Statement of the problem and some personal experiences
In the context of this essay the issue from my medical practice which I have chosen is “the nursing handover” which is indeed an important aspect given the need for effective management and leadership within the same. This aspect is also highly relevant for, and forms a significant aspect of, my professional practice recorded in the practice portfolio.
I would like to base my discussion on an incident which took place during my practice placement 5 (at an operating theatre) where I was working independently but within a supervised environment. This placement pertained to the learning of “scrub nurse” skills. It was observed that an important part of the scrub nurse’s responsibilities is to give a handover to the recovery team when the patient is transferred from operating to recovery rooms. This is obviously a sensitive stage of the medical procedure both for the patient and the doctors and requires effective management to prevent any mishandling. At this point although I had been assisting during the surgery I was mentally unprepared to give the handover to the recovery nurse. Based my judgement and convictions of my previous experiences at the placement I miscalculated the sensitivity of the situation and my mentor’s intention to take my duties to another step. Therefore I assumed that my mentor would do it as she had been doing it most of the time so far. However, on this occasion my mentor decided that I should take over the task at the last minute. This was a clear “failure to communicate” and, essentially, let to further mixing in the information and confusion. Even though I tried not to ‘noticeably’ panic, my reluctance and low self esteem became obvious to my colleagues and supervisors. Thankfully, my mentor was able to intervene in time and continue the handover without making the situation too obvious.
A failure to communicate?
As a newly qualified nurse this was clearly an embarrassing moment for me and I did feel that this encompassed a lapse in communication at some point of my training which involved both me and my mentor. Even though academic literature has stressed issues of professionalism and accountabilities in the medical profession for newly qualified nurses, I feel that the road to becoming an established and experienced nurse is long and tumultuous. To some extent this requires effective management but leadership within a certain group often overtakes the entire notion of organisation within nursing functions. The nature of the medical profession is such that it can test the patience and the reflexes of both doctors and nurses (Kerfoot, K. 2001:102).,Laurent, C.L. (2000:85), (Perra (2000)).
Leadership in medical theory: a coherent concept or abstraction
When we speak of the concept of leadership in contemporary medical professions it is possible to see that the meaning and usage of the notion of leadership as an ingredient of success, but its value has received a mixed response from medical academia: sceptics have gone as far as to say that “All definitions are arbitrary. They reflect choices that cannot be proved or validated” (Shamir and Eilam 2005:395).The question is that when we seek an authentic meaning of the role of leadership instead of the “glittery and shiny” part it can be seen that the mere display of socially desirable behaviours does not make a nurse a good leader. This was indeed my experience as a newly qualified nurse in the placement where I felt a cold distance and irritatingly lapses of communication with my supervisors. I felt and feel that good leadership in the medical organisational structure should exhibit something more “genuine” and that leadership should empower colleagues and sub-ordinates to follow their own convictions.(Shamir and Eilam 2005) .
According to Cooper et al (2005) this would mean looking at leadership behaviours rather than styles (such as transformational, transactional, etc). There is a need to discuss how nursing leadership promotes success in contemporary organisations and how it has to be multidimensional with regards to drawing from the elements such as traits, behaviours, and contexts with reference to the subordinates. This was entirely true for my multi-cultural placement as a newly qualified nurse. It was felt that the conduct of mentors should have been aimed at raising awareness of the need to maintain a clean record and to maintain transparency of actions. While cross-referencing my personal experience with literature it became more clear to me that while management focuses on the practicality of the situation at hand, such a situation requires a better understanding of the leadership aspects involved. However, leadership in the medical profession remains an abstract concept. I was able to observe that even within the medical profession there was a similar lack of consensus about notions of effective leadership “‘In the past 50 years there have been about 65 different classification systems developed to define the dimensions of leadership’ ( Northouse 2004)).
After this experience and the perusal of the relevant theories it became obvious to me that leadership was only one aspect of the “‘Focus of group processes’ (Bass, 1990) which involved the “process of inducing others to accomplish tasks” (Northouse, 2004). Coming then to main focus of this report, it will be seen that, while to some extent leadership was an “influencing’ force for me as a newly qualified nurse, a lot had to be said for effective management overall in terms of effective communication, motivation and mentorship. Although these notions do relate to the role of the leader they do come forward as an aspect of teamwork in nursing.
