Introduction
The modeling and role-modeling (MRM) theory provides a broad theoretical perspective on nursing care and suggests that nurses should employ individual approaches to patients by recognizing their needs and addressing those needs effectively (“Modeling and role-modeling theory,” 2015). Also, the theory addresses the concepts of leadership and suggests that successful nurse leaders should build trust in their followers and comply with a number of principles that promote the professional development of the followers.
A unit supervisor in Facility A has been chosen to address the issues of leadership, modeling, and role-modeling. To analyze her leadership characteristics, it is necessary to describe the facility, assess strong and deficient leadership features, examine the change she has brought to the facility, explore the ways in which she contributes to the professional development of her followers, and evaluate her from the perspective of MRM concepts and applications.
Clinical Setting and Role of the Nurse Leader
Setting Description
The clinical setting that will be addressed is Facility A, an in-patient and transitional facility that provides health care services to people with mental illness. The facility’s location is characterized by favorable climatic conditions. The hospital is divided into seven units for different patients; normally, approximately one hundred people can be accepted, and services are provided round-the-clock. A major division of patients is into two groups: those incapable of functioning in the society safely due to their mental health problems and those who were prosecuted but claimed not guilty due to mental illness; the care that the latter group receives qualifies as preparation for competency.
Health care services are designed as an individual treatment aimed at attaining and maintaining mental stability in patients and developing skills in them that are necessary to function properly in a group home setting. The medical components are present in most treatment cases; however, interactions with patients are recognized as the most important part of care delivery, and some types of interactions are part of nursing work. Additional services include assistance with activities of daily living (ADL), lab coordination, and medication administration.
The working hours are divided into three shifts: early, late, and overnight. The number and qualifications of employees present in the workplace during different shifts are different. During the early shift, there are the hospital administrator, the nursing administrator, a medical provider, a psychiatric provider, the unit supervisor, a pharmacist, a social worker, a psychologist, dental clinic staff, a phlebotomist, RN/LPN,HST/CNA, the maintenance crew, a nutritionist, house-keeping staff, rehab staff, and security officers.
During the late shift, units in the facility are overseen by the administrative officer of the day (AOD); one RN acts as the charge nurse in each unit, and RN/LPN provides nursing care such as medication delivery and communicating with patients concerning their needs and treatment plans. CAN/HST meets with patients, too, to assist in the latter’s ADL and to promote engagement in group activities.
The nutritionist serves dinner and snacks to units, and there is a front desk secretary who receives phone calls and communicates with visitors. During the overnight shifts, each unit only has three employees headed by the AOD; two security officers and the front desk secretary are present in their workplaces, too. Out of the three employees in each unit, two are LPN, and one is HST. The staffing plan may display variations in case there is a need for special observation; these situations mostly occur in the intensive care area. During the late and overnight shifts, no physicians are present in the hospital; however, on-call doctors and pharmacists are available.
The experience of working in the facility has demonstrated that proper leadership practices are crucial for the success of providing high-quality nursing care. Nurses work in teams and cooperate with other members of the staff, which is why it is necessary that their work is appropriately coordinated by someone who can accept the responsibility for the team and assume leading functions.
However, it is also important that, apart from officially holding an administrative position and performing supervisory functions listed in their job description, leaders display characteristics that allow other members of the nursing team to follow him or her, respect his or her decisions, trust the leader, and be willing to collaborate in the context of leadership. In other words, besides complying with the duties of a supervisor, a leader should also display certain informal influence on followers and gain their willingness to follow. Good leaders facilitate the development of their followers and nurture them. For me, such a leader is my unit supervisor Angela. Her position in the hospital is both a formal and informal leadership position.
Role and Responsibilities of the Nurse Leader
Angela reports to the hospital administrator, and her role generally is to oversee the work of nurses in her unit, compose teams, and provide proper staffing. Angela’s duties and responsibilities primarily include ensuring that the nurses are well-familiarized with all current nursing policies and procedures and ensuring that there is a sufficient number of nurses who are properly trained according to the annual schedule and whose contribution to the overall quality of care in the hospital is adequate.
Also, she cooperates with other leaders, including managers, physicians, and administrators, in order to improve the facility’s overall decision-making. Monitoring and evaluating the nurses’ work, including the provision of feedback to nurses and the composition of reports for the administration on the quality of care and patient satisfaction, are among Angela’s responsibilities, too. Further, she is responsible for improving the workflow of nursing care, for which purpose she may engage in collaboration with other departments, such as the laboratory or the pharmacy.
An important element of Angela’s role is that she participates in the hiring process at different stages of it; particularly, she attends job interviews and provides coaching to new employees to facilitate their professional development and adaptation to the facility.
