Today, dramatic changes in the provision of medical services and issues specific to health care are creating the demand for a new kind of medical professionals. A wide range of leadership-related issues arise due to rapid technological development, progress in medicine, scientific findings, new drugs, and innovative methods of treatment. In accordance with contemporary requirements, nursing leaders should be able to deal with complexity, change, and uncertainty, as well as work independently and interdependently, and consider quality care to be of the highest value. Therefore, an immediate and urgent need for the development of nursing leadership has become increasingly obvious nowadays.
It is necessary to carry out significant changes in leadership roles and practices to develop leadership skills and abilities of medical personnel at all levels of health care institutions. This development of professionalism can be crucial in order to eliminate issues specific to health care, such as the nursing shortage, insufficient availability of medical services, inadequate health insurance, high rates of chronic and incurable illnesses, etc.
The Concepts of Leadership
Leadership is a process that encompasses multiple influences occurring in a group setting. Leadership can be identified as the practice of leading people or entities in order to increase the effectiveness of the healthcare workforce. Leadership involves experimentation, failure, risk, and reward, as well as the movement toward a specific vision and a set of goals. According to Astin and Astin (2007), leadership is a method that targets the promotion of change. Leadership implies a procedure where movement is evident as this kind of headship is viewed in the light of association with leaders who are agents of change. Power, ascendancy, domination, and supremacy are frequently perceived as equivalents of the word “leadership”. Although the word “leader” has been always associated with renowned personalities, today, leadership skills are defined as obligatory managerial abilities in health care.
Furthermore, despite widely accepted viewpoints, leadership does not mean the power or ability to control what people do. According to Greenleaf (1996),
the simplest definition of a leader is one who goes ahead to guide the way… The essential abilities required to lead – values, goals, competence, and spirit – are expressed in two sets of requirements: the ability to set and articulate goals and reach them through the efforts of other people, and the ability to satisfy the people whose judgment must be respected even under stress (p. 294-295).
A plethora of psychology-oriented investigations and behavioral research studies have not entirely elicited the nature of leadership so far. Scholars, theorists, practitioners, and ordinary people endeavor to specify why some individuals are capable of inspiring and motivating others and whether they have inherited or developed abilities to influence others. In order to reveal contemporary requirements for leadership specific to health care, servant leadership theory, transformational leadership theory, situational leadership theory, and role theory should be explored. These theories are all interconnected and determine requirements for effective leadership. The diversity of these theories has erected a complex web of concepts related to issues concerning nursing leadership.
Servant Leadership: Theoretical and Practical Implications
Contemporary leadership-related studies indicate that alternative leadership styles are gradually replacing historically formed definitions of leadership. Leadership is now recognized as a phenomenon that can emerge from various places within an institution and is no longer focused only on formal leadership roles. Being developed by Greenleaf, servant leadership turns into a concept that starts to gain acceptance.
Geedey (2004) claimed that irrespective of their position, nurses should perceive themselves as public servants, keeping "in mind that nurses have internal and external customers". External customers are "patients, families, physicians and hospital administrators," while internal customers are "nursing staff and ancillary personnel within the organization". Striving to achieve the primary objectives of their organization, servant leaders perform their duties and activities to meet the needs specific to their patients, subordinates, and associates. Nursing servant leaders empower their subordinates, recognize their achievements, stimulate their natural desire for learning, growth, and creativity, increase self-esteem, and encourage involvement in problem-solving. Servant leadership greatly contributes to an increase in nurses’ motivation. Being motivated at work, nurses improve their job satisfaction, gain confidence, increase efforts, contribute to positive working environments, and promote better outcomes. In accordance with the principles of servant leadership, nursing professionals should be oriented toward the services they provide.
Situational Leadership in Nursing
Being developed by Hersey and Blanchard, a model for situational leadership involves leaders’ skills and abilities to recognize and assess the needs of their subordinates and respond to diverse situations that arise after the appropriate response. “Situational theories emphasize the importance of understanding all the factors that affect a particular group of people in a particular environment”. The effectiveness of leadership in health care depends on nursing leaders’ abilities to analyze and assess their subordinates’ skills, competencies, and commitments in order to respond accordingly. The implementation of situational leadership is stipulated by the fact that the best approach to leadership problems cannot be restricted by specific limitations. Situational circumstances will necessarily influence the way a problem and medical professionals involved should be addressed.
Transformational Leadership: the Implementation in Health Care
Effective nursing leadership is frequently associated with greater job satisfaction among nursing staff and improvements in patient care. Transformational nursing leadership includes leaders’ abilities to communicate objectives in an articulate manner, instill motivation in healthcare personnel to accomplish the shared goals, encourage creative problem solving, and establish trust-based relations.
