Critical Analysis of a Leadership Approach in Nursing

Introduction

Leadership is a critical management aspect of critical care practice. Often, intensive care environments consume large proportions of hospital financial and nursing human resources. In addition, intensive care units (ICUs) involve multi-professional collaboration to provide integrated care to patients suffering from terminal conditions. An ICU nurse manager must be self-actualising to implement his/her vision in the unit. Milton (2009) notes that every nurse has “untapped leadership potential” that can be developed through experience and learning (p. 117). Certain skills and experiences are conducive to critical care nursing leadership.

Nurse leaders involved in critical care must have experience in time management, organizational change, coordination of multi-professional teams, and task delegation. They also have excellent clinical skills and experience in critical care delivery. They learn from constructive feedback from preceptor mentors and colleagues in the workplace. A nurse manager should learn skills such as negotiation, teamwork and communication, and critical thinking to provide competent leadership on issues surrounding intensive care delivery.

This paper will assess the components of the leadership style of a head nurse of a hospital ICU based on a leadership framework that includes five components: social/emotional competence, task delegation, communication, conflict resolution, and mentorship. Nurse leaders need to ‘actualise’ these skills in their leadership to confront the multi-faceted challenges in intensive care environments.

The ICU Head Nurse

Patient care in the ICU involves diverse health care teams that offer integrated care. The head nurse in the ICU where the writer works coordinates the nursing staff and physicians of the unit to ensure quality care delivery to patients. The head nurse executes multiple key tasks that ensure a smooth running of the facility. As the head nurse, she plays a major role in directing activities within and outside the unit. She oversees quality management issues, including disease transmission, clinical errors, and patient morbidity and mortality. She also plays a role in quality improvement in the unit through quality assessment. The head nurse also promotes learning by facilitating nurse participation in various training courses.

Effective communication among the ICU professionals is crucial to quality improvement. The head nurse promotes openness in communication among healthcare professionals, which facilitates continuity of care (Milton, 2009).

She also acts as a liaison officer by coordinating communication among nurses, physicians, patients and their families, and other non-ICU partners. She communicates the patient’s condition to family members and informs them of the available medical options. Personnel management is another role of the head nurse. She handles matters to do with staff training, motivation, promotions, and conflicts. She also participates in the formulation of strategies and goals of the unit and develops the unit’s budget in consultation with the nursing staff. The financial resources go into the acquisition of equipment for the unit and innovation management.

Since the intensive care unit consumes large amounts of resources, budgeting and cost control processes should be effective and efficient. The head nurse plays a central role in budget planning and cost-benefit analysis of new interventions. She also controls resource allocation and spending in the unit. Besides monitoring resource utilisation, she also supervises nursing shifts and bedside care to critically ill patients in the hospital’s ICU.

Justification

The writer chose the nurse manager for this analysis because of her profound leadership and management experience and skills. She embodies the ideal qualities of a visionary leader in our hospital’s critical care unit. She is a skilled nurse with over 25 years of experience covering critical care, nursing research, and education. Before becoming a head nurse, she was a staff member in the medical/surgical, critical care, and OR units and a clinical preceptor. As an educator, she organised seminars and conferences and mentored nurse students. She serves as a role model for younger nurses in time management, teamwork, task delegation, and leading multi-professional teams.

The nurse manager is a mentoring preceptor to student nurses. She gives positive feedback that helps new nurses to learn skills, such as collaboration, communication, and critical thinking, among others. In the writer’s view, her experiences and skills epitomise the leadership qualities of a critical care nurse leader. She was the first critical care nurse specialist in the hospital. After becoming a head nurse, she formulated an orientation program for new nurses and initiated training in trauma nursing at the facility.

She is considered a ‘legend’ by the nursing staff at our unit. In all the positions she has held, the nurse manager has implemented changes directed towards improving the quality of patient care. She advocates for a ‘common sense’ approach (situational leadership) when dealing with patients, as each case is unique. She has had an opportunity to apply her skills and knowledge in different capacities, which has enhanced her leadership ability.

Critical Analysis of Her Leadership Approach

Head nurses have a big influence on staff motivation and performance and quality of patient care. For this reason, they must develop procedures for assigning roles and activities to co-workers. In addition, a head nurse focuses on building a good rapport with his/her staff. This can be achieved through effective communication, active listening, and being supportive (Porter & McLaughlin, 2006). Leaders who actualise their leadership style in the position they hold are visionary, creative, and self-aware. This paper evaluated the leadership qualities, skills, and abilities of the head nurse based on the framework identified earlier.

