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- Herausgeber: John Wiley & Sons
- Kategorie: Fachliteratur
- Serie: Interscience Abstract Service Yearbooks
- Sprache: Englisch
NOTES ON... NURSING LEADERSHIP
Unlock the secrets to effective nursing leadership with this essential guide
In the ever-evolving landscape of healthcare, leadership capability is a vital skill for nurses, however, leadership development and application within the field is rarely addressed during training. This essential resource ensures nurses are equipped with the guidance needed to develop as effective and resilient leaders within the workplace.
Centred on the clinical nurse’s perspective, this text serves as a practical guide to applying nursing leadership concepts and provides a timely and authoritative overview of what it means to be a nurse leader in the health service. Throughout the text, the authors provide vignettes that share their personal experiences, highlight the value of applying nursing leadership, describe the different components of leadership, and more.
Notes On... Nursing Leadership is a must-read for undergraduate and trainee nurses looking for a concise introductory text that links current key debates and thinking in leadership to nursing practice.
It is also an invaluable resource for qualified and practicing nurses wanting to develop their leadership skills, broaden their leadership potential, or inspire and support other nurses in their approach to leadership.
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Seitenzahl: 237
Veröffentlichungsjahr: 2024
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Table of Contents
Cover
Table of Contents
Title Page
Copyright Page
Preface
Acknowledgements
About the Authors
About the Notes On… Series
1 Introduction
1.1 About This Book
1.2 Leadership and Management are Different!
1.3 The Difference
1.4 The Challenges Leaders and Managers Face
1.5 Summary
2 What Is This Leadership Thing?
2.1 Introduction
2.2 Defining Leadership
2.3 Definition of Nurse Leadership
2.4 Theories of Leadership
2.5 Summary
3 Characteristics of Effective Nurse Leaders
3.1 Introduction
3.2 Qualities of Effective Nurse Leaders
3.3 Hard Skills for Effective Nurse Leadership
3.4 Soft Skills for Effective Leadership
3.5 Other Characteristics to Consider
3.6 The Attributes “Least” Likely to Foster Effective Nurse Leadership
3.7 Summary
4 Self‐Care for Leadership Effectiveness
4.1 Introduction
4.2 Self‐Care
4.3 Caring for Self
4.4 Building Self‐Care and Self‐Compassion
4.5 Mindfulness
4.6 Resilience
4.7 Summary
5 Leadership for Innovation and Change
5.1 Introduction
5.2 Tools for Change
5.3 Change Is Never Simple Even with a Model
5.4 Resistance to Change
5.5 Successfully Dealing with Change
5.6 Leadership, Innovation and Change are Linked
5.7 Summary
6 Leadership and Teams
6.1 Introduction
6.2 Healthcare Teams Defined
6.3 The Value of Teamwork
6.4 Types of Established Teams
6.5 Building Powerful Teams
6.6 Support and Challenge
6.7 Team Building
6.8 Team Roles
6.9 Leadership and Teams
6.10 Trust
6.11 Summary
7 Leadership and Networking
7.1 Introduction
7.2 Networking and Influencing for Change
7.3 The Skills of Networking
7.4 Summary
8 Leadership and Values
8.1 Introduction
8.2 Change and Values
8.3 Facing the Challenges and Balancing Power
8.4 Leadership and Its Role in Social Justice
8.5 Summary
9 The Challenges of Nurse Leadership
9.1 Introduction
9.2 Leading During Challenging Times
9.3 Examples of Leading Through Crises
9.4 Leading with Self‐Care
9.5 Summary
10 Followership
10.1 Introduction
10.2 Defining Followership
10.3 Follower Responsibilities
10.4 Good Followers
10.5 Poor Followers
10.6 Summary
References
Web References
Index
End User License Agreement
Guide
Cover Page
Table of Contents
Title Page
Copyright Page
Preface
Acknowledgements
About the Authors
About the Notes On… Series
Begin Reading
References
Index
WILEY END USER LICENSE AGREEMENT
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Notes On… Nursing Leadership
Dr. Alison H. James
Dr. David Stanley
This edition first published 2024© 2024 John Wiley & Sons Ltd
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by law. Advice on how to obtain permission to reuse material from this title is available at http://www.wiley.com/go/permissions.
The right of Alison H. James and David Stanley to be identified as the authors of this work has been asserted in accordance with law.
