Effective Nursing Leadership in Employee Retention

In the field of healthcare systems, there have been transitions included in the delivery of health acre along with the changes in the technology related to payment models and also the integration of the work force. In order to manage such transitions or changes in this field, first line nurse managers are required who are equipped to deal with such transitions (Brunetto et al., 2013). These nurse managers or nurse leaders also play an important role in retention of the staff in an organization. Employee retention is of big focus for these leaders as from a professional perspective of healthcare systems, employee retention is related to the quality and continuity of care. Employee retention is related to making the employees more committed to their job as well as to the organization they are working for (Tillott, Walsh & Moxham, 2013).  The role of the nurse leaders  are specifically important in the employee retention as they possess the first-hand knowledge about the challenges and the issues that the staff experiences in the workplace in relation to nursing and delivery of care (Laschinger & Fida, 2014).  This paper aims to investigate on the topic that how effective nursing leadership can contribute to retention of the staff in the healthcare facilities. The paper also illustrates the theories associated with the nursing leadership and how these theories will successfully address the problems faced by the staff followed by the discussion of the evidences which shows that the theories prove to be effective in successful retention of the employees in the workplace.

For conduction of the study, peer reviewed nursing journal articles were selected which were searched from various databases. The paper uses databases such as Google scholar, CINAHL, HAPI, EMBASE, ERIC and MEDLINE to search the articles that are used in the paper. The key terms that were searched for includes nursing leadership, nursing leadership management, organizational management, leadership in healthcare facilities, employee retentions, nurse leaders, nurse managers, social exchange theory, transitional leadership, Dynamic Leader-Follower Relationship Model, nursing leadership theories and models of nursing leadership. 

In order to gain competence as a leader, the nurses are required to practise leadership based on some of the theories which provides these nurses with guidelines as how to emerge as a competent leader in the healthcare field. Some of the theories that can be best practised by a nurse leader involves quantum leadership, transformational leadership and the dynamic leader-follower relationship model (Brown et al., 2013). These theories are applicable in order to embrace leadership at any given level of practise. According to the quantum leadership theory which was developed by Tim Porter-O’Grady and Kathy Malloch, there are certain principles which emphasises that the nurses should possess personality traits along with leadership skills and other such abilities to successfully managed the situation in an empathetic manner. Secondly transformational leadership plays a role in merging the ideals of the followers and the leaders (Butts & Rich, 2013). With use of transformational leadership, the nurse leaders are able to motivate new nurses for submitting a feedback related to the specific procedures of the unit that are implemented. Thirdly leadership fundamentals according to the Leadership Proficiency model, an environment can be created in which good people can provide good care.

Nursing Leadership Theories and Models

The theory of transformational leadership addresses the problems of the staff in terms of commitment towards their job and increase their interest in the workplace. The outcome of this is that the employees are more motivated and influenced towards their performance ending in more employee retention (Hutchinson & Jackson, 2013). Researches are of the view that using transformational leadership practices, the nurse managers are able to get positively involved in improving the outcomes of the nursing in terms of their job satisfaction, productivity along with retention. This in turn increases the patient satisfaction. Use of transformational leadership also plays a prominent role in decreasing the work stress and ill-being of the employees, hence transformational leadership is also recognised as a significant organizational strategy. Evidences from current literature suggests that the relationships that exists between positive relational leadership styles and patient satisfaction impacts patient mortality which is lower and less medication errors (Gellatly, Cowden & Cummings, 2014). It also restrains the hospital-acquired infections. While critiquing this article it should be mentioned that the study successfully presents a clear aim which is met at the end of the paper. The method used for the study was also appropriate as it implements as cross sectional design in order to take into account all the observations that are obtained from the views of the nurses working in such acute healthcare facilities. The study also involved the use of self-administered questionnaire which successfully brought out the themes of the study that was conducted. I was clear from the study that implementation of transformational leadership in this context helped to address the problems of lack of employee commitment towards the job (Blake et al., 2013). This was evident from the results that with the help of the theory of transformational leadership, there was a promotion supportive leadership practices that in turn helped in employee retention. However certain limitations are also identified from the study which involves that the assessment of leadership practices were only on the basis of the perceptions of the employees.  However there is a need of assessment from a perception of a good predictor who is qualified for this. Another limitation is related to the methodology of the study, where there might be prevalence of bias in the study.

According to the social exchange theory, the interactions that exists between the employees and the leaders is beneficial to the employees as well as the organization. The problem that the theory deals with is the relationship of the employee with the organization they work in. by proper implementation of this theory in this setting, the outcomes would be development of reciprocal relationships which is established on the basis of positive interactions in terms of trust and commitment that is mutual and the urge to help each other (Cook et al., 2013). The theory conceptualises the aspects of exchange relationships that includes the supervisor and the employee relationship as this is associated with the social interactions of the workplace. This involves resources exchange along with exchange of knowledge, time and emotional support. From the researches it can be evidently established that with the increase in the positivity of the leader and employee relationship, the employees have an easy access to the information, support and participation in decision-making process, which in turn solves their workplace related problems. The employees also tend to bene?t from it as it makes the promotional climb easier along with receiving of bonuses and other such bene?ts which might include interesting work assignments and elevated control over the workloads. All of these factors in turn increase the perceptions of the in-group members’ in terms of wellbeing and commitment to the organisation thus impacting on their intention to leave, which is highly reduced (Graham-Dickerson et al., 2013). The study conducted to establish that the social exchange theory can be successfully used in order to address the problem of the lack of interaction between the employees and the organization. The study provides a clear aim that is to use social exchange theory to investigate the relationship that exists between the supervisor–nurse relationships, teamwork, psychological wellbeing and turnover intentions for nurses. The study appropriately implemented the cross sectional study design that involved complete surveys in order to obtain a data by using a self-report strategy. From the results it was evident that the theory of social exchange successfully establishes affective commitment which reduces the intentions of the employees to leave the organization (Van den Heede et al., 2013). However certain limitations were identified from the study which involves that there was presence of a common bias within the self-report of the cross-sectional studies. In the study there was common method variance which had an in?uence on the signi?cance of relationships that existed between the variables. Another limitation was that the study was only limited to hospitals of the private sector. Hence these could not be generalised to the public or the not-for-pro?t sector hospitals which are also needed to be considered. Lastly the study was only limited to aspect of only one country therefore the results of the study could not be implemented to any generalised setting. Hence further research is required in order to implement the research in a generalised context.

