Leadership especially in the field of nursing has become an important topic today as healthcare researchers place a lot of emphasis in leadership training (Canadian Nursing Association, 2010). Most researchers (Daly, Speedy and Jackson, 2004) views leadership as integral in the creation of new health care systems around the world because it ensures there is proper health care delivery and patient management.
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The changing health care industry and the rapid changes that have taken place in the health care systems have placed a lot of importance in leadership amongst health care providers (Goodwin, 2006).
The changing health care systems have been attributed to the changing social institutions around the world that have been facing transitions since the beginning of industrialization and the introduction of the information technology era (Goodwin, 2006).
Therefore, building up leadership capabilities for nurses is very essential to enable them provide proper healthcare in any situation. This paper is a case study on building up leadership capabilities on nurses working in remote area in North Batinah Region in Oman.
Background of Nursing Management in Oman
The North Batinah Region of Oman which will be our area of focus in this study falls under the Al Batinah Region which is found in the coast of the Gulf of Oman. The area experiences health care shortages in terms of both staff as well as health care facilities to meet the primary health care needs of the citizens in the area.
In the North Batinah Region (NBR), there are ten health care institutions located in remote areas that offer a range of medical services such as dental and general health checkups, pre-natal and post natal healthcare, special care services for people with disabilities and dialysis treatment for kidney failure as well as treatments for various other types of illnesses (Alghemini, 2008).
These healthcare services are mostly offered by nurses and other health workers within the institution which means that nurses have the most work when it comes to health care service delivery in this region. Accessing these medical facilities and institutions is however a challenge for most residents in this area because the nature of this area is characterised by rough terrain and dry weather.
This, combined with the shortage in health care workers has made it difficult for nurses in NBR health care institutions to perform their duties effectively and efficiently. The role of most nurses within the health care institutions is to address the immediate health care concerns and issues presented by the patients.
Because of the infrequent visits made by physicians and specialist doctors, the nurses have to make the official decision on how the patient will be treated based on whether they have been able to diagnose their condition.
Besides, because of the constrained shortage in specialist doctors visiting this region, nurses have added responsibilities and duties of making the right diagnosis at the right time in order to save time. This makes it paramount for nurses to have essential skills in leadership and management in order to empower them to effectively perform these critical roles.
It is from this background that this study aims to explore and discuss the various leadership theories and concepts that can be effectively applied in this context in order to empower nurses working in NBR regions with necessary leadership skills that will enable them overcome their present limitations as far as leadership and management of cases is concerned.
More specifically this study intends to design and develop an education program that can be used for that purpose in NBR by reviewing similar case studies and literature review of theories that have been proven to be effective in imparting leadership skills among nursing professionals. This education program is primarily aimed at enabling nurses to become better medical decision makers when treating patients.
The idea is to create a leadership capability program which will train nurses on how they can take up leadership roles within their health care institutions in NBR. The program will basically be a leadership supported program where the nurses will be assigned to nurse leaders who are based in some of the major hospitals in the Al Batinah region to ensure they have been properly equipped with leadership abilities and skills.
The leadership and capability program will contain courses on leadership and management, leadership enhancement within the health care facility, succession plans within the work environment and more specifically leadership roles within the nursing profession.
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Indeed according to Curtis, Sheerin and Varies 2011, “leadership can be developed through specific educational activities and by modelling and practicing leadership competencies” (347).
Justification for leadership capability program for nurses in NBR
Nurses have been viewed to be in a position to influence healthcare systems, policies, legislation and delivery of health services while at the same time observing the nursing code (NMC, 2008).
Leadership therefore becomes important in exerting the necessary influence to effect such changes within the healthcare systems. Nurse training mostly focuses on how to provide adequate health care to patients seeking medical assistance and also how to operate medical technology.
These programs offer very limited training on leadership as the different levels of training for nurses mostly focus on administrative procedures and handling medical equipment instead of how to use their positions as nurses for leadership purposes.
