The stability, continuity and success of an organization are determined by how the managers and the leaders promote cohesion among the workers and the drive towards the achievement of the set goals and objectives. In the nursing field, there is the need to have motivational leaders/managers that will be icon of success and quality health care delivery. Nurse managers hold the most critical position which links all the other stake holders in the healthcare delivery sectors. The diverse forms of challenges that they face demand for wisdom, emotional intelligence and skills in handling human beings passionately.
Management can be defined as development of officialdom that derives its magnitude from the call for premeditated planning, co-coordinating, directing, controlling and sound decision making process. Through management goal and objectives are achieved. A manager is the individual in an organization (hospital) who devices how the workers/ stakeholders will achieve the institutions goals and objectives. A leader on the other hand, is involved in an organization to set goals, way forward and objectives of the organization and inspire the stakeholders in achieving the organization dreams.
In defense nursing, own individual management style also referred to as autocratic management approach is mostly used where the managers gives orders to their junior staffs after arriving at a decision without consultation or involving them. The advantages to this style are that the decisions are quick, uniformity maintained and goals achieved before deadline. Thus is favorable during emergencies and stressful situations to avoid bewilderment. One major demerit to this style is that, it lowers the morale of the staffs who, in their perception, are not valued hence put little dedication to work/job. Moreover, leadership skills among the juniors are handcuffed due to use of downward communication. More of the nurses result in fearing the leader instead of respecting him. This causes poor socialization increasing the rate of conflicts and rivalry among them.
Since hospital success is valued by the organizational cohesiveness that surpass personal self interest, nurse managers must enhance collaboration in decision making for the better of their client who are the primary target. A nurse manager is supposed to merge disciplines of human relations, job relations, individual management and organizational engineering into amalgamating the participants for effective running.
Theories of leadership
Understanding theories gives an idea of how people make sense of their world encounters. To understand the individual nurse behaviors in respect to leadership and management, a compulsive need to explore the leadership and motivation theories emerged. The theories as explained below gives the different perspective of individuals and how to effectively manage and direct people with a human concern/heart.
“Great mans” theory. The theory hold that leadership in inherited a long the lineage of fore leadership. It opposes the idea that great leaders can be made or modeled (Kelly P, 2008). The gender disparity in the title of the theory implicates how the theory is ancient- during the time only men could become great leaders mostly in the army. The theory assumed that great leaders will arise in times of emergency. This theory may not be used in nursing since it does not give room for developing new leaders.
Traits theory. The theory assumes that nurse leaders possess personality trait and characters that makes them apt to leadership roles. According to finding of McCall and Lombardo (1983) research emotional stability and tranquility, acknowledging owns error, excellent interpersonal skills and scholarly span determine triumph or wreck of a leader. The theory has failed to justify the claims in that, some people have leadership traits yet they are not leaders. Among the traits linked to leadership were; ambitious, assertive, persistent, tolerant to stress, dominant, dependable and decisive.
Contingency theory. The theory focuses on aspects in environment that determines the best leadership style to be deployed in such circumstances. Effective leadership depends on variables such as; character of the followers, aspect of the circumstances and style adopted by the leader.
Participative/consultation theory. This works as a tool to develop new (nurse) leaders by enhancing participation of the group members in decision making process though the go- a- head is give by the leader himself. People are believed to be more devoted to dealings where they have been incorporated in decision making. The leaders should be careful to avoid portraying a feeling of betrayal when ideas ask for are ignored.
Behavioral theory. The theorist believes that nurse leaders are made and not born. It bases it argument on the action of leaders rather than their inherent qualities. It stresses the idea that people can become leaders imitating leaders and acquiring the leadership skills through training. The role ascribed to an individual play a big deal in developing him/her as a leader.
Situational leadership theory. Thetheorist argued that leaders are flexible to the style to be used depending with the specific situation (Miner, J. B. 2005). For instance, in times of emergency the autocratic style is the best but was in areas affecting the colleague nurses.
