Nursing Leadership: Issues, Analysis, Theories and Evaluation

This article discusses the importance of nursing leadership, the role of a leader nurse, and the issues and analysis of leadership in nursing. It also covers leadership theories and evaluation of leadership in nursing. The article emphasizes the need for effective leadership in nursing and the importance of following the footsteps of role models in the field.

Running head: NURSING LEADERSHIP
NURSING LEADERSHIP
Name of the Student
Name of the University
Author note:

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Table of Contents
Introduction......................................................................................................................................2
Issue Analysis..................................................................................................................................3
Leadership theories and Evaluation:................................................................................................8
Organizational Theory.................................................................................................................9
Operational Planning:................................................................................................................11
Conclusion.....................................................................................................................................13
Reference:......................................................................................................................................15

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Introduction
Nursing is one of the profession that is extremely important to the human kind, as they
are the primary care givers when there is any kind of physical ailments. In the profession of
nursing it is very important for a person to have patience, sympathy, and understanding of the
human behavior so that the patients can be taken care of properly (Wong, Cummings and
Ducharme 2013). It is also important for the nurses to have the leadership qualities so that the
person may solve particular situations which are critical and problematic in nature.
In order to understand the concept of leadership and its applicability in mental health
nursing it is necessary to identify a role model. For this reason, David Sines is chosen as the role
model so that the discussion can be conducted in a proper manner. David Sines has been
involved as a pro Vice Chancellor and Executive Dean of Society and Health at
Buckinghamshire. He has been presented with the fellowship of the RCN in 1979 for his work in
the advancement of art and science of nursing and community care (Hutchinson. and Jackson
2013). The reason behind choosing David Sines as a role model is mainly the fact that he is
among the top 70 nurses that have been influential in the 70 years of the NHS.
In 2010, Professor Sines had been awarded with a CBE for his contribution towards
health care. Some of the qualities that Professor Sines possess include being a Governor of three
London trusts and he was the dean of health faculty in London South Bank University.
Therefore, the leadership style and the ability to manage people in crisis are well known for
Professor Sines. Apart from this, he was the head of nursing in the school of Health Sciences.
This had provided Professor Sines with an opportunity to become a leader of the nurses and
understand the situations that they currently hold.

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The leadership style applied by Professor Sines is more of a transformative nature. This
is because Professor Sines had aimed to provide scientific courses of action along with the
nursing profession and create an environment that can help nurses gain more control in health
care (Mannix, Wilkes and Daly 2013). He managed to execute a chain of command that needs to
be followed by the nurses so that success can be gained in the health care centers all across the
world.
Issue Analysis
Leadership in the field of wellbeing is additionally important to lead the subordinates
with the end goal to give the best treatment to the patients so that there is no lack of regard in
consideration providing for the general population who require it the most. Leader nurse will be
dependable if there is any issue identified with the mindfulness program and furthermore being
taken care of by the patients who are as of now treated under her she being a General Health
Practitioner (Ross et al. 2014). Leaders need aptitudes that incorporate performing multiple tasks
and taking care of complex issues. There will be circumstances where the workers would be out
of thoughts and the leader must share her own idea and take care of such issues. Preparing is
exceptionally fundamental in leadership. The nurse herself may experience a preparation
procedure which will upgrade her leadership aptitudes and improve her as an administrator,
communicator and the hireling of the general population on the loose. The representatives
working under her may likewise experience preparing of whatever is required by them. Helen
must distinguish the prerequisites with the goal that the workers get pertinent preparing.
Various examinations have investigated the connections between nursing leadership and
patient results. The outcomes are very fascinating, as they uncover clear connections between the
two. For example, transformational leadership was associated with diminished drug mistakes in

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most of the examinations. It appears as however things are done substantially more painstakingly
inside the clinic when this methodology is taken (Yoder-Wise 2014). The style likewise was
recognized with lower persistent death rates in half of the investigations.
The leadership that has social elements to it that incorporate the change and collective
styles normally cause understanding contentment. Persons are for the most part more joyful with
the administration that they get for both intense consideration and home healthcare. Necessity for
restrictions is furthermore diminished as patients are meaningfully more agreeable with their
medical attendants (Cherry and Jacob 2016). Aside from the lower frequency of medicine
blunders, there are additionally less announced doctor's facility obtained contaminations. In the
event that one will go to a healing facility, then it is certainly desirable over be admitted to those
that hero these social leadership styles, as the result will probably be sure.
The National Institute of Health as well as the Journal of Nursing Administration
disseminated related investigations in the past. It was discovered that transformational leadership
was a positive influencer of a more protected environment inside the healing facility. It was
associated with lessened staff turnover when compared with the others. The medical caretakers
were more joyful with their work and remained therefore. Then again, the free enterprise method
was seemed to greatly add to unit socialization.
Extra discoveries demonstrated that medical caretakers were rapidly ready to identify the
difference among transformational and value-based leadership. They may be comparable styles,
yet the execution and results are unique. Attendants were significantly more for the
transformational approach as it advances inherent inspiration and occupation fulfillment. They
loved the possibility of positive conduct impact and uplifting inspiration, considered by
numerous individuals to be the best out of the considerable number of alternatives out there. In

