Nursing leadership reflection

Introduction

Leadership is important for the effective operation and success of an organization. Leadership is about the ability to exert positive influence over followers to ensure the achievement of organizational goals. However, different leaders adopt different leadership styles to influence followers. In the hospital where I took my last placement, my supervisor adopted a laissez-fare leadership style that involved delegating responsibility and authority to me. This reflective report begins by describing the leadership example I observed while working in a hospital during my last placement. It will proceed to describe how laissez-fare leadership style was demonstrated at the hospital, its key characteristics, and how these characteristics were reflected. The report will also reflect on the underlying assumptions about the role of the healthcare professionals, the patient, and carers in the laissez-fare leadership approach reflected in the hospital, its contribution to the practice of quality healthcare, and whether or not it offers opportunities for a graduate nurse to develop leadership skills. Lastly, the reflective report will evaluate skills and knowledge and the development of an early career plan.

Leadership Approaches

My leadership example from the last placement

I was working in the general ward one busy morning when I was asked by an ANUM to look after three post-operative patients as they were short of staff and cannot get someone to do the shift.

“The ANUM told me that you will look after those three patients. I know that you are only a student that needs to be supervised by an RN nurse but we are short and I cannot get someone to do the shift. I have worked with you so many times and we don’t have any problems/issues with regard to your performance. Just do your best and let me know if you have any problems with your patients. So, as per ANUM instructions, I could perform the entire task required for my patients independently except for administering Medication as this required supervision. I also did all my documentation and handed over my patients to the next staff for the next shift. After that, I have been giving patients my own every time I come to work.

Description of the leadership approach

Leadership is important for the success of any organization and this also applies to healthcare delivery. Clark (2008, p. 4) defines leadership as the ability to exert positive influence over the followers. In order for an organization to succeed, there is a need for positive leadership to inspire subordinates to work hard towards the achievement of organizational goals. However, different leaders adopt different leadership approaches and styles to influence followers. The most common leadership styles are the behavioral leadership approaches proposed by Kurt Lewin, including autocratic, democratic/participative, and laissez-fare leadership styles while others include transformational leadership and transactional leadership styles (Northouse 2014, p. 52).

Autocratic leadership is a style of leadership where the leader makes unilateral decisions and expects subordinates to follow without question (Wren 2013, p. 89). This leadership style is also popularly known as authoritarian leadership and is associated with a hierarchical organizational structure where communication is from the top (Wren 2013, p. 89). This leadership approach is commonly used in the military (Wren 2013, p. 84). Democratic/participative leadership is an approach to leadership where the leader involves subordinates in the decision-making process through the final decision still rests with the leader (Clark 2008, p. 8). Participative leadership is associated with the delegation of authority by the leader to subordinates who have donated the powers to determine projects (Northouse 2014, p. 56). The distinct feature of democratic leadership is that communication us downwards and upwards and is arguable the most preferred leadership approach whose elements include fairness, creativity, competence, intelligence, courage, and honesty (Wren 2013, p. 87). Laissez-fare leadership is an approach to leadership whereby the leader gives employees all the authority over decision-making (Northouse 2014, p. 92). Here, the employee who is mainly a specialist in a given field or area is given the authority to make decisions as they so wish without interference from the leader. Studies, however, show that this is the least satisfying style of leadership. Transformational leadership, on the other hand, is about initiating change in a firm, oneself, and a group. Transformational leaders generally create a vision and inspire followers to increase their efforts more than they initially intended to ensure the achievement of the common goals (Kelly 2011, p. 18). Such leaders also create challenging expectations and aim at achieving higher results by empowering subordinates. Lastly, the transactional leadership approach is associated with the maintenance of the status quo (Northouse, 2014, p. 96). This leadership style involves giving employees immediate tangible rewards for an employee who follows the leader’s orders.

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From the description of the different styles of leadership above, it becomes clear that laissez-fare is the leadership style that was evidenced in the workplace, where I undertook my placement as described in the first part. Laissez-fare is an approach to leadership first described by Kenneth Blanchard and Paul Hersey in the 1960s (Wren 2013, p. 144). The first main features of this leadership style are delegation (Weiss & Tappen 2014, p. 8). In this respect, the laissez-fare style involves the leader delegating responsibility to an employee who is given full authority over a task or decision and there is no interference from the leader. Kenneth Blanchard and Paul Hersey argued that the laissez-fare leadership approach is more appropriate where the employee to whom the authority is being delegated has the knowledge, skills, and experience to successfully accomplish the task assigned and when such employees are comfortable with the responsibility assigned (Kelly 2011, p. 84).  The other feature is autonomy given to the employees. Under this leadership, employees are given the freedom and autonomy to make decisions free of interference. Additionally, this leadership style gives group members the authority to solve problems themselves while the leader only ensures that members have the right tools and resources (Northouse, 2014, p. 93).