Staff nurses who work for ten hour shifts in a day have the power and the influence to make changes in their work environment because of the various medical and administrative situations they are exposed to every day of the week (Valentine, 2010; (Swansburg, 2006).
For example, in most of the health care institutions in the North Batinah Region they have the power to decide when to call in a physician, choose medical interventions for the patient or decide on which medical plan is appropriate for treating the patient. Such level of responsibility indicates that nurses in NBR can greatly benefit from a leadership program and in the process drastically improve healthcare delivery in this region.
Allowing them some autonomy in making healthcare decisions will mean laying a foundation for leadership in nursing; such a nursing leadership capabilities can be built by evaluating their nursing decisions based on patient outcome assessment Building leadership capabilities for nurses is important as it helps them to take effective action and make fast decisions when it comes to health care delivery and patient management as we shall see in later section of this paper (Swansburg, 2006).
Consequently, Hendricks, Cope and Harris (2010) note that it is important to build leadership capabilities in nurses as it helps them to act autonomously within the clinical setting as well as make important decisions at the point of patient service. Building leadership capabilities in nursing is also important because it helps them to develop their professional careers to meet with the goals and objectives of the health care facility.
Apart from being effective leaders, nurses who have been equipped with leadership capabilities can be able to act as advocates for patients and other nurses within the work environment.
Finally, nursing advocacy in health care institutions is an important aspect of leadership as it reduces the internal and external work pressures in especially for new nurses and other health workers (Swansburg 2006). This justifies the decision to build leadership capabilities for nurses working in remote areas similar to NBR.
The concept for leadership capability program for nurses in NBR
The need for a leadership capability program for nurses working in NBR was based on an assessment conducted by the Nursing Association in Oman on the need to train nurses on nursing leadership within these health care institutions, the program was scheduled to start in January 2010.
The management of the Oman Nursing Association were the main decision making authority on how the leadership development activities would be conducted during the leadership capability program. The building up leadership capability program will involve attaching senior nurses to work with nurse leaders for a period of three months.
Through introducing leadership theories as well concept of nursing management to nurses working in remote area will enable them to manage health institutions based on theoretical manner and critical analysis of situations.
In this section, this paper will discuss the theoretical framework from which a leadership educational program can be designed that is case specific for nurses in NBR that is based on the unique nature of health facilities in this region.
Because of the nursing shortage that exists in the North Batinah Region as well as the lack of doctors and physicians to offer leadership guidance on how to treat patients, the leadership capability program will be an important instrument in addressing these gaps in many of the hospitals and clinics that exist in the area.
The use of nurse leaders drawn from the Nursing Association of Oman will ensure that the nurses placed under the program are properly trained on how they can be able to apply leadership skills in the performance of their work duties.
The leadership capability program will focus on leadership and management within the health care environment and how nurses can be effective leaders while carrying out the duties that come with their profession. While the program is focused on equipping the nurses with important leadership skills, it does not take away from their original roles which are those of caregivers.
Leading in healthcare involves incorporating leadership activities in nursing and healthcare activities to improve the current healthcare systems to better states. Leadership in nursing involves equipping nurses with the necessary skills and knowledge that will enable them to participate in decision making processes related to patient care and patient safety.
Leadership in healthcare places a lot of emphasis on nurses to acquire leadership skills that will be used in developing their careers.
This is because leading in healthcare requires nurses to seize opportunities that will enable them become leaders as well as influencing their peers towards change. Leadership in healthcare also requires nurses to provide support services especially to new nurses and other health care workers within the healthcare facility.
It also requires accountability and the application of the nursing code of ethics during the performance of work activities and duties (Canadian Nursing Association, 201).
As nurse training and experience becomes more important in the health industry, healthcare researchers have developed leadership theories that can be used to improve the leadership capabilities of these professionals (Laurent 2000).
