Telemedicine and COVID Concerns in Nursing

Nurse Leadership Interview Reflection

Abstract

This paper provides a reflection on an interview with a nurse leader at a medical surgical unit. The nurse leader provided responses to questions about her philosophy of leadership, her methods, and factors that influence staffing. While she applied a team leadership style, some elements of transformational leadership, authentic leadership and servant leadership could be detected in her approach. As for staffing, she observed that telemedicine could be viewed as an opportunity for addressing future staffing issues while at the same time relieving concerns about COVID.

Introduction

For this reflection an assistant manager on the medical surgical unit provided answers to questions about leadership, what makes a good follower, shared governance, and quality improvement. The interviewee also discussed the role of nursing leaders in the workplace, the role of technology, and the impact of organizational factors on staffing plans. This paper reflects on the answers given and compares and contrasts the nurse leader’s leadership style to other leadership styles, including authentic leadership and transformational leadership. Finally, it discusses the opportunity for implementing a quality improvement initiative.

Same-Team Leader

The nurse leader described herself as a team leader. Team leadership style typically consists of identifying a clear purpose or goal for the team to achieve, and in the team the leader understands the strengths each team member brings and uses them in complementary way so that the team is strong overall. The nurse leader did this by creating an environment in which all team members can reach their highest potential, but also by giving a positive example herself. By focusing on giving a good example, the nurse leader also engaged in what could be termed authentic leadership.

Her nursing philosophy, however, appears to be rooted in transformational leadership, as her outlook was defined by the goal of transforming health care so as to be recognized as the leader of positive change. To achieve quality leadership, the nurse leader noted that one must communicate effectively, be able to adapt to new situations and environments, implement motivating strategies to inspire and empower staff, assist the staff with planning and decision making, and make sure staff has the tools and training needed to meet patient needs. All of these remarks on leadership correspond with the fundamental principles of transformational leadership, including the need for the group to represent the values and beliefs of the unit to staff, other units and departments and to the organization as a whole. Thus, it is worth comparing the nurse’s team leadership approach to transformational leadership to see how they overlap, which will be done in the next section.

The nurse leader elaborated on how she communicates with followers and stated that verbal, face-to-face communication is the mode she prefers: however, because of the stress of a busy, noisy, distracting environment, communicating in this manner can be a challenge. Perhaps the best example of how she engages in same-team leadership is through her attempt to seek compromises when conflicts arise. For example, she stated that when conflicts arise among patients, family members, nurses, or physicians, she listens to each side and tries to come up with a compromise that satisfies each party of conflict: “We look at the problem together, analyzing situation, and look for resolution.”

At the same time, as a nurse leader she recognizes that she must make decisions especially when it comes to assigning tasks. When delegating, she stated that she takes into consideration a particular nurse’s level of education and training before delegating certain tasks. Her goal is always to make sure a task she delegates is within the scope of practice of the delegate. This approach corresponds with the same-team leadership approach, which is that a leader recognizes the strengths of each team member and uses them appropriately (Teguh, Hariyati & Muhaeriwati, 2019).

Other Types of Leadership

Transformational leadership focuses on implementing a change in a workplace by communicating a vision, using logic and reason to justify the change, and providing support and motivation to workers so that they can buy-in to the change and achieve the vision (Hadi & Tola, 2019). Empowerment is a big part of transformational leadership, but it is also a part of servant leadership, which aims at supporting followers so that they can reach their potential (Gandolfi & Stone, 2018). The interviewee stressed that she does aim to use empowerment strategies to motivate workers to grow professionally and to develop their potential. To that end, she stated that she also shares her own experiences, tries to answer all questions, resolves conflicts that arise, follows through on all promises, and acts as a good role model. This last point—acting as a role model—is what compares her method favorably with that of authentic leadership as well. Authentic leadership is a style of leadership in which the leader demonstrates a good work ethic, based on ethical principles, and motivates followers by providing a good example of how to work (Alilyyani, Wong & Cummings, 2018).

Some of the big differences between the interviewee’s same-team style of leadership and transformational leadership are that she focuses on shared governance, which is the strategy to promote ownership, autonomy, and input. Rather than making decisions for all and insisting on getting buy-in as a transformational leader would do, she partners with staff and includes them in decision-making that affects the organization. This is the main feature of her same-team leadership that distinguishes it from transformational leadership.

The differences between her same-team style of leadership and servant and authentic leadership styles are that she recognizes the need to organize and motivate while simultaneously pulling everyone together at once. Authentic leaders are open and direct; servant leaders are supportive and selfless; as a team leader she focuses on getting everyone on the same page through collaboration and the sharing of information (Lemoine, Hartnell & Leroy, 2019). In her style of leadership, collaboration is key:

“On our unit we try to identify our patient’s needs, create a team to review those needs, to gather data and identify problems. After problems identified, we create a plan, strategy, and goal for improvement. When plan is selected and implemented, we evaluate outcomes and effectiveness of the plan. If an outcome is not met, plan gets revised.” Through constant communication, sharing of information, revision, and monitoring of situations, the team works together to achieve solutions to problems that arise: this is the essence of her style of leaderhip. Authentic leaders also share information openly, but their emphasis is on being honest and ethical and not necessarily on building teams; servant leaders, likewise, focus on supporting individuals that they can become leaders of themselves. A same-team leader, like the interviewee, uses collaboration to foster a team mentality so that all members feel that they are working towards the same goal in the same way.

Opportunity for Quality Improvement Initiative

The interviewee stated that many factors can influence staffing, which in turn may affect patient outcomes: level of education of staff, experience, age, use of supplemental agency, floating nurses—all of these are factors. At the organizational level, however, there are even more considerations: since the unit is medical-surgical, and there is a high float of patients, there is always a need for nurses. Some organizational factors that affect staffing plans are bonuses offered for working extra shifts, incentive pay, overtime pay, and the use of supplemental staff such as agency or float pools. Staffing could be a place to start when it comes to conducting a quality improvement initiative. One way to implement a quality improvement initiative could be through the use of technology. The interviewee stated, for instance, that technology plays a huge role in medicine and how it advances and that she believed it would continue to revolutionize healthcare. She highlighted telemedicine in particularly and the threat that COVID has played in changing the way people think about providing and receiving health care. She noted that telemedicine has been successfully utilized since COVID and that in the future “we will be able to better manage chronic diseases and have more people living with chronic conditions” by using telemedicine. Telemedicine could be a way to manage staffing issues more effectively, as well (Elson, Oermann, Duehlmeyer & Bledsoe, 2020).