Nursing Leadership: Advancing Workforce Intra-communication

Introduction

Leadership is one of the core functions in every organisation or health institution. Effective leadership dictates the performance of employees in a given institution. Theorists and scholars have presented a number of theories and models that can be used by organisational managers to lead their followers (Spetz, 2014). The most agreeable fact is that leaders can use a wide range of theoretical approaches in their organisations, depending on the nature of the targeted goals.

Leadership theories can be redesigned in such a way that they meet the diverse needs of the targeted followers. In order to produce meaningful results, leaders should begin by examining the unique attributes, strengths, and personalities of the followers. The leaders should go-ahead to identify the weaknesses in the organisational setting and the targeted goals. These issues will inform the manager to implement the most appropriate leadership strategy that has the potential to improve performance. One of the theories that have received much attention from scholars and managerial experts in the leader-member exchange (LMX) model.

Gooty and Yammarino (2016) indicate that “leader-member exchange (LMX) has emerged as one of the most influential leadership models in predicting organisational outcomes” (p. 915). Many professionals and organisational leaders believe strongly that the existence of a quality exchange between followers and management is something that dictates the level of performance (Bortoluzzi, Caporale, & Palese, 2014).

This is the case because the existing leadership approach will influence the behaviours, action plans, and strategies embraced by different followers in an attempt to deliver positive results. Karanika-Murray, Bartholomew, Williams, and Cox (2015) go further to indicate that the relationship existing between employees and their leaders will definitely dictate the nature or level of organisational performance.

A positive relationship in the working environment will make it easier for the leaders to influence to roles and experiences of the workers. Consequently, the leadership approach will promote or support the psychological, emotional, and health needs of the workers. A positive relationship between a leader and his or her followers will eventually drive performance. The purpose of this paper is to give a detailed analysis of the LMX theory and its implications for the nursing field. Practical strategies that can be implemented to support or improve the quality of LMX will be described.

Basis and Importance of LMX

Basis of the Leader-Member Exchange (LMX)

The leader-member exchange (LMX) is one of the models that have received much attention over the years (Power, 2013). The occurrence of informal leadership practices in many organisations is not something new. Such informal leadership behaviours indicate that different workers within an organisation will be in need of diverse sources of motivation. With a positive relationship between the leader and the targeted member of staff, the supervisor will find it easier to promote performance. This is the case because the relationship becomes the best tool for empowerment, guidance, and problem-solving (Bauer & Erdogan, 2015). The unique needs of every employee are addressed using a personalised approach and eventually support the targeted organisational objectives.

Vidyarthi, Erdogan, Anand, and Liden (2014) indicate that the LMX theory views the concept of leadership as a process that promotes dyadic relationships that have the potential to bring the leaders and followers together. The quality of the relationship is what dictates the level of performance. The quality of this relationship exchange is reflected by the level of obligation, support, loyalty, and respect (Power, 2013).

The theory guides leaders to form different dyadic relationships depending on the competencies of the targeted followers and the intended objectives. The formation of different groups makes it easier for the leader in monitoring the processes implemented in an attempt to deliver quality goals. More often than not, the leader will form out-group and in-group teams (Vidyarthi et al., 2014). Buch (2015) indicates that the members of an in-group will be favoured by the leader in order to promote performance. The members of the in-group are selected based on a number of attributes such as age, personality, attitudes, and performance. More often than not, individuals who perform specific jobs or activities effectively are targeted and selected to join the in-group.

The out-group is comprised of subordinates who are usually disfavoured by the organisational leader (Vidyarthi et al., 2014). This means that the out-group members will not receive much attention, support, or resources from the leader. The theory, therefore, appears to put more emphasis on the in-group in order to drive performance. The theory is usually implemented using a number of stages. The first one is known as role-taking (Buch, 2015).