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Limit of Liability/Disclaimer of WarrantyThe contents of this work are intended to further general scientific research, understanding, and discussion only and are not intended and should not be relied upon as recommending or promoting scientific method, diagnosis, or treatment by physicians for any particular patient. In view of ongoing research, equipment modifications, changes in governmental regulations, and the constant flow of information relating to the use of medicines, equipment, and devices, the reader is urged to review and evaluate the information provided in the package insert or instructions for each medicine, equipment, or device for, among other things, any changes in the instructions or indication of usage and for added warnings and precautions. While the publisher and authors have used their best efforts in preparing this work, they make no representations or warranties with respect to the accuracy or completeness of the contents of this work and specifically disclaim all warranties, including without limitation any implied warranties of merchantability or fitness for a particular purpose. No warranty may be created or extended by sales representatives, written sales materials or promotional statements for this work. This work is sold with the understanding that the publisher is not engaged in rendering professional services. The advice and strategies contained herein may not be suitable for your situation. You should consult with a specialist where appropriate. The fact that an organization, website, or product is referred to in this work as a citation and/or potential source of further information does not mean that the publisher and authors endorse the information or services the organization, website, or product may provide or recommendations it may make. Further, readers should be aware that websites listed in this work may have changed or disappeared between when this work was written and when it is read. Neither the publisher nor authors shall be liable for any loss of profit or any other commercial damages, including but not limited to special, incidental, consequential, or other damages.
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Paperback ISBN: 9781394230198
Cover design: Wiley
Preface
The landscape of healthcare provision across the world has changed in the past few years. An increased dependence on technology, growing financial pressure on the world’s health services, the potential impact of AI, an ongoing shortage of qualified nursing and other health professional staff, the global pandemic, political turmoil and a host of other regional and local pressures has meant the act of providing and leading care in the healthcare domain or health service has come under growing pressure. In addition, the path towards becoming a nurse or health professional has changed, with unprecedented clinical challenges and changes in the way students learn. The provision of methods and content of education has required a rapid response as a result and the effectiveness of this is hugely important for the future of the healthcare workforce. The global pandemic has exposed weaknesses in health services around the world, but it has also emphasised the commitment, care and courage health professionals have been able to bring to their roles each day and in a multitude of clinical environments.
Today’s nursing and health professional students are leaders for tomorrow’s healthcare, and this book outlines the key aspects of leadership and what leadership means for today’s health professionals facing sustained and ongoing change and clinical challenges. Nurses and other health professionals are expected to employ a solid knowledge base, sound clinical skills and think critically and to do so with a firm grasp of what it means to lead and how leadership is applied in the health service. However, this too is coming under pressure from the same forces mentioned above with the additional challenges of burnout, compassion fatigue, bullying and a seeming host of more hostile detractors of the importance of professionalism. Yet those who embrace the challenges of being a healthcare professional do so with strength of belief in their worth and value to communities and society, and this is the potency from which great leadership evolves.
This text Notes On… Nursing Leadership is written to provide an outline or overview of what it means to be a nurse leader in the health service, with a focus on the perspective of a clinical nurse. Its aim is to help nurses and health professionals understand how concepts, skills and context within nursing leadership is applied and how effective nurse leadership can, or might, be used to enhance individual development, clinical practice and the overall health services and patient care.
Acknowledgements
This book would not have been possible without the support of a wide host of people including the team at Wiley‐Blackwell including Tom Marriott, Christabel Daniel Raj, Naveen Kumaran, and Swetha Kodimari, who have provided excellent and detailed support for the book’s production. Our writing colleagues, Clare Bennett and Dominic Roche, have been wonderful in joining this project and participating with writing contributions and practical advice and feedback.
In addition, thank you to our academic colleagues from around the world, who have offered encouragement and support especially those at Cardiff University.
About the Authors
ALISON H. JAMES DAHP, MA, PGCE, BA, DIP HE, RGN, BA, SFHEA
Alison began her nursing career in 1986 qualifying as a Registered Nurse and working in neurosciences for her formative years. Having previously completed a BA in Humanities, Alison then completed a Diploma in Critical Care and BA in Healthcare Studies before moving into clinical research nursing. Completing an MA in Healthcare Law and Ethics, Alison then worked as a Knowledge Transfer Consultant in health and social care for several years and returned to Wales in 2014 as an academic in adult nursing at Cardiff University where she completed her Doctorate in Advanced Healthcare Practice. This has enabled Alison to focus on her research and scholarship in healthcare leadership and she is currently a Reader in the School of Healthcare Sciences where she continues to teach and research her area of interest, publishing and speaking internationally. Having previously co‐authored Clinical Leadership in Nursing and Healthcare with David Stanley and Clare Bennett, Alison continues to contribute to evidence and scholarship in this area.
