Nursing leadership issues and contemporary challenges

Nursing Leadership Issues

Reflect on how you would create a safe environment in a healthcare setting by applying the 4 characteristics of a culture of safety. They are:

• Psychological safety. People know their concerns will be openly received and treated with respect.

One of the tenets of the total quality movement as expressed by W. Edward Deming is "Drive out fear" (Edward, 2012). The recommendation comes from a fundamental understanding of human nature: people do not like to call problem to the attention of their supervisors. No one wants to be the bearer of bad news, and in medical and healthcare settings this may be particularly true. Unsafe conditions can mean that patients are exposed to hazards or that employees are more likely to incur injury. In addition, nursing staff may occasionally find themselves in a position where a peer or another staff member are not following procedure. Not only is this an uncomfortable situation for all parties, it can lead to deteriorated esprit de corps.

• Active leadership. Leaders actively create an environment where all staff are comfortable expressing their concerns.

It is imperative that leaders communicate their receptivity to hearing about problems and to their dedication to preserving confidentiality, as appropriate. In the language of lawyers, when fear of retribution, punishment, or shame looms over employees, the work situation is called "a poisoned place." This is matter-of-fact recognition that people tend to ignore or keep quiet about issues that can potentially backfire on them. This is why whistleblower protection exists ("Undercover Lawyer," 2010). In the best of circumstances, the concerns expressed by staff can serve as instructional opportunities for other staff members, as well. It is more typical than not for a concern to be shared by more than one staff person. But a leader can only learn how many staff members are concerned about an issue or a challenge if that leader is open to vertical communication. It is important to remember that active leadership is conveyed in a number of ways, not the least of which is interpersonal tone and authenticity. Periodic reminders that openness is considered to be fundamental to good teamwork help to establish an accepting climate.

• Transparency. Patient safety problems aren't swept under the rug. Team members have a high degree of confidence that the organization will learn from problems and use them to improve the system.

A leader or a team can choose a communication framework that fosters the development of solutions to problems. A key variable is that the focus is not on finding blame, but rather on solving problems so that they don't return -- or cause problems in other areas, similar to squeezing on an inflated balloon. Some teams use an evidence-based approach to patient care safety issues. This type of approach assumes that patient care can always be made better, so the emphasis is on driving improvements into the system. Making these evidence-based plans an important part of regular staff meetings establishes system improvements as a team concern, and not just the concern of administrators. When nurses practice in an evidence-based context, they learn how to frame clinical questions so that efficient searches of the literature can be completed. The acronym "PICO" is used to help remember the key components of a clinical question ("Evidence-Based Practice, 2007). PICO expanded is as follows: P = Who is the patient population? I = What is the potential intervention or area of interest? C = Is there a comparison intervention or control group? O = What is the desired outcome? ("Evidence-Based Practice, 2007)

• Fairness. People know they will not be punished or blamed for system-based errors