Transactional theory. The theory assumes that peoples’ morale is activated by rewards and punishment. Leaders according to this theory creates clear margins of what subordinate are expected to do and possible rewards. They get into a contract where the subordinate nurses are given rewards while the nurse leaders/company gets authority
Transformational theory. The concept in this theory is innovation and improvement. It assumes that people will agree to be lead by inspiring leaders. The theory believes in charismatic nurse leaders. Many a times this theory is found applicable and appreciated by the nurses.
Theories of motivation
In the work places such as hospital, workers need to be stimulated in order to arrive at a desired goal of the institution and deriver their best. The act of stimulating ones morale in respect to channeling their energy to achieve goals and vision set is what is referred to as motivation. Good nursing management employs continuous motivation which is goal oriented. Motivation can be in term of either:
Monetary; reasonable salaries, adequate bonuses, allowances and rewards to excellent ideas or performance.
Non-monetary form of motivation such as; praises for good performance from higher officers, proper authority delegation, favorable working condition and environment, assured job security, involving the subordinates in decision making process, supportive leaders, proper recreation facilities, sound promotion, flexibility in scheduling and transfers as well as (Marquis and Hunston, 2006) provision of training forums.
Maslow’s-Hierachy of Needs Theory. The theory was developed by Abraham Maslow (1908-1970). He argued that there are five ranks of wants that employs have to achieve. Only when a lower rank is achieved that the worker will be stimulated to satisfy the next level needs. It therefore important for the manager to understand that not all workers need the same motivation hence should avail varied sets of incentives.
Herzberg’s Two Factor Theory. This is also known as motivational hygiene factor theory. His point was that there are factors in a business that can be employed to motivate workers (motivators) and others whose absence will lead to de-motivation but their presence cannot be motivating forces (hygiene). Some of the motivators include; responsibilities in the work place, recognition while hygiene factors includes; job security, salary, hospital policies, scope of nursing. According to him if a manager want to motivate the works on their job, he should deal with those factors intrinsic to the job (motivators) .
Theory ‘X’ and ‘Y’. The theory was developed by Douglas McGregor which comprises of two opposing ideas classified in X and Y. theory X holds assumptions like; people dislike work, must be coerced to deliver, hate being responsible and that job security is more important in work places. On the other hand theory Y, holds that people generally are fold of work, they have self drive to achieving the goals set, accept and yearn for responsibilities and are very innovative
Elton Mayo theory (1880-1940). He believed that workers concerns are beyond monetary terms. Hence they can be stimulated to achieve goal through improving their social desires. He noted that managers who treat their juniors like people who are worth add greatly in motivating them. These behaviors include effective communication between nurse managers and their juniors, improving working conditions and encouraging nurse team working.
Fredrick Winslow Taylor theory. (1856-1917). Contradicting to Mayo, Taylor thought that workers are highly motivated by good payment This theory holds that juniors must be closely supervised, hence need for specialization and division of labor depending on their qualification, payment should be congruent with the production hence worker can be motivated by aiming high production for better pay. This theory supports theory X. however such worker easily goes on strike questing for more money.
Goal setting theory. This holds that people are motivated by achieving their set goals. To increase the drive to achieve, the goals have to be made public and have to be self established to initiate personal control . However performance can also be affected by level of self efficiency. More over since the goals are self set the, a person may set too simple goals lacking the innovation.
Power, control and leadership
Power is the ability of a person/ group of individuals to influence others to act in a certain way or direction to achieve his/her/their (the power source) interest. To achieve this, the person has to be responsible and accountable for the results of the actions. This is different from authority-legitimate mandate to manipulate others. Power therefore is not always granted legally or morally as compared to authority. Authority is assigned to a position but power is ascribed to a person or party. Leadership is the process of swaying others actions by motivating, directing and inspiring on the spirit of realizing their mission and vision. Control is the process of maintaining limits or imposing restrictions in the jurisdiction of nurses’ responsibility. Control is more or less on extent of power and authority utilization. Therefore a leader should exercise his authority and power within the control limits. For proper communication in the organizations, power control and leadership should be defined and understood by both the leader and the juniors.