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truth, every one of the styles have their place and the characteristic of a decent leader is insight in
executing the correct style at the opportune time.
The new pattern of health care that is emerging requires the nurses to be effective leaders.
The leadership among the nurses set trends for directions of the future nurses and what pattern of
leadership they should follow. The future nurse leaders must be given clear directions about how
they must act and react to the critical situations in their field. One of the first requirement to gain
proper leadership in the field of nursing is by gathering knowledge and to understand the
intricacies of nursing in proper details. To gain leadership qualities in a certain field it is
necessary for the individual to be strong at the basic intricacies of the particular profession in
which leadership is sought. The issue with today’s nursing profession is the lack of knowledge
among people who are getting into the profession. Mere studying from the books and reading the
regulated syllabus would not suffice in making a person leader in the profession of nursing. The
care givers in the health field need other qualities such as patience, empathy, and patience among
others (Scott and Miles 2013).
Professor Sines who was very effective in the field of leadership in Nursing, has been showing
consistent qualities of leadership in the field of nursing. Therefore it is important for the nurses
who are at the learning phase to understand the style of nursing leadership that was followed by
David Sines and other role models who have set examples in the field of nursing. The
transformational leadership is key to successfully executing the responsibilities of a nurse who
can manage people assigned under him or r. This is the reason why the very successful nurse
leaders have all shown traits of transformational leadership. The Issue presently mainly deals
with various shortcomings of today’s nurses who do not have the larger picture in their mind

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while dealing with the patients and people under their care. Just performing the duty is not
enough.
The present issues that concern with the nursing leadership mainly comprises of the
attitude of the nurses and how they handle the critical cases that come across them. The nurses
with leadership qualities also have to manage people under them, most of whom are also
professionals from the same field but are juniors under the leader nurses. It is important for the
leader nurses to keep an eye on the activities of the employees who are employed under them.
David Sines himself had a high degree of management capabilities where extraordinary features
of managing people, empathizing with their problems, understanding their shortcomings and
helping in fulfilling those. They also have shown tremendous abilities in caring for the patients
and taking the proper actions to resolve critical issues that needs urgent attention.
The preliminary research in the field of leadership in nursing started in the 1960’s and it
is as of date under research and development stage as people are mainly doing their research on
the topic and understanding how leadership in nursing can be improved and how better nurse
leaders can be produced. Various topics that are under the research and development phase about
nursing leadership are mentorship, reflective practice, effective leadership in clinical field, the
relationship and adaptation of the nurses to health policies, effective care giving to the elder
population through leadership in nursing, clinical supervision of the nurse leaders in groups, how
patient outcomes are related to leadership in nursing and various other fields (Wong 2015).
There were various researches in the field of nursing leadership where the nurses in the
learning phase were interviewed about their ideas of leadership and how they plan to perform the
role of a leader. In this research (Barkhordari-Sharifabad, Ashktorab and Atashzadeh-Shoorideh
2017) has found that there are various issues pertaining to leadership in the field of nursing.