Transformational leaders are emotionally invested in themselves and their subordinates. Transformational nursing leaders’ interactions with the staff are performed in a positive and non-threatening manner. They possess abilities to initiate changes and utilize innovations. They achieve this through the identification of subordinates’ needs and concerns, assistance in finding new ways to solve old problems, and promotion of their critical thinking. Such a type of nursing leadership frequently results in significant changes in working environments, organizational strategies, culture, and the scope of medical services.
Demonstrating transformational behaviors more often than transactional, nurse administrators promote higher job satisfaction among the nursing staff. Transformational nursing leaders acknowledge the personal needs of followers and go further than this by "seeking to satisfy higher needs", such as those outlined by Maslow's hierarchy of needs. This degree of leadership results in "mutual stimulation and elevation" of both parties, which often converts followers into leaders themselves. Effective followers with high self-esteem can become leaders. The study conducted by Spinelli examined leadership orientation and outcome factors by investigating subordinate managers' ratings of hospital CEOs. This research found a significant correlation between transformational leadership and the positive outcome factor.
The Implementation of Role Theory in Nursing Leadership
Every work environment encompasses specific activities or roles, defined in accordance with certain behaviors that are expected to be performed in order to correspond to particular job parameters. A role theory addresses how managers' perceptions of organizational environments can influence their expectations related to their roles as leaders. These roles involve a set of norms or rules that guide the behavior of individuals. Role theory implies that individual behavior cannot be changed unless roles are changed because roles correspond to behaviors. Society expects health care providers to behave as highly skilled professionals. Their actions and demeanors should be interrelated with the code of ethics and the Nightingale Pledge irrespective of their roles.
Social and economic transformations in the health care systems initiate changes in a role repertoire of nursing leaders due to such reasons as the prevalence of their administrative responsibilities over professional functions, leaders’ involvement in processes of conflict resolution, irrelevant clinical practice, and so forth. The specificity of various duties, new responsibilities, and arising divergences between external requirements and internal possibilities of an individual can lead to conflicts and contradictions. Furthermore, while making a transition to a leader, a person can experience a “sense of loss and/or anxiety as old roles fade and new roles – and accompanying expectations – demand attention”. Therefore, nursing leaders should modify and develop their behaviors, beliefs, and attitudes to comply with new requirements for their roles in healthcare institutions.
Modern Requirements for Qualities of an Effective Nursing Leader
The significance of leadership in the management of healthcare settings has always been crucial. Nursing leadership assumes responsibilities for the effective provision of medical services by healthcare organizations. The increasing complexity of health care delivery, a great variety of severe and incurable illnesses, and constant progress in medicine stipulates growing requirements for nursing professionalism and knowledge.
Health care leaders have to be dynamic and adaptable to meet the needs of their profession, patients, and the nature of health. Despite differences in leadership styles, all effective leaders are characterized by self-confidence, respect for associates and partners, openness to their input and ideas, discernment, competence, creativity, loyalty, and persuasiveness. A leader should be able to involve health care providers in diverse novel activities, creating a highly motivating environment and assisting them to determine and reach objectives. Both parties become active partners in decision-making throughout their communication and cooperation.
All leaders’ initiatives and actions should be highly professional. Professionalism is directly proportional to a person’s knowledge, leadership abilities, skills, accountability, and honesty. Nursing leaders should possess sufficient knowledge related to their specialty, managerial practices, regulatory guidelines, psychology, modern economic trends, and healthcare issues. Leaders should be aware of their subordinates’ motivational variables in order to influence and improve their behavior, perceptions of duties, and performance of daily activities. Leading others, they should support them in their endeavors. Professional achievements significantly influence a person’s self-determination, development, and motivation. Professionals, whose achievements and successes are socially recognized, essentially differ in their personal characteristics from those who face insuperable difficulties, which, in reality, can be easily overcome. Leaders’ communication skills are very important, as well as such personal characteristics as responsibility, patience, tolerance, benevolence, and culture of behavior.
Efficiently functioning healthcare settings, as well as other organizations, are associated with skillful, experienced, competent, high qualified, goal-oriented, and motivated medical professionals. Being a leader of a healthcare setting, a medical professional provides employees with support and encouragement, inspires them to set goals, solve problems, and, thus, increases the general effectiveness of the provision of health care. Leadership development is an essential component of a complex strategy to overwhelm current problems in health care. “Professional nursing care is a vital component of the healthcare system”. The upbringing of future leaders is one of the greatest challenges faced by health care.