Leadership Characteristics
Observed Characteristics
Before starting to work in my current unit, I worked in a different one, and upon the transition, the contrast was impressive; I had a chance to actually observe good leadership practices in my new unit supervisor, Angela. Two leadership characteristics can be particularly noted. First of all, Angela empowers her staff, i.e., she affirms and promotes strength in nurses working in her teams. This is especially manifested in the way she encourages and praises positive behaviors; whatever a nurse in our unit does right, Angela will not fail to notice it and provide positive feedback. My experience shows that this practice is highly motivating.
In this regard, the attitude my unit supervisor has toward negative behaviors, mistakes, and poor performance is also remarkable. Rather than weaknesses, she regards them as opportunities for growth, and instead of reprimanding, she educates. In this, I see Angela’s deep understanding of the difference between evaluation and feedback. Evaluation is summative, i.e., it is scoring a person’s performance based on certain criteria and standards, while feedback is formative, i.e., it explains how the performance can be improved and what should be modified in attitudes and practices.
Part of Angela’s work is evaluation; however, she never fails to provide feedback as well because she cares about her staff and wants our work to be better. According to Grossman and Valiga (2016), these characteristics contribute to building an environment that promotes effective work in a facility. When one of the nurses informed a physician on a patient’s complaint that the patient had shared confidentially, Angela talked to her and discussed the principle of autonomy in nursing ethics. It showed how the unit supervisor promoted education instead of penalizing.
The other important leadership characteristic that Angela displays is her ability to affirm values. It means ensuring that the values, beliefs, and vision of the members of nursing teams are properly recognized and integrated into the process of providing care (Grossman & Valiga, 2016). This ability of a leader to accumulate the ethical principles of the nursing teams and to transform them into practices and procedures is important for designing individual care that meets the needs of patients (“Modeling and role-modeling theory,” 2015).
Angela pays much attention to ensuring that the nurses on her teams share the conceptual understanding of our work; for this, she holds regular conversations with nurses and discusses current issues and their connection to the overall theoretical framework of nursing care we provide. For example, many patients complain about the work of the nurses because they (patients) think that nurses stole from them or scheme against them behind their backs; I have repeatedly heard Angela explain to her nurses how these paranoid beliefs of the patients should be addressed, and how open communication with patients can help.
In analyzing a leader, one should also pay attention to those characteristics that need improvement (Grossman & Valiga, 2016). After working for some time with Angela, I can say I have detected several deficient characteristics she has in terms of leadership. First of all, Angela’s practices are largely evidence-based and come from her own experience, and this is a good thing for a nurse leader (“Modeling and role-modeling theory,” 2015); however, I have noticed that she tends to be more open with those nurses that already have extensive experience themselves.
With new employees, Angela is rather detached; she talks to them in a professional and formal manner. I think the quality of training and the professional development in the facility could benefit from Angela’s more open attitude toward new employees; if she could be more straightforward with them, the new nurses would master the necessary processes faster. With one of the new nurses, Angela was very formal for a long time; she could tell us, the experienced nurses, what she thought was wrong with the new nurse’s performance, but she avoided telling it directly to her. I think Angela should be more genuine with her new employees.
Another deficient characteristic is that Angela avoids conflicts and rarely argues with other leaders, including managers and physicians. When a patient was complaining about the quality of medical care, a nurse told Angela about this, but Angela was reluctant to bring up this case in front of the doctor that provided medical care to the patient. I think she did it for the sake of better cooperation between doctors and nurses; however, I think she should have been more active.
According to Grossman and Valiga (2016), one of the functions of a nurse leader is to be engaged in patient advocacy. A nurse leader should not be afraid of confronting a doctor because both nurses and physicians pursue addressing the needs of patients in a better way; if a nurse thinks that those needs are not addressed properly, he or she should convey this message to other health care providers involved in treating a particular patient.
Change
One of the important characteristics of a leader is “the desire to become more and more of what one is capable of being” (Erickson & Swain, 1988, p. 3). To accomplish this, one should be involved in changing and improving the practices of his or her own and his or her followers. I think that Angela perfectly understands the need for change, and she demonstrated it in one particular change that she brought to the facility. She introduced a new electronic health records (EHR) system, and this was a strategic change because it implied long-term benefits for the facility.
The importance of the new EHR system consisted in the fact the nurses’ work could become much easier, faster, and more efficient because the processes of collecting and retrieving information became automated. Moreover, the new system reduced the risk of mistakes made by nurses in keeping patients’ records. Also, the automation of the records system contributed to building closer relationships between nurses and patients, and this proximity is pivotal in ensuring that patients’ needs are properly recognized and met (“Modeling and role-modeling theory,” 2015).