DAVID STANLEY NURSD, MSC HS, BA NG, DIP HE (NURSING), EX‐RN, EX‐RM, TF, GERONTIC CERT, GRAD CERT HPE
David began his nursing career in the days when nurses wore huge belt buckles and funny hats. He ‘trained’ as a Registered Nurse and Midwife in South Australia and worked through his formative career in several hospitals and clinical environments in Australia. In 1993, he completed a Bachelor of Nursing at Flinders University, Adelaide, and, after a number of years of volunteer work in Africa, he moved to the United Kingdom and worked as the Coordinator of Children’s Services and as a Nurse Practitioner. He completed a Master of Health Science degree at Birmingham University. For a short time, he worked in Central Australia for Remote Health Services before returning to the United Kingdom to complete his nursing doctorate, researching clinical leadership. This resulted in the development of a new values‐based leadership theory: Congruent Leadership. He continued to research in the areas of clinical leadership, men in nursing and the role of the media in nursing while contributing to teaching roles at several Australian Universities. He has recently retired from nursing and is focused on writing poetry and fiction.
About the Notes On… Series
Florence Nightingale wrote two health focused books, “Notes on Nursing” and “Notes on Hospitals”; however, this series of short books inspired by her use of the “Notes on” title is developed to address a range of nursing and health professional specific topics in brief or note form. Each book in the series offers a comprehensive overview of information on a wide range of topics for nurses, midwives and other health professionals. It is hoped the books will be especially useful for health professional students in a number of professions with the books providing key, relevant, concise, information in an accessible way. Notes On… Leadership in Nursing is the second book in the series.
For us who nurse, our nursing is a thing, which, unless in it we are making progress every year, every month, every week, take my word for it we are going back. The more experience we gain, the more progress we can make.
Florence Nightingale (https://www.azquotes.com/quote/614045)
1Introduction
1.1 About This Book
In 1999, Colleen Wedderburn Tate (1999, p. 3) said, “Some healthcare staff are no longer working for patients, but are more motivated by pronouncements from government ministers, exposes in the media, and the latest scandal about misuse of public money.” As we begin this dialog about nursing leadership, we wonder if anything has changed. After decades of talking about, writing about and searching for what we mean by nurse leaders, has anything really changed in practice, at the bedside or in the involvement of nurses at the wider decision‐making table? We propose that nurses, more than any other healthcare employee group, need leaders, need to gain a deep understanding of leadership and need to be leaders for the profession. Because without a clear understanding of what leadership means, how it is recognised and how it is practiced, nursing and patient care will be poorer. It is in an effort to redress this shortfall that this book is written.
We believe that since Wedderburn Tate’s (1999) statement above, nurses continue to have only superficial influence over healthcare resource decisions. While managers, healthcare service administrators, many medical practitioners and their teams still see themselves as “all powerful” in terms of their decisions and leadership of nurses and some other health professionals. Thousands of nurses graduate and are employed every year, only to leave their chosen profession the following year or the one after. This is because they become frustrated by their lack of influence or power over the work they do, the contribution they could potentially make or their inability to contribute to or influence decisions. They become frustrated that they can’t provide the level of care they believe their clients/patients deserve. In addition, nurses often see their great ideas or projects relegated to lower priorities or ignored altogether by aloof hospital administrations and managers who (it should be acknowledged) are also under great pressure to deliver an effective health service with diminishing resources.
However, there is another issue with nurses and leadership. Nurses have been almost conditioned to see others (managers/doctors) as their leaders. When undertaking a number of studies exploring perceptions of clinical nurse leadership between 2001 and 2017 (Stanley et al. 2023), hundreds of clinical‐level nurses were approached and asked to identify colleagues they saw as clinical leaders. The most common response was, “What, nurses as leaders–no, don’t you want to talk to my manager?”. Wedderburn Tate (1999) confirmed this, saying, “nurses who are successful leaders do not recognise themselves as such” and it seems nurses have not been taught that their leadership potential is in their hands. Reassuringly, some respondents in Stanley’s studies (Stanley et al. 2012, 2014, 2017; Stanley 2019; Stanley and Stanley 2019) were able to point to highly skilled, effective and influential clinical‐level nurses who displayed and practiced leadership as part of their clinical role. After decades of discussion and training about leadership in nursing, the majority of clinically focused nurses still fail to grasp the value of leadership to their practice and their responsibilities as leaders in the health service. When exploring perceptions of leadership with student nurses, James (2020) and James et al. (2022) found that student nurses rarely saw themselves as leaders then or in the future, and many felt unprepared to take on the concept of leadership. Although in the United Kingdom (UK) nurses are expected to demonstrate leadership at the point of registration, there remains a disparate approach to leadership education and preparation (James 2023). While the nursing curriculum remains full of clinical skill competencies and nurses take on more and more of these, leadership seems to be advertised as something one can pick up with a quick course. It is our opinion that leadership requires much further consideration and thought from early within the development of a nurse, application of critique to traditional theoretical positions and ownership by nursing as a profession (James et al. 2023).
