Good leadership and management are essential skills that every nurse should have to become an effective practitioner (Mianda and Voce, 2018). In everyday practice, challenges and scenarios are bound to arise that will test one’s leadership skills. Efficacious leadership helps ensure efficient delivery of high-quality services and maintenance of a positive reputation for healthcare centres. Good leadership is important in reducing healthcare system costs in form of lawsuit settlements. Through proper leadership, members of staff are guided and motivated to surpass service goals and provide high-quality care. Good leadership ensures a supportive and safe environment for both patients and all healthcare providers (Mianda and Voce, 2018). To explore the features of exemplary leadership and management, this article will analyse a case of understaffing witnessed in a geriatric ward. The leadership skills exemplified by the nursing officer in charge of the ward in dealing with the understaffing problem will be analysed.
Scenario Analysis
Understaffing is one of the commonly encountered problems in geriatric care. I witnessed nurse short-staffing during my rotation in an elderly ward. Short-staffing reduces the quality of patient care, outcomes and contributes to the infringement of patient rights (Harrington and Edelman, 2018). Elderly patients are a vulnerable group in society with reduced physical, mental and functional capacities owing to the effect of aging. As a result, they depend on caregivers such as nurses to perform activities of daily living such as personal hygiene. Provision of quality care to geriatric patients, therefore, requires sufficient staffing to cater to the special needs of these patients. Understaffing results in poor quality of care as their number is inadequate to help patients perform tasks such as movement or provision of medication (Harrington and Edelman, 2018). To attend to the large number of patients who require their attention, members of staff had to rush while attending to patients; in the rush, some requests and patient needs were ignored.
The understaffing problem compromised the levels of patient safety in the ward. Nurses had to rush to attend to the large number of patients which resulted in errors of omission such as failure to regularly turn immobile patients. As a result, the cases of bedsores and wound infections among immobile patients increased. The number of recorded falls among elderly patients increased because patients had to move unaided due to the short staffing. The human resource department reported an increase in the complaints of neglect and abuse from nurses filed by patients from the elderly ward. Morale and work satisfaction among nurses sank to an all-time low. Due to understaffing and increased workload, some members of staff exercised less patience with patients and some inadvertently used unnecessary force while attending to patients.
Understaffing had a profound effect on the members of staff. An increase in stress levels was reported among the members of staff due to increased workload and longer shifts. To make up for the shortage, nurses were assigned more duties, so that duties that were previously allocated to three were now assigned to one individual. To accomplish this, nurses had to work at a faster rate, having to rush while attending to patients. This inadvertently reduced the quality of their work. Members of staff had to cut short on breaks to complete the extra tasks assigned to them. As a result, more members of staff suffered burn-out and applied for sick leave by the end of the first month of the understaffing crisis.
Understaffing reduced the efficiency and cost-effectiveness of the healthcare system. This was manifest by an increase in the number of lawsuits filed by patients. Over three months, the families of three patients filed medical malpractice lawsuits citing negligence and caregivers. In total, the three plaintiffs claimed damages amounting to two million pounds. Such lawsuits cause an increase in the cost of healthcare services and the fear of litigation negatively affects the working environment of healthcare providers. With the scope of the problem and its effect well defined, the nursing officer in charge demonstrated exemplary leadership skills by guiding and motivating other healthcare providers to provide excellent care despite the understaffing problem.
The nursing officer in charge demonstrated transformational leadership, thereby galvanizing colleagues to continue giving quality services. Transformational leadership calls for effective communication and emotional control in dealing with high-pressure situations (Fischer, 2017). He communicated there was an understaffing problem that stemmed from high staff turnover, high cost of labour, and conflict over overtime payment. Delayed payment of overtime fees had caused several staff members. The remaining nurses had to take on extra duties and task a move that caused more members of staff to resign. The officer in charge called for a meeting where he communicated the shortage and managed to convince a frustrated and agitated team of nurses to continue delivering services as he worked with the administration to sort the staffing problem which would take some time. In a highly charged atmosphere, he calmly convinced other nurses to deescalate from threats of resignation and industrial action and continue delivering services as he worked with administrators towards a solution. Communication and emotional intelligence were key features of transformative leadership that ensured the continued delivery of services.
Teamwork is an element of the scientific management theory essential for the continued delivery of quality services. Through a teamwork management approach, managers and members of staff can achieve better results by working together and dividing tasks equally (Upadhyay and Opoku-Agyeman, 2020). In this context, the nursing officer in charge recognized the demoralized nature of his staff and rekindled a positive attitude in them. He inspired a sense of comradeship among the staff, that they were a team working together to overcome a common challenge. The nursing officer made effort to recognize every member of staff’s hard work and made everyone feel appreciated. In addition, he took a hands-on approach by taking on extra duties and working extra shifts than other members of staff. On observing their leader working extra shifts, other members of staff were challenged and motivated to work extra to ensure continued delivery of services. Gradually, a sense of team effort was cultivated, strong bonds of co-workers grew strong and the understaffing situation was more tolerable.
