Philosophy of nursing leadership

¶ … Philosophy of Nursing: Employing the House-Mitchell Path Goal Theory of Leadership in a Heath care Context

The House-Mitchell Path-Goal Theory of contingent and situational leadership stresses that no single person or manager is an island. An individual leader must be responsive to the larger organizational environment. This theory underlines the commonly experienced truism for individuals in the health care field that no nurse can function outside of her specific situational environment. In other words, the behavior of a nurse in a suburban pediatrician's office would necessarily vary from the protocol followed by a nurse in a war zone, in terms of relating to subordinates and superiors. It is not that either nurse is incorrect in his or her leadership style, or more worthy than the other, rather a nurse must tailor his or her behavior to his or her situation.

This theory is valuable as well for nurses to understand their leadership roles as it also stresses that an individual in the caring profession, responsible for managing the health of patients, must be responsive to ever-changing patient and subordinate needs, shifting situational dynamics, and also to the fluid demands made upon their personal reserves of leadership and management within his or her organization. True to the situational and contingency theory, a good nurse must be a leader in advocating for the patient's needs and establishing what is necessary for the patient to be restored to health, and set clear and goal-oriented treatment plans that must be followed for the sake of the patient, rather than the sake of the nurse's personal sense of self-empowerment as a leader. (Blanchard, 2005)

Although many situational theories of leadership stress the integral relationship between the leader and the environment, however, the path-goal theory is unique in that it suggests that leaders are not necessarily born. This is a valuable lesson, given that not all individuals drawn to the nursing profession have actively sought leadership roles in their previous professional or personal lives, perhaps feeling that they are better suited to helping others, rather than leading others. But more and more, in an increasingly bureaucratic and oversubscribed American health care system, nurses find themselves in the roles of managerial leaders, leaders of other nurses, as the de facto if not de jure primary caregivers of some patients on a regular basis in a variety of environments, as well as becoming the leading advocates of better patient health. In other words, to be a nurse is to be a trained, knowledgeable professional with a quantifiable and clearly defined skill level, not to be a 'born leader.' (Blanchard, 2005)

To be a nurse is to be a manager and a monitor, not just of a patient's vitals but also of organizational health and like all managers can increase their effectiveness through education, training and development. A nursing leader may display, according to the theory four different types of leadership styles depending on the health care situation. For instance, to a young and uncertain subordinate nurse, a RN may apply directive leadership, giving specific guidance of performance, but to a fellow RN, the nurse may deploy supportive leadership and concern for the subordinates' theories about patient treatment, accepting input and suggestions. During a meeting with hospital staff of a variety of managerial levels, the same RN might use participative leadership styles, as the nurse consults with subordinates and considers other suggestions. Lastly, more and more nurses today may need to employ achievement-oriented leadership where the nurse sets high goals for the staff at large and expects other nurses to exhibit the same high levels of performance, even in the face of evident obstacles, such as in a bogged-down hospital bureaucracy or an understaffed ER. (Wu, 2005)

The Path-Goal Theory also stresses that a true leader's behavior is only motivating to patients, fellow nurses, and superiors and subordinates to the degree that the behavior increases the follower's goal attainment and clarifies the paths to these goals. (House, Mitchell, cited in Blanchard, 2005) The Path-Goal Theory holds a leader can change the expected reaction or behavior of a subordinate from a negative to a positive fashion through making expectations clearly defined, rather than simply asserting authority. This model proves to be a much more effective fashion, as it relies upon the needs and goals of the organization, rather than making the directive about the nurse giving the order, creating a potential personality clash between superior and subordinates. (Wu, 2005)