Throughout their degree and clinical placements, student nurses are given the great opportunity to witness and experience a wide range of approaches to leadership. In part A of this paper, one leadership approach will be discussed and evaluated, exploring the potential impact this leadership approach has on the practice of a newly graduated Registered Nurses. Furthermore, reflecting on how the leadership approach may impact nurses’ communication, documentation, professional relationships, teamwork, scope of practice, delegation of care, the practice of quality health care and opportunities for newly graduated nurses to develop leadership skills.
Nursing is a profession that requires engaging and inspiring role models and leaders. Due to the dynamic, challenging, and demanding healthcare environment, identifying and developing nurse leaders can be one of the hardest challenges (Scully 2015). There are many different styles to leadership, including democratic leadership, authoritarian leadership, transformation leadership and Laissez-faire leadership. In reference to a newly graduated nurse, one leadership approach that could be employed is the style transformation leadership. Transformational leaders are ones who are able to recognise their followers’ own potential, however, will go further to satisfy their higher needs, such as self-esteem and achieving their full potential. Giltinane 2013, described transformation leaders as those whom are able to express a clear, compelling vision of the future, intellectually inspire followers, identify individual differences and assist followers to develop their strengths. Transformational leadership is a trending style that is becoming grossly embraced by many industries and nursing practices. It is also believed to have a significant impact on students throughout their nursing profession when embedded into their nursing education (Fisher 2016).
In 1994, Bass and Avolio defined attributes and behaviours associated with transformational leadership to be identified by as the ‘five I's’. These includes: idealized influence (attributed), idealized influence (behavioural), inspirational motivation, intellectual stimulation and, individual consideration. In addition, modelling the way, inspiring a shared vision, challenging the process, enabling others to act and encouraging the heart, were five habitual practices of transformational leaders, identified by Kouzes and Posner in 2008. In a video shared on one of the UniSA Becoming a Registered Nurse course page, the pros and cons of the transformational leadership approach were identified. The pros of this approach were firstly that the leader applies inspiration and motivation by providing a vision of the future and motivates others to perform beyond expectations. Secondly, it was described that the leader is concerned about the needs and skills of members and treats them as an individual, and lastly, that the values and morals of others are observed and emphasised by the leader. The cons of this approach were found to be that the leader could possibly misuse influence, members may lose inspiration or motivation, the leader may give overemphasis to some individuals more than others, and lastly, pursuit intellectual ideas with no merit (Finkelaman 2006).
The major key points concerning a newly graduated nurse is that with this approach to leadership, leaders must display the skills required in order to be able to develop successful relationships with followers, in an environment where both leaders and followers, both work together to meet the organisational goals (Giltinane 2013). Transformational leaders also implement an autonomous approach to leadership. This autonomous approach allows followers to be able to develop their own leadership skills and, therefore, become independent, whilst also reducing the leader’s stress and evidently reducing the risk of burn out. Due to transformational leadership being an approach based on change, trust between leaders and followers is required. Leaders who display transformational qualities, appreciate implementing their own qualities in order to motivate their followers to change. A leader who is able to receive trust and support from their followers, is able to lead a team through change more successfully, in comparison to a leader who does not receive trust and support (Bach and Ellis 2011). Furthermore, it is essential to the future success of nursing as a profession that informal and negative leaders become discouraged, therefore, allowing space for positives leaders who provide evidence-based qualities of leadership to be identified and lead the profession (Scully 2015)
Newly graduated nurses are often found to be preceptors for nursing students, which is a great leadership opportunity. In a study conducted by Supleveda (2009) evidence found that qualities of support, motivation, approachability, consistency, organization, and effective communication are essential leadership qualities for preceptors. Furthermore, effective preceptor leadership skills include not only clinical competence, however, it also included interpersonal competence, which may be seen through communication, compassion, and supportive attitudes. The use of transformational leadership attributes in relation to communication, means that the nurse is able to support, inspire, motivate and create therapeutic relationships with student nurses, which evidently will provide a feeling of safety and support for the student, allowing them to perform at their best.
