This paper focuses on a clinical practice incident that occurred at a healthcare facility in my state. For the sake of privacy, I will refer to the hospital as Healcare Community Hospital and the dialysis nurse officer in charge of the facility's kidney dialysis unit as Abby.
She had been in nursing practice for about 12 years and had attended several nursing symposiums where she had learned and evaluated a somewhat new and modern technologically advanced method of measuring, recording, and monitoring vital information and other details for dialysis patients with kidney disease. It encompassed a software that was in use in most large healthcare facilities which enabled easy management and integration of patients’ records into the hospital database. She found it better as it was accurate and fast, so she opted to have the technology installed at Healcare. She discussed the issue with the senior hospital management, and it was concluded that the new system would be beneficial to the dialysis unit and the hospital in general.
Although some staff members were eager and reasonably receptive to the idea, a large number of nurses were hesitant to change their initial working procedures. They found quite cumbersome and inefficient to incorporate the new technology into their practice. Groups of nurses were meeting informally over tea and lunch breaks to talk about their discomfort over the incorporation of the new system and why it would be better to stick to their original arrangement.
Abby spent the following weeks going around talking to each of her staff and listening to their ideas with regards to the new technology and at the same time explaining to them why she considered having it at their facility. Personally, I realized that she was emphasizing the benefits of having the new system. Since most patients needing dialysis were frequent clients in the center, she also shared her sentiments with some of them. She organized for a staff meeting at the end of the week, aimed at discussing the matters raised. Before the meeting began, she did a short presentation to demonstrate to the staff the functionality of the system. She focused on areas that she felt the staff did not understand when she had introduced to them the idea some weeks earlier and underscored its role in service delivery and achieving the goals of the hospital. By the end of the meeting, it turned out that only about 10% of the staff were not in support of the idea, explicitly arguing that the system would not be compatible with the Healcare setting.
After deliberations, it was concluded that the new technology would be implemented at the unit but in phases. Abby would champion the initial stage where one wing of the dialysis unit would apply the technology. Then the staff would review after a month and establish whether it would be implemented in the whole dialysis unit or not, based on the outcome of the pilot project.
Introduction
In the clinical situation, Abby, being in a leadership position as a nurse found it difficult incorporating new technology into the current operations of her dialysis unit. There was a mixed reaction among her staff regarding the implementation of the system. As a result, she methodically applied the transformational leadership theory to encourage, coax and create enthusiasm among staff towards embracing the new technology to improve the institution service delivery. In this leadership theory, the leader involves the team in such a way that both parties raise each other to higher inspiration, creating need and vision for change and implementing it (Vaismoradi, Griffiths, Turunen, & Jordan, 2016). Precisely, the situation inspired me into hoping to apply transformational leadership in my leadership practice as it encourages positive emotions, effectiveness and job satisfaction among staff.
Initial Reflection
From the incident, I felt Abby was so passionate and enthusiastic about her work. She identified and established modern technology that would improve service delivery in the unit. She was also determined and persistent in her quest for change as she held on her idea all through, while at the same time being considerate the worker’s opinions. However, I found her quite egocentric when she involved the hospital management in the issue before approaching her staff.
I found Abby’s position somewhat muddling and confusing as far as decision making as a leader is concerned. I can imagine the trouble she went through; torn in between taking a decisive lead and instructing all the staff to incorporate the new technology or taking her time to involve the whole group in discussions and dialogue to come up with a final general decision. I was impressed by the fact that she was obliging enough to engage virtually all staff in the decision making.
I was quite disappointed by some of the employees who were opposed to Abby’s idea and went on to talk to themselves about the issue during breaks and backbiting her. By doing this, I felt that they lacked professionalism. I found Abby pretty friendly and approachable, so it would have been better if they just talked to her directly rather than expressing their discomfort to each other.
Additionally, I found it impressive that the outcome of the situation was a decision that was agreeable to virtually all staff. Some of the staff who were bitterly opposed to the changes in the facility initially later turned out to be advocators of the same. Also, it was through Abby’s way of handling the situation that the idea of carrying out piloting the project in a section of the facility to allow analysis of its applicability. I believe this would be beneficial because it would not only take into consideration of the minority who were adamantly opposed to the change, but also enable the management to evaluate the system before full implementation.