Generally, there are three main theories that have been postulated to apply in developing nursing leadership; these dynamic leadership, quantum leadership and transformational leadership (Laurent, 2000).
Quantum leadership theory
Quantum leadership theory is a concept that is derived from quantum physics; it deals with helping nurses or other healthcare professionals to make important medical decisions without the help of physicians or medical doctors (Curtin, 2011).
According to Curtin, “The quantum paradigm basically emphasizes relationships and integration; it is holistic rather than particulate”; it does this by looking at system units as separate entities that are essentially interconnected (Curtin, 2011).
In building leadership skills among nurses, quantum leadership theory is most suitable as it will enable the nurses to function autonomously within the context of a health institution which in this case is regarded as the system.
The essential features of quantum leadership are generally applicable to nursing professionals especially for this case since quantum leaders are characterized by the need to build relationship, are innovative, able to work effectively and independently within a team work and are passionate about functioning as change agents in their work environments.
In fact, quantum leadership according to Curtin (2011) is imperative as it “demonstrates that the only meaningful change comes from the bottom up” (36).
Additionally, Valadez and Sportsman (1999) has identified three critical components of quantum leadership theories that set it apart; these are “(1) the world is unpredictable; (2) the intent of the observer influences how the world is seen; and (3) interrelationships are what count, not the things themselves” (209).
All these characteristics and principles are essential for nurses working in NBR and would comprise valuable knowledge when incorporated in the proposed leadership program that targets this group of nurses.
In summary quantum leadership theory has been identified by various research studies as important in enabling nurses to overcome traditional management shortcomings and in coping within an ever evolving complex healthcare delivery system similar to those experienced by nurses in NBR
This is because quantum leadership will enable nurses for instance to make informed decisions such as on the appropriate time to call in a medical physician when it comes to the treatment of the patient. It will also help nurses to weigh the pros and cons of the different medical interventions available in treating patients under great time and resource constraints.
The quantum theory therefore equips nurses with self direction and self reliance skills that enable them function effectively within a larger team work (Hastings, 2002).
Indeed, considering the working environment for nurses in North Batinah region, notably because of the rare appearances that physicians make in many of the health facilities within the area, quantum leadership incorporates valuable skills that are essential for nurses to gain in this context.
This is because nurses will benefit from leadership skills that will enable them make important medical decisions in the absence of doctors and other specialist physicians (Hastings, 2002).
This is the type of leadership where a leader identifies the processes that are in need of change after which they develop a vision that will be used to guide the change processes.
The transformational leadership theory is usually used in motivating the nurses to develop their own leadership criteria as well as their self reliance skills and is meant to initiate changes within the health care industry by encouraging nurses and other healthcare workers to provide feedback to one another.
Transformational leadership style entails people management through innovative ways that are aimed at transforming how employee perceives job responsibilities within the organization (Babou, 2008).
Thus, in transformational leadership the focus is on inspiring employees beyond their present levels to a selfless level and is a leadership characterized by inspirational type of leaders and increased levels of motivation among employees (Babou, 2008).
Transformational leadership will thus empower nurses to evaluate the healthcare systems that are in place within their facilities after which they are allowed to take part in implementing new policies to improve service delivery (Marshall and Coughlin, 2010).
Transformational leadership is described by Flesner, Scott-Cawiezell and Rantz (2005) as the ability of a nurse leader to “transform the environment and the culture of a health care organization” in a successful manner that enables the nurse to “to see, act on, and satisfy followers’ values and motivations in addition to his or her own” (pg 38); this is in fact the main essence of transformational leadership as it relates to the nursing profession.
In concept, transformational leadership is a model that is largely founded on the educational background that nurses are imparted with during the four year duration baccalaureate degree which is described as the main component of transformational nurse leaders.
