Essay: Leadership And Management In Nursing: Contributions And Limitations Of Management Theories.

Contribution and Limitation of Leadership and Management Theories

Discuss about the Leadership and Management Nursing.

Effective leadership and management are vital in any health care organisation. It is required to balance the patient’s needs, physician’s, employees and the organisation. It is with the leadership that the mission, behaviours and, attitude of the organisation begins. It creates the direction and purpose to work. Health care organisations are greatly depended on the nurses and the nurse mangers (Gopee & Galloway, 2017). They play a great role in creating a healthy work environment. Nursing profession is very stressful and leadership and management skills are essential to deal with the diverse groups. Nurses play different roles in the management of the health services. To address this issues the nursing management nursing literature was conducted. The concerns of the nurses with regrades to health care management increased with increasing rate of aged population and chronic illnesses. The foundation of nursing practice is the humanism and interpersonal relationships. The concepts of the management and the leadership are essential for nurses to create awareness on the management that would help meet the organisational goals or lead to productive outcomes (Wong, 2015). The aim of the assignment is to discuss the contributions and imitations of classical management theory, bureaucratic management theory, and human relations movement.  Followed by the discussion the assignment presents the personal viewpoint on the styles of the management that best suits the organisation. Also highlighted is the personal preference of process of management that would be undertaken to ensure that the organizational objectives are met especially in today's challenging environment.

Classical management theory is based on the assumption that the employees have only economical and physical needs, and managers must fulfil them. It greatly focuses on the labour specialisation, decision-making, profit maximisation and centralised leadership. This theory is designed mainly to streamline the manufacturing operations. It is not widely subscribed in the modern times in health care. It originated in the 19th century and gained prominence in the 20^th century. The principles of this type of management are widely applicable in the small business settings. As per the theory the three main attributes of the workplace should be the hierarchical structure, specialisation and incentives (Lloyd-Smith, 2015).

The owners and the board of directors hold the top positions in the organisation and are responsible for setting long range objectives for nurses and clinicians. The middle level managers oversee the supervisors, and set the goals at the department level while confined to the manager’s budget. Superiors work at the lowest level, as they handle the day-to-day activities and address the nurse’s needs. Specialisation allows the breaking of large tasks into smaller ones. It ensures the assembly line view of the workplace. It contributes to worker’s specialisation in single area and eliminates multi-task. This theory allows the managers to have clear structure to manage organisational functions and operations. With the help of division of labour, accomplishing work becomes easier and productivity is enhanced. Management becomes easy with the clear definition of the roles and responsibilities in the health care complex setting (Gulzar et al., 2015).

Classical Management Theory

According to this theory higher wages will increase the work productivity. This theory applies scientific methods and techniques to improve the working conditions. It eventually contributes to improved relationships between workers and managers. It is advantageous to workers as they get training and development opportunities. Scientific selection and training of the employees increases the employee’s efficiency.  Application of theory in clinical setting considered to ensure fair section of health care professionals. The advantage of the theory is ensuring the line of authority.  Using this theory of management by the leaders and managers contributes to society as people get better product and services, better utilisation of resources, lowers the cost of the product and services. Using better product improves the standard of living of people. In nursing using this theory to better manage medical resources improves care quality and decrease hospital stay of the patients. It decreases the health care costs (Huber, 2017).

 There are limitations to the classical approach to management. It is mainly applicable for the simple organisations. Considering the health care sector to be dynamic and complex, using this theory is a drawback today. It is focused on the single best way to manage by focusing on the individual performance instead of the group process. The drawback of this approach comes from division of the labour into the efficient and inefficient categories. The theory of management emphasise on the increase in productivity by job specialisation and the job repetitions. Nurses on the other hand require diverse skill sets. It is the limitation as this approach only leads to monotony. It reduces the scope of innovation and creativity. This theory of management rarely focuses on the human factors and relationships.  It emphasises on monetary benefits to motivate workers. There is no scope of human resource development. Such management only leads to frustration and emotional distress among the employees. Since humans are treated as machines there is never a hope of job satisfaction and increase in morale. It greatly failed with emergence of theories that focused on human motivation for productivity. Considering the profession of nursing lack of human factors will lead to disastrous health outcomes (Kumar, 2017).