After a given subordinate becomes part of the team or group, the leader will begin by assessing his or her competencies. The leader will go a step further to offer new opportunities and activities to the individual. This practice is usually done in order to gauge the capabilities and competencies of the follower. The leader will then engage in role making (Gooty & Yammarino, 2016). The purpose of this role is to have an unstructured negotiation that empowers the follower to become part of the intended team or group.

The establishment of a leader-member relationship is usually governed by a number of attributes. For instance, the leader and the follower should have mutual support and respect for one another (Gooty & Yammarino, 2016). The leader is usually ready to acknowledge the capabilities and competencies of the follower. A sense of trust between the two players will increase significantly. The individuals use their competencies and ideas in order to support one another. These dimensions, therefore, make it easier for the organisation to realise its business goals.

The members of an in-group team act as collaborators or assistants. This is the case because they identify now opportunities and practices that have the potential to deliver positive results. The emerging exchange mentors the workers to focus on the targeted goals. The workers will also be happy to identify and complete various interesting tasks (Karanika-Murray et al., 2015). Throughout the process, the follower will receive various benefits such as favourable working conditions, personal support, guidance, empowerment, and provision of resources. These attributes will eventually drive organisational performance.

The model results in a process known as routinisation (Buch, 2015). This is an ongoing process of social exchange whereby the leader and the follower focus on the best approaches to achieve the targeted objectives. The social exchange process becomes part of the organisation. The workers receive the right support and resources from the manager. The optimisation process makes it easier for the targeted organisation to achieve its objectives.

Importance of LMX

Many analysts believe strongly that the leader-member exchange is a powerful framework that is needed by an organisation and its workers. When applied effectively, social exchange creates the most appropriate environment that has the potential to support the emerging needs of the employees. Buch (2015) indicates that high-quality social exchange relationships within an organisation will catalyse positive behaviours. The workers in the organisation become empowered to focus on the vision and mission of the company. The prevalence of problems and differences decrease significantly because the subordinates focus on the targeted goals. The leader finds it easier to identify the strengths and weaknesses of the followers. This knowledge is then used to pattern the nature of social exchange relationship and promote performance.

A positive relationship between members and leaders will contribute to admirable job attitudes. The workers are guided whenever taking up various organisational roles. Throughout the process, the followers find it easier to work as a team and focus on the best models to achieve the targeted goals. The workers are always willing to achieve tangible results, empower one another, and seek guidance from the leader (Bauer & Erdogan, 2015). The improved job attitudes within the institution or organisation will be directly proportional to performance.

The level of staff turnover will decrease in companies that embrace the power of positive follower-leader relationships. This is the case because the employees’ needs and expectations are met in a timely manner. Emerging issues are addressed by the leaders in a timely manner. The followers are also guided to be part of the problem-solving and conflict-resolution processes in the organisation (Pegram, 2015). The employees will be empowered, support each other, promote new relationships, and form teams. Such attributes create a conducive environment whereby the employees become satisfied with their working conditions. Consequently, the level of staff turnover decreases significantly.

More often than not, employees who are part of the in-group will benefit from the efforts and resources provided by the leader. The followers will acquire new skills and competencies that can support their career goals. The individuals will have increased chances of taking up leadership roles in the future. Employees who establish appropriate social exchange relationships with their managers will be able to achieve their career growth goals (Martin, McCormack, Fitzsimons, & Spirig, 2014). The support and empowerment presented by the leader will definitely promote career progress. This attribute explains why the model is embraced by both followers and managers.

Organisational commitment is something that dictates the goals recorded by a company within a specified period of time. In companies that embrace the power of the leader-member exchange (LMX), the level of organisational commitment increases significantly. This is the case because the followers are usually guided and equipped with the right resources that can support the targeted goals. The support provided by the leader will encourage the individuals to have a proper plan and understanding of the goals that must be achieved within a specific period (Pegram, 2015). The employees are usually evaluated periodically in order to ensure the targeted goals are realised in a timely manner.

