Leadership and management issues are of critical importance to the discipline of nursing. Some of the areas that leadership and management incorporate are finances, business focus, information management, and marketing (Baker, 2000a; Kelly-Hayes, 2003). From the point of view of nursing being a business, a medical mistake can be an example of poor management in that protocols were not in place to ensure that an incident did not occur (e.g., having checklists available so that the nurse could be sure she had followed all necessary procedures). In regards to marketing, the hospital as well as the nurse has provisioned the patient and family with an image of being incompetent and neglectful in their care for the patient.
Recent studies point to a distinct lack of leadership qualities amongst nurses in general, and attribute this to a lack of training in the area (Laukkanen, 2005). Unfortunately, this is a waste of resources as nurses are in key position to influence hospital care policies, as well as state and national legislation (Sullivan, 2001). It is contended that student nurses need to be encouraged to develop their leadership and managerial skills, as well as their clinical skills (Baker, 200b). For example, a more salient awareness of cost-containment issues could have motivated the hospital to have set protocols for the bed-care of elderly patients (Antrobus, 1999). Additionally, the use of job re-design amongst the nursing staff could have provided the hospital with a critical evaluation of the sequential tasks of each job a nurse undertakes, and provided solutions for combining tasks to improve patient care (e.g., saying goodnight/see you later to a patient also includes the action of the hands checking the bed-rail is up) (Sullivan, 2001).
Quality management is important to nursing as it allows for an evaluation of the outcomes of practices. In turn, this style of management provides for a preventative approach to nursing that identifies potential problems quickly, and facilitates research into viable alternative solutions (Belcher, 2000; Hendel & Steinmann, 2002). As such, the hospital working environment should be one that facilitates the nurse to carry out good practice. This requires support from more senior nurses to ensure that student nurses have been briefed and assessed on their understanding and practical demonstration of knowledge of known potential problems (Hendel & Steinmann, 2002), in this case, a patient falling from the bed due to rails not being in an position. However, nursing management that is over-controlling does not contribute to the nurse developing self-directed learning and concrete understanding of why protocols are undertaken as they are (Kelly-Hayes, 2003).
This study will evaluate the perceptions of nurses as to leadership and management practices in their department across staff levels to determine where gaps exist. Using a mixed-method design this study will ask a sample of 42 nurses from a local hospital to complete a mail-out survey, take part in a focus group, and perhaps be selected for a semi-structured interview. Descriptive and paramatretic tests will be used to analyze the data including. It is hypothesized that nurses perceptions will be dependent on their level within the management hierarchy, so that senior management are more likely to be satisfied with current leadership and management practices as compared to staffs that they supervise. It is anticipated that this study will contribute to knowledge and understanding of the critical relationship between nurses responsible for overall leadership and management, and the nurses that they supervise who are learning to acquire such skills.
A survey will be developed specifically for this study. The questionnaire will consist of 127-point Likert scale items to measure the perceptions of nurses about leadership and management practices in their department (1 = strongly disagree to 7 = strongly agree). Current literature and scale will be critically reviewed to determine the best wording of items. At least four of the items will be reversed scored to constrain a ‘halo’ effect when participants answer (i.e., checking the same response for each item), to slow respondents down in their answering to aid in more accurate measurements, and to increase the likelihood of honest responses. The items are anticipated to measure two dimensions; leadership and management. During analysis a factor analysis of the pilot test will be done to determine if questions worded to measure each construct do load onto each dimension. Further, analysis following a pilot test will also evaluate the internal consistency of the survey using Cronbach’s alpha. The scoring of the survey will be easy to do, adding across the scales to give sub-totals for ‘leadership’ and ‘management’ and an overall total score. Scores will range from 12-84, higher scores indicating positive perceptions of current leadership and management practices. Demographic items (e.g., age, gender, staff level, time of tenure) will also be included to provide control variables and IVs. These variables will enable Pearson’s product moment correlations between two variables, such as leadership and management sub-scores across age or staff level.
Clinical governance is the way in which an organization ensures the quality of care service that they provide to patients, by way of making the individual employees accountable for determining, maintaining and evaluating standards of performance (Henderson, 2002). To enable a high standard of clinical governance it is necessary that adequate and efficient leadership and management practices exist. Medical organizations accept accountability to continuously enhance their quality of care provision, and take action to safeguard these standards by developing a work environment which excels. This research study will contribute tot the continuous monitoring and development of leadership and management practices within the hospital. The study will achieve this goal using a standardized measure that has been tailored to the hospital and department to be used in the study. As such, the measure will be able to be used as a longitudinal measure across time.
References
Antrobus, S. (1999) Nursing Leadership: influencing and shaping Health Policy & Nursing Practice, in Journal of Advanced Nursing, 43(1):19-27.
Baker, C. M. (2000a) Problem-based learning for nursing: Integrating lessons from other disciplines with nursing experiences. Journal of Professional Nursing, 16(5): 258-266.
Belcher, J. V. (2000) Improving managers’ critical thinking skills: student-generated case studies. Journal of Nursing Administration, 30(7): 351-353.
Hendel, T. & Steinmann, M. (2002) Graduate students learn effective management. Journal of Nurses Staff Development, 18(4): 203-209.
Henderson, E. (2002) Managing quality in services: Part 2. Nursing Management, 9(8): 30-33.
Kelly-Hayes, P. (2003) Nursing Leadership & Management. Thomson Delmar Learning.
Laukkanen C. (2005) Leadership in health care–orchestrating change. Cancer Operating Room
Nursing Journal, 23(2): 37-38.
Sullivan, D. J. (2001) Effective Leadership and Management in Nursing, 5th Ed. Prentice Hall.