Critical Analysis of the Situation Using a Leadership Theory
The main pillars and behaviors of transformational leaders are the inspiration of a shared vision, idealized influence, having individualized considerations, intellectual stimulation and enabling others to act (Smith, 2011). These are the fundamental concepts exemplified in the situation at Healcare Community Hospital.
The inspiration of a shared vision emphasizes on the nurse leader’s ability actively motivate and cultivating relationships between nurses and also with other medical staff (Giltinane, 2013). This could be accomplished by focusing on the goal and vision of delivering healthcare and encouraging the nurses to fulfill their role in achieving the goal. Abby characterizes this pillar by finding a new technology that would place the facility in a better position to achieve its goal of delivering efficient dialysis services. She goes ahead and spearheads the implementation of the technology by having meetings, talking to individual nurses and motivating them to feel the importance of embracing it in their nursing role to achieve the facility’s role in healthcare delivery.
Modeling the way, challenges nurse leaders to have idealized influence by being a role model and “walking the talk”. It implies that the leader would not require staff to perform tasks that the leader would not do (Smith, 2011). The leader should, therefore, show consistency in action and words and demonstrate support to the procedures and policies of the hospital and have virtues like dependability, enthusiasm, and honesty in patient care. Abby volunteered to be the champion of the pilot project and worked with the system that she was advocating for rather than subjecting the nurses to it by themselves. She was firm in her course and was enthusiastic to the very end amid the different reactions from her staff.
Furthermore, transformational leadership calls for individualized considerations with regards to the staff’s needs, feelings, strength, weaknesses, and abilities (Avolio & Yammarino, 2013). Through motivation and supporting professional growth, the leader ensures that individual nurses expectations are met within the workplace. At Healcare, Abby paid individualized considerations to the nurses’ worries upon implementation of the new technology by talking to each of them and having meetings to get their views. More so, the implementation was meant to ease the nurses’ work while at the same time providing an opportunity for them to grow professionally by keeping in touch and working with modern technology in the nursing field. However, Abby failed to display individualized considerations by communicating to the senior management about her recommendations before talking to the staff and getting their views about it. Since the nurses were the ones directly affected by the changes, it would be more appropriate to get their views and feelings about it before engaging the management.
Intellectual stimulation underscores the nurse leader’s capability of aiding and promoting the nursing staff to practice critical thinking and problem-solving skills, alongside artistic and inventive approaches to tasks or various circumstances that they may be faced with (Northouse, 2015). By giving them an opportunity to learn, debate upon and coming up with a conclusion that was acceptable to almost all staff, Abby ensured that the staff engaged in critical thinking before coming to the final decision to solve the problem at hand. Asking for individualized ideas on how to handle a situation at hand and inspiring the staff to engage towards a resolution is the basis of intellectual stimulation.
Finally, a transformational leader should succeed in enabling others to act (Smith, 2011). He or she should give others an opportunity to lead and make decisions. The staff should be helped to learn how to apply their skills, talents, and experiences (Smith, 2011). They are trusted to complete their tasks effectively, and they take initiatives and act upon them. In the situation at Healcare, the nursing staff were given an opportunity to contribute directly to the decision making in the institution through the meetings and the individualized discussions. Moreover, the decision to institute a pilot program would enable the staff to get a hands-on experience of the new technology and therefore apply their skills, talents, and experiences in the new system. They would then decide for themselves whether the system could work for them and whether it would be beneficial before full implementation.
Besides demonstrating the significant pillars of transformational leadership, Abby displayed a myriad of character traits of a transformational leader. These include being positive as she was not emotional about the fact that some staff were opposed to her idea and even went ahead to backbite her. She was a competent communicator from the way she communicated to her team through meetings and individualized discussions (Kouzes & Posner, 2012). In her communications, she exemplified empathy, avoided sarcasm and did not talk down any of her staff’s opinions. She also talked to a few patients regarding the decision to change procedures to integrate the new system. She was visionary as she sought for methods of improving healthcare provision through enhancement of technology (Nahavandi, 2016). She was respectful, engaging and team-oriented since she gave audience to each of her staff before making the final decision. She also exercised charisma by being self-confident and possessing self-direction while avoiding internal conflict. She ad evaluated the new system and noted its benefit hence developing enough confidence in it before communicating I to the management and the staff. Other traits displayed by Abby include optimism, honesty, stability, and empowerment among others. Therefore, this situation was a clear illustration of transformational leadership. This style has a direct positive impact on the satisfaction of staff. Most likely, patient satisfaction will be achieved.
