Nursing Leadership and Change Management

This essay explores the context of nursing leadership pertinent to the Australian health care system and relates it with the leadership scenario. It discusses the different roles or nursing leaders in Australian as well as global leadership perspectives. The essay also covers the different leadership styles and approaches employed by the executive nursing leaders and clinical nurse leaders.

Running head: NURSING LEADERSHIP AND CHANGE MANAGEMENT
Nursing leadership and change management
Name of the student:
Name of the university:
Author note:

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Introduction:
Leadership can be defined as the need of the hour for the present day scenario. It has
to be mentioned in this context that the present professional scenario is operated in the
multidisciplinary team format where the professionals coming from a variety of different
professional designations need to collaborate with each other to continue the professional
work harmoniously and achieve the goals successfully. The importance of leadership in the
health care context is also extreme, as the implementation of the multidisciplinary team is
also extremely prevalent in the professional scenario of health care (Barr and Dowding 2015).
On a more elaborative note, there is mounting evidence that suggests that the primary
purpose of the leaders are to ensure optimal achievement of results (Amanchukwu, Stanley
and Ololube 2015). In the field of nursing, leaders are the primary contributors to the smooth
and effective functionality of service or care delivery to the patients. It has to be mentioned in
this context that the importance of the leaders in the field of nursing is to ensure that all the
staff can collaboratively cooperate with each other and provide safe and effective care to the
patients with prioritizing the needs of the patients over anything else. There are various styles
of leadership that the nursing professional can be employ in the health care scenario,
depending of the need of the situation. The most common form of leadership that is being
practiced in the health care contexts includes transformational leadership, situational
leadership, transactional leadership, and autocratic leadership (Kenney 2016). This essay will
attempt to explore the context of nursing leadership pertinent to the Australian health care
system and relate it with the leadership scenario I have experienced, relating them to the
various leadership theories, styles, roles and approaches.

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Leadership and its role in nursing and health care:
Leadership is an age old concept for human society, no civilization can sustain
without able leadership to guide and direct (G inter, Duncan and Swayne 2018). Similarly, in
the health care scenario as well, the need for able and potent leaders is vital. It has to be
mentioned in this context that the need for good leadership in the profession of nursing is not
only to facilitate change, the leadership in nursing acts like the vital aspect to patient care
which facilitates improved patient centred care, advocacy, and compassionate care. Along
with that, leadership also plays a fundamental role in maintaining the productivity and cost
effectiveness of services provided as well. There is mounting evidence which has indicated
at the fact that leadership is a fundamental aspect associated with effective nursing care, in
the context of patient care nurses are the leaders of care planning and implementation. The
white paper on nursing leadership discussed by the ACN or Australian College of Nursing
discussed the different roles or nursing leaders in Australian as well as global leadership
perspectives (Acn.edu.au 2018).
Nurse leadership in world health:
As discussed in the white paper by the ACN, there is a pressing need for nurse
leadership, especially for the global issues (Acn.edu.au 2018). It has to be mentioned in this
context that the common issues that the health care industry is facing includes workforce
development, ageing populations and reduced funding for health care. These prevailing
challenges in the health care scenarios are essentially similar in most of the nations and these
changes can also be adequately and successfully addressed by implementation of sound
leadership (Günzel-Jensen, Jain and Kjeldsen 2018f). The white paper discusses that the
nurse leaders have a significant presence in mitigating these global risks, especially in crisis
situations or in need for advocacy. In this context, the Australian nursing workforce has
availed a varied range of success via multiple domains, such as global nursing leadership