The social exchange model has been observed to promote new attitudes and personalities. The employees begin to emulate the leadership philosophies, attitudes, and competencies of their respective leaders. Consequently, individuals become responsible, hardworking, and realistic. The followers will eventually present their skills to support organisational performance. The increased level of job responsibility will eventually result in a win-win situation (Schnall et al., 2012). The situation is characterised by benefits for both the employees and the organisation. The skills and attitudes developed by the employees will definitely guide them throughout their career paths.

Leadership-Member Exchange in Nursing

The healthcare sector has been characterised by a number of changes within the past four decades. Many professionals in the industry have been focusing on a number of processes that can transform the experiences of many patients. Issues such as leadership have emerged because of the challenges affecting the sector. For example, the current nursing shortage, lack of adequate resources, and the emergence of different health conditions are powerful factors that dictate the future of the health sector (Wong, 2015).

Leadership in nursing has taken a new turn in an attempt to maximise the outcomes of the greatest number of patients. In the recent past, organisational management in healthcare settings used to focus on control measures and models that were aimed at delivering adequate care to the targeted patients. The use of autocratic and delegative leadership models dominated the field for years. The workers and nurses in different facilities mainly focused on the emerging needs of the clients (Mansueti, Grandi, & Grazio, 2016). Although these models continued to support the needs of many patients, the agreeable fact is that the welfare and experiences of many nurses were ignored. Consequently, a small number of patients could receive evidence-based and timely healthcare support.

Leadership has changed in such a way that it encourages managers to address the needs and expectations of the targeted workers. This approach has emerged because it has the potential to transform the nature of leadership and ensure more nurses are empowered to support the emerging needs of their patients (Mansueti et al., 2016). A wide range of theories such as transactional, transformational, and leader-member exchange have emerged in order to transform the outcomes of many patients.

The leader-member exchange (LMX) has gained much attention in nursing. This is the case because many leaders in the sector have been implementing appropriate models that have the potential to bring competent nurses on board, empower them to focus on the emerging patients’ needs, and support their unique needs. Within the past decade, many nurse leaders (NLs) have established unique relationships that echo the attributes of the leader-member complex (Hays & Lou, 2013). The leader-subordinate relationships have been established whereby the managers identify specific nurses who possess the right clinical skills. The next step is equipping the subordinates with the right ideas and resources that can make it easier for them to meet the diverse needs of their respective patients. Throughout the healthcare delivery process, the leaders have been working hand-in-hand with the followers to maximise the outcomes of the targeted patients.

According to Konya, Grubic-Nesic, and Matic (2015), the implementation of the LMX social exchange in nursing has been observed to produce positive behaviours. Nurses who form leader-subordinate relationships tend to benefit significantly from the ideas presented by their supervisors. Studies have indicated that the leaders offer adequate support and resources that can maximise the health of the patients. When this strategy is embraced, the nurse will find it easier to focus on the targeted goals. Additionally, the level of job satisfaction increases significantly because the caregiver is provided with the best environment, guidance, support, and resources (Auh, Bowen, Aysuna, & Menguc, 2016).

It is also evident that the nurse leader realises his or her goals much faster. This is the case because the nurses demonstrate the highest level of creativity (Walsh et al., 2016). The nurses will be obliged to form cohesive teams and focus on the best practices that can improve the health experiences of the patients.

The LMX exchange has been associated with increased levels of loyalty and respect in the healthcare field. The nurses expect and seek support from their respective leaders. The HL will find it easier to empower the followers, understand the emerging problems, and offer adequate support in accordance with the targeted goals. Decision-making is another area that has benefited significantly from the leader-member exchange. This is true because most of the nurses will acquire new attitudes, competencies, and ideas that can maximise performance (Andel, Davidow, Hollander, & Moreno, 2012). Decisions will be made much faster in an attempt to support the emerging health needs of the patients.