Developed by Max Weber, Bureaucratic Management Theory aligns with the classical management theory, in regards to structuring an organization into a hierarchy. It allows having clearly defined rules when governing the organisation. The theory focuses on the fixed division of labour and balance between the power and responsibilities. Application of this theory in clinical setting includes effective flow of decision-making information from top to bottom. The theory used in health care organisations is based on the principle of the rationality, consistency, precision and objectivity. The theory also focuses the managers of an organisation to have the formal and impersonal relationships with the employees and is mainly based on the position.  This theory well defines the rules and the responsibilities of the employees. The theory solely gives importance to the legal power. For instance the nurses may focus only on care and not on the organisational issues (Rahaman, 2016).  

Bureaucratic Management Theory

The theory with specialisation contributes to the communication, coordination and controls within the organisation as the higher unit controls the lower unit. The impact of such management style in nursing on the corporate enterprise demands the system shift from “narrow to a broad focus”. Such shift today will allow the management and the caring views to exist side by side. It may contribute to nursing field by realistically representing the transformation of the health care organisations for human benefit (Lloyd-Smith, 2015). 

The theory today is limited in the sense that the emphasis is mainly on the rules and regulations, which may delay important decision-making. In the health care sector, especially in nursing profession this aspect is the major drawback as the profession is based on humanism.  Too much of formality may hamper the communication and coordination which are vital in interdisciplinary team. Bureaucracy is argued to hamper the efficiency as the dedication of the employees is not considered. It is applicable only in government organizations as it is not the close-to-perfect solution. There is limited scope of the human resource development and is greatly criticised.   Though employees obeying the formalities may have sense of security, the window for red-tapism is maximised. It greatly diminishes the scope of innovation and creativity. It is difficult to be applied in the nursing profession as it prevents one to be goal oriented. It is challngeing for nurses to work against the basic nature of human being (Huber, 2017).    

The theorists of the human relations movement emphasised on the informal aspects of an organisation’s social structure. This approach was founded by the industrial psychology discipline and the industry relations. It now determines the organisational behaviour. The theory has contributed towards employee benefits in the organisation. According to this theory the employees’ health or psychological needs must be considered important to increase work productivity. In nursing it s greatly applicable as health care setting is the complex owing to care professionals dealing with chronic illness of patients. Nurses work under stress due to staff shortage, long shift hours and pressure to meet the organisational standards of care. Therefore, this theory contributes to understanding the nurse’s psychological needs and their relationships to work productivity (Kelly, 2014).

 This theory contributes to enhancing workers performance and reducing the industrial strife by improved cooperation between the workers and the management. In any organisation the psychological factors greatly influence the motivation of the workers. The theory emerged with concepts such paying attention to the workers instead of physical environment. The important contribution of this theory is the emergence of concepts of job enlargement and job rotation. It offsets the alienations faced by employees due to division of labour and excessive formalisation process. Before the human relations movement has emerged the organisations mainly used explicit rules, job descriptions, procedures, and communications to govern activities, prescribe roles, and standardise behaviour. As this theory focuses on the human factor, it led to employee welfare in many organizations. It led the labour gain more economic and political power. It revolutionised the management training laying importance on the manager’s style. It allows the nurse managers and the clinical leaders to think in terms of group process. It calls for group rewards instead of individual recognition (Ronald & Malcolm, 2017).

Human Relations Movement

The theories of  management greatly contributes to the nursing practice. It is reflected in the various approached taken by the health care organisations for development of nurses, for instance, mandating the cross-cultural training to cope up with cultural diversity. Streams of study working on human relations movement, contributed to the concepts such as leadership, motivation, small group dynamics, behaviour, morale, participative decision making and considering the workers characteristics. Nurse managers use this theory of management to establish trust in patients through interpersonal relationships. Using theories of human relations school, health care organisations are taking efforts to address the development needs of nurses. It is also reflected in efforts to increase autonomy and empowerment of nurses. In order to improve the organisational functioning the nurses are involved in decision-making process (Sheer, 2017).

There are several limitations of this theory. It includes viewing the human factors and relationship as the single most variable important for management. It committed the mistake of searching one most effective of managing like previous theories. A human being can be motivated by numerous factors. It may not be just autonomy or rewards that will increase work performance. Giving such benefits may not always increase the productivity of the workers. Although this movement paved the way for behavioural sciences in 1960s and 1970s, introducing fringe benefits on the assumption that satisfied employee’s increases predacity is a flaw. For instance, giving benefits of vacation may not increase productivity (Huber, 2017).

