Leadership - A Shortage Within The Nursing Shortage

Nursing leadership is essential if nurses are going to participate in the political arena for healthcare policy and if we are going to create the kinds of work environments where nurses can achieve their professional goals of expert patient care, autonomy, respect and relationships (P. Buerhaus, 2007). In recent conversations with nursing educators and human resource directors across Alabama, a recurring theme has been the desire for more nursing leadership in their facilities. This lack of nursing leadership is not a recent development. In Nursing Leadership and the New Nurse, Susan O. Valentine (2002), lamented the shortage of nursing leaders within the larger nursing shortage. Horton-Deutsch and Mohr wrote in 2001 that an "absence of nursing leadership" contributed to a less favorable opinion of the nursing profession by new and student nurses. Our profession rightly mandates continuing education in disease, pharmacology, and technology developments. Making the development of nursing leadership skills a priority ensures that time and energy will be focused on this area as well.

In nursing, as in any business, developing leadership skills is best accomplished with a performance based process that can measure behaviors and outcomes. Identifying behaviors associated with desirable leadership characteristices of competence, character, and empowerment means skill progress as well as a return on training dollars invested can be measured.

Competence

Initial professional competence is developed through academic and clinical programs and ensured by licensing examinations. As with many professions, Alabama requires continuing education for nursing license renewal. In practice settings, interview, orientation, and performance evaluations typically assess nurses' initial and ongoing competence levels in the clinical setting. Lenburg's (1999) Competency Outcomes and Performance Assessment (COPA) model identifies eight core competencies that can be used to identify behaviors that will result in competence in eight areas:

1. Assessment and intervention

2. Critical thinking

3. Teaching

4. Human caring relationships

5. Knowledge integration

6. Communication skills

7. Management

8. Leadership

Lenburg's model is flexible. Specific skills can be differentiated for practice settings and learning levels. For example, skill expectations would be different for nurses working in critical care, physician offices, managed care or administration and for new graduates or experienced associates. By pinpointing specific skills that result in the competencies listed above for an area of practice, and assessing your own or your staff's competence in the idenfied skills you develop a leadership tool that provides measurable comptetency outcomes.

Character

People don't follw a leader they don't trust. Recent surveys assessing the public's perception of trust among various professions (P. Beurhaus, 2007; J. Johnson, 2007) has shown nursing to be at the top of the list for trustworthiness. Character counts. Maintaining public and professional trust is essential for developing a leadership role. Character education has become an industry in itself. One example is goodcharacter.com which teaches elementary and advanced character concepts beginning with the "pillars of character" noted below.

* respect for others and for yourself

* responsibility for actions taken and the responsibility to act

* fairness in dealing with others

* caring for others and personal needs

* citizenship by participating in the community to give back

If an individual's behavior exemplifies these characteristics they would tend to be trusted, the sixth pillar of character. By pinpointing specific actions that demonstrate these pillars, nurses can take steps to maintain and build trust among their peers, patients, and administration.

Empowerment

More than connection ,which implies knowing or sharing some common ground with another person, people who empower others share common ground and through rapport and relationship enable others to take action on their own by instilling in them a process for success. A successful process begins with setting goals, identifying actions to achieve the goals, providing or finding necessary support and reinforcement, and a process to evaluate success or needed improvements.

Nurses use this process to empower patients to care for themselves to the best of their ability. Nurses listen to patients, assess their needs, help patients set goals, provide information, teach and help practice new skills,. They also provide feedback on their progress, celebrate their successes and share in their sorrows. The progression of care is with the goals of autonomy, respect, and dignity achieved through empowering relationships.

Empowerment is as applicable to nursing administration and nursing staffs as it is to patient care. By assessing individual nursing competencies, experiences, knowlege, and skills, feedback and reinforcement can be provided that builds expertise in each area including leadership. The progression of professional development achieves the professional goals that nurses and organizations want: quality patient care, autonomy within the scope of practice, respect through trust, and empowering relationships.

Measurement

Implementing leadership tools that assess pinpointed performance outcomes allows for measurement of progress towards the goal. Leadership implies followers and the real test of a leader are the actions of her followers. Followers behavior can be measured by:

* their numbers

* the direction they are moving

* their speed of action

* whether they continue to perform in the absence of the leader

* their innovation

* their persistence in pursuing the goal

* their satisfaction in achieving results

* their mutual rapport, respect, and trust with the leader (Daniels and Daniels, 2005)

Using a measurable process for developing leadership skills enables us to identify desired results, the actions necessary to accomplish the results, provide or ask for support, receive and provide feedback and reinforcement, and evaluate the achieved results for success or improvement. It is an actionable process with measurable outcomes.

At the October 2007 Alabama Center for Nursing Conference, a Chief Nursing Officer I was sitting with said that she agreed with a survey finding that nurses did not want to relocate, Her nurses wanted to work close to their families. She later commented that her staff didn't always make the same decision she would make but they made good decisions and could support their decisions with sound reasoning. The benefit was that she wasn't being called at all hours of the day or night. She sounded like a leader to me. Her nurses have autonomy, respect, and empowering relationships. I don't think the only reason her nurses are staying is because they don't want to relocate. I think her nurses stay because they have found their leader.

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