Critical reflection
Hsc
module1leadership.docx
Welcome to Module 1. In this module we will address the following unit learning outcomes:
1. Critically reflect upon the role of the registered nurse as a leader in a health care team in varying health contexts
2. Critically analyse concepts of management and leadership in nursing and health services.
What is leadership?
This is your first activity. Spend some time thinking about leadership and what it means to you. There's not necessarily a correct or incorrect answer. What is important that you consider what are the behaviours that you might observe in someone who is leading others, for example, leading a team of nurses to adopt a new practice in a clinical work area.
What is your experience of leadership?
Think about occasions when you have been led by someone else. What was the context and how did the leader make you feel? Was the outcome achieved or could things have been done differently? Consider also your own leadership roles. What behaviours did you consider to be important and why?
We will discuss these issues in further detail during our tutorial.
Why do nurses need to understand leadership?
Leadership in nursing is critical for the safe delivery of quality person centered care. Leaders in nursing enable adaptation to challenges inherent in the dynamic healthcare and clinical environment, while at the same time advancing the practice of nursing through innovative, evidence informed guidance of teams toward shared aims.
The Nursing and Midwifery Board of Australia (2016) Registered Nurse Standards for Practice refers to leadership practice, specifically, in the following standard:
Standard 2: Engages in therapeutic and professional relationships: RN practice is based on purposefully engaging in effective therapeutic and professional relationships. This includes collegial generosity in the context of mutual trust and respect in professional relationships.
Criterion: 2.8 Participates in and/or leads collaborative practice
However, across the standards, criterion that refer to inter-professional practice, collaboration and communication have clear implications for leadership practice.
The following reading introduces the rationale for nurses, especially newly qualified nurses, to understand and develop knowledge and skills in leadership work. The authors are explicit in their view that leadership can occur in nurses at any level and is not a factor of seniority or position. The sections on leadership theory can be skimmed over as we explore these ideas in more detail in the following section.
Kirkham, L. (2020). Understanding leadership for newly qualified nurses. Nursing Standard, 35(12).
Leadership and management
In this section you will explore and differentiate meanings of leadership and management as a basis for understanding models of leadership, and the roles of leaders and managers in healthcare practice.
Leadership and management are commonly used terms in healthcare, sometimes interchangeably. t is essential that you are able to differentiate between these two terms. Adding to your response to the previous activity:
What is management?
Now, spend some time thinking about management and what it means to you. There's not necessarily a correct or incorrect answer. What is important that you consider the behaviours that you might observe in someone who is managing others, for example, managing the implementation of a new practice in a clinical work area.
As I am sure you are aware, these terms (leadership and management) are used frequently and often interchangeably in health care workplaces. The term ‘leadership’ has replaced ‘management’ in the language of many organisations. Management is sometimes considered to be a less favourable term than leadership, and sometimes associated with rational approaches, bureaucratic profiteering and impersonal human interactions. In many workplaces, language privileges ‘leadership’ i.e., employees don’t ‘manage’ a task or a project, they 'lead' it. Perhaps the term is overused or perhaps, by using the term 'leading' we can influence our practice and that of others. What do you think? It’s important to be clear about our use of language, what it means and to avoid making assumptions. If we overuse the term ‘leadership’ we run the risk of overlooking the key behaviours that are central to leadership practice. We can also subordinate the important role of management in health care workplaces.
In contemporary organisations, there is an expectation that those appointed to management positions have well developed leadership skills (Yukl, 2014). Indeed, theories of management throughout history identify leadership as a vital component of management work. Henri Fayol (1949) defined management functions as planning, organising, coordinating (later redefined as leading), commanding and controlling. Henry Mintzberg (2009) identified leadership as a central manager activity, and advocates of contingency management theory (Robbins et al, 2018) position manager choice of leadership style as central to effective adaptation to changing situations. The vital place of leadership within management practice in healthcare is well recognised (Maddern et al, 2016), as managers in health care cannot achieve their aims without people, and effective management of people involves leadership (Griffin & Moorhead, 2012).
Kotter (1999), a seminal author on leadership and change, summarises the relationship between leadership and management.
Kotter, J (1999). Change leadership. Leadership excellence, 16(4), 16.
From this discussion, we can question whether management without leadership is in fact ‘effective’ management. However, the converse is well accepted. Leadership can exist outside of management roles. Informal leadership practices performed by those who are not working in designated management roles are well known and encouraged in health care organisations (Sullivan & Garland, 2013). It is this form of leadership that we are mostly concerned with in this unit of study.
What is leadership?
In this section we will examine this term more closely, as it is central to nursing work. Your task is to develop an understanding of leadership, and to develop a working definition or model that suits your preferences. There are many different perspectives on leadership, what it is and how it relates to management. Time does not allow us to look at all of these. You are encouraged to examine the following definitions, compare and consider their strengths, weaknesses and main messages, and work toward developing a definition, that resonates with you.
“Leadership is the process of influencing others to understand and agree about what needs to be done and how to do it, and the process of facilitating individual and collective efforts to accomplish shared objectives” (Yukl, 2014, p.7).
“Leadership is the intention to set direction, align efforts, and motivate people to achieve results which might involve managing change” (Sullivan & Garland, 2013, p. 36)
From your previous reading, Kotter (1999, para 9) , one of the classic leadership theorists, offers the following definition:
“Leadership is about establishing direction, developing a vision of the future, often the distant future, and setting strategies for making the changes needed to achieve that vision. Leadership is about aligning people, communicating the direction by words and deeds to all those whose cooperation may be needed, influencing the creation of teams and coalitions who understand the vision and accept their roles in the implementation of strategy. Leadership is about motivating, inspiring, and energizing people to overcome major political, bureaucratic, and resource barriers to change by satisfying basic but unfulfilled needs. Leadership produces change, often dramatic change, and may produce extremely useful change (new products that customers want, new approaches to labor relations that help make a firm more competitive).”