This is because a strong educational background provides one with skills such as communication, critical thinking, scientific thinking, assessment as well as the ability to be culturally sensitive (Flesner et al, 2005). According to Welford, (2002); “using transformational leadership means accepting that things will change from day-to-day basis and that various capabilities will be required” (pg 9).
Daly, Speedy and Jackson (2004) also asserts that the nurses are also expected to explore strategic thinking in management so as to provide a basis for critical decision making within the health care environment and also to respond to any health care issue that might arise in the course of performing nursing activities.
However, the key features of transformational leaders include the ability to cultivate interpersonal skills based on mutual respect, team building skills, change management and leadership through continuous education and training since most nurses’ works within a team environment (Flesner et al, 2005).
There is no doubt that these same characteristics resonates well with the need for having a leadership education program for nurses in NBR and will facilitate the necessary transition needed to make this nurses to acquire transformational leadership skills besides quantum leadership skills.
The transformational leadership theory for instance will be beneficial in providing nurses with necessary skills which they can use to deal with the healthcare needs and challenges of their patient.
This is because transformational leaders are equipped with change management and critical thinking skills that in this case will enable nurse leaders to manage change through proven approaches; and because transformational nurse leader is motivated to continuously gain new advanced knowledge in their field of work, they are better positioned to provide better care to their patients.
More importantly, transformational nurse leaders are overall more resourceful and more able to customize solutions to fit the unique challenges facing them; this will be an invaluable skill for nurses working in NBR.
Thus, the use of transformational leadership within the program will equip nurses with these and other skills as discussed above which they can use to develop and implement policies within the healthcare institutions in the North Batinah Region.
Transformational leadership will also be beneficial to this nursing program as the nurses will be taught on how they can effectively manage a medical facility without the help of any doctors, administrative officers or senior managers since they are continuously trained in current knowledge, are creative critical leaders competent in managing situations as they arise both administratively or for purposes of treating patients.
This is even more evident when you consider that transformational leadership involves developing the leadership capacity of an entire team within the work environment by invoking the use of motivation and inspiration to achieve the desired results. For these reasons transformational leaders often turns out to be persons who are charismatic, inspirational, motivational and visionary (Welford, 2002).
Indeed, current literature indicates that nurses have been able to demonstrate and promote transformational leadership within the context of healthcare facilities mainly because of the general training that nurses receive in college.
Nurses are also trained on how to intellectually stimulate themselves and their peers as they perform their professional duties; they are also trained on how to be considerate and humble when treating their patients (Marshall and Coughlin 2010). These qualities are consistent with transformational leadership and further assert that nurses are essentially imparted transformational leadership skills from an early onset.
Thus, this training should incorporate the various aspects of transformational leadership as we have discussed especially the essential transformational skills which empower the nurse leader to manage various challenges at health facilities towards improving healthcare.
In general therefore the education program should seek to include modules that will train the North Batinah nurses on how they can influence their colleagues within the health institution so that there is effective change within their work environment.
Leadership today plays an integral role in nursing as it equips nurses with decision making tools that are vital in assessing the healthcare of patients. The leadership education program proposed will enable nurses to learn practical frameworks which they can use to create and sustain superior health care delivery in the clinics and hospitals where they work.
The leadership frameworks taught will provide useful techniques that can be used in the effective and efficient delivery of healthcare services to the residents of North Batinah Region. The leadership capability program will also equip the nurses with important tools which they can use to improve the general performance of their work duties.
This is because leadership in nursing has continued to gain more prominence over time as more and more nursing programs incorporate leadership skills and theories into their curriculum.
The outcome of the leadership program will empower nurses in NBR to engage in active decision making which is directly related to the health care of patients and will allow them to develop important policies and procedures which they can use in managing health care situations within the work place.
Additionally, the acquired leadership skills will allow nurses to engage in systematic planning of activities within the health care institutions as well as facilitate the implementation of change in health care services. Providing nurses with leadership skills ensures that they are able to manage activities within the healthcare facility in an efficient and effective way.
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