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“Nursing leaders put forth various aspects of the problems associated with ethical leadership in
the clinical setting. This style of leadership could be promoted by developing suitable programs
and providing clear-cut strategies for removing the current obstacles and correcting the
organizational structure. This can lead to ethical improvement in nursing leaders and
subsequently the nurses.” Most of the interviews were conducted in details and recorded on tape.
The interviews in this particular case were semi structured and penetrative in nature. This
important study in the field of nursing found out that there were major barriers in the way
leadership was conducted ethically in the field of nursing. There were “These obstacles have
various aspects in ethical, cultural, and managerial domains. Identification of these factors can
promote the ethical dimension of leadership.” The findings of the study are aimed to solve the
problems and barriers that are discussed above and the strategies may be thus formulated which
will be helpful in better resolving of leadership issues in the healthcare organizations. The
organizational structure must be improved through leadership of the care givers and the nurses.
What more may be helpful is the ethical codes of the organization that will enhance the
performance of the leaders. This study therefore again helps us to understand some of the issues
in the field of nursing leadership.
The issues in nursing leadership are presently being studied closely so that they solutions
can be explored. Nursing as a profession is quite exhaustive and testing and it is quite
problematic for the new people joining in the profession. It takes a lot of efforts to get
accustomed with the new environment and the new job conditions. It is very important for the
nurses to be motivated and work more than their stipulated duties. The nurse leaders have more
complicated duties to perform as they have to manage people apart from taking care of the
patients under them (Makaroff et al. 2014). The concept of leader is dynamic and complex.

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Leadership is a characteristic trait that a few people possess and this can be cultivated in a better
way when the people having leadership traits are trained in a better way.
The general leadership issues are concerned with the behavioral and managerial issues of
the leaders and how these are resolved, in the case of leadership in nursing there are other factors
that have to be kept in consideration (Giltinane 2013). The humanitarian aspects of the nursing
profession are important factors to consider. It is very important for the nurse leaders to be
following the footsteps of the role models in the field of nursing leadership. The nurse leaders
who are otherwise seen to be not enthusiastic and not taking extra efforts for the betterment of
the patients must be discouraged and the leaders who are focused in their job, in managing
people in the most efficient way and giving care to the patients and others who need it with ease
and efficiency should be encouraged to improve and progress in their career. The higher
authorities must be careful of these facts so that better nurse leaders can be made.
Leadership theories and Evaluation:
In the context of nursing there are two types of leadership forms which are formal and
informal. These notions of leadership however can exist in any form of organization. Formal
Leadership in the context of nursing exists in case of a nurse being appointed and being endorsed
with certain responsibilities and roles. In case of formal leadership the nurse concerned has a
position and role approved by the management and other higher authorities of the medical
institution (Scully 2015). These positions could be of a nurse manager, supervisor or even
director. On the other hand, informal leadership is practiced by a nurse when no one has
appointed responsibilities for the nurse. In this case the person does not have any responsibility
or accountability on a formal basis. The nurse in this case is able to persuade others ad influence
them without making use of any position or power. The informal leader in this case might or

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might not be a professional nurse. However, at the very same time the person has enough
influential power among the group pf workers that he/she is working with. This can affect the
workflow, efficiency and the achieving patterns of the concerned group of workers. This helps in
easier setting of goals and finding solutions to problems in an easier and faster manner. Thus, it
is very crucial and important for the nursing leader to recognize who these informal leaders are
and work with them so that the operations are handled and monitored smoothly. This in turn will
help in increasing the quality of services and help in increasing customer satisfaction as well as
help in full capacity utilization of the employees in a motivational manner. In this context it is
also important to mention that the employees who are directly working with the customers will
be able to handle the challenges better and solve the problems arising in an efficient manner.
Some of the most commonly applied theories of nursing are discussed and evaluated in the
subsequent sections.
Organizational Theory
Leadership and management theories have evolved over the years in the context of
organizational management and operations monitoring. Complex organizations in the healthcare
sector are operated and managed using these theories. These theories can be divided into smaller
theories which are mainly the systems theory and the chaos theory.
The Systems Theory is concerned with dividing up the entire organization into smaller
departments depending upon the specialization or the responsibilities of these departments
(Lathrop 2013). According to this theory all of these smaller sub divisions are independent and
are concerned with their problems and their respective solutions. However, considering the
bigger picture these smaller independent divisions are interdependent and so the functioning of
one of these departments affects the other. It is also important to mention in this regard that the