Developing a vision, inspiring people through language and actions to follow, and importantly, the leader removes barriers to change are key messages in Kotter's (1999) definition.
The Australian College of Nursing defines clinical leadership:
"At the unit level, nurse leaders focus on clinical leadership through the integration of clinical expertise and leadership practices. Clinical leadership involves delivering and monitoring evidence-based practice, evaluating outcomes within a continuous improvement framework, assessing and mitigating risks to individual patients, improving efficiency and coordination at the point of care and advocating for patients (Jukkala et al. 2013; Ott et al. 2009). Clinical leaders are able to engage with patients in the context of the care and take account of the patient’s social, cultural and economic environment. They also facilitate strong communication and collaboration with patients and within the multidisciplinary team. As a result, they are able to recognise and address gaps in patients’ care as well as systemic issues of concern. The clinical leadership of nurse unit managers and nursing teams is critical for identifying issues and implementing the necessary solutions in collaboration with management and other health care professionals (Begun et al., 2006; Tornabeni & Miller, 2008)." (Australian College of Nursing, 2015, p. 7)
The ACN's (2015) definition focuses on leadership at the point of care delivery. This definition extends Kotter's definition by including the context of leadership, and the influence of the leader on team communication and collaboration.
What criticisms can you make of the definitions offered above? How well do they reflect the nature of nursing work and the context in which it is practiced? Share your ideas on our Module Discussion Area
Start working on your own definition or personal philosophy of leadership. Read the following article especially from the section 'on p. 65 that poses a series of questions that guide this process. Your leadership philosophy will be included in your Third Assessment: Critical Reflection.
Conclusion
That concludes Module 1. The nature of leadership and management, the relevance to nursing practice and the concept of a leadership philosophy have been introduced in this topic and I hope you feel ready to dive into some of the specific theories of leadership in more detail in Module 2.
References
Australian College of Nursing (ACN). (2015) Nurse leadership. https://www.acn.edu.au/wp-content/uploads/2017/10/acn_nurse_leadership_white_paper_reprint_2017_web.pdf
Avolio, B. J. & Gardner, W. L. (2005). Authentic leadership development: Getting to the root of positive
forms of leadership’, L eadership Quarterly, 16, (3), 315–38.https://doi.org/10.1016/j.leaqua.2005.03.001
Bamford, M., Wong, C. A., & Laschinger, H. (2013). The influence of authentic leadership and areas of worklife on work engagement of registered nurses. J Nurs Manag, 21 (3), 529-540. https://doi.org/10.1111/j.1365-2834.2012.01399.x
EPM (2020, April 4) Leadership styles explained (Kurt Lewin) [Video] YouTube.https://www.youtube.com/watch?v=RmqsV1293Rk
Fischer, S. A. (2016). Transformational leadership in nursing: a concept analysis. Journal of Advanced Nursing, 72(11), 2644-2653. https://doi.org/https://doi.org/10.1111/jan.13049
Greenleaf, R. (1991). The servant as leader. Robert K Greenleaf Centre.
Gregg Learning (2018, Jan 30) Contingency approaches to leadership [Video]. YouTube.
https://www.youtube.com/watch?v=yrvLHkf35i0
Gregg Learning (2018, December 12). Trait approaches to leadership. [Video] YouTube
https://www.youtube.com/watch?v=9oxMQgaKHeI
Grint, K. (2005) Leadership: The heterarchy principle. Palgrave.
Kirkham, L. (2020). Understanding leadership for newly qualified nurses. Nursing Standard, 35(12).https://doi.org/10.7748/ns.2020.e11589
Kotter, J (1999). Change leadership. Leadership excellence, 16(4), 16.
Mortier, A. V., Vlerick, P., & Clays, E. (2016). Authentic leadership and thriving among nurses: the mediating role of empathy. Journal of Nursing Management, 24(3), 357-365. https://doi.org/https://doi.org/10.1111/jonm.12329
Robbins, S. P., Bergman, R., & Coulter, M. K. (2018). Management (8th ed.). Pearson.
ShiftWizard Inc. (2019, March 5). Transformational leadership at the bedside. [Video].YouTube.
https://www.youtube.com/watch?v=BrLrNSO22wM
Stanley, D. (2016). Clinical leadership in nursing and healthcare: Values into action. John Wiley & Sons, Incorporated. https://ebookcentral.proquest.com/lib/cdu/detail.action?docID=4721402
Sullivan, E., & Galrand, G. (2013). Practical leadership and management in healthcare (2nd ed.). Pearson.
Swanwick, T. (2017). ABC of clinical leadership (2nd. ed.). Wiley-Blackwell. https://doi.org/10.1093/occmed/kqx128
The Nursing and Midwifery Board of Australia (2016) Registered Nurse Standards for Practice. https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards/registered-nurse-standards-for-practice.aspx
Thusini, S. T., & Mingay, J. (2019). Models of leadership and their implications for nursing practice. Br J Nurs, 28(6), 356-360. https://doi.org/10.12968/bjon.2019.28.6.356
University of Wollongong Australia ( 2001). Effective studying: Concept mapping. https://www.uow.edu.au/student/learning-co-op/effective-studying/concept-mapping/
Yukl, G. (2014). Leadership in organizations (8th ed.). Pearson.