Challenges and Issues Faced by Healthcare Staff

In order to conclude it can be stated that the problem that existed related to the retention of the employees can be addressed with effective nursing leadership. The theories in the context of nursing leadership evidently shows that by the implementation of these theories the problems of employee retention can be solved. There are enough evidences available in the existing literature that proves the successful outcomes of these theories like the social exchange theory and the transformational theory. The studies conducted for establishing the fact that these theories can implemented for addressing the problem uses the cross sectional study design. However there are certain limitations to these studies. Therefore the scope for the future research might include addressing these limitations like implementing a larger sample to remove biasness. Additionally in order to make the studies more generalised and not only focus on one country, the sample should include participants from other regions as well.

References

Blake, N., Leach, L. S., Robbins, W., Pike, N., & Needleman, J. (2013). Healthy work environments and staff nurse retention: The relationship between communication, collaboration, and leadership in the pediatric intensive care unit. Nursing Administration Quarterly, 37(4), 356-370. doi: 10.1097/NAQ.0b013e3182a2fa47

Bormann, L., & Abrahamson, K. (2014). Do staff nurse perceptions of nurse leadership behaviors influence staff nurse job satisfaction? The case of a hospital applying for Magnet® designation. Journal of Nursing Administration, 44(4), 219-225. doi: 10.1097/NNA.0000000000000053

Brown, P., Fraser, K., Wong, C. A., Muise, M., & Cummings, G. (2013). Factors influencing intentions to stay and retention of nurse managers: a systematic review. Journal of Nursing Management, 21(3), 459-472. Retrieved from: https://doi.org/10.1111/j.1365-2834.2012.01352.x

Brunetto, Y., Shriberg, A., Farr?Wharton, R., Shacklock, K., Newman, S., & Dienger, J. (2013). The importance of supervisor–nurse relationships, teamwork, wellbeing, affective commitment and retention of North American nurses. Journal of Nursing Management, 21(6), 827-837. Retrieved from: https://doi.org/10.1111/jonm.12111

Butts, J. B., & Rich, K. L. (2013). Philosophies and theories for advanced nursing practice. Jones & Bartlett Publishers. . Retrieved from: https://books.google.co.in/books?hl=en&lr=&id=ZPCVAgAAQBAJ&oi=fnd&pg=PR1&dq=Butts,+J.+B.,+%26+Rich,+K.+L.+(2013).+Philosophies+and+theories+for+advanced+nursing+practice.+Jones+%26+Bartlett+Publishers.&ots=mAXGaKgDH1&sig=UqJMnEPPoeG2RuXrS4rrvsBAgL0#v=onepage&q&f=false

Cook, K. S., Cheshire, C., Rice, E. R., & Nakagawa, S. (2013). Social exchange theory. In Handbook of social psychology (pp. 61-88). Springer, Dordrecht. Retrieved from: https://link.springer.com/chapter/10.1007/978-94-007-6772-0_3

Gellatly, I. R., Cowden, T. L., & Cummings, G. G. (2014). Staff nurse commitment, work relationships, and turnover intentions: A latent profile analysis. Nursing research, 63(3), 170-181. doi: 10.1097/NNR.0000000000000035

Graham-Dickerson, P., Houser, J., Thomas, E., Casper, C., ErkenBrack, L., Wenzel, M., & Siegrist, M. (2013). The value of staff nurse involvement in decision making. Journal of Nursing Administration, 43(5), 286-292. doi: 10.1097/NNA.0b013e31828eec15

Hutchinson, M., & Jackson, D. (2013). Transformational leadership in nursing: towards a more critical interpretation. Nursing inquiry, 20(1), 11-22. . Retrieved from: https://doi.org/10.1111/nin.12006

Laschinger, H. K. S., & Fida, R. (2014). New nurses burnout and workplace wellbeing: The influence of authentic leadership and psychological capital. Burnout Research, 1(1), 19-28. Retrieved from: https://doi.org/10.1016/j.burn.2014.03.002

Tillott, S., Walsh, K., & Moxham, L. (2013). Encouraging engagement at work to improve retention. Nursing Management (through 2013), 19(10), 27. Retrieved from: https://search.proquest.com/openview/e863040a1137931e7019382231e38294/1?pq-origsite=gscholar&cbl=29902

Twigg, D., & McCullough, K. (2014). Nurse retention: a review of strategies to create and enhance positive practice environments in clinical settings. International journal of nursing studies, 51(1), 85-92. Retrieved from: https://doi.org/10.1016/j.ijnurstu.2013.05.015

Van den Heede, K., Florquin, M., Bruyneel, L., Aiken, L., Diya, L., Lesaffre, E., & Sermeus, W. (2013). Effective strategies for nurse retention in acute hospitals: a mixed method study. International journal of nursing studies, 50(2), 185-194. Retrieved from: https://doi.org/10.1016/j.ijnurstu.2011.12.001

Weaver, K. B. (2013). The effects of horizontal violence and bullying on new nurse retention. Journal for nurses in professional development, 29(3), 138-142.  doi: 10.1097/NND.0b013e318291c453