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Leadership Roles and Management Functions in Nursing

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Leadership Roles and Management Functions in Nursing

Introduction

The role played by leadership and management is pivotal for every organisation because
this role helps in achieving the goals and targets set at the organisational level. In an
organisation, both the leaders and managers make effort to fulfil organisation’s mission and
vision very effectively and successfully. Leadership and management have been studied in all
disciplines, whether it is healthcare administration, nursing, aviation, or business management,
with respect to its strong effects on the organisation’s outcomes (Grohar-Murray, DiCroce &
Langan, 2016).

With this consideration in mind, this essay aims to present an action plan regarding the
leadership roles and management functions in nursing in the context of a given situation of poor
performance of Siu Mei, a 36 years old Health Care Assistant (HCA) (see appendix). In doing
so, different leadership and management theories, along with their application in the context of
nursing, are discussed as well.

Discussion

Situation Analysis

Siu Mei is a 36 years old Health Care Assistant (HCA) and also a single mother of 4
years old son. She is also a new immigrant in Hong Kong with Mainland accent, and she has
been living here for last five years. She also worked as HCA in Mainland before coming to Hong
Kong. As her ex-husband was not enthusiastic to care or give any financial assistance to them,
this situation brought her into conflict with her ex-husband. As seen in the appendix, she is very
depressed due to her internal matters, as described; her performance is very poor as a HCA.
There are also some external factors contributing to her poor performance, including different
working practice and culture between Hong Kong and Mainland. After transferring to the
Geriatric Ward, she also explain that she would like to transfer back to Surgical Ward as she
does not enjoy to work here.

Thus, some major problems have been created by her situation, which include poor work
performance as a HCA in the ward and negative work attitude like long leaves for poor health,
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lack of motivation and enthusiasm, and low self esteem. Due to these problems, she has made
many severe blunders at work. For example, she nearly choked a patient to dead when feeding
him breakfast and she almost dropped a patient on the floor when giving bed bath to him, and
even she could not imagine the seriousness of her mistakes. There are some patients as well as
their family members who complained her for reluctance to respond to call bells. Colleagues in
the same ward were gossiping about her negative work attitude as she is little committed to work
as a team.

Poor performance of Siu Mei is the main problem, which not only disturbs her but also
the patients as well very seriously. In fact, her poor performance will ultimately result in the bad
reputation of the health care service provider. To handle this serious issue, there is a need to
manage this problem and here the role of the organisation’s leader and the management is
pivotal. In this situation, both the leadership and the management need to play their role by
making their leadership and management styles better.

Role of Leadership and Management

The management has a basic function encompassing comprehensive planning, effective

staffing, proper organisation, directing and controlling professionally (Sandström et al., 2011). A
vital thing is important that the leadership and management role in the context of nursing goes
hand in hand and cannot be evaluated in isolation. As an instance, shortage of staffing in nursing
ultimately results in a dearth of leadership. In case of improper and ineffective management, new
nursing staff find themselves directionless which then leads to a vacuum of leadership.

In this scenario, the decisions are made with the aim of making sure the best possible and
optimum level of patient care. As far as the leadership role in concerned in the context of
healthcare and nursing, this role may be related to those of mentors, advisors, advocates and role
models (Weiss & Tappen, 2014). When effective leadership works with the management in any
scenario, this blend has the strong potential to guarantee the growth and development of a variety
of professions in general, and particularly the professional of HCA or nursing. One of the great
features of a leader is that he or she always stresses to develop interpersonal relationships
because it is essential to develop a friendly, competitive and result-oriented working atmosphere
in organisations.
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Management Theories

It is the universal fact that the focus of theories associated with management is strongly
on the pivotal role of overall management including supervising, administering, organising and
group performance. Douglas McGregor was the great researcher who developed and proposed
theories including Theory X and Theory Y (cited in Kopelman, Prottas & Davis, 2008). These
two are contrasting theoretical assumptions of management that are all about the human
motivation at work place. According to the Theory X, human beings have the natural
phenomenon that they avoid work, and hence it is necessary to control them through effective
management (Kopelman, Prottas & Davis, 2008). On the other hand, it is assumed by the Theory
Y that their works are treated by humans as natural and play thus the focus of management
should strongly be on exploring the workers’ unrealised potential, expertise and creativity
(Kopelman, Prottas & Davis, 2008). The Theory Y has many followers claiming that if
favourable work environment is provided to the workers, majority of them will ultimately look
for offer the best they have in them at workplace. Put differently, the emphasis of the Theory X
is on the need for control of human behavioural patterns, and emphasis of the Theory Y is on the
need of workers’ own self-direction and responsibility.