Implication for My Leadership Roles and Clinical Practice
The situation at Healcare has motivated me to apply transformational leadership in my leadership roles in my future nursing career. I will approach most of the issues more or less like Abby. However, I will approach a few problems a bit differently.
Conferences, seminars, and symposiums are great opportunities to provide staff with chances to cultivate their experience and provide exposure to the current trends in their areas of specialization. To maintain inspiration of a shared vision and enabling others to act, I will provide opportunities for my staff to attend such sessions and share their experiences with other colleagues (Vaismoradi, Griffiths, Turunen, & Jordan, 2016). For instance, in the situation at Healcare, I would have attended the symposiums with a few of my staff so that they get fast hand experience of the same unless the symposiums were meant for the nurse leaders only. Then it would have been easy for them to communicate their skills to their colleagues and to convince them, rather than doing it by myself.
Additionally, I will facilitate benchmarking programs by sending a few of my staff to observe and have the experience of how the new system has been applied in other institution (Lucas & Nacer, 2015). Then, it would be easier for them to decide whether or not the system could be applicable and beneficial if implemented at their institution thereby enabling them to act by themselves.
Some of the nurses at Healcare exhibited lack of professionalism by failing to communicate their criticisms against the institution of the new technology in the facility. In my future leadership roles, I will institute in-service classes and conduct professional development meetings during the time between nurse’s shifts. These would be aimed at promoting professionalism and proficiency in handling issues within the lines of duty (Lucas & Nacer, 2015). As a result, the nurses would gain experience on and see the need of effectively communicating their grievances with their leaders rather than keeping them and discussing them among themselves. As a result, I will have focused on intellectual stimulation as a component of transformational leadership.
Besides, engaging the management of the implementation of the new technology before letting the staff know about it was a breach of individualized consideration as a component of transformational leadership. In my role as a leader, I will get the reaction and opinions from my staff first and ascertain how they would perceive the idea before forwarding the suggestions to the institution senior management for implementation.
Engagement of stakeholders is a fundamental characteristic of a transformational leader. I will engage my staff in decision making just as Abby did (Avolio & Yammarino, 2013). However, when in a position of leadership, I will also involve other stakeholders other than nurses, would be directly affected by the changes in the in service provision. This would include doctors, the hospital records department among others. They too would have given their opinions and recommendations with regards to the new technology.
Save for the few aspects above that I would have acted differently, I would have emulated almost the entire of Abby’s philosophy of leadership since it encompasses nearly all components and traits of transformational leadership. I will inspire a shared vision through championing the implementation of technology and at the same time engage all staff in all major decision making (Nahavandi, 2016). I will also pay attention to the staff’s needs, skills and opinions needs and challenge them to develop critical thinking and problem-solving skills just like Abby did.
Conclusion
The situation at Healcare embodies almost all the key aspects of transformational leadership. From the initial identification of a new technology, engagement of staff on the decision to install the latest technology through discussions/meetings and to the final stepwise implementation of the idea. The critical components of transformational leadership were exemplified; inspiration of a shared vision, idealized influence, individualized considerations, intellectual stimulation and enabling others to act. The situation is, therefore, is essential in my future leadership role since mine would involve just integration of my few different approaches into Abby’s philosophy to achieve a better outcome. (Word count: 2044)
References
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Giltinane, C. L. (2013). Leadership styles and theories. Nursing standard, 35-39.
Kouzes, J. M., & Posner, B. Z. (2012). The Leadership Challenge: How to Make Extraordinary Things Happen in Organizations Ed. 5. Jossey Bass Incorporated.
Lucas, B., & Nacer, H. (2015). The habits of an improver: thinking about learning for improvement in healthcare. The Health Foundation.
Nahavandi, A. (2016). The Art and Science of Leadership -Global Edition. Pearson.
Northouse, P. G. (2015). Leadership: Theory and practice. Sage publications.
Smith, M. A. (2011). Are you a transformational leader? Nursing management, 44-50.
Vaismoradi, M., Griffiths, P., Turunen, H., & Jordan, S. (2016). Transformational leadership in nursing and medication safety education: a discussion paper. Journal of nursing management, 970-980.
