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Discusses leadership and management principles.... More...
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Paper Abstract:
Discusses leadership and management principles. Importance of nursing perspective. Three critical issues: health care delivery system, organizational change and transition, quality improvement/risk management. Focuses on key role nursing plays. Reviews studies of nursing leadership; empowering nurses, new roles. Application to clinical practice.
Paper Introduction:
Nursing: Leadership and Management Principles
Introduction
Huber (2000) has noted that the U.S. health care system is a network of subsystems characterized by complexity and fragmentation. The application of leadership and management principles, theories, and concepts from the nursing perspective is critical in the context of health care delivery systems, organizational change and transition, and quality improvement/risk management. This brief study will explore these three critical issues. The argument will be advanced that nursing plays a key role in ensuring a high quality of health care services in an environment characterized by funding and other resource constraints, rapid technological advances, and a new focus on patient rights.
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Similarly, Kerfoot (1998)suggests that the traditional "command and control" style of leadership innursing is no longer appropriate. Nurses are being challenged tobecome leaders in holding institutions and their staff accountable forclinical, quality, and risk issues and also in identifying opportunities toimprove the quality of patient care that is rendered by the institution. In allaspects of institutional management and delivery system oversight, theroles played by nurses have expanded dramatically. Huber (2 ) argues that the role of nursing is facilitative. Nurseleaders must apply the nursing process to staff interactions as well as topatient care. Nursing Administration Quarterly, 25(3), 1-4+. By enhancing the roles of nurses in the clinical setting andsimultaneously creating a position of chief nursing officer, Pinkerton(1999) believes that the continuum of care can be significantly improved.New integrated delivery systems require an integration of the goals of theprofessional discipline of nursing with the mission and goals of theinstitution. Theapplication of leadership and management principles, theories, and conceptsfrom the nursing perspective is critical in the context of health caredelivery systems, organizational change and transition, and qualityimprovement/risk management. The role of nursingleadership in creating caring environments in health care delivery systems. health care system is a networkof subsystems characterized by complexity and fragmentation. Kerfoot, K. In practice settings, specifically in quality improvement teams,nurses have a unique opportunity to identify the specific knowledge andskills that are needed to reduce quality deficits and to enhance nursingsatisfaction with their roles (Calomeni, et al, 1999). Huber (2 ) believes that aneffective response to change involves the elimination of resistance and thecreation of a positive attitude towards change. Calomeni, C.A., Solberg, L.I., & Conn, S.A. The ability to change patterns of organization,budget, staffing, and other personnel policies in the process of planningfor appropriate quality and quantity of patient care is the hallmark of anexemplary nursing leader. This brief study will explore these threecritical issues. (1999). (1996). Huber, D. Leadership and Nursing Care Management.Philadelphia: W.B. Integrated delivery systems: The chiefnursing officer. By directly involving nurses in all of the qualityimprovement activities undertaken in an institutional setting, Calomeni, etal (1999), assert that major strides can be achieved. Clinically, nurses control manyimplementation decisions and are the organizers of quality driven service.Summary and Conclusions In the new health care environment, nursing leadership has becomeincreasingly important. Integrated health care delivery systems must adaptrapidly to changes in the external and internal environment (Pinkerton,1999), while changes in the workforce itself mandate new leadership rolesfor nurses (Brown, 2 2). Preventive servicesand patient education are areas in which nurses are ideally suited to workproactively to improve quality outcomes. (2 ). For nursing today, leading changeconsists of empowering nurses and other professionals to functioncreatively and to adopt a proactive attitude toward innovation. At the same time, a new level of creativity isneeded in the nursing arena to ensure that change will be managedeffectively, quality improved, and risk reduced. Nursing involvement in quality improvement and risk management isseen by Hardy and Wilson (1996) as based upon a working collaborationbetween medical and nursing management. Leading change is leading creativity.Pediatric Nursing, 24(2), 18 -182. Nursing: Leadership and Management PrinciplesIntroduction Huber (2 ) has noted that the U.S. The intent of such an integration is viewed by Pinkerton(1999) as maximizing the quality of