Effective Approaches in Leadership and Management of Nursing

Nurses are crucial in providing quality care in the health care industry. It is imperative to maintain the proper staffing ratio to ensure that nurses can maintain high quality care for their patients. Studies have shown that the increasing workload of nurses can be linked to increased patient deaths, medical errors, hospital-acquired infections, longer hospital stays, and many other complications. (National Nurses United n.d. ) Leaders and managers play a vital role in developing staffing and scheduling for their units. This paper will explore nurse staffing ratios, the approaches to this issue from the management and leadership styles and the author’s personal philosophy regarding the role of a leader and manager.

“Safe Staffing Saves Lives”

-American Nurses Association (ANA)

Nurse staffing ratios is a growing concern that is seen by nurses everywhere, and studies have shown it is a problem. Hospitals that have insufficient staffing ratios have poorer patient outcomes, increased patients deaths, nurse burnout, higher turnovers, dissatisfaction among employees and their patients.

(American Nurses Association 2013) This has led to new laws and regulations that require adequate staffing that is based on the acuity of the patients. Nurse staffing is measured two different ways; hours spent on each patient daily and how many patients per nurse. The hours spent on patient care covers registered nurses, licensed practicing nurses, and nurse aides. Increasing staffing ratios is not an easy task and according to the Agency for Healthcare Research and Quality (2004), can be due to a higher level of acuity patients being seen and a gap that is nationwide in the positions available and the number of qualified applicants who are able or willing to fill them.

Hospitals have both leaders and managers to ensure that their facility runs properly and efficiently. Both managers and leaders help implement strategies and policies regarding staffing. They present these plans to administrators for approval. During this time, administrators are able to review these plans according to a variety of factors that include; patient acuity/volume, nursing skill mix and experience, and regulatory standards. (Rich, V. 2009) According to Carter (2004), leaders and managers are under extreme pressure to be able to balance improving the quality of care while keeping costs down, handle staffing yet control labor expenses and do this while maintaining high quality care. This can be a difficult task for those who are in management and leadership roles.

“Effective leadership is putting first things first. Effective management is discipline, carrying it out” —Stephen Covey

In order, for an organization to be successful they must have leaders and managers who are skilled and competent. There are many who may view leaders and managers as one in the same. However, there are managers who are not leaders and leaders who are not managers. Managers are in roles of authority that was given to them. They have expectations and responsibilities that require them to carry out specific duties and roles. They often coordinate both financial and personnel resources, enforce rules and policies, and meet the goals and objectives of the organization. They are responsible in rewarding and disciplining employees. (Anderson 2012) A leader however, does not necessarily have an assigned role of authority.

They may have acquired authority or power informally from others around them. Leaders can have a vision and are able to help guide people to that vision. Leaders focus on, “empowering others, as well as motivating, inspiring, and influencing others” (Anderson 2012). They have great communication skills, take the blame for mistakes, and are seen as genuine. They are able to get people to follow them by motivating them and being a positive role model.

“The key to successful leadership today is influence, not authority”

—Kenneth Blanchard

A leader can help the staffing ratio issue by creating a vision. With this vision, they are able to create a plan that incorporates new ideas to find solutions. Leaders are risk takers and like to challenge others to formulate ways of doing things better. Leaders like to build relationships and promote those around them and help them develop so they as well as the company can grow. (Coonan 2007) Since leaders are not always in manager roles, they often are the ones who are working at the bedside and can help staffing ratios because they can base them on the individual needs while taking into account the training and experience of the nurse taking care of those patients. They are trying to look out for the best solution for everyone involved. Leaders act as guides to those around them rather than try and control others. Leaders are the ones who stand up for others. These kinds of leaders are able to inspire and motivate people to achieve solutions to problems.

“Management manages by making decisions and by seeing that those decisions are implemented.” – Harold S. Geneen

A manager’s approach to the staffing ratio problem is by using numbers and facts. They use this information to balance and allocate budgets. However, they may not take into account how it may affect others. A manager is usually the one who will follow policies already in place. They will do what is necessary to get the job done without much thought or risk taking. (Coonan 2007) A manager has to achieve goals set for them by the organization through planning, organizing, directing, controlling and staffing.

A manager will implement the goal or plan by, “making sure that regulations and policies are followed and that employees perform as expected and that the company operates within its annual budget” (Lincoln, n.d.). A manager is held accountable for themselves, those who work for them, and for their unit. Since they are in a role that was given to them, they also have expectations that need to be met. They have to be productive and effective through managing the complexities of the organization. To meet these expectations, they may only focus on the “bottom line” versus those who may be affected.

“Management is efficiency in climbing the ladder of success; leadership determines whether the ladder is leaning against the right wall.” — Stephen R. Covey

This author philosophy is that a good manager is one who can lead, and a good leader is one who can manage. Due to the complexities of the healthcare industry, a manager needs to have the skills and qualities of a leader. When dealing with people’s lives, the focus cannot be about the bottom dollar. Being able to find and create solutions to these complex issues is crucial. Doing this efficiently without sacrificing the safety and well being of the staff and patients can only be done by someone who has the qualities of both a leader and manager.

There is no one size fits all solution to everything; any patient or situation can change suddenly. The healthcare field needs a manager who can lead others and maintain control in difficult situations. This is important when trying to find solutions to problems. Creating goals and working to achieve those goals is vital. Manager/leaders can help others maintain their commitment and further develop their organizations. Being able to balance both these roles is the most ideal approach to solving the complex issues that arise in the healthcare field.

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