Nursing Leadership as Nursing Has Moved Toward

Nursing Leadership

As nursing has moved toward professionalization, roles for nurses in leadership positions have been created. Historically, the roles of charge nurse, nurse manager, nurse educator, and nurse leader, have existed to coordinate and improve care delivery. In recent times, advanced practice nursing education has been introduced in order to formalize and improve performance of this role, in order to ensure evidence-based practice and improve patient care outcomes. While the presence of CNS's and other graduate-prepared nurses has been shown to improve patient outcomes, the existence of problems with medical errors and cost escalation still extant in hospitals has prompted health care leaders to develop a new role addressing these problems. This nascent, credentialed role, created by the American Association of Colleges of Nursing (AACN) in consultation with nursing faculty, clinical experts and other stakeholders, is called a Clinical Nurse Leader (CNL).

Nursing administrative position

The outcome variable of nurse job satisfaction measures the degree to which nursing care delivery systems acknowledge, nurture, and protect the practice of the professional nurse. Common indicators of nurse job satisfaction are the degree of job autonomy, the accountability of the professional nurse, and the presence of meaningful work (Aiken, Clarke, Sloane, Sochalski, & Silber, 2002; Deutschendorf, 2003; Kramer & Schmalenberg, 2002).

Nurses work in several different settings and have many different job titles, responsibilities, and credentials. (As new roles for nurses develop in the health care setting, many nursing professionals describe these innovations in care modalities as nursing care delivery systems.) This paper will discuss some of the innovations and advancements in health care delivery as evolutionary adaptations of the four basic nursing delivery systems using Marie Manthey's (1990) definition of a nursing care delivery system. Manthey describes nursing care delivery systems as ". . . A set of concepts defining four basic organizational elements. The definitions of these elements are based on principles that are in turn based on fundamental values. These fundamental values will ultimately determine the quality of the product. These four fundamental values or elements are clinical decision making, work allocation, communication, and management" (Manthey, 1990, p. 203). Marie Manthey's definitions of nursing care delivery systems published in 1990 are still widely accepted.

Management responsibilities

The CNL is not a manager, but is expected to lead in the design and implementation of care & outcome objectives while advocating for the best interests of her patients. As such, she collaborates with other health care providers, patients, family and community members, and must be comfortable in delegating (and in many cases, teaching) goals and responsibilities to each. As well, the Clinical Nurse Leader should be vigilant in anticipating risk for illness or injury to her patient or population; and, work to mitigate those risks through coordination of health promotion & illness prevention education. (American Association of Colleges of Nursing, 2007).

Good fiscal stewardship is a condition of quality care. The CNL, as a patient manager and care coordinator, cannot turn a blind eye to the cost of care, and must maximize resources using evidence-based practice. As an owner of a small business would keep an eye on possible cost-reduction actions, so does the CNL have to understand economic influence in the clinical world, be able to balance and monitor the flow on a business account sheet, and have some basics in marketing and business as well.

Effective leadership style

An effective leadership style for nursing would be transformational leadership. This is because this style of leadership adapts to its profession. By substituting the nurse as the leader and the followers as anyone in needs of the nurse's services, whether it is a patient, organization or even other healthcare professionals, a very useful philosophy of nursing can be established. For instance, transformational leaders have 1) charisma, b) the ability to inspire and motivate, c) the ability to provide intellectual stimulation and c) the propensity to provide individualized consideration to followers. These traits, when applied by the transformational leader, can enhance the followers self-worth and value -- this is needed in healthcare practice.

Communication strategies

Communication technology will facilitate the continuity and comprehensiveness of care. Use of technologies such as telephone, email, video conferencing, and discussion boards for education and patient care will be part of the CNL role. The ability to provide care and continue to do so using distance technologies is a key component of the CNL role because of the presence of rapid technological growth and also the feature of being a rather mobile society. So, all of the normal nursing activities of assessing, diagnosing, interventions, and teaching are a little bit transformed onto the computer screen or telephone and so the CNL requires competence in using all of these means to interact with patients, groups, media, and public.

Nursing care delivery system

Practice is at the microsystems level. A CNL's role is therefore different from an upper-level manager's because it is focused on a small group of patients with a specific set of needs. This involves the CNL being accountable for the design and implementation of care plans, which means importance is placed on the creation, clinical course of action, and actual delegation of the clients' care plan to other nurses, assistive personnel, and other heath professionals, such as occupational therapist or social worker, as needed. Another key factor is to maintain the execution of best practice nursing but at the same time being open and willing to revise protocols when evidence-based research has given adequate support for the decision to do so. Microsystems are always evolving, thus a desire to learn and flexibility to change should be inherent in the nature of the clinical nurse leaders. This is the only way to encourage the development of superior outcomes; for patient and the health care system alike.

Evidence of negotiation and conflict management