The laissez-fare leadership style was the one exemplified in the hospital where I took my placement in the sense that the ANUM delegated the task of being in charge of three patients to me. She did this because she strongly believed that I had the skills, knowledge, and ability to perform the tasks assigned without problems or supervision. This clearly shows that laissez-fare was indeed the leadership style exemplified in the health facility. Besides, the fact that I was confident enough of performing the tasks assigned also justifies the fact that the laissez-fare leadership style was the one evidenced at the placement. Moreover, after delegating the duties to me, the ANUM did not interfere with my work whatsoever, a situation that also proves that the laissez-fare leadership approach was the one at play.

What are the underlying assumptions about the role of the health care professional, the patient, and the carer in this approach?

The above discussion has shown that leadership is an important aspect of any organization. The same applies to healthcare delivery that requires effective leadership. Laissez-fare is one of the most common leadership styles applied in healthcare facilities as indicated previously. As indicated earlier, this leadership style is based on the delegation of duties to individuals with skills, knowledge, and experience in a given line, where they are assigned a task. Analysis of this leadership style shows that it is more person-centered than organization-centered. The person-centered organization is where the person-centered principles and tools are utilized at all levels in all interpersonal relationships (Freeman 2015, p. 228). Michael Kendrick argues that being person-centered involves focusing more on the quality of individuals whereas the qualities of the systems come second (Groves 2010). The same applies to the laissez-fare leadership approach that focuses more on the ability of employees to whom the tasks and authorities are to be delegated.

Accordingly, there are a number of underlying assumptions about the roles of healthcare professionals, the patient, and the carer under the laissez-fare leadership style. As with the healthcare professionals, such as nurses, because laissez-fare leaders normally take a back seat and delegate all decision making authority to the healthcare providers, the assumption is that the healthcare provider to whom the tasks have been delegated with ensure health promotion as well as ensure that patients are well taken care of and that they are provided with patient-centered care (Marquis & Huston 2009, p. 40). Patient-centered care is a type of care where the healthcare providers deliver care that suits the health needs of a patient, such as culture, communication, and treatment. For this reason, in a laissez-fare leadership approach, the role of a healthcare provider is to ensure that they use their skills, knowledge, and experience to deliver quality care that meets the needs of customers (Northouse, 2014, p. 93). This is because the leader does not interfere with what a healthcare provider does due to the trust bestowed based on the skills, experience, and knowledge they have with regard to the assigned task.

It is also notable that healthcare is no longer the responsibility of hospitals, doctors, and nurses; rather patients also play a critical role in the delivery of care under the new models of care. Under the laissez-fare leadership approach, the underlying assumption is that patients also take an active role in healthcare delivery by becoming actively involved in the delivery of care (Marquis & Huston 2009, p. 41). In this respect, patients are expected to take part in decision-making on how they would want care to be delivered. For instance, as the world increasingly becomes a global village, healthcare professionals handle patients from different cultural backgrounds. To help make their healthcare safer, patients are expected to help healthcare providers understand their cultural beliefs that might influence how they won’t care to be delivered to ensure that their cultural beliefs and values are taken into account so as to ensure quality patient outcomes.

Lastly, with regards to carers, the assumption under the laissez-fare leadership approach is that carers are able to deliver quality care services to patients without necessarily having to be supervised. This is because, with the laissez-fare leadership approach, the leader does not interfere with the tasks or decisions made by an employee (Asiri et al., 2016, p. 38). As such, carers handling patients with assistance, such as those suffering from terminal conditions like cancer are expected to deliver quality patient-centered care by applying their skills, knowledge, and experience.

How does it contribute to the practice of quality health care?

Any leadership style adopted in the healthcare institution should be that which aims at promoting quality care delivery (Wong et al. 2013, p. 709). Whenever patients visit a healthcare institution, they expect that they would be provided with high-quality services that improve their health and wellbeing. Laissez-fare is one of the leadership styles that, though not common in most organizations, have been shown to contribute to the practice of quality healthcare. First, the laissez-fare leadership approach contributes to the practice of quality healthcare by promoting autonomy in healthcare delivery. Autonomy has been found to be one of the most important motivators for employees. Kelly (2011, p. 78) demonstrates that autonomy often increases the level of satisfaction among members of the staff and this motivates the staff to increase their efforts, and this results in productivity among staff. Laissez-fare is one of the leadership approaches that increase autonomy among members of the staff. With laissez-fare leadership, once a leader has delegated the work to an employee, the worker is given autonomy and full control of what they do without any form of interference and this, in turn, increases the level of satisfaction of the employee with their work (Weiss & Tappen 2014, p. 15). Accordingly, this hands-off approach to leadership can result in quality healthcare delivery in hospitals because it provides the healthcare providers with the opportunity to take matters into their own hands and accomplish their tasks in a timely manner.