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representatives, voluntary outsourcing support to nations that are victims to crisis and support
for the refugees and the asylum seekers. As discussed by Barr and Dowding (2015), the
emergency relief nursing workforce have to face a variety of challenges including climatic
hardships, geographical challenges, financial constraints and even issues in accommodating
to the culture and responsiveness of the target patient groups. Many research studies have
focussed on the apt nursing leadership employed by the emergency relief nurses that helped
them mitigate all the risks and provide sound care practices to the victims of war,
environmental calamity, accidents, pandemics or epidemics (Lohman 2016).
Nursing leadership in Australian health systems:
The role of nursing leaders have been exceptional in the massive improvements that
the Australian health care industry has seen in the last couple of decades. A few notable
examples of the tremendous contribution of the nursing leadership on the Australian health
system includes policy making, advocacy strategies, not for profit agencies and groups,
health care regulatory bodies, health education and health promotion, and lastly screening. As
discussed by the White paper by ACN, the nursing leaders are present in government
departments, agencies and steering groups, health care regulatory bodies and health advocacy
groups in the Australian health care systems (Acn.edu.au 2018). There is mounting evidence
that indicates that the nurse leaders have to possess a variety of skills and knowledge,
political, economic, and societal knowledge in the health care contexts. As discussed by West
et al. (2014), the nursing leaders bring to the table a deep understanding of evidence based
practice and education system which had been and is essential for the revolutionary transition
of the modern health care system. There are various examples of leadership pertinent to
different health care scenarios and departments, and each of the examples had been illustrated
effectively in the white paper as examples of leadership in nursing.
Executive nursing leaders:

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The most common form of the nursing leaders present in the health care industries are
the executive nurse leaders. They are the organizational entities that helps in building allies
and connections across the organization and fosters communication across the organizational
silos. They are the nursing managers that handle recruitment, training, staffing, shift
allocation, remuneration and to some extent human resource management. The white paper
by the ACN discusses the fact that the executive nursing leaders play a fundamental role in
providing guidance support and leadership to the clinical nursing leaders as well (Arroliga et
al. 2014).
The roles and responsibilities of the executive nursing leaders include leading the
nursing leaders, throughout the organisation and the nursing staff as a whole, setting the tone
for nursing care within the organisation, ensuring proper resource and workforce distribution
across the variety of different nursing units, creating positive practice environments,
monitoring the delivery of high quality, safe and effective care to the patients. The executive
nursing leaders have very minimal contact with direct patient care and their professional
responsibilities are more concerned with the administrative form of leadership. In support,
Sergi et al. (2016) have mentioned that workplace culture, staffing levels and mix,
interprofessional collaboration, job satisfaction, burn-out and turnover to patient outcomes
and productivity are the main areas of concern for the executive nursing leaders. Hence, their
contribution to direct patient care is limited as a result their leadership style or approach is
also more transactional than transformation across the nation. Nurse executives have the
position in the health care industry which has the power and potential to implement long term
changes in concerning both administration and infrastructure and in turn improve not only
service delivery and patient satisfaction, can improve the safety and quality of care (Landis,
Hill and Harvey 2014). For instance implementation of a technological change such as an
Electronic health record or EHR in the hospital facility to reduce the instances of medical

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errors is a change implementation which will require change management and able leadership
skills across a variety of different professional domains such as the administration, the staff,
the supervisors, and lastly the patients and their family members as the consumers of the
facility or the service they are providing. In this case the leadership or change management
approach employed by the executive nursing leaders will have to rely on is the situation
leadership style, which will let the executive nursing leaders have the opportunity to morph to
different leadership styles and approaches such as the transactional and translational style as
per the need of the situation and cater to the each of the stakeholders with the best fit
leadership style that can instil the change management as applicable to acceptance and
compliance to the EHR system implemented. Although, there are certain cases as well, where
the executive nursing leaders have to employ the aesthetic leadership style for conflict
resolution or administrative change management in the health care facility. Hence, it can be
considered in this situation that the use of the leadership styles and approaches are divers in
the Australian health care system for the executive nurse leaders (Kenney 2016).
Clinical nurse leaders:
Aside from the executive nursing leadership which is more associated with
administrative aspect of the healthcare management, the second most important
representative of nursing leadership in the Australian healthcare system as well as the
healthcare scenario across the globe is the clinical nursing leadership (McSherry and Pearce
2016). The clinical nursing leadership represents the nurse leaders that focus on clinical
leadership using the integration of clinical expertise and leadership practices. Authors have
described this leadership by clinical nurse leaders to be directly associated with patient care
and hence are more feasible for the staff and the patients as well. There are various domains
to clinical nursing leadership and each encompasses different sectors of responsibilities that a
clinical nurse leader has to accomplish while in practice. The concept of clinical leadership

