Nurses Agenda for the Future: Work Environment

 

 

 

 

Nursing Leadership and Management

 

 

Nurses Agenda for the Future: Work Environment

 

Introduction

            The American nursing community has joined hands around a sharedvision for the future of the nursing profession and has developed acomprehensive strategic plan – Nursing’s Agenda for the Future – to address the increasing nursing shortageand the factors contributing to it. This strategic plan corresponds to the shared vision of more than 60 organizations of nurses in the United States thathave put forward strategies to address the factors driving the increasing shortage of nurses. Nursing’s Agenda for the Future concentrates on various strategies aimed at moving the profession towards greater heightsand at the same time making certain that consumers have access to high quality healthcare. The nurses hope to collaboratewith other stakeholders in strengthening the profession through the development of the Nursing’s Agenda for the Future, and in the processmake certain that the consumers will still have access to high qualityhealth care and a safe health care environment (2006).

 

Domain

            Nursing’s Agenda for the Future included the work environment as one of the domains which needed strategies in order for the nursing profession to move on to greater heights. In the strategic plan presented by the Nursing’s Agenda for the future, the work environment is viewed as an area so basic to nursing’s future. Improving the work environment of nurses can optimize the quality of patient care and there will also be retention of the professional nursing staff (  2006).

            The deterioration of healthcare work environments is a major problem of concern to the nurse leader or manager. A healthy work environment is necessary to bring about quality healthcare service to the clients. An unhealthy work environment would create a devastating impact not only to the nurses and the clients but most importantly on the effectiveness of the entire healthcare system.

            The possible root causes for this apparent deterioration of healthcare work environments are outlined in the succeeding sentences. (1) The nurses are placed in leadership positions even if they are not adequately prepared and without adequate support for their roles. (2) Each individual nurse is assigned to handle many clients than they can handle. (3) Decision-making within the work environment is done only by one department, without consultation of all the other parties that are involved.

            The resulting environment created by these situations brings about many negative results in the working environment. When inadequate leaders are placed in positions, there will be dissatisfaction and high turnover for nurse leaders and the staff as well. When each nurse is assigned to handle many clients, this would result in confusion and the clients are placed at risk for errors and injury. The nurses are also frustrated, angry and stressed out. Decisions that are made without consulting all the parties involved places everyone involved – clients, nurses, managers and other staff – at risk. The overall quality of care offered by the healthcare service would be diminished.

The nursing staff and managers are the ones responsible for the problem. The lack of leadership skills is one major factor. In order to solve this problem, focus should be given to the nursing leaders and managers. Leadership training programs should be offered and nursing managers and leaders should be required to attend. These managers and leaders in turn should perform their responsibilities of teaching and guiding the rest of the staff in promoting a healthy work environment.

 

Theoretical Foundations

Change appears to be a driving force in society today and the American healthcare system is no exception. In addition to the need for change in today’s society, the importance of creativity in bringing about needed change must also be considered. An organization will quickly lose strategic advantages that it has worked hard to gain unless it invests in innovation and creativity, and consequently, change (1999).

With the particular problem concerning the deterioration of the work environment, a change is needed. This change would include on a large scale the leadership and management styles within the work environment. Aside from that, there should also be empowerment for all the parties involved in the work environment. Nursing organizations must empower their staff to deliver client-focused care. Empowerment is defined as “moving decision making down to the lowest level where competent decisions can be made” (1998).

 In the hospital setting, this would most commonly be at the point of direct client care or staff nurse level; however, this kind of empowerment requires an environment of autonomy where mutual trust and respect are encouraged. The empowerment process requires that staff be prepared to accept and effectively use expanded decision-making responsibilities (1998). To start changing the work environment into a healthy one, there should first be mutual trust and encouragement in all the parties involved. Each and every opinion should be respected and given consideration in the decision-making process. There should also be an all-out support for this desire for change.

            Effective leadership style is an integral part of creating an environment that nurtures the development of an empowered nursing staff.  (1997) defines leadership as “a process of social influence in which one person is able to enlist the aid and support of others in the accomplishment of a common task.”       

The major points of this definition are that leadership is a group activity, is based on social influence, and revolves around a common task. Although this specification seems relatively simple, the reality of leadership is very complex. Intrapersonal factors (i.e., thoughts and emotions) interact with interpersonal processes (i.e., attraction, communication, influence) to have effects on a dynamic external environment (1997).