Second, the laissez-fare leadership approach contributes to the practice of quality healthcare by promoting personal accountability. With a laissez-fare approach to leadership, a leader delegates the responsibility and authority over tasks performed to an employee with the right skills, experience, and knowledge to perform the work in a manner they deem fit free of interference (Asiri et al., 2016, p. 38). The benefit of this is that it promotes personal accountability on the part of the staff members to whom the work has been delegated and this in turn gives the employee the urge to do their best as they know that they are in total control and are personally accountable to the results achieved. Accordingly, this results in quality delivery of healthcare services among the members of staff.

Additionally, laissez-fare leadership contributes to the practice of quality healthcare by promoting trust between the leaders and the nursing staff. It has been shown that trust is an important factor in the delivery of quality healthcare to patients. The laissez-fare leadership approach promotes trust through delegation of responsibility to a member of the staff by giving the member full control over how tasks are performed and this ensures the delivery of quality healthcare services to patients (Asiri et al., 2016, p. 38).

Does it offer opportunities for graduate nurses to develop leadership skills?

Indeed, the laissez-fare leadership style is the right leadership approach that gives graduate nurses the opportunity to develop their skills than does any other leadership style. Laissez-fare approach does this by delegating responsibilities and decisions and empowering graduate nurses and ensuring that they take full control over everything that happens free of interference from the leader (Weiss & Tappen 2014, p.9). Accordingly, the fact that this leadership gives graduate nurses the opportunity to take control over decisions promotes the development of leadership skills among graduate nurses. Furthermore, once responsibility has been delegated, the graduate nurse become accountable for accomplishments and mistakes and this motivates graduate nurse students to apply their skills, knowledge, and experience to ensure better patient outcome and in the process develop strong leadership skills (Ross et al. 2013, p. 4).

Critical evaluation of knowledge and skills and the development of an early career plan

Upon evaluating the skills and knowledge I have gained as a nurse practitioner, my plan is to become a chronic care nurse. The prevalence of chronic diseases has increased significantly in the last decade. Many developed countries like Australia are grappling with the growing cases of chronic illnesses, such as cancer, diabetes, and heart diseases (Islam et al. 2014, p. e83783). As such, I feel that I am well-positioned as a nurse practitioner to be able to make a difference by providing care and support to chronically ill patients and their families. In my position as a chronic care nurse, I will also be involved in administering the right medication to the patients with the guidance of the physicians. Additionally, as a chronic care nurse, I hope to help patients with chronic conditions to engage with their care and provide them with the information and support that they might need to self-manage their conditions.

However, to be able to effectively discharge my duties in helping patients with chronic conditions and their families, there are certain skills and knowledge that I consider critical that I will have to develop to ensure the delivery of quality care to the patients. First, an important factor will be the uniqueness of the population. Australia is a highly multicultural society with people from different cultures and backgrounds. In fact, studies show that a significant number of Australians are immigrants from other parts of the world and this makes the country culturally diverse. Accordingly, this implies that, as a chronic care nurse, I will be handling patients who subscribe to different beliefs and values that determine how care is delivered. Therefore, in light of this, I feel indebted to developing a cultural awareness and competency skills to be able to effectively deliver quality and patient-centered care. This way, I will be able to work with patients of all backgrounds in a manner that respects their cultural beliefs, values, and practices. In practice, I can develop cultural competency skills by undertaking culture competency training.

The second factor related to knowledge and skills that is important to my transition to my new role as a chronic care nurse is further training. There are skills that I need to develop through further training to be able to discharge my new role effectively. In particular, effective communication skills will be important to me as a chronic nurse as I will need to be able to effectively communicate with the patients and their families to ensure that they are able to manage the disease. At the same time, because I will be working with other healthcare professionals such as physicians and oncologists, I will need to develop my team-building skills to be able to work with others in delivering quality care to patients.

Conclusion

The reflection has found that leadership is indeed important for quality healthcare delivery. Although different leaders adopt different leadership styles, the analysis has shown that laissez-fare, though not common in most organizations, this leadership style is appropriate for healthcare delivery as it promotes quality healthcare delivery as well as promotes the development of graduate nurse leadership skills. Therefore, this is a leadership style that should be encouraged for quality healthcare delivery and nurse skill development.