Effective Approaches in Leadership and Management Discussion Assignment

There are several problems that affect nursing practice. These problems range from quality issues such as medication errors, to human resource matters such as staff shortage (Combes et al., 2018; Jacobs et al., 2018). For instance, a psychologically unsafe workplace may be a reason for nurses to give care that is or low quality. In most cases, this kind of scenario is borne out of the nurse manger’s inability to exercise transformational leadership and instead employing strong-arm tactics. Inadequate pay may also be a string contributor to this kind of disincentive. Last but not least, a high turnover rate of nurses will also be encouraged by a situation in which the organization does not give incentives such as fringe benefits related to for instance a retirement package or a paid holiday. The purpose of this paper is to analyze the issue of high nurse turnover and the role of the nurse manager in ensuring that this is prevented and patient safety is safeguarded. Effective Approaches in Leadership and Management Discussion Assignment

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The Impact of High Nurse Turnover on the Quality of Care and Patient Safety

Nurses are the single most important category of healthcare employees that have the greatest impact when it comes to deciding the quality of care patients receive. Being the most numerous in terms of numbers, nurses are expected to spend the most time with patients and this is why a high turnover of this human resource will impact care quality. Combes et al. (2018) posit that a high nurse turnover has a negative impact on the quality of are delivered to patients. This can be measured by outcome measures referred to as nurse-sensitive quality indicators. Moreover, research also shows that this high turnover rate also affects the morale of the care team and contributes to errors.

Antwi and Bowblis (2018), who believe that increased nurse turnover is associated with lower overall nursing care quality, agree with the aforementioned position. They state that different care settings that include hospitals and health centers may experience a spike in mortality rates due to the simple reason that there are insufficient numbers of nurses affecting the nurse-patient ratio. The effectiveness of the care teams will also be low when these care settings or organizations employ new inexperienced nurses that are also still unfamiliar with organizational procedures (Antwi & Bowblis, 2018). With an increased rate of nurse turnover, it is the organization’s bottom line that begins to suffer because patients will start avoiding the facility. This position has been proven by a number of studies that take the position that a high nurse turnover leads to poor health consequences all-round. Effective Approaches in Leadership and Management Discussion Assignment

Correcting Turnover Status and Upholding Professional Conduct Using Emerging Professional Standards of Practice

In the healthcare setting, it is the registered nurse that has the responsibility for ensuring desired patient outcomes are arrived at for each individual patient. This is according to standard number 3 of the American Nurses Association’s Standards of Professional Nursing Practice (ANA, 2015). This is so because one of the central roles of the registered nurse is to make the nursing care plan for each patient. Amongst others this care plan includes assessment of the patient, planning the care based on set objectives that are measurable, implementing the plan, and evaluating the results to see if the outcomes have been achieved. All this is not done by one nurse but a team that includes fellow nurses, nurse assistants, clinicians, and pharmacists.

The Different Roles Played by Nurse Leaders and Nurse Managers

In a clinical setting where there are different levels of nurses, it is the registered nurse that usually assumes the role of the clinical nurse leader. This role entails dividing tasks and delegating the same to the other nurses for accomplishment. In doing this, the role may not necessarily mean that this registered nurse acting as the clinical nurse leader is part of the actual administration of the unit or department (Northouse, 2019). This is however not to say that she cannot assume both roles concurrently. But seeing as it is that this clinical nurse leader may not have an adequate number of nurses to cover the patients in the correct nurse-patient ratio, he or she may not succeed in upholding the required professional standards because of the high turnover and shortage. Effective Approaches in Leadership and Management Discussion Assignment

A situation in which there will be an acute nurse shortage with more patients than nurses can handle will call upon the clinical nurse leader to really be innovative. That is only if she or he would like to maintain the expected professional nursing standards of care (Northouse, 2019). In doing this, they will still need to pay attention to individual needs of each patient and meet these needs. Given this responsibility, the clinical nurse leader will have wide discretion in assigning every nurse including fellow registered nurses. This may include but not be limited to assigning the registered nurses more duties that will not require him or her (the clinical nurse leader) to supervise. In other words, the delegation will be hierarchical in nature. After the registered nurses have been given the heavier and more complex tasks, the enrolled nurses will follow with less complex tasks requiring some supervision. Lastly the clinical nurse leader will delegate and supervise the nurse assistants as they offer assistance with activities of daily living and run errands. Effective Approaches in Leadership and Management Discussion Assignment