patient care, enhancing theprofessional satisfaction of nurses, and improving long-range strategicplanning for the organization as a whole. Huber (2 ) claims that the American health care system tendsto lack central planning, direction, and control. Huber (2 ), indiscussing this issue, maintains that quality is freedom from defects plusvalue and meeting customer expectations. Hardy, V.S., & Wilson, L.A. Saunders Company. The changing workforce. Brown, B.J. The literature supports the belief that new roles for nurses areemerging (Huber, 2 ). Nurses represent key elements inensuring that standards of care and standards of professional performanceare maintained and exceeded in the delivery of services. A CNO would beresponsible for integrating the goals of the professional discipline ofnursing with the mission and goals of the integrated delivery system. Journal of Nursing Care Quality, 11(1), 1-2. Qualityimprovement was seen by these researchers as an important role undertakenby clinical nurses, who are the front line service providers in health careinstitutions. Pinkerton, S.E. Brown (2 2) believes that in most situations, change can be plannedfor and guided by leaders. Partnering for action orientedrisk/quality management. (1999). Quality improvements and risk management are acritical focus of all nursing activities and represent the locus for newpartnerships between nurses and other new actors in the new delivery system(Hardy & Wilson, 1996).Application to Clinical Practice In the clinical setting, Kerfoot (1998) believes that a newBusiness model of health care delivery has been developed that emphasizesefficiency and results. This brief report has identified some of the key principles andpractices related to health care delivery systems, the management ofchange, and the role of nurses in quality improvement and risk management.In sum, at both the clinical and administrative levels, there are manyopportunities for nurse leaders to bring the perspective of nursing toorganizational efforts (Boykin & Schoenhofer, 2 1). Journal of Nursing CareQuality, 13(5), 75-98+. Integralto this process is the management of change and the recognition that changeis endemic in the profession (Brown, 2 2). (2 2). Nursing AdministrationQuarterly, 26(2), 2. Nurses onquality improvement teams: How do they benefit? The argument will be advanced that nursing plays a keyrole in ensuring a high quality of health care services in an environmentcharacterized by funding and other resource constraints, rapidtechnological advances, and a new focus on patient rights.Review of Literature Huber (2 ) contends that nursing leadership in the health caredelivery system is an essential element in responding to ongoing needs aswell as situational crises. Brown (2 2) agrees with Huber (2 ) in thatcongruence of values in trust-building can be enhanced through strongeducational support to advance the clinical expertise of every nurse. Establishing a CNO wouldassist in achieving greater integration. Nursing Economics, 17(4), 219-222+. Inother words, nurses as leaders are likely to take a key role in qualityimprovement because of their presence with the client and their consistentrole as monitors of patient outcomes. Huber (2 ) alsopoints out that managed care, coupled with growing nursing shortages, arechallenging nurse administrators and leaders to adopt new roles and newattitudes that will move the health care delivery system forward. According to Boykin and Schoenhofer (2 1),nurse administrators play a key role in articulating the uniqueness ofnursing in today's complex, corporatized health care delivery system.Nurse administrators whose viewpoint is grounded in the concept of caringas articulated by Leininger are seen by Boykin and Schoenhofer (2 1) asmost likely to assist their colleagues, organizations, and patients inmaximizing outcomes and resource distributions. Calomeni, Solberg, and Conn (1999) explored via a randomizedcontrolled trial, the effect on clinic nurses in the roles of team leaders,of new continuous quality improvement (CQI) initiatives. Boykin and Schoenhofer (2 1) believe that nurseadministrators should take a lead role in articulating a clear nursingviewpoint that emphasizes care as the central function of nursing. As Brown (2 2) contends,nurse executives are the key touch points in managing the inevitablechanges in the workforce that occur in all health care settings. Given that many contemporary health care delivery systems are movingtoward integration of delivery systems to realize economies of scope andscale, Pinkerton (1999) argues that such institutions would be well advisedto create the position of Chief Nursing Officer (CNO). This necessitates an action-oriented risk and qualitymanagement strategy (Hardy & Wilson, 1996). A second issue of significance revolves around the roles of nursesin organizational change and transition. (1998). References Boykin, A., & Schoenhofer, S. (2 1). Theintent of this integration is to maximize the quality of patient care, theprofessional satisfaction of nurses, to meet the cost-effectiveness goalsof the integrated delivery system and to perform long-range strategicplanning.
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