The aspect of management in team work in nursing field can be employed to solve conflict in the working places that result from defective cohesion in the work place. A good manger should embrace the best management style to solve arising issues in the hospitals. Democratic is the most embraced style in group leadership since with the increased level or awareness and education; the juniors can be useful in improving the quality of services delivered. Autocratic leaders may find it difficult meeting the clients’ needs due to the antisocial atmosphere in the work place leading to elevated levels of conflicts. It is however difficult to consistently implement on type of management style due to varying situations and conditions to be handled. Conflict through confrontation enhances continuity of relationship and improving the positivity of outcomes acceptability. For this, to be realized the manager should therefore establish a close relationship with the workers. Integrity should at all times be upheld by the managers to avoid bridging the professional boundaries.
Change. Change as a concept can be traced from 500 B.C. This is the time people like Herictus and Ephusus (Armstrong, 1995) quoted that ‘nothing is fixed’. In life, due to the incorporation of new ideas, methods and devices, there is no doubt that change must occur. The consequences of change can be beneficial to some while to others it comes with ample demerits causing obstacle in their life dreams(Marquis B.L and Huston J, 2003). Generally change can be classified as either; Evolutionary- which is the gradual process of transformation. For instance health center grow to referral hospital or infant to adulthood, unprompted change- occurs abruptly without being planned for-for instance death of a Nurse in-charge in a certain hospital, or deliberate changes- which are planned events that have a view of bringing out the desired modification in the hospitals or in the nursing profession; for example; employing more Nurses, remuneration process (Marcus, L. J. (1999). Nurse Leaders or managers are suppose to be change agents - one who has the responsibility to initiate and direct the process of leadership. The purpose of a nurse manager is to solve problem and prepare to handle tomorrows’ changes.
Reasons for resistance to change arise mainly due to poor communication between the change agents (nurse managers) and the target cluster (Stoner and Wankel, 1986). Some of the reasons to resist change include; Fear of unknown where the nurses anticipate loses, insufficient information concerning the change effects and consequences, inaccurate information regarding the change mostly caused by poor chain of communicating between the change agents and the affected group e.g. rumors, when the degree of change is higher the resistance tends to be more eminent, interruption to routine which makes nurses feel incompetent, threats to loss control especially when competition seems to set in, mistrust in the change agents resulting uncooperative subordinates, customs violations , group inertia among the informal flocks in the hospital due to fear of breaking current upheld social bonds and bureaucratic organizational structure were there are proper outlines of jobs and line of authority. The nurse leaders may fear losing their authority hence can among them resist change.
Proactive measures to resistance of change.
Effective communication channel before, during and after the change process contribute enormously to eschew resistance to change. Ensure that the message reaching the target group is accurate in context and structure (Van Wormer et al., 2007). Currently there is the need to embrace emotional elements of change so as to cope with physiological transition of nurses affected by the change. More over the culture of the nurses in the hospital is largely influenced by the organizational culture. The latter depicts how the nurses will respond to changes in the organization (Marquis B.L and Huston J, 2003). Leaders find it easier to implement planned and evolutional changes which take longer thus giving the nurses time to assimilate the changes. And finally it is in no doubt that everything has a limit which when not realized can lead to considerable constrain. Nurse leaders should develop insight to be acquainted with what is can change and what can’t and grace to accept it or rather introduce changes in bits to avoid creating stressful situation in the work places.
Ways of coping with resistance to change amongst nurses
Participation technique –rarely will nurses oppose changes if they have been fully involved in the change process in all the phases. Nurses in this hospital should be participants in devising and executing the modifications thus creating a sense of loyalty in the organization. This can easily be achieved by developing programs (workshops, seminars or guide literatures) to inaugurate the nurses with necessary skills to cope with change (Marquis B.L and Huston J, 2003). Concession approach – the nurse leader or the change agent indulges in an egalitarian, friendly and wooing campaign targeting the resistant groups to a firm their stand in the process is respected and their rights not violate in whatever way. In Coercion approach when critical changes are facing resistance, coercive forces are used e.g. threats or callous punishments are employed to hasten the implementation of the desire changes (Van Wormer et al., 2007). Manipulation approach is ‘scape- goating ‘the purpose of the changes to suit the nurses appetite to encourage them to accept the changes. The opposing individuals are ‘bought’ by making them leaders in the change processes (Marcus, L. J. 1999).