Relating back to the 5 I’s used to identify transformational leadership: inspirational motivation, intellectual stimulation and individual consideration, this can be used in relation to documentation. Documentation is an extremely important and vital part of nursing and is considered as a way of communication, presenting as an indicator for quality of care. The perception of nurses towards documentation implies that nursing documentation is a significant step in their daily practice, as well as emphasising patient’s safety (Alkouri, AlKhatib, Kawafhah 2016). Therefore, a nurse who is motivated, intellectually stimulated and has consideration for other individuals, is more likely to complete their documentation and do so to an acceptable level, in comparison to a nurse who is lacking in motivation, stimulation, consideration and even organisation. The lacking of these key attributes may cause nurses to leave their documentation to the last minute and could, therefore, miss important information about the patients’ health. The Documentation of information criterion under the Communicating for Safety Standard (NHSQHS 2019) states that ‘undocumented or poorly documented information relies on memory and is less likely to be communicated and retained’, which can lead to a loss of information and, therefore, can result in misdiagnosis and harm.
In a study conducted by Rodwell, McWilliams and Gulyas investigated the relation between in-role or discretionary behaviours and intent to quit, influenced by the characterisers of nurses’ relationships with their supervisor. Results showed that engagement, trust and loyalty were negatively related to the intention to quit. Whereas, perceptions of variability in their team's relationship quality with their leader was negatively related to trust and positively related to intent to quit (Rodwell, McWilliams and Gulyas 2017). Having a clear and common purpose, compensating for each other, regularly providing feedback to each other and the team, self-correcting, being able to adjust strategies under stress, valuing team goals over individual goes and believing in the team’s ability to succeed are knowledge, skills and attitudes that highly effective teams often exhibit (Kaiser and Westers 2018). Multiple key attributes specifically related to effective teams are also key attributes to a transformational leader, such as clear and common purpose, provides feedback, self-corrects, anticipates others actions or needs, and values and believes in the team. Therefore, these studies provide evidence that transformational leadership is pivotal to great team work and positive professional relationships.
Delegation by registered nurses must be guided by the NMBA’s ‘A national framework for the development of decision making tools for nursing and midwifery practice’. The framework states that ‘A registered nurse delegating care to an assistant in nursing or any other unregistered person, such as an enrolled nurse, is responsible for determining that the delegation is appropriate, and the outcome is evaluated and recorded’ (Australian Nursing and Midwifery Federation 2018). As a newly registered nurse, taking on a leadership role and delegating tasks to assistants in nursing or enrolled nurses could be daunting. By taking on a transformation approach to this delegation, the registered nurse will therefore recognise followers’ potential, identify individual differences and assist followers to develop their strengths. The use of this guideline will assist newly graduated registered nurses through delegating aspects of nursing care and clarifying the role and obligation of employers in delegation of aspects of nursing care (Australian Nursing and Midwifery Federation 2018).
A registered nurse who is a positive influence, has inspirational motivation, intellectual simulation and individual consideration (Bass and Avoilo 1994), as well as, modelling the way, inspiring a shared vision, challenging the process, enabling others to act and encouraging the heart (Kouzes and Posner 2008) will lead to an overall better quality of health care. A registered nurse who displays these attributes and applies them to their work will be more likely to practice in relation to the NSQHS standards, as well as the NMBA registered nurse standards for practice.
As mentioned previously, a great opportunity for a newly graduated nurse to develop leadership skills is to become a preceptor for student nurses. In the study by Sepulveda (2009) conducted with the purpose to provide a leadership opportunity for newly graduated nurses, by serving as a preceptor of a student nurse, clinical competence and purposefulness were rated by 100% of the respondents as essential traits that they look for in preceptor. Furthermore, qualities such as support, motivation, approachability, consistency, organization, and effective communication, were also rated essential leadership qualities that students admired in their preceptors. Interpersonal competence (communication), compassion, and supportive attitudes were also deemed as effective preceptor leadership skills. The qualities found as essential for preceptor leadership traits are highly similar to those found in relation to a transformational leader. Preceptors who took part of this study strongly agreed that the experience preceptorship provided an opportunity for them as newly gradated registered nurses to enhance their leadership and teaching skills (Sepulveda 2009).
Transformational leadership has been described as a style of leadership that focuses on providing inspiration motivation, motivating others to perform beyond expectations, being concerned about the needs and skills of members and treating them as individual, and that the values and morals of others are observed and emphasised by the leader. A transformational leadership approach, specifically related to a newly graduated registered nurse, will aim to improve their work ethic and professional relationships and potentially open doors for leadership opportunities such as becoming a preceptor of a student nurse.
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