The role of the nurse manger is very complex. It is the position hold by the nurse within the hierarchy of an organization.  A nurse manager may or may not be a good leader and similarly, all good leaders many not be a good nurse manger. A leader may not have recognised authority within the organisation. Leadership skills can be demonstrated at any point of work. A nurse manager must come up with management style that is most suitable to meet the organisational goals and possess effective leadership skills (Grossman & Valiga, 2016). Nursing management is the process of working through staff to ensure comprehensive care to the patients. Therefore, Henry Fayol’s management process is considered to be best suitable. It involves the careful planning organising, directing, leading and controlling of human resources, financial material to provide economic and effective care to the group of patients (Efthymiou & Yacoub, 2016). I also believe in implementing the elements of the human relations approach considering its benefits and as it eliminates limitations of classical and beauracratic style of management.  

Among the leadership style the best suitable to meet the organisational goal is the situational leadership style. It is the change of leadership style depending on the situation, as no particular leadership style can be used for the entire situation. This model involves four leadership styles. Telling leadership is used when repetitive results are required. Selling leadership is used to gain cooperation especially when introducing change. For instance, introduction of patient centered care model. Participation leadership is used to allow staff to make choices. Delegating leadership is used to let nurses do their job. The situational leadership model has been widely used in residential aged care sector and has been found to be successful (Lynch, 2015). Apart from this transformational leadership is the best suitable for nursing profession. This theory allows nurses to transform the healthcare. The components of this style of leadership are intellectual stimulation, individualised consideration, idealised influence, and inspirational motivation (Kossek et al., 2018).   

Process of management that would be undertaken to ensure that the organizational objectives are met; especially in today's challenging environment is discussed in this section. Base on my personal experience and research conducted the nurse managers and the leaders must play a significant role in solving various issues in nursing such as shortage of staff, training and development needs, patient abuse, workload, financial cost and others.

The essentials of good planning for nurse managers and leaders are developing alternative approaches to meet the organisational goals. Nurse Manager can come up with different approaches to address the above mentioned nursing issues to make the health care process run smoothly. The main role would be to create a healthy environment that is pleasant and productive. Clinical nurse leader must cultivate variety of skills to adjust to cultural diversity in workplace. Other skills required are communication, creativity, vision, analysis, strategy, and organisational management (Fleiszer et al., 2016).  According to Bender et al. (2016), organising function of a manager refers to relating people and things to each other. All must be combined into a unit that can well direct the organisational objectives. This function needs perfect balance of the authority over nurses and responsibility to ensure care safety. 

The nurse managers are critical to the retention and the recruitment efforts. The nurse leader must demonstrate the integrity honesty and optimism. Nursing staff are motivated with the leaders who are good communicators, approachable motivating, receptive to others, empowering and fair (inspirational motivation). Using the skills the nurse must walk the talk and such leadership leads to effective patient outcomes (idealised influence) (Rahaman, 2016). According to Morsiani, Bagnasco & Sasso (2017) 84% of the nurses are dissatisfied with the nurse manager and are leaving the job. In this regard using the system theory is effective for the nurse manger for making appropriate changes in the workplace and retains the skilled nurse. It is associated with low patient outcomes and increased hospital stay.

According to Morsiani, Bagnasco & Sasso (2017) nurse leaders and mangers play a vital role in staff selection, training and motivation. The nurse must investigate the nurse’s turnover and scrutinise their personal needs.  Nurse manger can ensure flexible work schedule, considering the age of the nurse staff. Young nurses may have long shift hours when compared to older nurses. Nurse managers can play a significant role in recruitment and selection of the nurse staff. They can encourage lobbying the law makers to hire nurses from abroad. It will prevent overall nurse shortage issue. The nurse leaders can avoid recruiting staff with unrealistic expectations which can be recognised by using appropriate assessment tools. Using effective methods such as exposure of the candidates to the duties, requirements and responsibilities of job the nurses can create realistic job previews. It may be suitable to reduce the turnover associated with poor-fit related to pay rates and other job characteristics. Such practice is associated with growing evidence of improved patient care quality and safety outcomes (Bender et al., 2016).

