Introduction
The specifics of the nursing environment include its complexity, high level of stress, constricted resources combined with the need for improved performance, and rapid changes (Yi & Park, 2015). These specifics require proper management and leadership, and in the context of a nursing unit, the Nursing Unit Manager (NUM) is performing the roles of a manager and leader.
NUMs are an integral part of modern healthcare; their activities are crucial for its safety and quality. NUMs can be defined as registered nurses who “manage patient flow and staff issues in their designated departments, wards, or units” (Kornman, Wilson, & Paterson, 2013, p. 54).
Effective NUM leadership and management results in higher-quality, safer care that is also patient-centered (Kornman et al., 2013). However, both NUM roles are complex phenomena, and here, their most crucial element will be discussed.
This paper attempts to link the theory of leadership with NUM practice, which is one of the main aspects of studying nursing research (McCrae, 2012). Three NUM leadership roles will be considered: lead, direct and coordinate care in the ward/unit; inspire and support others to achieve their potential; monitor and maintain a safe environment for patients, staff, and visitors. Every one of these roles will be considered within the context of leadership and management theory, and examples of the practical application of the theory with the goal of fulfilling the role will be provided.
Concepts of Leadership and Management
Before proceeding, we need to define two key terms of the work. The concepts of leadership and management are distinct, but they are both crucial for the smooth operation of a nursing unit (Jefferson, Klass, Lord, Nowak, & Thomas, 2014). In short, the term management means “managing operational tasks through control and planning” (Kornman et al., 2013, p. 61). It is concerned with staffing, budgeting, planning, organizing, supervising, problem-solving; in other words, it involves orchestrating all the elements of the working process (Roussel, Swansburg, & Swansburg, 2015, p. 26). Leadership is concerned with interaction and requires motivating the followers, being visionary and inspirational, and it can be considered a part of management that is necessary to make the latter effective (Roussel et al., 2015, p. 27). As a result, NUM needs to combine the two phenomena to manage the unit effectively (Clarke et al., 2012).
Role: Lead, Direct and Co-ordinate Care in the Ward/Unit
The first part of the first role is concerned with “leading,” which is why it is necessary to consider the concepts of leadership, leader, and relevant theories.
Definitions of a Nursing Leader
Nursing leadership (NL) has become a popular and frequently highlighted topic in the modern research literature (Thompson & Hyrkas, 2014). As a result, the definitions of NL and its concepts have been formulated in a variety of ways by different authors who highlight various aspects of one and the same phenomenon (Mannix, Wilkes, & Daly, 2013). Giltinane (2013) suggests the following definition: a nursing leader (NLR) is someone who is directly involved “in clinical care while constantly influencing others to improve the care they provide” (p. 35). In other words, this author emphasizes the “leadership” part of the term. Jeffery (2013), on the other hand, insists on the importance of the nursing part of an NLR, indicating that the key concept of NL is “caring.” Apparently, NLR needs to bring leadership into the specific environment of a nursing unit, to balance the duties of a healthcare provider with those of a leader. To help NUMs in this task, the theory of NL presents various ideas and patterns of effective leadership.
Theories of Leadership and Management
The study of the theory of leadership is recommended to healthcare practitioners since it helps to get a better understanding of the relevant concepts and develop an informed approach towards one’s own practice (Giltinane, 2013). Naturally, the number of associated theories is greater, but here, the central and opposing ones (transactional and transformational) will be discussed to improve our understanding of leadership.
Transactional theory
The transactional theory (TA) focuses on rewards and punishments that are used by the leader or the manager as methods of ensuring compliance (Giltinane, 2013). In this case, leadership is task-oriented, and the tasks are primarily managerial. TA neglects the aspects of leadership that are concerned with team-building, values development, empowerment, and others; basically, it is just aimed at productivity and quality of the service (Hutchinson & Jackson, 2013). According to Giltinane (2013), the competition-based relationships between employees in TA can have an adverse effect on healthcare. In general, TA is considered inferior to the transformational theory (TF). For example, the full-range leadership theory describes TF and its methods as basic (necessary, but insufficient) and TF as advanced leadership that includes TA methods (Witges & Scanlan, 2014).