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internal factors that affect one of these departments will also affect the other smaller departments
and so the entire organization as a whole will be impacted. The external factors affecting the
organization also affect the smaller sub divisions in a similar manner. This is asserted by the
open systems theory. It is also asserted by the same theory that the internal factors have an
impact on the external environment facing the firm or the organization operating in the
healthcare sector. In contrast to the open systems theory, the closed system theory states that the
internal working of the various smaller subdivisions of the firm are not affected by the external
environment of the firm. This theory is thus considered to be quite impractical in nature.
Chaos Theory on the other hand is associated with analysis of complex and dynamic
nursing management activities and operations. This theory has primarily been developed in
alignment to various mathematical and computer science theories (Hauck, Winsett and Kuric
2013). It consists of mathematical equations and complex problem solving models. This is thus
considered to be the most practical theiry that can be applied to the modern organizations in the
healthcare sector. Small changes in the input values of the various variables affecting a particular
sector produce huge changes in the output which helps in both predicting or estimating the future
impacts of a change and also building easier solutions to problems already existing or problems
that might crop up later. In the context of nursing, the application of this theory is very essential
and important as it helps nurses to understand and evaluate the lack of stability and
unpredictability through the use of non-linear systems and equations such that they gain insights
to the occurrence of the problem and its consequent solution (Hutchinson and Hurley 2013).
Various studies have shown that the application of chaos theory in the context of critical care is
very important (O’neill 2013). The specializations of physiology and epidemiology are identified
as the two specializations that especially need the application of chaos theory for purposes of risk

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assessment and problem solving. There are many purposes for which the chaos theory is implied
and used on a specific basis and this includes the tracking of the census of patients in the
intensive care unit of a particular healthcare organization. Increasingly the use of chaos theory is
also being seen in the study of the natural or ecological system of a patient where nursing
development is possible. It is this very theory which helps in integrating the notions of
individuals, families and communities into a single entity in a pragmatic manner. It is used to
study the dimensions of human beings that are based out of ecological or natural health. As
nurses have to deal with a number of differentiated systems which can be human systems,
physiological systems or even care systems, there can be random occurrences of problems which
can actually be interconnected and this can be identified by the nurses with the help of the chaos
theory. Nursing informatics is another study being used by nurses increasingly to the context of
chaos theory in order to enable better management and operational functioning of the healthcare
organizations.
Operational Planning:
This form of planning is also very important when it comes to the context of nursing. It is
also known as the short range planning. There are many management functions that come under
the context o operational planning and organizing is one of these management functions.
Organizational chart is a very important tool used in this context (Hodgson and Scanlan 2013).
It helps in effective and efficient management of the various subdivisions of nursing through the
division of responsibilities in a critical and stringent manner. Staffing is another such
management function. This in turn helps in catering to the needs of the patients on time and also
recruiting and retaining and efficient and innovative workforce full of capable registered nurses.
This aspect of operation al planning is also involved with providing the correct forms of training

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and orientation to the employees and registered nurses that have started off with their
professional experience. It also helps in forming a frame work that helps to estimate the number
of employees needed to meet certain goals and the budget allocation required for the same
purpose. It helps nurses to improve upon their already existing skill sets and provides them with
opportunities that will help them grow and in turn help in the growth of the organization as a
whole. The next management function associated with operational planning involves the usage
of the principles of directing. Under this concept the issues of the employees and the problems
faced by them are solved and this helps in looking after the well being of the nurses employed
for different specializations. Customer expectations are conveyed down to the nurses through the
help of this management function such that the employees perceive these expectations in the
form of performance expectations from the directors and other higher authorities of the
organization (Dyess, et al. 2016). It is required of the nurse managers in this context to
personally encourage and motivate the employees and especially the fresher employees in this
sector. Further, another aspect of operational planning involves the concept of the management
function which is role modeling. Effective communication and the capability of solving conflicts
forms an important part of this management function. The delegation and work division skills are
also equally important parts of this management function.
`Thus, it can be stated that there are various types of leadership theories in terms of nursing
leadership and different theories are implemented for different management purposes as the role
of the nursing manager keeps changing. Just like other leadership theories, the nursing theories
are also differentiated into formal and informal theories and the application of these theories
depend upon the situation arising in the organization (Sharkey, S. and Lefebre 2017).

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Conclusion
Leadership is one of the most crucial qualities that is required in all fields of activities,
and nursing is no exception. In a number of areas of the developed world the complexities in the
field of clinical activities and healthcare are giving rise to the need of developing able leaders in
the field of nursing. The nurse leaders are mainly dedicated towards managing people under
them and also provide quality healthcare to the patients. The above discussion mainly expresses
the fact that the role models in the field of nursing leadership has set standards for the future
nurse leaders to follow. Empathy, patience and similar characteristics are necessary for the nurse
leaders to maintain all the time they are working. The nurse leaders may have to work beyond
their stipulated work time because the job is mainly humanitarian and there can be emergency
responsibilities any time of the day. Leadership in the field of nursing is one of the emerging
areas of study and it requires further research so that proper theories and principles can be
developed in the field of nursing leadership and the issues at hand may be solved in the most
efficient way possible.

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