Leadership and Management in Nursing

This essay discusses the importance of leadership and management in nursing care, with a focus on applying leadership skills to manage and lead problem staff. The essay also explores the use of situational and transactional leadership styles, as well as the drawbacks of transformational leadership. The case study of a healthcare assistant with performance issues is used to illustrate these concepts.

Leadership
Leadership and Management
Leadership
Nursing leadership
Name of the author-

Table of Contents
Introduction................................................................................................................................2
Scenario analysis.........................................................................................................................3
Action plan..................................................................................................................................4
Transformational leadership and its drawbacks.........................................................................7
References:...............................................................................................................................11
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Introduction
With the increasing complexity and business ramified, leaders needs to customize their
leadership style as per their followers. A leader must have a group of followers. He must
indulge in influencing its followers in positive manner so that they could make efforts in
achieving goals (Prentice, 1961). The Leader should understand the possible key factors such
as available resource and plants which should be used by leaders to positively influence the
employees and followers towards the better business outcome.
Leadership and management both are different than each other’s and play pivotal role in
nursing management. The proper management and leadership influence employee and their
services to manage the patients and strengthen their satisfaction level from the health care
organization (Marriner-Tomey, 1993) Accordingly, learning to be a competent leadership in
nursing care, it will lead to safe and better health care environment and also boost team
building and patient’s oriented environment (Van der Voet, 2016).
In this essay, I would like to use the leadership theory and transactional leadership to explain
how I could apply the leadership skills and abilities to manage and lead a problem staff in my
workplace based on my clinical experience in school. After that, transactional leadership style
will be used to set up process for supervision, organization, and performance as it is an
integral part of the full range leadership model which positively influences other employees to
make better and efficient health care working environment (Goswami, et al. 2016).
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Scenario analysis
The scenario analysis is required to assess the leadership issues and problems which might be
faced by leaders in nursing health care and other issues. In this case, a thirty years old woman,
K, who is a Healthcare Assistant (HCA) transferred from a surgical ward to our out-patient
department. She was found to be performing less satisfactory. One morning, K nearly choked
a patient to death when she was feeding him medication and she almost dropped a patient on
the floor when she was transferring a patient from wheelchair to bed. However, she could not
see how serious the mistakes she had made and she tended to deny her faults when she was
interviewed by our colleague (the shift-in-charge). Besides, K’s sick leave rate is noticeably
high recently with reasons of dizziness, headache and abdominal pain. She also has been
complained about patients and relatives for her impolite attitude. My colleagues also
complained about her little commitment to work as a team. They also found K was difficult to
work with and some even expressed dislike to be put on same shift to work with her (Frankel,
2008).
According to the interview with K by my colleague, K is a single mother of a 5-year-old son.
She is also a new immigrant in Hong Kong with mainland China accent. She got work
experience as HCA before in mainland China. Recently, she had conflict with her ex-husband
as he refused to care or give any financial support to them. Accordingly, she is very depressed
due to her situation (Banks, et al. 2016).
In the K’s nursing case there are following major issues which have been found such as her
careless behavior, lack of training and less monitoring. Among these four major problems, I
think K main problem is negative work attitude and less training imparted to her. The main
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issue of K’s behavior at workplace is based on less -effective work culture, less motivated
towards better and efficient health care program and her careless behavior. In one of the
incident, she was least prompt in handling patient and due to which patient was not handled
properly (Hersey, & Blanchard, 1977). It caused high loss that patient at that time and he had
to be admitted in hospital for more than 1 month due to her lack of patient care. In addition to
this, she is less concerned about the work due to her less pay and failure to comply with the
code of conduct. She has also been facing several issues due to her personal life which might
had resulted to quarrel in her professional life. She has been facing issues to meet her basic
needs and having trouble in her budget (Banks, et al. 2016). It was found that her attitude
towards other colleges is also not satisfactory and she least like to communicate with others.
There are several behavioral issues cases which have also been found due to her less
supportive behavior and disturbing attitude (Kuokkanen, & Leino-Kilpi, 2000).