In nursing environments where LMX is embraced, the NL encourages the subordinates to work hard and ask for resources that are needed to improve the existing healthcare delivery models (Furunes, Mykletun, Einarsen, & Glaso, 2015). The process creates the best environment for information-sharing. This information is then used to make new adjustments and changes that can improve the healthcare delivery process. According to Altunoglu and Gurel (2015), healthcare institutions that embrace the use of the leader-member exchange realise their goals much faster. This is the case because the nurses are guided and mentored within the social exchange complex.

Research has indicated that LMX in nursing is an opportunity for furthering empowerment (Hsieh, 2012). The empowerment process enhances unique feelings and emotions, such as self-efficacy and commitment. The nurses tend to own their roles and work hard to realise the targeted goals. The level of empowerment results in increased morale, promotion of new health delivery models, and emotional intelligence.

The nurses will be willing to focus on their goals and support their patients’ health goals. Another unique attribute arising from the LMX relationship is affective commitment (Hunt, 2014). Hsieh (2012) defines “affective commitment” as the level of emotional attachment and identification with a specific institution or healthcare organisation. With the use of the LMX theory, the leader will promote affective commitment whereby the nurses become loyal, promote the outlined institutional goals, and support the emerging needs of the patients.

LMX Issues Likely to Occur in Nursing Workplaces

The ultimate goal of a leadership strategy is to develop the best environment for effective performance. The leader creates the best models and pioneers sustainable practices that resonate with the vision of the organisation. With proper implementation, the LMX social exchange theory promotes the development of various issues that can support the performance of many nurses (Xerri, 2012). When such issues or best practices emerge, the nurse will find it easier to meet the health needs of the targeted patients.

One of the outstanding LMX issues is intrapersonal communication. In nursing organisations that embrace the power of dyadic relationships, intrapersonal communication becomes a reality. This is the case because the nurses find it easier to use their internal languages and thoughts (Tummers & Bronkhorst, 2014). The concept becomes a driving force that guides the nurses to come up with powerful ideas and maximise patients’ outcomes. Throughout the process, the nurse will be liaising with the other practitioners in order to achieve the targeted goals. Intrapersonal communication has, therefore, been associated with LMX relationships and eventually promotes the level of performance.

As mentioned earlier, affective commitment is another unique attribute or issue associated with the LMX social exchange. This kind of commitment emerges when the nurses are attached to their respective health institutions. The nurses will always examine the model of the organisation, support it, and encourage others to focus on the best outcomes. When there is a positive relationship between the NL and the nurse, the affective commitment will increase significantly (Daly, Jackson, Mannix, Davidson, & Hutchinson, 2014). The relationship will ensure the nurse is guided to support the targeted goals. Consequently, the nurses will not be willing to leave their positions or jobs in the institution.

Another issue associated with the leader-member social exchange is trust. The workers and leaders trust one another in order to ensure the targeted goals are realised. This kind of trust encourages nurses to work hard and collaborate with their leaders (Tummers & Bronkhorst, 2014). The increased level of trust makes it easier for the nurses to work as teams and eventually, to deliver positive results.

Guidance and empowerment are unique issues that are likely to occur in nursing workplaces. These issues emerge because the leader creates both in-group and out-group teams, depending on the unique attitudes exhibited by the nurses. The in-group team will receive the intended resources and empowerment throughout the process. The nurses will be able to acquire new insights and ideas that have the potential to improve the experiences of targeted patients (Keeler, 2013). With proper guidance, the nurses can design appropriate models that can meet the needs of every client or underserved population.

Casimir, Ng, Wang, and Ooi (2012) indicate that the LMX exchange in nursing can result in self-efficacy. Most of the followers involved in the exchange will emulate the personality of their respective leaders. By so doing, the nurses will acquire new competencies such as time management, job responsibility, and integrity (Mastrangelo, Eddy, & Lorenzet, 2014). These attributes will definitely result in self-efficacy and eventually improve the level of performance.