It has been suggested that is Theory Y is coupled with effective and strong leadership,
more rewarding will be proven in the context of health care and nursing (Kopelman, Prottas &
Davis, 2008). Further, it has also been argued that effective management and leadership in
nursing was carved out on the principle that every single nursing staff is a leader who uses his or
her wisdom and skills of decision-making with the aim of paving the way for a working
atmosphere dedicated to delivering quality care to all patients (Kopelman, Prottas & Falk, 2010).
This management style is one of the most favourable one for nurses.

Leadership Theories

There is a variety of theories associated with nursing leadership, but the overall focus in
this essay is on only some of them, including transformational leadership, transactional
leadership and situational leadership.

Transformational Leadership
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Transformational leadership is a most favourable leadership style and was presented by

James V. Downton, and this concept of leadership was further developed by James MacGregor
Burns who was the leadership expert and presidential biographer (cited in Bailey & Clegg,
2008). Transformational leadership theory brings positive developments and changes in those
who strongly and effectively pursue it. Leaders with this style are typically dynamic in nature
and they also are energetic, passionate and robust. They have the strong potential to partake in
the process, while supporting all members involved with the aim of achieving successful results
(Bailey & Clegg, 2008). Moreover, transformational leadership style has the potential to merge
ideals of both the leaders and their followers. Focus of this theoretical concept of leadership style
is strongly on uniting both manager and employee working in an organisation, so that they are
able to pursue a greater good and motivates others to exercise leadership (Barker, Sullivan &
Emery, 2006). One of the main features of leaders with this style is that they challenge the status
quo through which creativity among the followers is infused. They let their followers or
employees to identify and adopt new approaches and benefit from learning opportunities.

With the intention of encouraging and maintaining supportive and sociable relationships
with others, leaders with transformational pattern never lose sight of relationship among
followers, while letting them to exchange and communicate innovative and creative ideas. They
are straightforward and hence they never have any worries and uncertainties when they come to
recognise the contributing part of each follower. In fact, their vision is quite clear and they have
the strong capability of expressing it for their followers. Overall, leader with this style serve as
role models through which their followers learn and grow. Another strong feature is that this type
of leaders always develops inspiration and motivation on the part of followers and also the
inclination to trust and respect the leader (Barker, Sullivan & Emery, 2006).

Transactional Leadership

On the other hand, transactional leadership is also a theoretical concept which was first
proposed by Max Weber, a great sociologist (cited in Houghton, 2010). According to this
concept, humans yield the best and desired results when a leader’s goal and target is clearly
defined and communicated (Houghton, 2010). In organisations, workers are more encouraged
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and motivated when they are rewarded, and hence they tend to accept and follow the instructions
given by their leader. It is also suggested by the transactional leadership that followers need to be
monitored closely to maintain their integrity, because when they work with passion and integrity
they will be able to meet the leader’s expectations (Houghton, 2010). This style of leadership in
nursing can be very effective but it is typically taken into consideration as a theoretical concept
through which both the leaders and followers can be impeded from meeting their full potential
(Houghton, 2010).

Situational Leadership

Kenneth Blanchard (2008) developed the situational leadership (or situational

management) theory, according to which there is no "right" style of leadership: a leader must
adopt the style best suited to the situation. The goal of a leader is to progressively increase the
level of maturity of its employees in order to develop their autonomy in the work. Autonomy is
understood here as the crossing of competence (the collaborator knows or does not know how to
do) and the motivation (the collaborator wants or does not want to do) (Blanchard, 2008).
Managers and leaders often need the ideal directivity style. There is, however, no style of
directivity that is suitable for all situations (Farmer, 2005). A good manager tries to adapt his
behaviour according to the circumstances and the various collaborators. It is then a question of
situational management and leadership (Lynch, McCormack & McCance, 2011). It is within this
framework that Kenneth Blanchard developed the model of situational management. This model
is based on the fact that management involves an aspect related to the task and an aspect related
to the relationship (Blanchard, 2008).