Action plan
For K’s situation, I would like to use the Hersey-Blanchard situational leadership (Hersey &
Blanchard, 1977) to analyze how the Hersey-Blanchard Situational Leadership Theory has
reflected different four maturity level such as M1 to M4. For M1 – This shows a person
ability and inability to take particular task. M2 – Employees might face issue in undertaking
the responsibilities for task being done but they are more inclined towards doing work for the
undertaken task (Sorenson, Peter & Yaeger, Therese 2015). They are new to a field but
showing great interest towards their job. M3 – They have knowledge and skills and able to do
the job but lacking confidence or the intention to take on the responsibility. M4 – They are
skillful and experienced at the job, willing and comfortable with their own ability to do the
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job well. They not only show the willingness and the ability towards the job, but also willing
to take the responsibilities to the job. . A person could be generally confident, skilled and
motivated in their job, but might still have a maturity level M1 when asked to perform a job
requiring skills they don't know. For K’s case, she should be M1, who lacks the particular
skills required for the job in hand and are unwilling and unable to take responsibility for the
job as she has poor sense of working quality and she believed that she is doing just fine with
her pay and unwilling to take responsibility for her mistakes (Mittal, & Dhar, R2015). For the
directing part, I would like to suggest assigning a senior HCA staff to act as a mentor of K as
her mentor should be someone with better knowledge and greater experience for giving her
advice. But the mentor would not take over the job of K, the mentor may demonstrate the
method and guide K through critique her work, or solving a problem (Wang, Tsai, & Tsai,
2014). K is a good learner as he has learned from her mistakes several times (Banks, et al.
2016). It is considered that K has been making mistakes several times. But He has not
repeated same mistake twice. It means that he is a good learner (Tingum, 2017). A
mentorship might help K feel less isolated at workplace, too. The mentor may also encourage
her to interact more with other co-workers. A mentor can provide K with better understanding
on career growth and introduce K to other colleagues. Besides, I also would like to suggest K
to attend some clinical skill strengthen course or refresher programme so as to renew her
knowledge base and strengthen the core competence of her work. It may help to promote the
development level. However, situational leadership theories emphasis upon the transactional
leadership which may focuses on the leadership process to fit in the particular scenario (Vera,
& Crossan, 2014). A leader should make efforts towards making employees more productive
towards the organizational goals and objectives the importance of adjusting leadership
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processes to fit the needs of followers in a given scenario. A leader should focus on following
the transformation leadership process where he makes efforts to influence employees in
positive manner (Breevaart, et al. 2014).
Apart from that, the Transactional leadership may also be able to be applied to K’s case.
According to Maslow's hierarchy of needs (Maslow, 1943), transactional leaders work at the
basic levels of need satisfaction (Donohoe, & Kelloway, 2016). This leadership style allows
leaders to focus on satisfying the employee’s basic needs such as shelter, bread, cloth. This
transactional leadership model makes leaders to reward all the good work and punish all the
bad outcomes in better and learning way. This may relate to setting code of conduct and
contingent ideas towards the forward- thinking. It leads to focus on contingent positive ideas
and influencing employees towards the achieving their set targets (McCleskey, 2014). For the
application of the transactional leadership style, set targets, articulate clear agreements
regarding the expectation of the leaders from team members and the way they would be
rewarded for their commitment and efforts, and suggest constructive feedback to keep
everybody on task (Vera & Crossan, 2004). Besides, the Theory X (McGregor, D. 1960) can
also be compared with transactional leadership styles. Theory X is based on pessimistic
assumptions on workers. This leadership style assumed that most of the workers have no or
little ambition, tend to escape away from work or responsibilities. They also are individual-
goal oriented. In general, theory X style leaders believes that employees are more efficient
and if they are shown right path then they could independently lead the better outcomes to
society. . This leadership style is accompanied with the hard and soft leadership approach
(Deinert,, et al. 2015). The "hard" approach and the "soft" approach are two opposing
approaches for implementing Theory X. The hard approach is based on close supervision,
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imminent punishment and intimidation. This approach can possibly yield a hostile, minimally
cooperative work force that could work towards leadership (Qu, Janssen, & Shi, 2015). The
soft leadership skill approach focuses on setting code of conduct and aligning the interest of
the employees with the organization development. Accordingly, I would like to set a goal for
K as to let her characterized that how serious the mistakes she had made. For the “hard”
approach, I would suggest to schedule a meeting with K to review the specific problem and
give her a warning noted. Besides, during the meeting, I would also suggest to inform K that
her poor performance and her poor work attitude will be documented in her SDR (Staff
Development & Review) and this document may affect her salary and her promotion
(Nanjundeswaraswamy, & Swamy, 2014). I would also suggest scheduling follow-up
meetings and be prepared to acknowledge improvements as well as let K know she also will
have chance for promotion or additional studies if her performance improved and give her
some positive comment and encouragement when she done a good job of achieved certain
level of standard care. This part will be the “soft” approach. However, the hard approach may
result in less satisfied work, increasing business complexity and low satisfaction in work
culture. These soft skills of the leaders not only align the interest of the employees work with
the organizational goals but also increase their work more efficient (Hackett, et al. 2018). I
would only suggest that if we could work effectively then it will not only align the interest of
the employees but also strengthen the health care management work. In a team, every
employee and staff members need to work as per the instruction and direction of the leaders.