Leadership “at the bedside”
This brings me to yet another query whether this was a matter of failure of communication due to an effective vacuum of leadership or a product of overall miss-management. Northouse (2004) has stated that ‘Leadership is a process whereby an individual influences [another individual or] a group of individuals to achieve a common goal.” Although the efforts of my mentor are clearly appreciated, it was recognized that this is true when it came to facing the day to day decision-making challenges I would face in the future, at present I was mainly on my own. But is this not true for the entire medical profession? While working towards a common goal of patient safety it is inevitable that, at times, we will all be cornered with a critical live threatening situation where we will be on our own. At such a point there will be no team work and no mentor to look towards but our own individual skills and experiences where it can be seen that leadership will become an experience of the hindsight (Sullivan & Decker, 2001).
Valentine (2002:1) has examined some interesting perspectives into the dilemma of the newly qualified nurse, which I faced in person. While speaking about the context of leadership and management in nursing Valentine states the problem thus:
“The nursing profession trains new nurses on operating the latest technology and complex medical equipment. In contrast, once at the bedside they rarely get the opportunity to apply even basic leadership principles. Nursing as a profession does a disservice to new nurses by not developing their leadership capabilities”
Whereas his statement might explain my training dilemmas, one keeps wondering if there is a solution to this gap in training of newly qualified nurses.
The answer has been given by Valentine (2002:1) who has, in agreement with several other members of medical academia (Antrobus, S. & Kitson, (1999) Benefield et al. (2000), Horton-Deutsch and Mohr, (2001)), proposed that there is a need for incorporating “quantum leadership, transformational leadership and the dynamic leader-follower relationship models” into the training of newly qualified nurses. This is necessary if there is to be any hope for these nurses to be able to handle critical situations in their medical practice. Thus, there is a need to develop nurses as competent clinicians at the “bedside” and not just high scoring nursing academics. Valentine (2002:2) while citing Horton-Deutsch and Mohr (2001:121) has spoken of what he calls an “absence of nursing leadership” which will lead to more demoralized nursing professionals if their seniors and supervisors do not address the communication gap between themselves and their trainees. According to Horton-Deutsh-Morh (2001:60) (cited by Valentine (2002:2) the solution for senior management is to adopt a more reflective learning attitude to training and to “develop one’s own leadership skills as well as those of one’s staff”.
On a concluding note then, there is a need, quite apart from effective management, to ensure training for nurses at every level. Leadership as a quality or skill should not be restricted to supervisors and administrators, but also to newly qualified nurse who will have in their hands the lives of future patients. Therefore, effective leadership and management skills need to be developed in newly qualified nurses, as Valentine (2002:2) has stated, “ at the bed-side”. Going back to my own experience as a newly qualified nurse it seems now that these lapses in communication may not have been intentional but due to an overall lack of an effective leadership culture within the nursing profession.
- Antrobus, S. & Kitson, A., (1999). Nursing Leadership: Influencing and shaping health policy and nursing practice. Journal of Advanced Nursing 29, 746-753.
- Benefield, L.E., Clifford, J., Cos, S., Hagenow, N.R., Hastings, C., Kobs, A., et al. (2000). Nursing leaders predict top trends for 2000. Nursing Management, 31(1), 21-23.
- Horton-Deutsch, S.L., & Mohr, W.K. (2001). The Fading of Nursing Leadership. Nursing Outlook, 49, 121-126.
- Kerfoot, K. (2001). The Leader as Synergist. MEDSURG Nursing, 10(2), 101-103.
- Laurent, C.L. (2000). A nursing theory for nursing leadership. Journal of Nursing Management, 8, 83-87.
- Perra, B.M. (2000). Leadership: The Key to Quality Outcomes. Nursing Administration Quarterly, 24(2), 56-61..
- Sullivan, E.J. & Decker, P.J. (2001). Effective Leadership and Management in Nursing (5th ed.). Upper Saddle River, NJ: Prentice Hall.
- Northouse, P. G. (2004) Leadership (2nd Edition) Sage, London
- Cooper, C.D., Scandura, T.A., Schriesheim, C.A. (2005), “Looking forward but learning from our past: potential challenges to developing authentic leadership theory and authentic leaders”, The Leadership Quarterly, Vol. 16 pp.475-93.
- Shamir, B., Eilam, G. (2005), “What’s your story? A life-stories approach to authentic leadership development”, The Leadership Quarterly, Vol. 16 pp.395-417.
- Bass, B.M., Avolio, B.J. (1994), “Shatter the glass ceiling: women may make better managers”, Human Resource Management, Vol. 33 No.2, pp.549-60.
- Valentine (2002) Nursing Leadership and the New Nurse University of North Carolina, Charlotte -Copyright© by The University of Arizona College of Nursing; All rights reserved available at http://juns.nursing.arizona.edu/articles/Fall%202002/Valentine.htm