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NURS 440 Issues and Trends in Nursing

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Monica Davila graduated from California State University in 2004 with a BSN. He later worked for a cumulative five years in UCLA Medical Center and Johns Hopkins Hospital before going for a Master of Science in Nursing at Johns Hopkins University. She was quick to highlight that she comes from a lineage of nurses, with her mother and grandmother being nurses. The selflessness of her mother led her to a career in nursing. After taking her MSN, Monica started working at Valley Care Medical Center, where she moved from a head nurse to a patient care director and finally a chief nursing officer. She hopes to move to a Chief executive position before she retires.

Leadership Style

Strong and effective leadership is an essential virtue in every profession, but it is particularly critical in nursing care for positive patient outcomes. According to Stantou et al. (2017), there is a strong correlation between leadership styles and quality care and associated measures. In other words, nursing leadership is paramount for an effective and integrated provision of care from a patient and care provider’s perspective. Due to the many identifiable leadership styles, including autocratic, laissez-faire, task-oriented, transformational, and transactional styles, nurse leaders often get the challenge of embracing the best style. Monica maintained that she embraces a transformational leadership style. A transformational leader is one who “inspires confidence, respects employees, and communicates loyalty through a shared vision leading to enhanced productivity, strengthening employee morale, and job satisfaction” (Stantou et al., 2017). Monica embraces an autocratic leadership style in times of emergency due to a lack of time to consider staff opinion.

Monica was categorical that she has not always been a transformational leader. Initially, she embraced a transactional style by inspiring, motivating, and leading others to follow a path that she considered the most ideal. However, she realized that her influence did not always lead to the right decisions. For instance, she could make abrupt and harsh decisions out of emotions, which was detrimental to adequate care provision. Her charm to influence even when a specific decision was not in the team's best interest ended up creating adverse outcomes. Also, because she was open to change and development, she could influence teams to work towards a shared dream. However, due to the nursing profession's nature, where nurses have to work for long hours, some nurses had to go beyond their tasks to achieve the desired goals, which made many of them feel taken advantage of and dissatisfied. Due to the limitations of a transactional leadership style, she had to ensure that she factored in every nurse’s needs and wants before making any decision to ensure they remained motivated enough even when working for long hours, leading to a transformational leadership style.

Monica’s experience has a lot to do with her current leadership style. For instance, despite her transformation from a transactional to a transformational leader, she realized that neither style works best in emergencies. She argued that patients coming to the emergency department (ED) have unique needs and wants from experience. An article by Lateef (2018) defines the ED as undifferentiated and unpredictable, which makes the environment challenging for effective management and administrative leadership. Having been in the field for more than ten years, she realized that the ED requires leadership to handle all the chaos while managing every patient objectively with total disregard for all the commotions and distractions.  Here, she argued that consulting and seeking a second opinion from colleagues is not always effective, making an autocratic leadership style the most ideal.

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Future Planning

Monica has always focused on developing new leaders in her practice. She embraces Peterson et al. (2020) thought that leadership matters because a great style can make colleagues more competent than they indeed are, while a poor one can drag down a superior skill set. During the interview, she argued that developing new leaders is paramount due to the need to work towards a common goal. She also understands that a leadership style is different from individual personality, with the latter being immutable. However, style is what one regularly does over time. As a leader, Monica and other leaders organize leadership development and succession planning programs to engage employees who demonstrate leadership potential to prepare them for formal leadership roles. Here, the program's best employees are those that depict leadership qualities in their clinical duties, communication, and ability to delegate. Monica is also a part of the leaders who nurture nurses by offering them individualized coaching while creating a unit that advocates for shared responsibility and collaboration. Here, he engages nurses in a professional development process before many can identify their leadership capabilities.

Professional organizations play a critical role in the nursing profession. As a nurse leader, Monica is a member of the American Nurses Association (ANA) and the American Organization of Nurse Executives (AONE). She was categorical on the organization’s role in developing nursing leaders. In the case of the ANA, she highlighted how the organization builds, enhances, and strengthens leadership competencies of nurses through the ANA Leadership Package consisting of three documents including the Nursing Scope and Standards of Practice, Code of Ethics for Nursing, and Nursing’s  Social Policy Statement (American Nurses Association, 2018). Using the documents, the ANA helps nurse leaders prepare and enhance their leadership qualities and abilities by outlining some of the most impactful leadership competencies, including collaboration, communication, education, ethics, environmental health, and resource utilization. Similarly, Monica maintained how AONE outlines the fundamental leadership skills that nurse leaders should embrace in a clinical setting regardless of their education, level, title, or setting. The leadership skills include "communication and relationship management; knowledge of the health care environment; leadership; professionalism; business skills and principles” (American Organization of Nurse executives, 2016). Such competencies and skills have been highly impactful in her leadership journey.