Social/Emotional Intelligence

Critical care requires multi-professional collaboration or a team, which must have a leader. As the teams are diverse, the leader should be emotionally intelligent to foster a positive relationship between him/herself and the staff (Goleman & Boyatzis, 2008). This creates trust and understanding, which can help the leader navigate through difficult situations. The nurse manager stands out as someone who is ‘sensitive to others’. She holds weekly meetings with the staff to gather views about their needs and changes nurses would want her to implement in the unit.

One way nurse leaders can motivate staff is by being sensitive to their needs. Thus, leaders must seek to know the needs and views of nurses concerning working conditions, shifts, and clinical procedures in the ICU. Social competence means that the nurse leader shows empathy and comprehends the other nurses’ needs (Goleman & Boyatzis, 2008). A nurse leader must also appreciate diversity and differences of opinion among the staff in his/her unit.

Individual differences, if not well handled, can create tension and conflicts. Nevertheless, workplace diversity can promote creative thinking and performance in the team. The head nurse supports nursing interventions that promise quality care to critically ill patients. She also believes that the quality of care is dependent on the working conditions, skills, and knowledge of the nurses. That is why she organises mentorship and training programs to help new nurses sharpen their skills in critical care.

A head nurse must create conditions that foster tolerance and respect in the intensive care environment. If nurses feel that the leadership respects their personal views and perspectives, they become motivated and satisfied with their work. Motivated nurses have a strong group identity and work as a team to improve the quality of care and promote patient outcomes. The head nurse often assumes a mediating position when dealing with human resource issues in her unit. She strives to make a win-win situation for nurses and patients concerning ICU service. She balances workloads and bedside care in a way that benefits both the nurses and patients.

Head nurses are also expected to be emotionally intelligent. Emotional intelligence describes the intrapersonal and interpersonal strategies that help a leader to continually “evaluate, reflect, and improve his/her leadership skills” (Akerjordet & Severinsson, 2008, p. 575). It encompasses four attributes: self-awareness, self-regulation, empathy, motivation, and socialization skills (Akerjordet & Severinsson, 2008).

The head nurse exhibits a strong ability to introduce and manage change within the unit. Previously, she has launched conferences and seminars to facilitate knowledge transfer. She seems to enjoy new challenges as evidenced by her propensity for reflective learning and mentorship. In her interactions, she considers other people’s views before providing a direction. These attributes paint a picture of an emotionally intelligent nurse leader.

The head nurse often takes a neutral and objective stance when dealing with staff issues in the unit. A leader nurtures positive ‘mental states’ in the co-workers by being understanding and empathic (Goleman & Boyatzis, 2008). In addition, the head nurse’s emotional intelligence skills help her manage team ‘psychology’ and improve her work relations with others. Willcoxson and Millett (2000) state that highly effective leaders “seek to understand to be understood” (p. 93). This implies that leaders can achieve more by learning to listen to others before offering a direction than by making unilateral decisions.

The head nurse is aware that she is the leader of the entire unit and thus, must be emotionally intelligent to foster cooperation and teamwork. She uses a ‘situational leadership’ approach when dealing with different professionals in the unit.

Interpersonal Communication

Effective communication is a central approach for resolving conflicts and fostering harmony between the leader and the co-workers. Conflicts are bound to emerge in situations of poor interpersonal communication. The ICU is a high-stress place that requires communication tools such as active listening, concise summaries, and clear verbal messages to promote understanding (Davidson, Elliott, & Daly, 2006). In particular, clear communication between nurses and other specialists enhances teamwork, which often translates into improved health outcomes, reduced stress, and better workplace relationships (Milton, 2009). The head nurse facilitates information exchange between nurses and physicians by establishing an explicit reporting structure during ward rounds and holding regular team briefings.

Interpersonal communication is essential during daily ward rounds. Nurses assess a patient’s needs during daily rounds and communicate this information to the physicians. In the ICU, information exchange is important because different specialists are involved in patient care. Thus, a well-structured mechanism for information transfer between nurses and physicians prevents time wastage and avoids frustration. A nurse leader must facilitate information sharing during daily rounds to promote satisfaction and improve the quality of care. The head nurse assigns responsibilities and ensures that each nurse passes information about the patient’s therapeutic needs to other specialists.