Conflicts. Conflicts are obdurate truth of an institutional life (Kolb and Putnam 1992). It’s therefore wise for leaders to prepare in advance on how to cope with them rather than assuming they will not happen. With the increasing diversity of cultural differences and jobs expectations it is imperative that that we embrace the skills to solve conflicts. Conflicts in the hospitals can be defined as a state where interdependent individuals manifest differences in achieving their needs and interest thus encountering interferences among/between them (Finkleman, 2006). To resolve conflicts good understanding of the root causes and effective communication must be implemented. Communication leads to conflicts, helps reflect conflict and it also the medium for resolution.
Styles of conflicts management
Avoidance style is a non-confronting tactic where an individual ignores or denies existence of a conflict. Mostly used for conflicts with mild repercussions when unsolved (Marquis B.L and Huston J, 2003). Accommodating style is adopted when ones ideas or behaviors are not assertive thus overlooking his objectives. In Competition style one party loses at the expense of the other party/person. The win fights withal means disregarding the other person’s needs. Collaboration style is a problem solving approach where both parties engages in searching for underlying issues by clarifying ideas to arrive at a mutual consensus resolution . Compromise style is a give and take approach applicable when the parties are confident in their ideas and cooperative . They are ready to share their ideas thus ending up partially satisfied. It works best when conflict is complex and no need for win-win intentions. Force approach indicates lack of concern for in the parties involved relationship. The powerful people in the hospitals may force their subordinates neglect their desires and utilize theirs (Buchanan D, & Badhan R., 2000). It is mostly used when immediate solutions are eminent, when one party is accountable for endorsing a decision or uniformity is needed in the hospital.
Understanding the best method to apply in solving conflicts and problems in an organization is a vital task for all managers to be able to maintain conducive atmosphere which will enhance profound outcomes (Marquis B.L and Huston J, 2003). Irrespective of the management style adopted by a manager conflicts will still arise in organization the difference is what level, kind and extent of conflicts do affect your organization. In many institutions nurses are believed to used avoidance approach which leads to job dissatisfaction. Managers can therefore face great challenge in solving issues which are deep-rooted in the personal life or accumulated hatred among the nurses that impacts negatively to realization of the goals and objectives.
Resistant to adopt changes can lead to changes or modification of management style used in a give institution (Dixon N. 1994). For instance a leader who believes in democratic leadership may be forced to be autocratic to force the nurses in adopting critical changes in the hospital that do not need negotiation irrespective of the outcomes to the affected group, e.g. scheduling in times of emergencies (Finkleman A.W, 2006). The above described method of dealing with resistance to change and conflict resolution among nurses, can lead to poor or effective and efficient management. For instance, a manager who uses avoidance, force and /or compromise to resolve conflict among his/her nurses will defiantly at a point fail to bring things in order due to pilling up of rivalry (Kelly P., 2008).
Use of coercion and manipulation methods to deal with changes in the working places amongst nurses will lead to defiance or low productivity due to lack of motivation and self drive where they fill that they are being used as robots by their managers.
In the working places nurses are supposed to handle each other professionally respecting each others’ stand but not looking at others as them (civilian nurses) and us ( defense nurses) since primary goal is the same- better care for the client. All nurses should be involved equally (within their jurisdiction) since they all have adequate capability and training in their responsibilities. Some cases that demands the employment of emotional intelligence will help boost the ‘civilian nurses’ self esteem (Harper, Collins, 2001) thus giving them a feeling of worth and hence skyrocketing the performance quality.
For conducive environment in the working places for nurses, the need for adorable leadership, management that encourages participation and contribution, skills in solving conflicts and problems, motivation of workers at all levels and facilitating rooms for innovation and assimilation of changes must at all cost be clinched. In such a hospital the nurse leaders will be able to employ their best technique skill in inspiring the junior nurses to deliver maximally.