The professional accountabilities of the empowered nurse includes having a sense of value about their work and willingness to provide the full scope of practice as well as ability to work as equal members of a comprehensive interdisciplinary team. In order to move into a fully empowered position, professional nurses need mentoring, education, awareness of political activism opportunities, and networking skills ( 1998).

In order to achieve all these, shared leadership should be employed. Shared leadership is a nursing management model that supports staff nurses in extending their influence about decisions that affect their practice, work environment, professional development, and self-fulfillment (2001). As previously mentioned, leadership is a group activity. In shared leadership, every voice is heard and given consideration.

Shared leadership is a collaborative team process in which team members share key leadership roles ( 2004). Shared leadership is empowering employees to act autonomously, be decisive at the point-of-service, and create a shared vision aligned with organizational goals. Shared leadership development and autonomously practicing nurses appear to be the equation for success in delivering quality patient outcomes in today’s organized health care delivery systems. Employees must develop or refine new behaviors and skills in empowerment, facilitation, negotiation, systems thinking, and accountability on behalf of patients (2002).

Shared leadership is a way to strengthen continuous learning and enhance relationships between leaders/managers, staff and clients, which are the foundation upon which the nurses can develop a new type of relationship with management and with each other. This in turn could significantly improve the work environment. There is an emphasis on ‘relationships’ since these relationships can be tenuous at times as both managers and staff members adopt attitudes of contention and competition with each other.

Aside from shared leadership, the transformational leadership theory can be employed. The transformational nurse leader typically inspires followers to do more than originally expected. Transformational leadership theories predict followers’ emotional attachment to the leader and emotional and motivational arousal of followers as a consequence of the leader’s behavior. Transformational leaders broaden and elevate the interests of followers, generate awareness and acceptance among the followers of the purposes and mission of the group and motivate followers to go beyond their self-interests for the good of the group (1997).

Many staff nurses are said to have the natural characteristics of transformational leaders, but these characteristics must first be nurtured and allowed to blossom. The nurse managers/leaders have a responsibility to encourage and support this growth, as this is very important in the transformation of the work environment (1998). A practice/work environment in which transformational leaders strive to create new visions for enhancing patient care and nursing practice is a better environment to work.

Various authors have discussed the use of transformational leadership. Many researches also suggest that all nurses could use this leadership style to enhance their practice environment ( 1998). The workplace can be transformed by creating a work environment that ensures quality patient care. This transformation can be achieved by nurses becoming transformational leaders in the workplace.

The demands of the health care environment have brought about changes that have not always contributed to positive work environments, and nurses have been concerned about the impact this has had on client care. Managers have had to develop ways to achieve expected outcomes and meet targets required by their organizations. To address all these issues, nurses need to focus on developing relationships that facilitate working with each other from strengths and not just criticizing weaknesses ( 2001).

Developing an empowering culture in which positive relationships are nurtured, leadership capabilities are developed, and professional practice is supported can improve the work environment and satisfaction of staff nurses (2001). Simply put, collaborative work relationships should be actively enhanced and promoted in order to create a positive work environment.

 

Planning

            In the current work environment, the people should be ready for a new way to share the power and the responsibility that goes with it. They should be ready for partnering relationships, collaborative work relationships and shared leadership.

For this particular problem, shared leadership has to be employed. Shared leadership provides an organizational framework that offers the nursing staff maximal participation in decisions about work and the work environment. Every staff has to be given a chance what he or she thinks about a current situation and what they think can help such issues.

When implementing new policies or rules, or even with simple matters, the staff should be allowed to contribute to the decisions to be made. Goals have to be set also. To support the nurses’ use of shared leadership behaviors in the clinical setting, the nurses will be mentored by the manager and clinical nurse specialist to apply the shared leadership skills during their daily work to achieve the goals that are set.

The creating and sharing of this setting and achieving of goals is a key implementation challenge, and also calls for transformational leadership. Through effective communication and persuasion, and confidence building, the transformational leader encourages the adoption of new values and beliefs, endorses the goal of organizational effectiveness, and sustains the effort to realize the improvement of work environment.

The transformational leader could be a staff nurse. But first he or she has to be educated on the responsibilities that the role entails. Aside from that, he or she must also be open to change.