Regular briefings of the unit staff are another approach the head nurse uses to engage nurses. The briefings help clarify new changes, alleviate misunderstandings, and enhance commitment to a particular course of action. For a leader, team briefings present an opportunity to communicate one’s decisions and position on an issue. Another aspect of communication relevant to the ICU environment is the orientation of new nurses. The head nurse acts as a preceptor to beginners by training them on various aspects of intensive care at our unit, including the physical assessment of patients. She believes that a good introduction to new nurses makes them better performers in the future. A good introduction prepares nurses for the challenges of intensive care and motivates them.

Highly motivated nurses exhibit a high level of job commitment and satisfaction. The orientation programs entail teaching the nurses essential job skills to ensure that they fit in the job. The head nurse also undertakes regular evaluations to determine how the nurses have integrated the skills into their practice. Quality of care in the ICU depends on nurses’ skills and experiences. The essence of the orientation is to ensure that the quality of care is not affected by staff exchanges. In addition, it makes nurses confident and well prepared for their job.

Personal qualities define a leader’s leadership style. The head nurse identifies the aspects of her leadership style as vision, emotional sensitivity, win-win situation, reflective practice, and mentorship. These aspects define her internal and external leadership. External leadership relates to the management of interpersonal interactions (Kent, 2006). Critical care practice entails a high level of interaction between different healthcare specialists. Ideally, a head nurse requires a leader who respects and values the other professionals. He/she should gain the approval of the nursing staff, the physicians, and the hospital administration. The head nurse has a good reputation within the hospital, partly because of her many years of experience in clinical practice.

One of the key components of the head nurse’s leadership style is making any issue a ‘win-win situation’ for all parties involved. She plays a mediator role in policy development and dispute resolution. Her decisiveness and firmness of character help build strong partnerships with other specialists for the benefit of the patient, nurses, and physicians. An ICU takes a centre stage in in-hospital care and thus, it requires concerted action from various services. The head nurse has a responsibility of promoting a spirit of interdisciplinary collaboration in the ICU.

Task Delegation

The head nurse delegates most leadership tasks to nurses in the ICU except for emergencies. She, however, monitors the delegated tasks and takes control of emergencies in the unit. Task delegation boosts the team’s self-confidence and motivation (Braynion, 2004). It also motivates staff to integrate leadership roles into their daily routine, which results in effective clinical governance (Braynion, 2004). The orientation equips nurses with the skills and knowledge to perform leadership responsibilities at the unit. She monitors all the activities because she is responsible for what happens in the unit. Role delegation builds trust and respect in the leadership and shows that the nurses are competent in their work. Nevertheless, the head nurse must take the ultimate responsibility for what goes on in the unit.

Conflict Resolution

In the workplace, differences in opinion may breed conflicts. Leaders should know how best to manage disputes because they can affect the performance and productivity of the organisation. Additionally, optimal conflicts spur creativity and create competition that motivates staff to do better (Willcoxson & Millett, 2000). However, too many conflicts increase stress and reduce productivity, which harms an organization. Effective leadership must manage conflicts in ways that benefit the organisation. In the ICU environment, conflicts can arise from task allocation, social interactions, and disagreements with families, among others.

In the ICU environment, deficiencies related to equipment and resource management can impede optimal care delivery. Failure in computer systems or delay in drug dispensation from the pharmacy can affect the nurses’ ability to provide quality care, as they should. Malfunctioning systems can also breed conflicts. The head nurse in our unit has developed elaborate procedures and processes for overcoming shortcomings of materials or equipment in the unit. She has also trained personnel in risk assessment and case management as interventions to prevent resource-related conflicts.

Mistrust can impede interactions in the workplace because it creates antipathy. In addition, prejudice towards certain people or cultures can cause conflicts in the workplace. A nurse leader should entrust his/her team with the responsibility to care for critically ill patients without prejudice. In this way, he/she will demonstrate that the nurses are competent and dispel feelings of mistrust and prejudice against them. Conflicts related to prejudice or discrimination can be destructive to the unit if not addressed. The head nurse often confronts those who harbour feelings of hatred or mistrust. She also conducts group training to encourage tolerance within the workplace.

Effective leaders make sound decisions that bring about a positive transformation within the organisation. In an ICU context, head nurses have to choose the best option among many alternatives. This requires compromise to ensure that the decision made does not affect other people, as this would result in conflicts. A self-actualised leader implements his/her vision and influences others to follow her (Sellgren, Ekvall, & Tomson, 2006).

If people affected by the policy are not consulted, conflicts are bound to emerge. The head nurse gives regular information regarding new changes and intervenes whenever nurses express opposition to a new policy. She also communicates the strategic goals of the unit to the nursing staff during team meetings.

