Leadership and Management in Nursing

Question: Discuss about the Leadership and Management in Nursing. Answer: Introduction: Nursing is one of the most exciting professions where nurses play a wide variety of roles to promote health, prevent disease and help patient to manage their illness. In this assignment, I intend to provide an evidence for the widely held claim that nursing is a theory and evidence based practice. The essay deals with description of an event from my own experience as a nurse and associated response. The essay critically evaluates the event and supports with evidence base. The essay intends to discuss the consequences of the event and the organisational constraints imposed on health care delivery. The essay draws the information into the conclusion and recommends remedial strategies with appropriate theoretical and research evidence. In a hospital setting, one of the commonly occurring issues is conflict due to continuous human interaction. Nurses play a wide variety of roles such as care provider, manager, educator, that includes different types of interactions among nurses and other members in the healthcare team that significantly increases the probability for workplace conflicts (Day, 2015). Conflict refers to disagreement between two or more people, or departments that may be positive or negative. Conflict is a result of variation in behaviours, attitudes, common goals, and beliefs (Arnold Boggs, 2015). In health care setting, conflicts have long term complications such as damage to interpersonal relationships, professional life that adversely affects the patient care due to communication gap in transferring accurate information. Nurses experience various types of conflicts such as interpersonal, intrapersonal conflicts, interagroup conflict, competitive and disruptive conflicts. In this essay, I would like to discuss about interpersonal conflicts, its related issues and its impact on patient care and to find resolving strategies. According to Arnold Boggs, (2015) an interpersonal conflict occurs due to disagreement between two individuals, ending in bitterness and dissatisfaction. The reason of such conflict includes altered interpersonal relationships, misinterpretation of individual roles, and variation in professional and economic values. Excess workload, lack of adequate resources, poor communication skills are other sources of conflicts (Blais, 2015). I have several experiences as a nurse but the event of interpersonal conflict had a significant impact on me. It is the rationale for particularly dealing with this issue in this essay. I have joined one of the hospitals in Bahamas after completing my diploma in nursing. I was placed in ten bedded intensive care unit. During each shift, one floor manager, three staff nurses, and one medical officer were present. I observed high turnover rate of nurses in this hospital. While I worked here the major issues that I have encountered were poor communication and cooperation among co-workers, negative attitude of physicians towards nurses, bullying by seniors, and over exhaustion at emotional level. The quality of care delivered was not meeting the nursing standards. Consequently, the patients were suffering with dissatisfaction and delay in care. One fine day, while I was in my morning shift the attending physician visited to follow up his diabetic patient, Mrs. Rosie who was then complaining of urinary tract infection (UTI). Within few minutes I heard him shouting on top of his voice that why the patient was not catheterised although it was recommended at the time of adm ission. She was supposed to be catheterised in the early shift. The other reason for his fury was missed insulin dose of the patient. Later, I have obtained some information on this issue and found that the attending nurse had some professional issues with the physician and with other staff nurses. The patient stay in the hospital was extended as she was not receiving adequate quality of care from the nurse, which detoriated her condition. I personally believe that the organisation was responsible for this phenomenon. It was difficult for me to work here because the hospital had no facility to address nurses complains. Most of the the nurses in the night shift left their work incomplete which added my work load in the morning shift. As I tend to sort out this matter with the nurses manager, I was disappointed. Her leadership style was autocratic and she hardly paid any heed to the issues faced by the in-house members. She was always dominating and had a tendency to establish her poi nt without realising its effect on the nurses and their professionalism. The very month that I have joined, three staff nurses have left the job. It was challenging for me to work here and most of the staff members spoke English in accent that was different from mine. It was difficult for me to concentrate on my work and very soon I was frustrated. However, conflict was obvious because the workplace was formed of different personalities having different views and opinions (Aberese-Ako et al., 2015). With this event, I have realised the importance of good interpersonal relationship. It was necessary to address this issue from a different perspective, as I did not want to quit like other nurses. I was passionate about my career in nursing profession