Current Issues and Trends

According to Monica, the Coronavirus pandemic exposed the nursing field to unprecedented challenges. Some of the most recent challenges for her and most nurses in the profession following the pandemic include “overcrowded intensive care units, critically ill patients, insufficient equipment, and loss of life” (Oliveira, 2020). Undoubtedly, one of the nursing duties is protecting life, but the pandemic has thrust most healthcare facilities to a point where nurses can no longer save life due to a lack of sufficient equipment. She argued that sometimes they have had to watch patients succumb due to the lack of adequate intensive care units to care for all admitted patients. Also, nurses remain sensitive to a possible infection due to a lack of quality personal protective equipment, contributing to a high nursing turnover. Consequently, a high nurse turnover contributes to a significant nurse shortage. It is critical to highlight that the nursing shortage is not a new problem. In the last five years, the US has experienced significant nursing shortages due to a lack of potential educators, high turnover, and inequitable workforce distribution. Before the pandemic, nurse burnout forced many out of the profession despite completing their education and fulfilled all professional pre-qualifications. As a result, the nurse-patient ratio has become a substantial clinical concern.

Monica revealed that the problems faced in Valley Care Medical Center are not unique to the facility. On staffing, for instance, she highlighted that it is both a national and global problem. At the national level, the Covid-19 pandemic has forced many nurses out of the profession for fear of infection, and the same case applies at a global level. The death of nurses after an infection has further exacerbated the nurse shortage situation. A unique challenge to Valley Care Medical Center facility is a lack of sufficient ICUs being a small local care facility. The facility only has thirty ICUs compared to the hundreds of patients admitted following the onset of the pandemic. However, Monica maintained that the facility’s leadership team is in talks with other local and national facilities to scale up. She was, however, pessimistic about the nurse shortage issue and maintained that the problem would persist unless the government takes drastic action.

Conclusion

The interview was highly impactful. One of the key takeaways was that there is no one-size-fits-all kind of leadership style. Although she mainly embraces a transformational leadership style in Monica's case, the technique remains ineffective in emergencies, leading to an autocratic leadership style that disregards consultations. A second takeaway is that every nurse leader should focus on depicting leadership qualities in their clinical duties by communicating effectively and delegating tasks since nurse managers use such competencies to develop future nurse leaders. The third takeaway is that despite the degree of preparedness in any care facility, there is always something disruptive such as a pandemic that might throw everything out of balance. Here, nurse leaders and the government have a critical role to play in promoting positive care outcomes. Lastly, as a nurse, it is paramount to be part of a professional organization as they are highly impactful in developing nursing leaders. Moving forward, I plan to work on my leadership qualities and purpose to join a professional organization. I will also be a strong advocate of educating more nurses to address the shortage issue.

 

 

References

American Organization of Nurse Executives. (2016). Nurse Executive Competencies. https://www.aonl.org/sites/default/files/aone/nurse-executive-competencies.pdf.

American Nurses Association. (2018, July). ANA Leadership: Competency Model. https://www.nursingworld.org/~4a0a2e/globalassets/docs/ce/177626-ana-leadership-booklet-new-final.pdf.

Lateef, F. (2018). Grace under pressure: Leadership in emergency medicine. Journal of emergencies, trauma, and shock, 11(2), 73. https://doi.org/10.4103/JETS.JETS_18_18.

Oliveira, A. C. (2020). Challenges faced by nursing professionals in the COVID-19 pandemic. Rev Min Enferm, 24, 1-3. https://doi.org/10.5935/1415-2762.20200032.

Peterson, S. J., Abramson, R., & Stutman, R. K. (2020). How to develop your leadership style. Harvard Business Review, 98(6), 68-77.

Sfantou, D. F., Laliotis, A., Patelarou, A. E., Sifaki-Pistolla, D., Matalliotakis, M., & Patelarou, E. (2017, December). Importance of leadership style towards quality of care measures in healthcare settings: a systematic review. In Healthcare (Vol. 5, No. 4, p. 73). Multidisciplinary Digital Publishing Institute. https://doi.org/10.3390/healthcare5040073.

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