It is our conclusion that nursing leadership is essential, not just to pay lip service to the nursing profession and bolster its ego or place in the scheme of the health service but to make a genuine contribution to improving patient care and making the health service more robust and responsive to client/patient needs (James et al. 2023). This book sets out to offer a clear and straightforward perspective on what nursing leadership means and how it can be recognised and applied in practice.
The book is aimed at undergraduate nurses as a useful resource and may be of use to a range of qualified and practicing nurses who wish to review their insights into nurse leadership. It aims to inspire and support nurses in both understanding and developing their approach to leadership in nursing. It also aims to serve as a useful resource for nurses who are more advanced in their careers and who are interested in developing their leadership skills and broadening their awareness or leadership potential as nurse leaders. It is a contemporary introductory text that links current key debates and thinking in leadership as it applies to nursing practice.
Chapter 1 sets out the importance of leadership in nursing and why leadership is important in nursing now. It describes how the book is structured as well as considering the difference between leadership and management. Chapter 2 begins with an oversight of definitions of leadership, nursing leadership and an exploration of several leadership theories. Chapter 3 explores the attributes seen as vital for effective nurse leadership to prevail. This is presented as hard and soft skills and attributes and it goes on to explore why these skills are vital for nurse leaders to be successful. Chapter 4 outlines the importance of an understanding of self‐care for leaders to be successful and remain vital. Chapter 5 offers an outline of the role of nurse leaders in driving innovation and change in the health service. Chapter 6 provides an overview of the relationship between leadership and teams, suggesting that nurse leaders need to understand how teams function and recognise their place when helping teams work. Chapter 7 takes the relationship of the leader to others further by exploring the significance of “networking” as a skill in the “toolbox” of effective nurse leadership. Chapter 8 looks at the central place of values for nurse leaders to be their best selves. Chapter 9 deals with the challenges nurse leaders face in the application of leadership, and Chapter 10 considers the flip side of leadership, followership, and how this can impact on the effectiveness of nurse leaders. Throughout the book, the value of applying nursing leadership is outlined, and the component parts of leadership are expressed.
1.2 Leadership and Management are Different!
Leadership and management are equally important, interdependent and inter related; however, they are also different and distinct, serving different purposes and requiring different skills (St George 2012; West et al. 2015; Gumbo 2017; Leech 2019; Nene et al. 2020; Stanley et al. 2023). In the health service, leadership and management are frequently seen as one all‐encompassing thing (Stanley et al. 2023). However, Wood (2021, p. 284) suggests that “Working out who leads and who manages is difficult, with the added anomaly that not all managers are leaders, and some people who lead work in management positions.” This has the potential to lead to role ambiguity (Stanley 2006; Cutcliffe and Cleary 2015; Nene et al. 2020), and conflict can occur when clinicians take on management roles without appropriate training, support or instruction (Nene et al. 2020; Stanley et al. 2023). Likewise, tensions can occur between clinical leaders and managers, when leaders feel that their efforts are hampered by management or organisational aspirations or targets (Stanley 2006; Kerridge 2013; Orvik et al. 2015; Scully 2015; Stanley 2017a, 2017b; Nene et al. 2020). Zaleznik (1977) makes the point that management and leadership positions require different types of people which may be problematic in healthcare with the tendency for role overlap (Stanley 2006; Cutcliffe and Cleary 2015; Nene et al. 2020). Kotterman (2006) argues that a well‐balanced organisation requires a blend of leaders and managers to succeed, and while there are overlaps, there is clarity in the distinction when explored further. This is important if you are interested in becoming a leader and/or manager.
Reflective Activity 1.1
Before you read on … Think about someone you have worked with who you saw/see as an inspirational leader. The only restriction placed on this activity is that you must think of a clinically focused nurse or midwife. Not a manager, not a doctor, not another health professional, not a relative or friend who is not a nurse. Think primarily of a clinically focused nurse/midwife.
Why did you think of this person?
What was it about them that made you see them as leaders?
Was it difficult to think of a nurse/midwife?
Were you drawn to think of others, of doctors, managers or other senior (non‐clinical) nurses? If so, why?
1.3 The Difference
Delineating between management and leadership can help ensure that the most appropriate skill set is utilised to achieve the best outcomes in practice (Jones and Bennett 2018). Moreover, Kotter (1990a) and Bass (2010) feel that using the terms interchangeably is misleading, adding that management and leadership are not synonymous, with Bennis (1989) recognising that leaders and managers have different ways of seeing the world.
