. Before returning to Wales in 2013, Alison worked in clinical practice and higher education in Oxford. She is the co-author of Clinical Leadership in Nursing and Healthcare.
David Stanley, NursD, MSC HS, BA NG, DIP HE, GRAD CERT HPE, worked through his formative career in several hospitals and clinical environments in Australia. After several years of volunteer work in Africa, he moved to the UK and worked as a Coordinator of Children's Services and as a Nurse Practitioner. He developed the Congruent Leadership theory and has taught at several Australian Universities.
Content
Preface x
Acknowledgements xii
About the Authors xiii
About the Notes On... Series xv
1 Introduction 1
1.1 About This Book 1
1.2 Leadership and Management are Different! 4
1.3 The Difference 5
1.3.1 Management 5
1.3.2 Leadership 6
1.4 The Challenges Leaders and Managers Face 7
1.5 Summary 9
2 What Is This Leadership Thing? 11
2.1 Introduction 11
2.2 Defining Leadership 12
2.3 Definition of Nurse Leadership 14
2.4 Theories of Leadership 15
2.4.1 The Great Man Theory 15
2.4.2 The Heroic Leader 15
2.4.3 The Big Bang Theory 15
2.4.4 Trait Theory 16
2.4.5 Style Theory 16
2.4.6 Situational or Contingency Theory 17
2.4.7 Transformational Leadership Theory 17
2.4.8 Transactional Leadership Theory 18
2.4.9 Authentic/Breakthrough Leadership 19
2.4.10 Servant Leadership Theory 19
2.4.11 Shared/Collaborative Leadership 21
2.4.12 Compassionate Leadership 21
2.4.13 Congruent Leadership 22
2.4.14 Conscious Leadership 23
2.5 Summary 24
3 Characteristics of Effective Nurse Leaders 25
3.1 Introduction 25
3.2 Qualities of Effective Nurse Leaders 26
3.3 Hard Skills for Effective Nurse Leadership 27
3.3.1 Advanced Clinical Knowledge and Technical Skills 27
3.3.2 The Healthcare System, Advocacy and Policy 27
3.3.3 The Day- to- Day Clinical Activities of Your Role 28
3.3.4 Conflict Management, Networking and Negotiation 28
3.3.5 Finance, Business and Human Resource Management 28
3.3.6 Strategic Management 29
3.3.7 Political Awareness 29
3.3.8 Professional Development 29
3.4 Soft Skills for Effective Leadership 30
3.4.1 Sense of Teamwork and Collaboration 30
3.4.2 Creativity and Innovation 31
3.4.3 Dedication to Excellence 32
3.4.4 Create a Culture That Drives High Reliability and Quality 32
3.4.5 Being Approachable 33
3.4.6 Honesty and Integrity 33
3.4.7 Excellent Interpersonal Skills and Effective Emotional Intelligence 33
3.5 Other Characteristics to Consider 35
3.5.1 Courage 35
3.5.2 Vulnerability 35
3.5.3 Compassion and Empathy 36
3.6 The Attributes "Least" Likely to Foster Effective Nurse Leadership 36
3.6.1 Visionary 36
3.6.2 Controlling 37
3.6.3 Bias/Favouritism 37
3.6.4 Dishonesty 37
3.7 Summary 37
4 Self- Care for Leadership Effectiveness 39
4.1 Introduction 39
4.2 Self- Care 39
4.3 Caring for Self 41
4.4 Building Self- Care and Self- Compassion 43
4.5 Mindfulness 44
4.6 Resilience 45
4.7 Summary 46
5 Leadership for Innovation and Change 47
5.1 Introduction 47
5.2 Tools for Change 49
5.2.1 SWOT Analysis 49
5.2.2 Stakeholder Analysis 50
5.2.3 Pettigrew's Change Model 50
5.2.4 The Change Management Iceberg 51
5.2.5 PEST or STEP 52
5.2.6 Kotter's Eight- Stage Change Process 52
5.2.7 Nominal Group Technique 53
5.2.8 Process Re- Engineering 54
5.2.9 Force Field Analysis (FFA) 55
5.2.10 Initiating, Envisioning, Playing, Sustaining: A Theoretical Synthesis for Change 56
5.2.11 Seven S- Action Words Model for Organisational Change 57
5.2.12 Beckhard and Harris's Change Equation 57
5.2.13 People- Mover Change Model: Effectively Transforming an Organisation 57
5.2.14 Instituting Organisational Change: A Examination of Environmental Influences 58
5.3 Change Is Never Simple Even with a Model 58
5.4 Resistance to Change 59
5.5 Successfully Dealing with Change 61
5.6 Leadership, Innovation and Change are Linked 62
5.7 Summary 64
6 Leadership and Teams 66
6.1 Introduction 66
6.2 Healthcare Teams Defined 67
6.2.1 A Group 68
6.2.2 A Team 68
6.3 The Value of Teamwork 69
6.4 Types of Established Teams 71
6.4.1 High- Performance Teams 71
6.4.2 OK or Functional Teams 72
6.4.3 Struggling Teams 73
6.4.4 Self- Led Teams 74
6.5 Building Powerful Teams 76
6.6 Support and Challenge 77
6.6.1 Support 77
6.6.2 Challenge 77
6.7 Team Building 78
6.8 Team Roles 79
6.9 Leadership and Teams 81
6.10 Trust 81
6.11 Summary 83
7 Leadership and Networking 85
7.1 Introduction 85
7.2 Networking and Influencing for Change 86
7.3 The Skills of Networking 86
7.4 Summary 90
8 Leadership and Values 91
8.1 Introduction 91
8.2 Change and Values 92
8.3 Facing the Challenges and Balancing Power 94
8.4 Leadership and Its Role in Social Justice 96