The aspect of directing in the nursing profession means the nurse managers would issue orders to nurses, delegate tasks and monitor adherence to the national guidelines, code of ethics, and professional standards in the organization. Leading, motivating and communicating are the main components of directing management process (Davidson & Everett, 2015). In order to motivate the nurses stressed with complex care process, the nurse   administrators and the managers  must ensure attractive benefits such as retirement plan, health insurance, vacation based on years served and tution reimbursement. The manager must empower nursea to pursue higher education. Facilities such as nursing training and development and job rotation may prevent nurse’s burnout. Upgrading technology will allow the nurses to decrease their workload.  For instance, nurse manger must ensure adequate supply of equipment such as technology for lifting patients, proper training for body balance. Such supervision will allow proper execution of orders The nurses may promote intellectual stimulation that is asking nurses to exercise innovative thinking, problem solving and critical thinking skills (intellectual stimulation)  (Huber, 2017).

It is the personal belief that the nurse manger should involve in effective communication with the care professionals to identify and address their issues (individualised consideration). Sincere efforts must be taken to resolve the issues to make the staff comfortable. Professional boundaries must be maintained and at the same time fellow nurses and the staff must be treated with respect at work and in community. With the help of collaborative council, mutual respect can be developed among all the health care professionals. The management literature in nursing suggests involving nurses in decision making to make them the part of team. It will help address the challenge of staffing in the active workforce. Effective communication will help to facilitate coordination and control, which is again essential of good planning (Wagner et al., 2015).

Another crucial part of the management process is the leadership. Effective interaction between the nurse staff and the nurse leaders will lead to successful leadership. Various styles of leadership are available such as transformational, democratic participative leadership, and autocratic leadership. I believe that situational leadership is the most effective leadership style.

The controlling aspect of the management by clinical nurse leader involves regulation of activities in accordance with the set plans. It refers to established standards, measuring performance and comparing actual result with standards and addressing deviations (Weiss & Tappen, 2014). For instance nurse leaders can set standards or policy for hand hygiene. It will help monitor the rise or fall in noscomial infections. It will help nurse to address the barriers to compliance with hand hygiene policy. This controlling aspect of the management process is applicable for clinical nurse leader in medical care as well as other clinical aspects.

Conclusion

In conclusion the nurse must involve in evidence based management style.  There are different leadership styles and theories. The nurse manger must pick up management style that has less limitation and more advantages. Based on research conducted and personal experience transformational and situational leadership are most effective.  I consider the Henry Fayol’s management process to be best suitable. The most effective nurse emerges from strong leadership from nurse managers or clinical leaders. The management style and the overall morale set by the nurse manager/leader have direct correlation with the nursing staff’s attitudes and outcomes. Nurse managers have complex role to play owing to challenges pertaining to nurses turn over, emergency care, allocation of resources, and others. The nurse leadership and management should focus on the staff retention as nurses are frontline carers. It calls for nurses to be persuasive. Nurses must plan to set patient care goals managers plan to create objectives. Effective organising skills are required to ensure patient outcomes. Nurse’s mangers must lead the nurses to deliver patient centered care and address the physical and psychological needs of nurses.  The manager must monitor the activities of nurses to overcome inefficiencies.

References

Bender, M., Williams, M., Su, W., & Hites, L. (2016). Clinical nurse leader integrated care delivery to improve care quality: factors influencing perceived success. Journal of Nursing Scholarship, 48(4), 414-422.

Davidson, P., & Everett, B. (2015). Managing approaches to nursing care delivery. Transitions in nursing: preparing for professional practice. Chatswood, New South Wales, Australia: Elsevier Health Sciences, 125-142.

Efthymiou, L., & Yacoub, M. (2016). The Influence of Classical and Human-Relations Approaches in Management Today, A Critical Evaluation.

Fleiszer, A. R., Semenic, S. E., Ritchie, J. A., Richer, M. C., & Denis, J. L. (2016). Nursing unit leaders' influence on the long?term sustainability of evidence?based practice improvements. Journal of nursing management, 24(3), 309-318.