1.3.1 Management
Managerial activities are essential to the smooth running of an organisation and the attainment of care standards and targets (see an example in Box 1.1). Good managers bring order and consistency, which can ensure that key dimensions such as quality are maintained. Katz's (1955) seminal work describes management as being concerned with directing a group or organisation with a focus on task orientation, staff development, conflict resolution and the maintenance of ethics and discipline. Kotterman (2006) describes managers as focusing on the attainment of short‐term goals, risk avoidance and standardisation to enhance efficiency, with Zaleznik (1977) adding that managers promote stability, exercise authority and are task orientated. Kotter (2001) expands this definition, claiming that management is concerned with planning, organising, budgeting, coordinating and monitoring. Managers rely on strategy, structure and systems; in other words, the operational element of organisations, requiring planning, budgeting, organising, staffing, problem‐solving and controlling. Watson (1983) suggests that management roles tend to be dependent upon formal positions and attained through specific training schemes such as the NHS Graduate Management Training Scheme (NHS Graduate Management Training Scheme 2021). Management is seen as procedural and task focused, while attributes of leadership include visionary, influencing qualities. Kotter (1990a) adds that management consists primarily of three things:
analysis
problem‐solving
planning
Box 1.1 An Example of Management
An example of a fundamental management role is staff rostering. Whilst widely held as one of the more mundane aspects of clinical management, the skill involved in providing around‐the‐clock cover, that takes into account patient acuity, variability in admission patterns, regulations regarding staff breaks between and during shifts and staff availability, should not be underestimated (Adapted from Wynendaele et al. 2021).
1.3.2 Leadership
More is offered about leadership in the next chapter (Chapter 2); however, it is clear that leadership is about the leader’s values, coping with change and/or creating disruption (Stanley et al. 2023). Leaders promote change and are people orientated, with Watson (1983) and Heinen et al. (2019) asserting that leaders use the “softer” skills of leadership such as being staff focused, being style driven, having shared goals and key clinical skills. Bryman (1986) and Goleman (1998a) add that leaders are also concerned with strategic motivation, and the Healthcare Leadership Model (NHS Leadership Academy 2021) emphasises that leadership is not necessarily related to seniority within an organisation. Clinical leaders focus on motivating and inspiring others towards common goals (Kotter 1990a) as they create a passion among others to share their vision. Leaders focus on the attainment of long‐term goals; they take risks, challenge the status quo and work towards adapting to change (Nene et al. 2020). Kotter (1990a) suggests that leadership consists of:
vision,
values and
communication of vision and values.
With change and innovation characterising modern healthcare, the role of healthcare/clinical leadership has become more relevant in recent years, because it is integral to initiating innovation and change (West et al. 2015; Stanley et al. 2023). Innovation and change always demand more leadership (Kotter 1990a, 1990b) because of its concern with aligning people, setting direction, motivating, inspiring, employing credibility, adopting a visionary position, anticipating change and coping with change (Jones and Bennett 2018; Stanley et al. 2023). Leaders also align their leadership with the values central to the organisational goals (West et al. 2017; Stanley et al. 2023).
1.4 The Challenges Leaders and Managers Face
Management and leadership are two different, yet complementary activities (Kotter 1990b); consequently, they present several challenges. The efficient running of any organisation requires both and recognises that management is a function that must be exercised in any organisation, while leadership is a relationship between the leader and the led that can energise an organisation (Stanley et al. 2023). It is also clear that when management and leadership functions are embodied in the same person, or within the same post, it can lead to:
values breach (Stanley
2006
),
confusion,
conflict (Stanley
2006
) and
diminished clinical and management effectiveness (Kippist and Fitzgerald
2009
; Kerridge
2013
; Cutcliffe and Cleary
2015
; Veronesi et al.
2019
; Nene et al.
2020
).
Leadership and management are different. You cannot manage a person into battle or into the teeth of a global health emergency – they must be led.
It is also clear that within healthcare, both leadership and management are essential to ensure patient safety and inspire innovation and change and are central to improving the efficiency of clinical areas and developing sustainable improvements in the quality of patient/client care. For a genuine opportunity to develop more efficient clinical management and clearer, more effective nursing leadership, it may be time to accept that having leadership and management functions reside in one person or post is inefficient and counterproductive, both to the individual concerned and to the health service's future development and success.
Since the 1970s, numerous authors have highlighted the differences between leadership and management (Zaleznik 1977; Stanley 2006, 2017b). The health industry is constantly dealing with change, and organisations need both effective and values‐focused leaders and managers (Kline 2019