therefore; there was need of managing the conflict implementing best strategy. It was time for me to implement my theoretical knowledge into practice. Critical thinking is the essential skill for nurses and it has been emphasised in nursing education for more than fifty years (Zuriguel Prez et al., 2015). Critical thinking refers to self-corrective and self disciplined thinking where judgement is based on analysis, interpretations, evaluation, and explanation of the evidential and contextual consideration (Solbrekke et al., 2016). While critically analysing this issue as well as individual performance I was sure about certain things. The leadership style of the nurses manager was not correct. According to Lin et al., (2015) the transformational leadership style is more effective than the autocratic style. The former style mainly emphasises on the significance of the interpersonal relationships. This style would promote the self esteem of nurses and elevate self actualization in terms of respect, creativity, achievement, confidence, acceptance and problem solving. The nurse manager should have been more alert when the nurses attending Mrs. Rosie missed her insulin dose and catheterisation. She was supposed to communicate and address her issues effectively in a way that would increase her work efficiency. It was also not appropriate for the physician to react violently at the nurses misconduct. Explaining the nurses about the consequences of her unprofessional behaviour would have sorted the ongoing problem. Suc h support and guidance would definitely retain the nurses and increase their confidence to handle job stress. Conflicts of this type hamper the professional, personal and organizational outcomes (Jeffreys, 2015). My first step was to familiarise myself with the environment before I unveil my true personality. I had to overcome my timid and extrovert nature. Instead of seeking nurses managers help I did what I believe was the right solution to the problem. I requested the nurse manger to allow me to care for Mrs. Rosie. I took me two days to get a grasp of her clinical situation. Mrs. Rosie was 65 years old patient with diabetes mellitus. This made her UTI more complicated. I was strict in adhering to the nursing code of ethics (Bell, 2015). I have planned her care based on the best evidence from the literature review. I had put my best effort to deliver patient centered care (Johansson Johansson, 2015). After carefully analysing Rosie case I tend to address her physical, social, and spiritual needs. I carefully monitored her insulin therapy and administered antibiotics prescribed by the physician for UTI. I aimed to meet all the standards set by the National Service Framework (NSF) for diabe tes. As it was a complex disease, it required day-to-day self care by the patient. I taught her how to manage the disease by having balanced diet, ways to recognise signs of complications, about weight management. I have assisted in dietary care planning and insulin therapy management (Munshi et al., 2016). I have encouraged, motivated, and involved her family to aid concordance. I was involved in collaborative care management with other professionals. I have worked with same dedication with other patients as well. After few days, the nurses leader praised me for my performance. This minimised the workplace conflicts, as other staff nurses tend to maintain the culture of respect and acceptance. The patients were satisfied with my services, which in turn changed the attitudes of other nurses towards their work. I had to learn to be patient and practice reflective listening when dealing with patients as well as other nurses. It would in turn motivate others to engage in meaningful conversation with others (Arnold Boggs, 2015). Due to my experiences, I have stopped relying on others for delivering my tasks. I believe my capability to deliver authentic workload to my satisfaction. In my team, I tend to focus narrowly on my nursing skills (Laschinger et al., 2015). I initiated taking maximum responsibility and workload for the team exercise and avoided complaining. After three months, I have gained collective trust of others. Being temperamental and aggressive was my weakness but I have learnt to develop my self-awareness (Day, 2015). While working in a team, I had to open to new perspectives. This also changed the attitude of other nurses towards me. Some of the nurses tend to approach me for resolving issues. This was possible to be established by the self-exploration approach of the psychoa nalytic group theory (Lichtenberg et al., 2016). Eventually, it helped me to tackle disagreements with my seniors and reduce job stress. I would like to discuss about the strategies that were effective in my case to resolve the workplace conflicts. The five best conflict management style described by Pines et al., (2012) are: Avoidance, competition, collaboration, compromise and accommodation. The best thing about these styles is its implementation as per the need of the hour. I used the avoidance style when I was aware that I was wrong and it was trivial matter. It was effective method when other could resolve the issues more effectively and there was no chance of satisfying my concerns. Avoidance provided a way to preserve harmony. The competition style was used in emergency that demanded a quick