Gopee, N., & Galloway, J. (2017). Leadership and management in healthcare. Sage. Retrieved from: https://books.google.co.in/books?hl=en&lr=&id=GRgjDgAAQBAJ&oi=fnd&pg=PP1&dq=classical+and+bureaucracy+management+theory+for+nurses&ots=R4OmufEOz6&sig=zdvdPsb4JeD08SI6KcRpPDVwGG4#v=onepage&q=classical%20and%20bureaucracy%20management%20theory%20for%20nurses&f=false

Grossman, S., & Valiga, T. M. (2016). The new leadership challenge: Creating the future of nursing. FA Davis. Retrieved from: https://books.google.co.in/books?hl=en&lr=&id=C5YSDQAAQBAJ&oi=fnd&pg=PP1&dq=nurse+managem,ent+and+%3Bleadership&ots=tYlBsAZFyt&sig=OJm7ryAdK8NJ27av3NaCGRqCDxs#v=onepage&q=nurse%20managem%2Cent%20and%20%3Bleadership&f=false

Gulzar, A., Ghumro, N. H., & Memon, P. A. (2015). Impact of Industrial Revolution on Management Thought. Sukkur IBA Journal of Management and Business, 2(1), 1-16.

Gunawan, J., & Aungsuroch, Y. (2017). Managerial competence of first?line nurse managers: A concept analysis. International journal of nursing practice, 23(1).

Huber, D. (2017). Leadership and Nursing Care Management-E-Book. Elsevier Health Sciences. Retrieved from: : https://books.google.co.in/books?hl=en&lr=&id=OTg1DwAAQBAJ&oi=fnd&pg=PR1&dq=classical+management+theory++for+nurses&ots=QqCtqNndSD&sig=bsmD5aRug8sR7WGwp3RmdV7pqw8#v=onepage&q=classical%20management%20theory%20%20for%20nurses&f=false

Kelly, J. (2014). Human Relations Movement. Wiley Encyclopedia of Management. DPOI: 10.1002/9781118785317.

Kossek, E. E., Petty, R. J., Bodner, T. E., Perrigino, M. B., Hammer, L. B., Yragui, N. L., & Michel, J. S. (2018). Lasting Impression: Transformational Leadership and Family Supportive Supervision as Resources for Well-Being and Performance. Occupational Health Science, 1-24.

Kumar, P. (2017). Analysis the impact of classical management approaches on the management practices. Asian Journal of Management, 8(3), 841-853.

Lloyd-Smith, M. (2015). The ideas of the classical theorists, particularly those of bureaucracy and scientific management, are generally considered as rather old fashioned and out of date, and of little relevance to work and organisation today. Is this really the case?. Unpublished Paper, 6, 10.

Lynch, B. (2015). Partnering for performance in situational leadership: a person-centred leadership approach. International Practice Development Journal, 5.

Morsiani, G., Bagnasco, A., & Sasso, L. (2017). How staff nurses perceive the impact of nurse managers’ leadership style in terms of job satisfaction: a mixed method study. Journal of nursing management, 25(2), 119-128.

Rahaman, A. (2016). 4 Leadership and Management. The Handbook of Federal Government Leadership and Administration: Transforming, Performing, and Innovating in a Complex World, 78.

Ronald, B., & Malcolm, W. (2017). The role of the Human Relations School vis a vis today's Human Resource Management. Advances in Management, 10(10), 1-5.

Sheer, V. C. (2017). Human Relations/Human Resources Perspectives. The International Encyclopedia of Organizational Communication.

Wagner, J. D., Bezuidenhout, M. C., & Roos, J. H. (2015). Communication satisfaction of professional nurses working in public hospitals. Journal of nursing management, 23(8), 974-982.

Weiss, S. A., & Tappen, R. M. (2014). Essentials of nursing leadership and management. FA Davis. Retrieved from: https://books.google.co.in/books?hl=en&lr=&id=EIEsBQAAQBAJ&oi=fnd&pg=PR1&dq=Leadership+and+Nursing+Care+Management&ots=O5evspMRsr&sig=YNtlMMDRv_uxK13FxhXwHqbop5Q#v=onepage&q=Leadership%20and%20Nursing%20Care%20Management&f=false

Wong, C. A. (2015). Connecting nursing leadership and patient outcomes: state of the science. Journal of nursing management, 23(3), 275-278.