Workers have career goals and aspirations, which they pursue during their practice. Organisations invest in career training and development to improve the skills and abilities of their workers and achieve high productivity (Porter & McLaughlin, 2006). Leaders must give individuals an opportunity to pursue their career interests and goals without restrictions. Conflicts can emerge if people are not allowed to grow their careers within an organisation or outside the workplace. The head nurse believes that quality patient care can only be achieved if workers acquire advanced skills. Through negotiations, she helps each nurse to identify his/her career goals and develop a training and development plan for him/her.

Conflicts can also arise with the family of a patient in ICU if there is no openness in communication. A nurse leader should know how to resolve conflicts of this nature. Most family-nurse disputes usually relate to end-of-life decisions with a lack of information exchange being the root cause (Kent, 2006). The decision to terminate or continue therapy for a patient can cause conflicts between the family members and nurses.

A nurse leader must be a good listener to understand the family’s fears and views regarding end-of-life care. The head nurse first understands the family’s feelings and attitudes towards the medical system, procedures, and the physician treating the patient before seeking an appropriate intervention to resolve the conflict.

All types of disputes can be resolved through negotiations involving the relevant parties. A leader must be a skilled negotiator to address the competing interests in a manner that yields a mutual agreement (Burak & Bashur, 2013). A skilled negotiator is a good listener because it is through active listening that one can understand the underlying interests and perspectives of either party. According to Burak and Bashshur (2013), followers have a strong social influence on the behaviour and actions of their leader. The head nurse first listens to interests common to both parties before presenting an agreeable solution to both parties.

Conclusion

Leadership entails the management of relationships and tasks within the organisation or team. Leaders acquire skills and competencies through learning and experience. The skills and experiences make them effective leaders in the organisations they lead. The ICU is a very dynamic practice environment that requires skills and experience in leadership and clinical practice to manage effectively.

The head nurse characterises her leadership style, as one founded on ‘win-win’ situations, sensitivity/empathy to the worker’s needs, skill development, conflict resolution, and mentorship. The analysis has revealed that the head nurse exhibits a situational leadership approach, is emotionally/socially competent, is experienced in conflict resolution, and shows a strong commitment towards staff development. These qualities indicate that the head nurse has actualised her leadership potential in the critical care unit.

Personal Leadership Development Plan

Objectives Rationale Learning Needs Indicators Threats / Barriers Strategies
1. To develop proficiency in communication skills to improve my negotiation and collaboration tactics in my clinical community/ group (intensive care unit) -Skilled communication is of utmost priority to leaders. Charismatic leaders find solutions easily, influence others, and develop collaborative relationships with workmates, which contribute to leadership success.
  • Consensus-building /mediation skills
  • Being respectful of other’s opinions
  • Matching my words with actions
  • Negotiation and persuasion skills
  • Active listening
  • Positive feedback from colleagues
  • Self-assessment based on personal communication goals
  • Staff appraisal results
  • Uncooperative colleagues
  • Limited opportunities to develop this skill
  • Leadership theories and seduction to influence others
  • Join professional associations and volunteer as a mediator
2. To look for opportunities to mentor young nurses within the ICU department Mentorship will help me advance my ‘soft skills’ and assist others to realize their career goals. Mentorship also has high-priority leadership qualities.
  • Explaining clinical procedures in the ICU
  • Providing practical opportunities to nurses to learn
  • Task delegation
  • Increase in the number of nurses under the mentorship program
  • Constructive feedback from colleagues
Resource constraints
  • Liaising with the Unit manager to provide more funding
  • Forming partnerships with other hospitals
3. To become more accountable, competent, and responsible in my actions and duties Transparent interactions with nurses and patients are of utmost importance in clinical settings. Leaders must also show financial frugality.
  • Planning for each task
  • Budgeting
  • Private partnerships
  • Increased revenue generation
  • Improved nursing and patient outcomes, e.g., low turnover rates
Expensive projects/unexpected costs
  • Outlining project milestones, goals, and outcomes before resource allocation
  • Regular performance reviews
4. To develop strong integrity and ethical principles in my leadership practice By applying ethical principles, a leader makes his/her followers exhibit higher values Applying leadership theories and learned experiences in my practice
  • Improved self-awareness
  • Positive feedback from colleagues
Unshared opinions/contrasting viewpoints from other nurses and patient families Maintaining high integrity to earn their trust and respect

References

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