Nursing Leadership Philosophy: Management in Clinical Practice

Organizational, Economic, Social, and Demographic Factors in Nursing Settings

In contemporary healthcare and nursing practice, the delivery of healthcare is affected by a wide range of organizational, economic, social, and demographic factors (Kennedy, 2006; Reid, 2009). Globally, countries with highly developed economies and technologies tend to provide the best healthcare, while those with less developed economies suffer disproportionately from inadequate access to care. At the national level, substantial disparities exist as a function of various variables including political, socio-economic, demographic, and geographic elements (Kennedy, 2006; Reid, 2009).

Locally, the quality and sufficiency of access to healthcare varies in relation to local government priorities, the nature of public transportation, and the location of healthcare providers and institutions (Reid, 2009). At the institutional level, the variables that determine the quality and availability of healthcare also include organizational policies and politics, management and leadership culture, and the qualifications and commitment of the individuals making up healthcare units and medical teams (Reid, 2009).

The Difference Between Management and Leadership

Management and leadership functions are frequently discussed together, but they represent substantially different elements of modern organizational structure and operation (Dalton, 2003; Russell-Whaling, 2008). Management comprises organizational structure, hierarchical chains, supervisory responsibilities, operational efficiency and economy, and tactical decision-making. Leadership encompasses the specific roles of supervisors, foresight, strategic vision, commitment, and character (Maxwell, 2003, in Russell-Whaling, 2008).

Typical examples of good management include the development of assembly-line production processes, working groups, and a creatively astute appreciation of potentially obscure factors capable of dramatically affecting production — such as the identification of the optimally efficient hand-shovel load of coal in late nineteenth- and early twentieth-century industry (Russell-Whaling, 2008). Examples of good leadership include the purposeful internal cultivation of organization-wide commitment; the development of leadership potential in employees who demonstrate such capacity; management that is, in principle, receptive to critical perspectives and intellectual independence; and a corporate culture maximally conducive to identifying, recruiting, retaining, and developing the future leaders of the organization (Maxwell, 2003, in Russell-Whaling, 2008).

Strategies for Self-Management and Career Advancement

One of the most important elements of modern nursing — responsible for its tremendous value and contribution to human health — is the role of empirical research in evidence-based clinical practice (Hamric, Spross, & Hanson, 2009). On the other hand, the importance of empirical research in evidence-based practice also imposes some of the greatest challenges on contemporary nurses. Specifically, medicine has always been a fundamentally dynamic field; however, the current rate and complexity of its evolution requires that nurses be prepared to continue their education essentially indefinitely throughout their careers. This, combined with the daily realities and volume of clinical nursing responsibilities, can be especially challenging for newly graduated nurses who must balance adapting to an intense vocational environment with ongoing preparation for certifications, licensing exams, and advanced practice education (Hamric, Spross, & Hanson, 2009; Taylor, Lillis, & LeMone, 2005).

With regard to career advancement, one of the goals of self-management would seem to be considering — realistically and based on full awareness of one's responsibilities and the expectations of others — how and when to pursue continual advanced education. Failure to weigh those factors accurately could undermine either the quality of clinical performance or the success of advanced academic pursuits. In the worst-case scenario, premature simultaneous commitment to both could jeopardize the chances of success in either area. Ideally, therefore, effective self-management must include the realistic establishment of short-term goals.

The actual practice of professional nursing also requires the ability to identify, understand, and compare several different sources of fundamental obligations owed to patients and clients (Reid, 2009). As often as cases present relatively straightforward analyses, they also present tactical, practical, legal, formal ethical, and objective moral dilemmas that cannot necessarily be readily resolved without significant trade-offs, depending on which perspective is weighted most heavily (Reid, 2009).

Finally, self-management in modern clinical nursing often requires the ability to maintain a clinical focus even under potentially challenging interpersonal circumstances in the workplace (Hamric, Spross, & Hanson, 2009; Taylor, Lillis, & LeMone, 2005). Many contemporary nursing administrators acknowledge fairly significant problems affecting the industry — more so in some institutions than others — related to interpersonal issues between and among co-workers within nursing units. These issues routinely involve perceptions and expectations about seniority, national or ethnic origin, race, as well as ordinary interpersonal conflicts, power struggles, and social cliques (Hamric, Spross, & Hanson, 2009; Taylor, Lillis, & LeMone, 2005). To a large degree, it falls within the professional responsibilities of healthcare providers to self-manage their behavior in the workplace so that they contribute positively to both the quality of care and operational efficiency. In principle, this is no different from the characteristics of successful professional working groups in general (Blair, 2003).