Nurses working in an in-group team will benefit from the issues arising from the LMX exchange. In-group members are usually advantaged because they are included in the leader’s inner circle (Tse, 2014). These nurses will focus on the leader because they go further to ensure the intended goals are realised. With proper support, empowerment, and provision of adequate resources, the nurses of the in-group team will embrace the best behaviours in an attempt to achieve the targeted objectives (Kundu, 2015). The followers will also receive the best attention and rewards from the organisation. The new situation results in continuous empowerment, collaboration, and teamwork. This fact explains why many hospitals and nursing institutions associated with the LMX social exchange achieve their goals much faster.

Practical Strategies to Improve the Quality of LMX

Chan and Mak (2014) believe strongly that healthcare institutions have the potential to tap the benefits of the LMX exchange and provide quality medical services. In nursing environments, NLs can use a number of strategies to improve the quality of LMX. By so doing, the process can make it easier for the targeted nurses to realise their career goals and support the goals of their respective institutions. To begin with, NLs should be on the frontline to implement a powerful change process. The use of a powerful change model can ensure the right practices and attitudes are developed in the nursing environment (Fusch & Fusch, 2015).

Kurt Lewin’s change model has the potential to support the transition process. The unfreeze-change-refreeze model will ensure the targeted nurses are prepared and guided in order to accept the LMX social exchange. The NL will go further to embody the unique attributes of the LMX practice. The implemented practices, attitudes, and ideologies defining the LMX exchange will become part of the institution.

The leader is always expected to establish powerful relationships with individuals or nurses who have the potential to deliver results. This practice is relevant because leaders who establish high-quality relationships with their followers or nurses will find it easier to promote the major issues associated with the LMX exchange (Power, 2013). The quality relationship between the follower and the leader will result in increased morale. When the leader embarks on a new journey to promote the best relationships, it will be easier to make the organisation successful. Consequently, the emerging LMX social exchange will empower each and every follower or nurse.

Another strategy that can make a difference for leaders who want to implement LMX in their departments is the use of personalised guidance. Every employee or nurse has unique strengths and expectations. The leader should always consider these attributes and implement powerful models to ensure the individuals with specific attributes are encouraged to form specific teams. Such teams will then be guided and equipped with the right resources. The psychological and emotional needs of the group members should also be addressed throughout the process (Bradshaw, 2015). This approach will eventually improve the quality of LMX.

Hanse, Harlin, Jarebrant, Ulin, and Winkel (2016) support the use of development and training opportunities to promote the quality of LMX in an organisation. The organisational manager should be on the frontline to mentor the targeted nurses or followers. The leader should identify the right resources and use them for training the followers. The NL should go a step further to monitor the level of skill attainment and advancement.

The use of a powerful coaching program will ensure the employees are mentored and guided to work as teams. A constant reflection process should also be implemented in order to identify specific gaps that affect the level of social exchange in the organisation (Cocowitch, Orton, Daniels, & Kiser, 2013). The gathered information will then be used to improve the nature of LMX in the company.

Conclusion

The LMX theory has gained much attention in the recent past because it has the potential to transform the experiences of both the leader and the follower (Chan & Mak, 2014). In the field of nursing, the LMX model promotes positive relationships between a subordinate and the leader. The nurse will benefit from the competencies of the leader and develop a new model that can meet the changing needs of the clients. Intrapersonal and interpersonal communication processes emerge whenever promoting such relationships. The leader embraces the best attributes that will develop, guide, empower, and mentor the followers.

New issues such as respect, trust, empowerment, and affective commitment emerge from the LMX social exchange (Tummers & Bronkhorst, 2014). The effectiveness of this leadership model has, therefore supported the personal needs of both customers (clients) and employees (nurses). Nursing institutions that want to transform the experiences of their patients should, therefore, consider the benefits of the LMX social exchange.

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