Angela demonstrated excellent leadership characteristics in the process of adopting the new system. She realized that the system would not add to the efficiency of nurses’ work unless nurses understood what the system could do, learned to use its functions fully, and committed to using the system in their practice. Angela repeatedly gathered her nurses to explain these things to us, and her arguments aimed at persuading us to use the system were reasonable and convincing.
Followership Characteristics
An important aspect of leaders’ work is developing their followers (Grossman & Valiga, 2016). A leader is not a leader without anyone to lead; that is why, when evaluating leadership characteristics, one should pay special attention to what practices and attitudes the leader’s followers adopt that contribute to positive outcomes. Grossman and Valiga (2016) note that good followership is harder than good leadership in a way because followership involves fewer rewards. This is why a leader should cultivate effective followers.
Angela is successful in this regard, and the particular characteristic that she demonstrates is the ability to effectively communicate with her followers that she wants to be a good leader. During our regular meetings, Angela repeatedly stressed that she wanted to be a unit supervisor as long as she knew that she did her job properly, that her nurses trusted her, and that she was a good fit for the position.
A particular practice that demonstrates Angela’s efforts in building followership is her practice of regularly requesting feedback. Just like she praises any positive behaviors in her nurses and educates them about negative behaviors, she expects the members of her nursing teams to tell her what they think she does right and what they think she does wrong. This practice is not automated, and we do not fill in any questionnaires in this regard, but we feel absolutely free to share our opinions, including opinions on Angela’s work, during our regular meetings with the unit supervisor.
Modeling and Role-Modeling Concepts
One of the key concepts of the MRM theory is nurturance, which is defined as the striving for “know[ing], understand[ing] and valu[ing] client’s model of the world” (Erickson & Swain, 1988, p. 2). Angela has been fully displaying this characteristic; moreover, she promotes nurturance in her nurses. What Angela constantly stresses is that a patient’s understanding of his or her treatment and the patient’s vision of the world should be understood by the nurse in order to properly identify the patient’s needs and address them.
Another thing that Angela recognizes is that “nurse is a facilitator, not an effector” (Erickson & Swain, 1988, p. 2); therefore, she encourages her nurses to act softly and promote the patient’s own strengths through interaction instead of imposing anything on patients. Finally, Angela promotes the concept of unconditional acceptance, which is an important part of the MRM theory, too. To the nurses in her unit, Angela repeatedly recommended that, if they could not accept their patients as unique and worthwhile, they should not provide care to them.
However, the cases of refusing to provide care are rare due to Angela’s efforts in explaining every nurse in her unit why patients should be unconditionally accepted. All three concepts are important in nursing leadership in general because, without them, the promotion of high-quality care is impossible; a nurse leader who does not practice nurturance, facilitation, and unconditional acceptance cannot ensure effective followership.
Modeling and Role-Modeling Application
It is noteworthy that the MRM theory is a grand theory, i.e., it mostly describes abstract concepts and reflects on the philosophical understanding of nursing. However, the theory has applications. As it has been demonstrated, my unit supervisor complies with the theory, and after working with her for some time, I can say that her approaches result in actual benefits for the facility and for patient satisfaction. First of all, her practice of constantly providing feedback to her nurses and receiving feedback from them both improves the quality of care provided by the nurses and increases the level of their trust and appreciation for their leader.
I believe that Angela fully understands the nursing goal of helping people achieve holistic health; this goal is essential in the MRM theory (“Modeling and role-modeling theory,” 2015). Moreover, my unit supervisor is committed to promoting these values among her nurses, and she is a great educator who manages to convey these concepts effectively to everyone who works in her unit. That is what makes her a good leader.
Conclusion
Upon assessing Angela’s strong and deficient leadership characteristics, examining the changes she has brought to the facility, exploring the ways she develops followership, and applying the perspective of MRM concepts and applications, it was shown that the unit supervisor is an effective leader. She manages to encourage her staff to perform better and successfully develops in them the understanding of the key concepts of high-quality nursing care. It can be concluded that the MRM framework is helpful in assessing one’s leadership characteristics because it provides certain criteria for evaluating how effective one’s leadership practices are.
References
Erickson, H. C, & Swain, M. A. P. (1988). Modeling and role-modeling: A theory and paradigm for professionals: Philosophical assumptions.
Grossman, S., & Valiga, T. M. (2016). The new leadership challenge: Creating the future of nursing (5th ed.). Philadelphia, PA: F. A. Davis.
Modeling and role-modeling theory: An introduction. (2015). Web.