Issues in Contemporary Nursing Leadership

Issues in Contemporary Nursing Leadership

• Objectives: Identify relevant nursing leadership and complexity theory concepts; describe leadership-change relationships; identify ethical leadership opportunities in nursing; describe the inseparable link between ethics and leadership in relationships with others.

Complexity Theory and Leadership

• Human beings and organizations are constantly transforming systems that evolve with changing circumstances.
• Change is not linear or predictable; what we think and expect to happen can influence what does happen.
• Relationships are vital for successful change, innovation, collaboration, and growth.

Situating the Topic: The Nature of the Issue

• Leadership is an active participation; not something that passively occurs to us.
• One way to participate in leadership is through accepting the designated leader's authority, similar to a mentorship model.
• Another way is through reciprocal engagement with others, leveraging strengths and discussing responsibilities.

Situating the Topic: Nature of the Issue (cont.)

• Some criticize that management is overemphasized, and leadership is underemphasized.
• There are questions regarding leadership being tied to authority, which each nurse has potential and responsibility to exhibit.
• Leaders lacking management skills may be as detrimental to an organization as managers lacking leadership vision.

Situating the Topic: Nature of the Issue (cont.)

• Authority figures might make decisions not aligned with patient needs if they base decisions on something other than patient care.
• Internal practice goals within nursing are often conflicted; nurses may align with diverse loyalties in their professional practice.

Historical Analysis

• Efficiency often replaces effectiveness as practice standards.
• Nurses are judged by outcomes that don't reflect the profession's ideological values.
• Loss of purpose and autonomy within nursing affects the quality of care and services.

Social and Cultural Analysis

• Patients have an increased role in care decisions; therefore, they might shift towards alternative providers.
• Nurse practitioners show public willingness to expand scope of practice since patients view them as equals, aiding greater access to care.
• Nursing's changes are akin to societal shifts, reflecting broader healthcare transformations.

Political Analysis

• Research supports the idea that healthcare systems are constructed and influenced by human choices regarding how things are done.
• Nurse leaders and managers face challenges navigating between professional practice knowledge and organizational priorities.

Critical Analysis (Feminist and Postcolonial)

• Critical feminist analysis focuses on how traditional gender structures influence issues, rather than focusing on the gender of the individual.

Economic Analysis

• Economic challenges are not new for nurse leaders; negotiating among employee needs, healthcare organizations, and patient needs has been consistently a challenge since the postwar period.
• Intense economic constraints limit resources and nurses' control over their practice.
• Nurse leaders' roles are influenced by tension between professional practice needs and economic pressures.

Barriers to Resolving the Issue

• Nurses experiencing undervaluation may be dissatisfied with their roles which also represents challenges faced by nursing leaders.
• Barriers arise when the organization's goals conflict with professional nursing goals, which leaders/managers may be obligated to support.
• Overfocus on short-term problem-solving may impede long-term leadership effectiveness.

Strategies to Addressing the Issue

• Meet with nurses, leaders, and physicians in oncology programs to understand concerns related to research.
• Meet with research assistants to better understand their experiences, concerns, and issues with research participation from patients, and families in the oncology unit.
• Analyze whether the issue is limited to a specific oncology unit or more widespread.
• Gather specific details about the issue, and avoid dismissal/emotional overlay to focus on facts.
• Meet with the research director, an ethicist, and chairperson of the ethics committee.

Strategies to Addressing the Issue (cont.)

• Create one-page summaries to concisely outline the issue, scope, and consequences.
• Privately share the summaries with the CEO to gauge support.
• Privately discuss the issue with appropriate executive leadership to understand their perspectives to possibly identify potential conflict areas that could be avoided.
• Share a draft of the one-page summary with other leaders for feedback, incorporating their perspectives in a revised document.

Strategies to Addressing the Issue (cont.)

• Work collaboratively with higher-level committees(MAC, PCC, REB) to establish short-and-long-term strategies to mitigate potential impact to patient care.
• Conduct interviews or focus groups with engaged parties (patients, staff) and engage an ethics committee member.
• Create a support structure (e.g., discussion group or arts-based program) for nurses to discuss issues.
• Recognize the potentially lengthy journey toward resolution.
• Maintain a focus on the facts to ground discussions, and ensure there is no dismissal/emotional overlay.
• Stay true to yourself while navigating challenges.

Summary

• Experiences, education, nursing knowledge, and complexity science shape our views.
• Complexity provides a way of understanding nursing, leadership, and organizations.
• Understanding interpersonal relationships is key for positive change and transformation.