8.5 Summary 97
9 The Challenges of Nurse Leadership 98
9.1 Introduction 98
9.2 Leading During Challenging Times 99
9.3 Examples of Leading Through Crises 100
9.4 Leading with Self- Care 101
9.5 Summary 102
10 Followership 104
10.1 Introduction 104
10.2 Defining Followership 105
10.3 Follower Responsibilities 105
10.4 Good Followers 107
10.5 Poor Followers 109
10.6 Summary 110
References 111
Index 134
1
Introduction
1.1 About This Book
In 1999, Colleen Wedderburn Tate (1999, p. 3) said, "Some healthcare staff are no longer working for patients, but are more motivated by pronouncements from government ministers, exposes in the media, and the latest scandal about misuse of public money." As we begin this dialog about nursing leadership, we wonder if anything has changed. After decades of talking about, writing about and searching for what we mean by nurse leaders, has anything really changed in practice, at the bedside or in the involvement of nurses at the wider decision-making table? We propose that nurses, more than any other healthcare employee group, need leaders, need to gain a deep understanding of leadership and need to be leaders for the profession. Because without a clear understanding of what leadership means, how it is recognised and how it is practiced, nursing and patient care will be poorer. It is in an effort to redress this shortfall that this book is written.
We believe that since Wedderburn Tate's (1999) statement above, nurses continue to have only superficial influence over healthcare resource decisions. While managers, healthcare service administrators, many medical practitioners and their teams still see themselves as "all powerful" in terms of their decisions and leadership of nurses and some other health professionals. Thousands of nurses graduate and are employed every year, only to leave their chosen profession the following year or the one after. This is because they become frustrated by their lack of influence or power over the work they do, the contribution they could potentially make or their inability to contribute to or influence decisions. They become frustrated that they can't provide the level of care they believe their clients/patients deserve. In addition, nurses often see their great ideas or projects relegated to lower priorities or ignored altogether by aloof hospital administrations and managers who (it should be acknowledged) are also under great pressure to deliver an effective health service with diminishing resources.
However, there is another issue with nurses and leadership. Nurses have been almost conditioned to see others (managers/doctors) as their leaders. When undertaking a number of studies exploring perceptions of clinical nurse leadership between 2001 and 2017 (Stanley et al. 2023), hundreds of clinical-level nurses were approached and asked to identify colleagues they saw as clinical leaders. The most common response was, "What, nurses as leaders-no, don't you want to talk to my manager?". Wedderburn Tate (1999) confirmed this, saying, "nurses who are successful leaders do not recognise themselves as such" and it seems nurses have not been taught that their leadership potential is in their hands. Reassuringly, some respondents in Stanley's studies (Stanley et al. 2012, 2014, 2017; Stanley 2019; Stanley and Stanley 2019) were able to point to highly skilled, effective and influential clinical-level nurses who displayed and practiced leadership as part of their clinical role. After decades of discussion and training about leadership in nursing, the majority of clinically focused nurses still fail to grasp the value of leadership to their practice and their responsibilities as leaders in the health service. When exploring perceptions of leadership with student nurses, James (2020) and James et al. (2022) found that student nurses rarely saw themselves as leaders then or in the future, and many felt unprepared to take on the concept of leadership. Although in the United Kingdom (UK) nurses are expected to demonstrate leadership at the point of registration, there remains a disparate approach to leadership education and preparation (James 2023). While the nursing curriculum remains full of clinical skill competencies and nurses take on more and more of these, leadership seems to be advertised as something one can pick up with a quick course. It is our opinion that leadership requires much further consideration and thought from early within the development of a nurse, application of critique to traditional theoretical positions and ownership by nursing as a profession (James et al. 2023).