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encompasses implementing and monitoring evidence based practice in the care along with
evaluating the outcomes of the care practices given within a continuous improvement
framework. It has been mentioned that it involves assessing in mitigating risk to individual
patients so that their individual needs and care priorities are addressed in a systematic and
evidence-based manner. along with that it is also the responsibility of a clinical nurse leader
to improve the efficiency and coordination of all of the employees at the point of care so that
advocacy for patients is prioritized over anything else in the care scenario (Rosenman et al.
2015).
As mentioned by Trastek, Hamilton and Niles (2014) the clinical leaders are in a
position where they have the opportunity to engage with the patient and discuss and a dress
each of social cultural and economic needs of the patient and the surroundings that they live
in which also is associated with their condition and recovery. However, as criticized by the
authors the responsibility of a clinical nurse leader in Australian healthcare system also
encompasses strong communication and collaboration with the patience that will faster better
therapeutic relationship with the patient and will also ensure that each of the member in the
multidisciplinary team is completely and clearly aware of their personal roles and
responsibilities and the care is provided in a collaborative and cooperative manner
prioritizing the best interest of the patients. For the more there is mounting evidence that
such as that clinical nurse leaders are just supervisors of the different nursing disciplines that
address to different patient requirements. As a result they have a direct contact with the
patient and have the opportunity to recognize and address the cabs in the outcomes of the
patient and raise systematic issues of concern (Borkowski 2015). The example of such
leadership and Management designations in the clinical nurse leadership context includes
nurse unit manager, nursing supervisor, and head registered nurses. the white paper of
nursing leadership published by the Australian College of Nursing as discuss that the

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specifications of such notes unit managers and supervisors for nursing teams within the
context of clinical nurse leadership is essential for recognizing issues and implementing after
unnecessary solutions while collaborating with the administrative management which
represents the executive nurse leaders and other healthcare professionals for better improved
and more goal-directed care outcomes (Acn.edu.au 2018). It has been mentioned that these
are nursing leaders that are associated with direct patient care hence they are more interested
associated with the care environment, workforce challenges, and conflicts that occurs in the
healthcare scenario on a day to day basis. Hence, the leadership style for the clinical nurse
leaders is more focused on transformational and compassionate leadership approach, which
sometimes can required event situation leadership characteristics for crisis or emergency
situations (Duffy 2018).
Leadership scenario:
The assignment requires to critically analyze the leadership style or approach
employed in the leadership scenario that has been illustrated with respect to the different
leadership styles and rules set out in the white paper by the Australian College of Nursing
(Acn.edu.au 2018). In my case I would like to mention the leadership scenario that I have
had the opportunity to experience when I was in my placement. There is mounting evidence
that suggests that the leadership needs in healthcare scenario is dynamic with respect to the
dynamic situations and crisis that are healthcare facility experiences. The white paper of
nursing leadership by the Australian College of Nursing has also illustrated the fact that there
are various forms of leadership that are pertinent to the health care scenario in Australia
(Acn.edu.au 2018). In case of both a clinical nurse leader and executive nurse leader, both
of the designations represent in leadership and the nursing scenario require different
leadership approaches and styles when encounter in different situations. Similarly the
leadership scenario that I will be illustrating involves our leader that have to incorporate a

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combination of different leadership styles and theories in order to address a crisis situation
that had represented itself in the facility (Lee 2014).
As mentioned by the white paper of ACN, strong leadership is crucial for recruiting
and retaining an appropriately skilled nursing workforce (Acn.edu.au 2018). In this case our
nursing leader had been very strict and committed to her work and her leadership style was
also representative of dedication to her roles and responsibilities as a nurse. In the facility we
had multiple changes implemented in our system which required robust leadership
capabilities and compromising organizational citizenship behavior to adjust to the new
changes that were being implemented. Many of the staff resigned and existing staff took long
leaves from the facility and contemplated leaving due to the lack of consistent and
compassionate leadership. It has to be mentioned in this context that although our nursing
leader had been very dedicated and inspiring she also had been very strict and followed
autocratic leadership style. While the strict leadership style had been fruitful in the previous
situation to maintain quality and productivity in the facility, in the face of the recent changes
that have been implemented the lack of a compassionate a transformational approach to
leadership led most of the staff to get overwhelmed by the stress and frustration and decide
leaving the company which has been detrimental impact on the service quality and reputation
of the facility (Richter et al. 2015).
Theories of leadership:
According to the theory of autocratic leadership is the authoritarian leadership that is
characterized by individual control over your decision incorporates little to no input from the
rest of the group members (Cheng et al. 2016). Autocratic leaders are the kind of leaders that
typically do not share the decision making power with the rest of the team members and
make the choices that are sent on their ideas and judgments involving absolute authoritarian
control over a group or a team (Whitehead, Dittman and McNulty 2017). An autocratic

