Evidence-based practice and leadership in establishing safety culture

Nursing Leadership

Modern nursing has become a multi-disciplinary career that encompasses a number of roles and requires more expertise than ever before. In modern nursing, there are a number of stakeholders: patients, families, the community, insurance companies, governmental agencies, administrators, colleagues, staff and physicians. Healthcare solutions in the 21st century require a collaborate effort that remains focused on continual progress towards customer service satisfaction. The key is to understand the overall paradigm of healthcare and nursing management -- even through the terms "manager" and "leader" are often used interchangeably, they are not. In general, management organizes affairs, projects, and people -- therefore subordinates are involved. The manager is in charge, but not necessarily leaders in that they do as directed and then direct tasks. Leaders do not have subordinates, rather they have followers. Leaders motivate, challenge, coach and inspire vision, enable others to act and encourage (Carrroll, 2005; Kouzes and Posner, 1994, p. 960).

At the heart of a leadership practice, though, is patient care and customer satisfaction. Another additional issue surrounding satisfaction, quality and measurement centers around the dual issues of nursing shortages and nurse retention, both of which have been proven by research to influence patient care, quality of care, employee satisfaction, and overall stakeholder satisfaction (AACN, 2010; Glazer and Alexandre, 2009). There is a very real and quantitative relationship between nurse staffing, patient acuity, and performance within a healthcare system. Certainly, it makes sense that hospitals with low levels of nurse staff have higher rates of poor patient outcomes (Gerristen and Van Beek, 2010). However, it is not easy, with modern budgets and fiscal demands to simply add more staff -- rather like adding a Band-Aid to a serious injury -- there is some benefit, but it does not solve the issue. Research in the industry show a number of "tipping points" that are central to the paradigm of patient care. These trends combine nursing leadership, the aging demographics of the population, health insurance trends, and the ever-increasing squeeze on budgetary line items (Dickson & Flynn, 2008, p. 311; Manthey, 2008). We must also remember that stakeholders are customers, too, and are not just patients, but also colleagues, the community, other staff, and the various other agencies and individuals who interact with the healthcare system on a regular basis.