Transformational theory
The key distinction between TA and TF is their focus: TA focuses on the task, and TF is concerned with the people (Wong, Cummings, & Ducharme, 2013). TF presupposes a more holistic approach to the employees (Giltinane, 2013). In this case, the NLR takes into account a larger scope of the needs of the followers including the need for socialization and belonging and the need for expressing oneself and achieving one’s potential. TF is typically concerned with empowering employees, motivating them with incentives beyond immediate rewards and punishments, developing their loyalty, ensuring that the level of their job satisfaction is high, which is especially beneficial since nurse job satisfaction leads to better patient outcomes (Ulrich, Lavandero, & Early, 2014). To sum up, TF is aimed at the individual employee (Doody & Doody, 2012, p. 1214). As a result, the followers also perceive TF leadership more positively than in TA (Witges & Scanlan, 2014). Emotionally intelligent, empowering, visionary, inspirational leaders practice TF (Hutchinson & Jackson, 2013).
A TF leader also works with the environment ensuring that it is capable of promoting positive behavior (Giltinane, 2013; Ulrich et al., 2014). TA is also concerned with change, which is especially significant in the turbulent modern environment (Roussel et al., 2015).
By studying the theories of leadership and management, and NUM can define their personal style.
Styles of Leadership and Management
There is a variety of leadership and management styles, and the most popular ones will be mentioned here. In real life, there is a chance that the presented methods exist in combinations and not as pure forms. In fact, the situational leadership style is concerned with adapting the approach to the requirements of the situation (Giltinane, 2013; Kornman et al., 2013). Still, these examples of different leadership styles are typically presented to describe the options that a leader can choose from. The choice will have a great effect on the relationships between nurses and the leader, their performance, and patient outcomes (Cummings, 2013; Zydziunaite & Suominen, 2014).
Authoritarian
An authoritarian leadership style that is carried out by an autocratic leader (ALR) is based on the TA theory. Typically, an ALR is controlling, does not share the power, uses transactional methods, and works to increase the employees’ loyalty and obedience (Giltinane, 2013). Still, this style of leadership is concerned with the danger of over-management and lacks a number of transformational aspects, which makes it a less attractive option than democratic leadership (in particular, in the nursing environment) (Doody & Doody, 2012).
Democratic
The democratic style (DL) is correlated with TF and aimed at providing employees with a great level of autonomy while also motivating them and guiding them for change and improvement. A democratic leader is considerate and chooses to “make suggestions, rather than issuing orders” (Giltinane, 2013, p. 37). Such an approach allows preparing a new generation of leaders, improves the job satisfaction of the employees, allows empowering and developing them professionally and personally (Doody & Doody, 2012). The issues of the democratic style include the possibility of decentralization (Giltinane, 2013).
Other: paternalistic and laissez-faire leadership styles
The paternalistic leadership style is concerned with coaching the employees (Zydziunaite, Lepaite, & Suominen, 2013). In this case, a charismatic leader acts as a “father figure” and treats the employees with utmost concern. This style appears to represent the middle variant between the authoritarian and democratic ones, and, as a result, it combines their advantages and disadvantages. The laissez-faire style means letting the followers take care of themselves. While it is correlated with a significant level of freedom, it is still considered to be a weak leadership style since it presupposes a passive leader who is incapable of or chooses not to direct the employees’ efforts (Giltinane, 2013). It is suggested that this style can be beneficial for mature employees with a high level of autonomy, but most would struggle to achieve positive results under such a leader.
Conclusion
The question of which style and theory are best suited for the nursing environment and NUMs remains open. According to Kornman et al. (2013), TA theory and authoritative leadership have been promoted for nursing units for many years. However, Witges and Scanlan (2014) insist that TA theory, which motivates and inspires employees to serve the community regardless of their direct benefit, is more ideologically suitable for a nursing unit (p. 68). Nowadays, professional development is typically a must, and numerous modern training programs are aimed at developing leadership skills (Roussel et al., 2015).
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