decision, when the welfare of the patient was at stake and the resolution was vital. The competition style allows one person to win using every power required to win and does not concern others (Pines et al., 2012). Collaboration style was effective in use when there was a need of considering different perspectives to implement better solution. The aim of this style is to reach a common goal that satisfies all the members involved in conflict. It is important to work through feelings that damages relationships (Pines et al., 2012). Collaboration style fosters commitment by reaching a consensus (Kantek Kartal, 2015). The style of compromising was effective in conflict management when complexes issues were to be settled for a short period. It can be used when the previous two styles does not work. This style is preferable when the important goals are not worth the potential violation of inflexible standards (Pines et al., 2012). The last style, which is accommodation, is used to resolve conflicts when it is necessary to maintain cooperation. It includes setting aside personal concerns for other members satisfaction. It is effective to use when one is losing to a majority of staff nurses. Conclusi vely, there is no particular strategy to resolve conflicts in workplace. I believe a nurse must have strong communication skill, self-awareness and knowledge of severity of situation and its consequences. There is another method recommended by Kantek Kartal, (2015) which is negotiation. This approach requires engagement in honest communication with the healthcare professionals to adjust the differences and finally reach a consensus. However, it is effective when nurses involved in conflict share their wants, needs, and objectives. Therefore, individuals can achieve the common goals by adapting to their needs and wants. As per Lin et al., (2015) the nurses manager implementing transformational leadership regularly highlight on the team goals, confront disagreements and incorporate best ideas and reliable information. I personally believe that the nurse manager should learn to be adaptive to different situations and modify their style accordingly. On the other hand, the nurses who left the job should have been more competent and tactful. According to the Tuckman model of team development conflicts are distressing, yet it institutes an opportunity to advance, grow and function properly (Zoogah et al., 2015). Upon requesting the hospital manager, he has implemented the system of reporting workplaces issues for the nurses although it took one year for all the positive changes in the workplace. In conclusion, power when used constructively ensures success for healthcare professionals and organisations. I would disregard the traditional view of treating conflict as a destructive force which is supposed to be ignored or silenced. I would agree with the modern view of conflict as an opportunity. Conflict management using a collaborative effort helps to rebuild trust and create a future of enhanced professional relationship. Managing conflicts at a work place is a complex phenomenon. Working in this environment, and experiencing the conflict has increased my awareness of the problem and improved my preparedness to cope up with workplace issues. I have realised about some of my leadership skills such as driven to deliver, personal competence, and accepting responsibility. It has strengthened my relationships and improved morale. Therefore, conflict management enhances personal growth and encourages psychological development (Day, 2015). Based on the best evidence from literature and my personal experience it is suggested that the nurse leaders should master their skills of negotiation, mediation, conflict resolution, and expert communication (Grohar-Murray et al., 2016). The organisation should understand the current state of moral distress experienced by the nurses. A valid and reliable tool should be used for conducting survey and identifying the ways to support moral courage for nurse leaders and the d irect care nurses (Gilin Oore et al., 2015). The healthcare organisations must strive to create a professional culture in the workplace and integrate healthful practices in the areas where care is delivered. There is need of peer support programs and provision of mentoring (Ellis Bach, 2015). There is a need of participative leadership model as mentioned in (Almost et al., 2016). I believe in implementation of best model to increase the moral courage of the staff. The model should align with the strategic vision of the nursing department. There are adequate resources to implement, maintain, and evaluate the model outcomes (Grohar-Murray et al., 2016). I would like to recommended helpful strategies for nurse leaders and nurses to minimise workplace conflicts keeping in view of the complex environment. Nurses and leaders should enhance their knowledge about the theory of ethical decision-making and ethical practices. Based on the above discussion it can be concluded that the claim nu rsing is a theory and evidence based practice is justified. However, I still need to develop my creative skills. I have to work more hard to be collaborative and leadership skills. References Aberese-Ako, M., Agyepong, I. A., Gerrits, T., Van Dijk, H. (2015). 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