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leader is a dictator and there is lack of trust and compassion in this leadership style which is
often deleterious on the success of the team as whole. Although and autocratic leadership is
beneficial in quick decision making clear chain of command or oversight and effective when
directive leadership is required there are many drawbacks are challenges that are associated
with autocratic model of leadership. The most important disadvantages of autocratic
leadership includes discouraging group input, detrimental on moral, installing resentment
and disappointment, and lastly the ability to create creative solutions and expertise from the
subordinates. In our case as well as the dictating and authoritarian leadership style of the
leader disappointed and discouraged many of the resolving and talented employees to leave
the facility and its strenuous working environment and look for better opportunities (Asiri et
al. 2016).
On the contrary the most suitable leadership style that could be employed in the
situation that could have handled the crisis in a more effective manner is the transformational
leadership. The transformational leadership on the other hand is the leadership styles that is
inspiring and optimistic helping the followers get a positive influence while facilitating better
change management. Transformational leaders are energetic, enthusiastic, and
compassionate (van Rossum et al. 2016). As mentioned by the theory of transformational
leadership, there are four components of transformational leadership, intellectual stimulation,
individualized consideration, inspirational motivation, and idealized influence.
Compassionate empathetic effective approaches to leadership helps the leader implement
change in a manner that will also attract the best interest of the organization that will be
safeguarding the wellbeing of the staff as well. In this case if my leader adopted for a month
transformation and approach to leadership and communicated compassionately with the staff
helping them understand the need for the different infrastructure and culture oriented changes
that will be implemented in the facility the turnover rate could have been saved.

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Transformational leadership has been highlighted in the white paper in many accounts. The
authors have mentioned transformational leadership to be the key to creating positive and
improving work environment. Nurse leaders need to develop strong working relationship
with the staff acknowledging the individual contributions made by each and every staff
despite their designation to implement a positive and productive environment which in turn
will facilitate better care outcomes (Acn.edu.au 2018). Along with that the paper also
mentioned transformational leadership capable of supporting the self-efficacy and sense of
competence and the nurses, in turn improving the resilience and compatibility of the nursing
staff.
Conclusion:
On a concluding note, the contemporary hospital care is now confronted with a
variety of challenges that are associated with workforce complications, changing consumer
demands and expectations, fiscal constraints, escalating demands for enhanced accessibility
to care, improving the patient centred care, and cost effective all in one care services. As a
result, the area for nursing leadership has been developed effectively in the context for the
health care system. Although, the ideation and trajectory of leadership in the health care
scenario is different from the scenario of organizational management. This essay has
explored the need for more able leadership across different domains in the health care
facilities to improve administrative aspects as well direct patient care. The white paper has
discussed the benefits of transformational leadership as the key leadership style that has
represented itself as the need of the hour in the present day Australian health care scenario.
Recommendation:
Hence it can be mentioned from the leadership scenario illustrated as well, the need
for transformational leadership is crucial and there is an imperative need for better training

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and skill enhancement of the nursing leaders that are in position so that they can understand
the requirement for a transition from autocratic leadership to a transformational or even a
situation and leadership style to better suit the requirements of the situation. In this case, our
leader had very limited idea regarding the benefits of transformational leadership approach or
the need to switch leadership styles, when facing a crisis situation. Hence, the most impactful
recommendation in this case will be to educate the nursing leaders regarding transformational
leadership and how to implement it successfully in practice. I would also propose quarterly
motivational workshop to be held for the staff where eminent transformational leaders will
share their understanding of transformation leadership, its advantages and how to
successfully implement it (Lee 2014).

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