To be included with the overall plan for achieving a positive and healthy work environment is the training of the nurses for empowerment. Training nurses for empowerment must include leadership techniques to prepare the nurse for the integrative and collaborative role. The environment in which the professional nurse works is influential in developing empowered behavior ( 1998) since professional nurses do not function in a vacuum. They need an environment that encourages empowerment. The professional nurse cannot reach empowerment if there are unsatisfied needs within the working environment.

Incorporated within the concept of empowerment is the individual’s willingness to see the vision and make the personal changes necessary to connect with that vision. It is how the concept of shared leadership works (2002). All management staff plays an important role in leading the emergence of legitimacy of this “new professional authority.” The encouragement of individual nursing staff to establish individual goals that achieve more self-direction, more knowledge and self-confidence, and more networking ability by the process of shared leadership leads to a more committed employee. A more committed employee in turn contributes to a positive and healthy work environment.

            In this proposed approach, negative consequences may also present. Shared leadership may present a conflict and ambiguity of roles. Some of the staff might revel in the shared power to the point that they will forget what the essence of shared leadership is all about. Some staff might also take advantage of such opportunity and this creates competition and jealousy within the staff. All of these wouldn’t be in line with the goal of creating a positive and healthy environment.

            To minimize such problems, there should be an ongoing monitoring of the staff. Although they are given the rights to take part in decision-making, they should also not forget where they really belong. The staff should also be constantly reminded by the managers that this effort needs teamwork and this is done for the improvement of the work environment. Perhaps motivation would also work in minimizing this problem.

 

Evaluation

            Outcomes have to be measured in order to know if the clients are satisfied with the services and products. In the case of the problem regarding work environment, outcomes have to be measured because the work environment plays a significant part in the job performance and satisfaction of the nurses. If the work environment continues to be negative or diminished, this could significantly affect the quality of care that nurses give their clients.

The main gauge for identifying if the plan or solution proposed is successful is when there is a significant positive change in the relationships of clients, staff and managers/leaders. This fosters a positive and healthy work environment. The managers or leaders can identify if the plan or solution is working if they can see the results with their eyes – like increased work performance of the nursing staff.

            Aside from that, the change can also be evaluated by various tools for measuring outcomes which are available – like questionnaires and surveys that the staff, managers and even the clients can answer.

In evaluating the outcomes, it is important to note that in addition to a strong and committed leadership (shared and transformational leadership), the success of improving the work environment depends on a receptive environment, strategy, structure, and culture.

 

Conclusion

            In every profession, not only for the nurses, the work environment is deemed crucial for the provision of quality services. In the case of the nurses, the focus on work environment is very important since this could affect the performance of the nurses and this in turn can jeopardize the lives of their clients.

            The Nursing’s Agenda for the Future supports the improvement of work environment as one of the domains that is necessary for further progression of the nursing profession as well as the quality of care that they offer to their patients.

            In some healthcare setting, there is a deterioration of the work environment which contributes to the deterioration of patient care also. There is a need to improve this and in this paper I have proposed a shared leadership strategy to overcome this problem. Shared leadership is a collaborative team process in which the team members all share key leadership roles. A positive and healthy work environment needs the support of everyone working within the environment.

            Implementing this program of improvement for the work environment should be constantly monitored so as to determine if progress is made, and if progress is made, there should still be monitoring so that this progress is maintained. Progress can be gauged if there is a significant improvement not only in the relationships of the nurses and other staff but also of the quality of patient care.

            The transformation of the work environment to make it an environment where stress levels are less high and morale levels of the nurses improve would require a transformational leader who is willing to get involved. A staff nurse could be such a leader, but he or she would first need conscious awareness of how the role is approached, a positive attitude and a mind open to change. A staff nurse can create a vision for better patient care, perhaps not on a big scale, but in the nursing care team. After all, this is a collaborative process.

In conclusion, the Nursing’s Agenda for the Future presents strategies designed for the work environment in the goal of minimizing the increasing incidence of nursing shortage. The deterioration of the work environment vastly contributes to the nurse’s job performance and satisfaction, which can ultimately lead to the problem of nursing shortage. Thus, there are various strategies that can help in improving the work environment and ultimately patient care.

 

 

 

 

 

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