Since healthcare providers experience constant development and change, it is vital for
their leaders to motivate their subordinates and management personnel to develop and adopt a
variety of leadership styles so that they manage different situations professionally and effectively
(Jones, 2014). This requires embracing of the approach called the situational leadership style,
where strong and effective leaders adjust their leadership style with eth aim of managing specific
circumstances very professionally. As an instance, top-tier leaders and their subordinate leaders
can adopt task-orientated approach, such as transactional leadership, through which they can
easily handle both the simple and complex situations (Sellgren, Ekvall & Tomson, 2006). Of the
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leaders with situational style, the core competencies are the strong capability of recognising the
workers’ overall performance, competence and dedication, and to be flexible (Blanchard, 2008).

Action Plan to Improve Siu Mei’s Performance

By reviewing and understanding some of the leadership and management theories or

models, it seems that the situational leadership model will be the best for those who manages and
supervises Siu Mei.

Bases on Blanchard’s leadership and management styles, the concerned leaders and
managers need to follow the following four situational leadership and management styles in
different situations (Blanchard, 2008):

Directing

The leader and the manager need to give specific instructions and closely monitors the
completion of the tasks and the services of Siu Mei. They will have to explain, for example, a
variety of steps that constitute a task, how such steps must be crossed and the patient care quality
that must be achieved. During the work, they need to follow Mei’s actions and control the
results. This style is mainly task-oriented.

Coaching

The leader and the manager will have to continue to direct and closely monitor the
completion of the tasks given to Mei, but it also explains the decisions, asks for suggestions and
encourages them at all times. They need to continue to give instructions, but they also pay more
attention to the attitude of Mei. If Mei moves forward, the manager should give her space to
participate in the reflection on the best approach and encourages her to evaluate the work
method. This style is both task-oriented and person-oriented.

Supporting and Motivating

The leader and manager with this style will need to facilitate and support the efforts of
Mei as a HCA in carrying out the patient care task, while sharing with her the responsibility for
the decision-making process. They need also to give instructions. This style is characterised by
the expression of ideas and the stimulation and assistance to the collaborator in the adoption of
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decisions. Asking open questions, asking HCA about her ideas and listening empathically are the
main means used to apply this style of leadership and management. It is a person-oriented style.

Delegate

The leader and the manager will need to transfer responsibility for decision-making and
problem-solving to Mei. They need to delegate a wide range of responsibilities and expects Mei
to put the details to the point. They should expect Mei to find and correct her own mistakes. It
leaves behaviour at risk and innovation to Mei and other nursing staff members. Thus, the leader
and the manager of the Geriatric Ward will need to bring little support. This style is not geared
towards the task and the person.

Conclusion

The leadership and management style adopted by an individual supervising a health care
ward, for example a Geriatric Ward in Mei’s case, should be effective and consistent with her/his
ideals. Individuals can adopt any management and leadership model that fits his/her overall
personality best. Although majority of the health care leaders and management favour and adopt
the transformational leadership model, a situational leadership theory would be highly effective
to successfully make the poor performance of Mei adequate. Due to the flexibility of situational
leadership, people adopting this approach can adopt as a variety of leadership and management
styles as necessary. Nursing staff is faced with a variety of situations on daily basis, and there is
no specific suitable style of management and leadership for all situations. Thus, the ward’s
supervisors as managers need to be quite flexible in their leadership and management styles, and
adapt these to fit various situations.
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References

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Blanchard, K. (2008). Situational Leadership-Adjust your style to suit the development

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Farmer, L. A. (2005). Situational leadership: a model for leading telecommuters. Journal of

nursing management, 13(6), 483-489.

Grohar-Murray, M. E., DiCroce, H. R., & Langan, J. C. (2016). Leadership and management in
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Houghton, J. D. (2010). Does Max Weber's notion of authority still hold in the twenty-first
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Sandström, B., Borglin, G., Nilsson, R., & Willman, A. (2011). Promoting the implementation of
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Sellgren, S., Ekvall, G., & Tomson, G. (2006). Leadership styles in nursing management:
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Weiss, S. A., & Tappen, R. M. (2014). Essentials of nursing leadership and management. FA
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Appendix

The Situation