Role of the Nurse Manager in a Situation of Nursing Shortage Due to Turnover

A shortage of nurses is sure to test the nurse leader to the maximum. This is because despite the shortage, care quality is still expected to remain the same. As a matter of principle and because the professional nursing standards must be held, errors and mistakes must still be avoided and excellence allowed to reign (Northouse, 2019). This means in part that the nursing leadership in the organization must come up with interventions and strategies that will make this a reality still. Above all, this requires transformational leadership in addition to resourcefulness, communication skills, and persuasion. Clinical nurse leaders are therefore expected to be transformational leaders who empower, motivate, lead, and inspire performance. Effective Approaches in Leadership and Management Discussion Assignment

The matter of staff shortage and high nurse turnover may be addressed in a variety of ways that differ from each other by the nurse leaders. Transactional leaders who are mostly authoritative in style will consider the end as justifying the means. They will delegate duties without due consideration of the nurse, expecting them to be complete at a particular time (Northouse, 2019). Unfortunately, this style of leadership and management usually ends only in aggravating the situation. Nurses will be demotivated due to high workload; they will suffer burnout, and will be short-tempered. For others, the position will be different. They will adopt a more employee-friendly attitude working with the nurses to deliver results without tension. In most cases, the clinical nurse leaders who fall in this category are very good with psychomotor skills themselves. They can thus work side by side with the other nurses to fill in the gaps left by the turnover.

The additional nurse manager will then make sure that the working environment is appropriate despite the workload strain. As a result, the workers will feel valued and work hard. The core of transformational leadership, according to Islam et al. (2018) and Robbins and Davidhizar (2020), is what this is. Nurse Managers are putting the management tenets of power and responsibility into practice by delegating these duties to other nurses while still holding them all responsible.  Effective Approaches in Leadership and Management Discussion Assignment

Additional Measures the Nurse Leader and Manager Can Take in the Face of Nurse Turnover

To ensure that patient safety, professionalism, and professional standards are followed, the nurse leader can take further measures. She can vouch for the appropriateness of the team’s skill mix (Northouse, 2019). She must, as a nurse and clinical manager, ensure that the right mix of skills among registered nurses, enrolled nurses, and nursing assistants persists despite the shortage (Islam et al., 2018). Additionally, she must make sure she keeps an eye out for signs of burnout among her remaining employees, such as a rise in irritability. This is because burnt-out nurses have a history of routinely mishandling drugs and providing nursing care, endangering patient safety.

Leadership Style Best Addressing the Issue

As was already mentioned, the leadership style that would be most successful in resolving the problem of nurse turnover is transformational leadership. According to Robbins and Davidhizar (2020), this management approach ensures employee motivation, a welcoming and supportive work environment, and a listening ear. Even if this leadership style is still the most effective in this situation, the lack of succession planning has made it difficult to duplicate. Effective Approaches in Leadership and Management Discussion Assignment

Conclusion

At the national level, nurse shortage is a major and extremely important healthcare issue. This is due to the wide-ranging effects on both specific organizations and the healthcare industry as a whole. The standard of services is the first thing to suffer in an organization when there is a substantial turnover of nurses. This is simply due to the fact that the surviving nurses get overworked and overloaded, which leads to major blunders and errors that endanger patient safety.  High nurse employee turnover threatens all healthcare organizations. The quality of care provided by the remaining staff members suffers as a result of their increased workload. Therefore, to adequately manage its effects, transformational nursing leadership is needed.  Effective Approaches in Leadership and Management Discussion Assignment

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References

American Nurses Association [ANA] (2015). Nursing scope and standards of practice, 3^rd ed. Silver Spring, MD: Author.

Antwi, Y.A. & Bowblis, J.R. (2018). The impact of nurse turnover on quality of care and mortality in nursing homes: Evidence from the great recession. American Journal of Health Economics, 4(2), 131–163. https://doi.org/10.17848/wp15-249

Combes, J-B., Elliott, R.F. & Skåtun, D. (2018): Hospital staff shortage: The role of the competitiveness of pay of different groups of nursing staff on staff shortage. Applied Economics. https://doi.org/10.1080/00036846.2018.1490000

Islam, T., Tariq, J., & Usman, B. (2018). Transformational leadership and four-dimensional commitment: Mediating role of job characteristics and moderating role of participative and directive leadership styles. Journal of Management Development. https://doi.org/10.1108/JMD-06-2017-0197

Jacobs, B., McGovern, J., Heinmiller, J., & Drenkard, K. (2018). Engaging employees in well-being moving from the Triple Aim to the Quadruple Aim. Nursing Administration Quarterly, 42(3), 231-245. https://doi.org/10.1097/NAQ.0000000000000303

Northouse, P.G. (2019). Leadership: Theory and practice. 8^th ed. Sage Publications, Inc.

Robbins, B., & Davidhizar, R. (2020). Transformational leadership in health care today. The Health Care Manager, 39(3), 117–121. http://dx.doi.org/10.1097/HCM.0000000000000296 Effective Approaches in Leadership and Management Discussion Assignment