Leaders should understand the perception, values, belief of the employees so that he could
motivate employees towards the organizational output.
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Transformational leadership and its drawbacks
For Transformational leadership, it is a new style for me that I just learnt from this module
and rarely to see others to lead and manage by using this style in my clinical experience and
observation (Carleton, Barling, & Trivisonno, 2018). Transformational leadership is a theory
of leadership which promotes those leaders to intensify their team members to stop seeking
for their personal gain and hunts for the higher moral good by supporting the team building
and customized work culture. Transformational leaders are being suggested to make and hold
positive and more employee oriented work culture for team members, believing that they
could do their best. Accordingly, they stimulate, inspire and empower those team members to
exceed the set targets and goals (McCleskey, 2014). Transformational leaders are also focused
on and concerned about the team members and their personal requirements and development.
This is a very ideal style of leadership, but in my point of view, I found some drawbacks of
the application of this style. The first problem of transformational leadership is team
members’ favoritism. This shows that the intellectual stimulation and individualized
consideration in the organizational workplace (Breevaart, et al. 2014).
It is considered that transformational leadership works with the team of employees to
identify the needed changes and creating vision for all the employees. It identifies the need of
individual employees and creates a different motivation for every employee so that they could
indulge in meeting the set targets and goals (Qu, Janssen, & Shi, 2015). By using the
transformational leadership style, leaders could easily mitigate the possible issues and
complexity in the process which could strengthen the process and also allow K to work more
efficiently.
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The transformation leadership set groups for employees and give more opportunity to
succeed. In K’s case, it is found that transformation leadership will focuses on achieving the
set goals by working in team and building the team efforts among all the employees. It is
considered that K should also be convinced to work as team members and collaborating with
others so that organization could deliver best outcomes and good care to patients. The second
problem is Burn Out. Being a great motivator seems very ideal (Mittal, & Dhar, 2015). I would
inspire my team so they tend to be worked at doing great things. However, this is a slippery
slope. Those team members may still have their own personal lives that require attention.
Spending long working time towards a team goal while disregarding personal needs and goals
might lead to burn-out. For K’s case, I think she would be burnt out quickly as she also needs
to pay attention on her complicated family problem and financial problem. In individualized
consideration, leaders pay close attention towards the follower’s needs. It is done by them by
listening, learning and developing ideas. As per the individualized consideration, leaders hear
employees individually and become more actualized. It helps in identifying the specific
motivation for followers to accomplish set goals (Renko, et al. 2015). This will help in
motivating K and other employees towards the team building and collaborating with each
other in the best interest of the patients (Hackett, et al. 2018).
Last but not least, the third problem is bad Decisions and failure. However, leaders will have
to listen all the ideas and plans from different employees and take decisions accordingly. It is
done to make organizational culture more employees oriented (McCleskey, 2014). For me, I
am just a new graduated RN who just converted to RN from EN, I don’t think I am able to
take constructive criticism or get enough confidence to hold any effective brainstorming
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meetings with my team members that help to make my innovation better, therefore, I may run
the risk of overlooking a problem that leads to failure (Wang, Tsai, & Tsai, 2014). Conclusion
In conclusion, learning to be a good leader of a health care team is very important. It could
promote aligning the interest of the employees with the organizational growth and encourage
employees to achieve the set goals. A good nurse leader also will provide a role model for
staff at all levels. Besides, being engaging in coaching and mentoring roles will also empower
staffs. There is need to implement the evidence based work practice so that all the nurses and
employees could be more aware about their responsibilities.(Kuokkanen and Leino-Kilpi,
2000). For managing K’s case, I would to like apply the Hersey-Blanchard situational
leadership and the transactional leadership instead of the newly learned transformational
leadership. It is because Transactional style can address small operational details quickly than
the transformational style as transformational style is work for the strategic development of a
group. The transactional leadership can helps in allowing employees to understand the team
work and team-building skills so that the best outcomes could be delivered to employees.
After studying this module, I learnt how the leaders and leadership skills could positively
influence the employees towards accomplishing set goals and objectives.
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