Nursing: Theory and Nursing Practice Issues Theory and Nursing Practice Issues: Nursing

The modern-day staff nurse faces a variety of challenges in the work environment. These include inadequate staffing, the authority gradient, and issues related to changing models of care. The nurse leader has a duty to aid staff nurses working under him in addressing the challenges posed by these, and other issues facing the nursing profession. Leadership theories provide effective guidelines by which nurse leaders can address issues inherent in the nursing profession. In so doing, they accord staff nurses adequate opportunities to make meaning out of their lives. Leadership theories such as the situational leadership theory, the transformational leadership theory, role theory, and path-goal theory provides crucial insights from which nurse leaders could draw reference when seeking solutions for problems facing subordinate staff nurses. This text explores how leadership theory can be applied to nursing practice issues, and the implications of such application on the work attitudes and morale of staff nurses.

Applying Leadership Theory to Nursing Practice Issues

Nurse leaders empower themselves and others to aid in the realization of organizational goals. They are in key positions to participate in decision-making that has an effect on client care. Effective leaders use leadership theories and principles to guide their decisions, actions and visions. These theories provide a framework for defining nursing practice, supporting the quality of client care, and providing solutions to nursing practice issues. Theory can be used to address nursing practice issues in research and education, in direct patient care situations, as well as in the management and administration of nursing care services. This text analyzes selected leadership theories and demonstrates how nurse leaders could use the same to address the core issues facing staff nurses in the contemporary world.

Leadership Theory

Nursing staff will often thrive if they perceive strong and effective leadership from their nurse leaders, managers and supervisors. Towards this end, the leadership style and overall morale set by the nursing leader has a direct correlation on the outcomes and attitudes of their staff. Leadership theories are varied. However, some theories, as the researcher judges from their own leadership experience, resonate better with one's team than others. William Harman, a futurist, states that there is no need as compelling as that felt for one's life to have some meaning (Souba, 2006). People tend to give their best when accorded opportunities to give meaning to their lives (Souba, 2006). As a leader, the best one can do to get the best out of their team is accord them opportunities to acquire meaning out of their lives. From my own leadership journey, I have identified four theories that allow a leader to do this effectively: the situational leadership theory, path-goal theory, role theory, and transformational leadership theory.

Situational Leadership Theory

This theory was advanced by Paul Hersey and Ken Blanchard in the 1970s and early 1980s (Barker, 1992). It draws its views from contingency thinking, asserting that no single leadership style can be identified as the best; different leadership styles work best in different situations (Barker, 1992). The theory suggests that tasks are different, and each type of task requires a different style of leadership. As such, a good leader is one who is able to adapt his leadership style to the objectives/goals to be achieved. The theory emphasizes the issue of follower maturity -- that a leader ought to choose the most appropriate style of leadership based on their followers' experience and level of maturity (Barker, 1992). The highest level of maturity exists when followers are ready, willing, and able to do the task. The most appropriate leadership approach to use in this case would be delegation. However, when the followers are not as experienced or mature, the telling, selling, and participative approaches to leadership may be more effective (Barker, 1992).

Path-Goal Theory

The path-goal theory was introduced by Martin Evans in 1970, and further developed by House in 1971 (Barker, 1992). It is based on selecting specific leader behaviors that serve to effectively guide guided followers through the path leading to the accomplishment of their daily work activities (goals) (Barker, 1992). In this theory, a leader identifies the goals to be achieved, eliminates the roadblocks preventing followers from achieving the same, and increases favorable elements such as rewards to aid followers in the achievement of the same (Barker, 1992). This helps to ensure that followers have the best opportunities to make meaning out of their lives (Barker, 1992).

Role Theory

Role theory is based on the assumption that human behavior is influenced by expectations held by the individual and other people. Role theory in the context of organizational leadership...

The theory draws its views from the social role theory, and suggests that leaders define their roles as well as those of their followers based on reading and social learning (Early, 2005). They then form expectations about the roles that everyone, including themselves will play, and encourage their followers to act within the role expectations that they have about them (Early, 2005). At the same time, the leader strives to act within their own role expectations.
In an organizational setting, leaders and followers both have designated roles. Social theory suggests that leaders have role expectations about their followers, just like followers have expectations about their leaders. Followers consciously or unconsciously send these expectations to their leaders, for instance, forwarding a customer escalation mail to the leader for guidance and decision-making even when the employee knows the desired actions in resolving the same. By balancing which decisions to take upon themselves and which ones to pass on to the leader, employees pass their expectations to the leader. The leader is in turn influenced by these expectations, playing the leadership role placed upon them and striving to make themselves better through leadership values training and mentoring from other senior leaders. The organization is able to function effectively, therefore, because both the leader and the followers understand their roles and roles expectations, and strive to live within these expectations.

Transformational Leadership Theory

The transformational leadership theory was introduced by McGregor Burns. Transformational leadership is a process where followers and leaders raise each other to higher levels of motivation and morality (Barker, 1992). The transformational leadership theory suggests that leaders should not just be focused on managing managerial challenges; they should also strive to change the nursing environment through a transformational process (Barker, 1992). The theory is based on two core assumptions:

i) People will often follow a leader who motivates and inspires them

ii) The best way to get things done is by injecting energy and enthusiasm into the effort

Nurse leaders can transform the work environment for their followers by:

i) Establishing the organization as a learning organization

ii) Involving them in the decision-making process

iii) Managing the change process

iv) Building and sustaining trust throughout the organization

v) Balancing the tension between efficiency and production

Applying Leadership Theory to Nursing Practice Issues

Inadequate Nurse Staffing

Decreasing the number of staff nurses is often seen as the most logical way of combating the rising healthcare costs (McHugh, 2010). Failure to ensure sufficient numbers of staff nurses results in overwork, compassion fatigue, burnout, and injuries, all of which affect the quality of care delivered to patients. Studies have shown a negative correlation between high nurse-patient ratios and the quality of care delivered to patients (Stanton, 2011). A study by the Agency for Healthcare Research, for instance, showed that hospitals with low nurse staffing levels had higher rates of poor patient outcomes, urinary tract infections, cardiac arrest, shock and pneumonia (Stanton, 2011). Studies project that the nurse staffing problem could get worse over the coming years -- the demand for nursing care is expected to grow by around 40% by 2020, whereas the number of nurses is expected to grow by only 6% (Stanton, 2011).

Low nurse staffing rates has been associated with low nurse morale and job dissatisfaction, both of which compromise the quality of care delivered to patients (Stanton, 2011). Effective nurse leadership can, however, be used to minimize this risk and accord the right support to nurses in the face of the current staffing problems. Individual nurse leaders may do little to influence the number of staff nurses entering the profession; however, they could influence the attitudes, morale and performance of the few available nurses to ensure that patient outcomes are not compromised.

The transformational leadership theory suggests that leaders focus on getting things done through motivation and inspiration as opposed to giving commands and instructions. When Nelson Mandela was released from prison, he made an interesting remark concerning one of Robben Island's cruelest commanding officers; that his nature has another facet that though obscured, still exists. This remark represents a handy reminder that every man has a decent core. Even the most hardhearted of people can transform if touched because no one is ultimately evil. One only reflects inhumanity because the same is imposed on their person by a merciless system.

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