Critical thinking and problem-solving are essential skills that characterize effective transformative leadership. They empower leaders to effectively analyse problems and provide creative solutions (Werner & Bleich 2017). In this scenario where the ward was short-staffed, the nursing officer involved the staffing in stratifying tasks as high, medium, or low priority. High priority, life-saving procedures such as suctioning were to be performed first. This ensured the quality of services given to elderly patients remained high and reduced the high rates of mortality that had been previously reported. Additionally, unlicensed support staff, family members, and volunteers were incorporated into the larger team to assist in performing the low-priority activities such as giving meals. Involving family members in the caregiving process made them appreciate the challenges involved in the caregiving process. In one remarkable case, one family member who had previously threatened litigation over claims of neglect changed their mind after experiencing the caregiving process.
In the context of the scientific management theory proposed by Taylor, financial incentives were used to motivate nurses who took on extra work (Gull, 2017). As the process of hiring more talent continued, extra pay was used to motivate those who took on extra work and extra shifts. The promise of better extra pay went a long way in boosting the morale so that despite the heavy workload, members of staff felt it was worth it. Additionally, efforts were made to improve working conditions by availing work equipment, such as personal protective equipment, more readily without delay. Improving the working conditions ensured services were delivered smoothly without delays. New technology that was previously unavailable was introduced into the ward, this included better blood pressure and cardiovascular monitoring equipment. The boost ensured every patient bed had easy access to this equipment as needed. This improvement in the work environment boosted productivity despite the staff shortage.
Members of staff were involved in the making of duty roster, proving the efficiency of the Theory Y management approach. In contrast to previous management practices, the nursing officer involved members of staff in the assigning of shifts and duties. For the first time, members of staff were asked to give feedback and offer suggestions regarding the work environment and the process of assigning duties and shifts. Members of staff suggested a new approach to the timing of shift that entailed staff members relieving each other of duties to create time for break and rest. Through this initiative, the rate of burnout and fatigue was reduced significantly. This participative leadership and inclusion approach comes recommended by West et al., (2017) as it creates an optimal environment and improves the quality of care delivered by the staff. Employees have ideas that can boost productivity and should always be considered by managers and leaders.
In contrast to this transformative approach, an autocratic leadership approach would have resulted in a poor outcome. In an autocratic leadership approach, the staff would not be involved in the decision-making and problem-solving process (Poels et al., 2020). Dissatisfaction levels would escalate given the workload and poor term of overtime remuneration. More members of staff would have resigned compounding the understaffing problem. Despite the best efforts of the nursing officer in charge, bureaucratic red tape at higher levels of hospital management delayed the process of recruitment of new members of staff. During this delay, it was transformative leadership that inspired members of staff to continue delivering services to the elderly in honour of their oath to service to humanity.
Conclusion
Leadership and management skills are essential for every nursing practitioner. Having the skills allows a leader to rally members of staff towards achieving tasks and the organization’s goals. There are different theories and models of leadership all of which are important to understand to apply the appropriate approach depending on the situation at hand. No one model works in all situations, it is important to exercise wisdom to select a suitable approach. The leadership and management lessons acquired in this course will be essential in future practice to rally colleagues to work together to solve common challenges which are bound to come up. Medical practice is multidisciplinary, involving nurses, nutritionists, and doctors from different specialities. Leadership skills will be essential in guiding interactions with fellow medical practitioners with the common goal of providing optimal services to patients.
Appendix
Scenario: working short-staffed at elderly ward
During my rotation in the elderly ward of a local hospital, I witnessed a short-staffing problem firsthand. However, it was during this challenge that I also witnessed great leadership skills demonstrated by the nursing officer in charge of the elderly ward. In a ward occupied by one hundred patients, there were only three nurses to attend to them. One nurse was expected to attend to thirty patients at any one given time. The nurses had to work longer shifts of 10 hours, while previously shifts lasted 8 hours. For the past 6 months, all members of staff had not been remunerated for the extra hours they worked. Most of the nurses I interacted with reported increased stress levels and burnout at the end of their shifts. A number disclosed a lack of satisfaction with the work environment due to delays in the provision of basic equipment such as personal preventive equipment. Delivery of drugs to patients was delayed, incidences of falls had increased and families often complained about the neglected states of their elderly relatives. One nurse expressed fear of the compromised state of patient safety, due to a large number of patients some procedures such as wound care were delayed resulting in life-threatening infections. Several nurses confirmed they were experiencing anxiety, sadness, and a sense of guilt for being unable to provide elderly patients with the care they deserve.
