Nurses and paramedics play a central role in the delivery and development of

the nations health care industry. The heath care environment is constantly changing
and producing new challenges in developing future nurses and paramedics. Thus, a
effective leadership skills needed by all nurses and paramedics to enhance this
objectives. Leadership is a process which influences individuals to accomplish an
objective, usually occurs in group setting and directs the organization in a way to
achieve a comman goal. Kahn, (2001) defined that leadership is ability to inspire
confidence and support among the people who are needed to achieve organizational
goals.

A good leader have a good quality of leadership blended with style of

leadership which contents the autocratic leader, bureaucractic leader, democratic

leader, laissez faire and the situational leadership. This is where the leader switiches
between the above styles depending upon the situation and competence of the
followers (Faugier & Woolnough, 2002)
This paper will discussed about leadership ability and quality in my
organization mentoring newly qualified staff nurses and medical assistants. Currently
I am practicing at a general hospital in state of Selangor based emergency
department. Our unit comprises triage unit, critical, non- critical zone, trauma
operating theatre and emergency observation room. It is provided with adequate
amount of nurses and paramedic who run their daily responsibilities efficiently in
immediate patient care. As a professional health care, we are well trained for
decision making skill to deals with the patients in critical situation or emergency
treatment. With 5 years experienced in giving treatment for the patient, I have met
many types of leadership by different person style and behaviours.
Here I will talk about my leader who is supervisor incharge of the paramedics
in my department. He also assign to manage newly qualify staff nurses and medical
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assistants who are required to undergo a one year practical before they can earn
their Annual Practice Certificate. According to Chua (2006) newly graduated nurses
are now required to undergo a one year practical before they can earn their Annual
Practice Certificate and this is a part of the efforts to arrest the decline in nursing
standards in public hospitals as health centres. He is well experienced and effective
leader as he apply his leadership knowledge , skills and styles which contributes to
the development of my department and practice nursing team. He has 15 years of
experience in managing emergency cases from various discipline and has a post
basic in advanced emergency medicine and trauma care (AEMTC). Good leaders
develop through a never ending process of self-study, education, training and
experience (Jago, 1982).
There are three style of leadership which are autocratic, democratic and
laissez-faire as cited in Kelly- Heidenthal (2003). Authoriratian climates were
charactized by leaders who make decisions alone and dictate each step taken. In
this situation my leader make his own decisions to purchase new equipment as
required by paramedics. Sometimes my leader demands strict compliance to his
orders when dealing with new qualified or less experienced paramedics and here he
will be giving only one-sided instructions so that paramedics expand their practice
with safety. Fieder (1967) defines that autocratic leadership style based upon the
assumption that the leader knows everything and what the best for their
organization.
My leader also practises democratic leadership where paramedics given
choices and actively decide in medical decision-making activities. Here my leader
utilize his influence of group decision setting style where by facilitating the
conversation and encourage the group to share their ideas and guide them with
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motivating questions and suggestions. For instance, my leader also practises the
laissez-faire style leadership in situations where group member are highly skilled
especially among the senior paramedics who are capable of working on their own
and expected to solve problems on their own in emergency setting. Though my
leader closely oversees their work and provides tools , answers questions to the
followers questions so that they achieve their goals.
Currently my emergency faces a significant nursing and paramedics shortage
which seriously affects the quality and availability of health care due to increasing
numbers of patients. So that they are overloaded with the number of assigned
patients, besides that there is massive paperwork due to billing and administration
purposes. Due to this, the nurses unable to cope with growing population and are
over worked. This increases their stress levels and intend to leave the working force.
One study showed that dissatisfaction and burnout are higher among nurses with
higher patient loads. ( Aiken, 2002 ).
Mentoring is a good leadership method to lead newly qualified staff improves
their skills and advance their careers. Milner and Bossers, 2004 urged that
mentorship involves a relationship in which the mentor, who is usually more
experienced, works closely with the mentee for the purposes of teaching, guiding,
supporting and facilitating professional growth and development. In my department,
my leader encourage the newly qualified staff to attend Continuous Professional
Development program

which definitely improve knowledge and skill to assist in

patients health education effectively. Besides that my leader also guide and coach
them to develop

their

skills and gives them a motivation as develop career

enhancement incentives for nurses to pursue professional practice. This will help in
the retention of the nurses.

important characteristics of a good mentor are

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approachability, effective interpersonal skills, a positive teaching role providing

supervisory support and professional development ability (Darling 1984,Andrew
1993, Earnshaw 1995, Rogers & Lawton1995).
There are several theories qualify as leadership theories and found to be
beneficial. It comprises the situational leadership, transactional leadership and and
transformational leadership.The situational leadership define as the best action of
the leader depends on a range of situational factors. Factors that affect situational
decisions include motivation and capability of followers. Tannenbaum and Schmidt
(1958) identified three forces that led to the leader's action: the forces in the
situation, the forces in then follower and also forc es in the leader. I believe my
leader practises this theory whereby he changes leadership styles depending upon
the situation he faces such as managing emergency situation with staff in emergency
department. Transactional leader represent by efficient managers that focus at on
hand task, solve problems, communicate clear expectation to their staff and give
reward to good performance ( Tatum et al., 2003) a transactional leader works in
some kind of corrective action is applied for performance and the rewards that they
get for following orders. This from of leadership motivates people by rewards . The
third type is the transformational leadership which combined the strengths of leaders
and followers. According to Burns (1978), transformational leadership is a process in
which leaders and followers make each other to advance to higher level of moral
and motivation . Here where my leader motivates the new paramedics by giving an
opportunity to evaluate new and old policies or procedures and encourage them to
offer improved feedback. In order this, he holds meetings and gets the feed back
from the nurses and paramedics so that he can make an effort to solve the problems
or implement to new ideas to produce a well managed emergency department.
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Kotter, 1990 cited that leadership is about creating change where else
management is about controlling complexity in order to bring order. Leadership and
management are linked together eventhough both are two different things.
Leadership is the process by applying the leaders knowledge and skills to perform
a task Management ,on the other hand, is a process where help the followers to
determine knowledge and confidence levels to overcome barriers involving patient
care so as to improve their skills and job performance.

Both leadership and

management help to create a situation that causes the followers to learn, gaining
information and by applying it to their practice which improve job performance. In my
emergency setting , the skills of both leaders and managers are needed for a
successful organization and produce a good outcome either from the staff or
department. I hope the health administrators aware about the importance of a
leaders commitment to the department which can change our present poor working
environment.

Every organization requires good leadership to ensure successful

team building ( Marquis & Huston, 2003) and effective management of the
organization ( Perrs, 2000) .
It is the greates challenges in this era is developing future nurses and
paramedic in health care. Thus I have learnt that a powerful leadership skills are
needed by all nurses and paramedic to enhance this goal. Good leader are made
not born. There are various leadership styles and qualities which can attained
through practice and experience. So on that, a leader should identify which is the
most suitable leadership styles and theories can most effectively use to achieve a
comman goal. A leader needs to ensure that all the staffs able to perform their job
correctly and patient care is delivered in health care services.
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In conclusion, a good leadership and management

department to function effectively.

are required for a

A good leader also will able to implement

effective leadership and produce a excellent nurses and paramedics indeed play a
central role in the delivery and development of the nations health care industry.