It is our conclusion that nursing leadership is essential, not just to pay lip service to the nursing profession and bolster its ego or place in the scheme of the health service but to make a genuine contribution to improving patient care and making the health service more robust and responsive to client/patient needs (James et al. 2023). This book sets out to offer a clear and straightforward perspective on what nursing leadership means and how it can be recognised and applied in practice.
The book is aimed at undergraduate nurses as a useful resource and may be of use to a range of qualified and practicing nurses who wish to review their insights into nurse leadership. It aims to inspire and support nurses in both understanding and developing their approach to leadership in nursing. It also aims to serve as a useful resource for nurses who are more advanced in their careers and who are interested in developing their leadership skills and broadening their awareness or leadership potential as nurse leaders. It is a contemporary introductory text that links current key debates and thinking in leadership as it applies to nursing practice.
Chapter 1 sets out the importance of leadership in nursing and why leadership is important in nursing now. It describes how the book is structured as well as considering the difference between leadership and management. Chapter 2 begins with an oversight of definitions of leadership, nursing leadership and an exploration of several leadership theories. Chapter 3 explores the attributes seen as vital for effective nurse leadership to prevail. This is presented as hard and soft skills and attributes and it goes on to explore why these skills are vital for nurse leaders to be successful. Chapter 4 outlines the importance of an understanding of self-care for leaders to be successful and remain vital. Chapter 5 offers an outline of the role of nurse leaders in driving innovation and change in the health service. Chapter 6 provides an overview of the relationship between leadership and teams, suggesting that nurse leaders need to understand how teams function and recognise their place when helping teams work. Chapter 7 takes the relationship of the leader to others further by exploring the significance of "networking" as a skill in the "toolbox" of effective nurse leadership. Chapter 8 looks at the central place of values for nurse leaders to be their best selves. Chapter 9 deals with the challenges nurse leaders face in the application of leadership, and Chapter 10 considers the flip side of leadership, followership, and how this can impact on the effectiveness of nurse leaders. Throughout the book, the value of applying nursing leadership is outlined, and the component parts of leadership are expressed.
1.2 Leadership and Management are Different!
Leadership and management are equally important, interdependent and inter related; however, they are also different and distinct, serving different purposes and requiring different skills (St George 2012; West et al. 2015; Gumbo 2017; Leech 2019; Nene et al. 2020; Stanley et al. 2023). In the health service, leadership and management are frequently seen as one all-encompassing thing (Stanley et al. 2023). However, Wood (2021, p. 284) suggests that "Working out who leads and who manages is difficult, with the added anomaly that not all managers are leaders, and some people who lead work in management positions." This has the potential to lead to role ambiguity (Stanley 2006; Cutcliffe and Cleary 2015; Nene et al. 2020), and conflict can occur when clinicians take on management roles without appropriate training, support or instruction (Nene et al. 2020; Stanley et al. 2023). Likewise, tensions can occur between clinical leaders and managers, when leaders feel that their efforts are hampered by management or organisational aspirations or targets (Stanley 2006; Kerridge 2013; Orvik et al. 2015; Scully 2015; Stanley 2017a, 2017b; Nene et al. 2020). Zaleznik (1977) makes the point that management and leadership positions require different types of people which may be problematic in healthcare with the tendency for role overlap (Stanley 2006; Cutcliffe and Cleary 2015; Nene et al. 2020). Kotterman (2006) argues that a well-balanced organisation requires a blend of leaders and managers to succeed, and while there are overlaps, there is clarity in the distinction when explored further. This is important if you are interested in becoming a leader and/or manager.
Reflective Activity 1.1
Before you read on . Think about someone you have worked with who you saw/see as an inspirational leader. The only restriction placed on this activity is that you must think of a clinically focused nurse or midwife. Not a manager, not a doctor, not another health professional, not a relative or friend who is not a nurse. Think primarily of a clinically focused nurse/midwife.
Why did you think of this person?
What was it about...
