Nursing Leadership And Management Essay

Week 1 Project

Time Management

This assignment is about you. It is an assessment of your abilities and traits.

Based on your research and understanding, create a paper in a 3- to 4-page Microsoft Word document that: Nursing Leadership And Management Essay

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Incorporates your time management self-assessment information and the concepts learned this week (leadership theories, leadership versus management, professional nursing organizations, and time management.
Includes identification of one leadership theory, which you feel best describes your leadership style.
Includes a comparison between leadership and management.
Support your responses with examples.

PLEASE READ: My leadership theory is Relationship or Transformation Theories, I am very detailed and organized.
Title: Nursing leadership and management for patient safety and quality care / Elizabeth J. Murray.

As in all assignments, cite your sources in your work and provide references for the citations in APA format.

Please note that the title and reference pages should not be included in the total page count of your paper.

Submission Details

On a separate references page, cite all sources using APA format

Name your document SU_NSG4029_W1_Project_LastName_FirstInitial.doc. Nursing Leadership And Management Essay

Mergers illustrate the focus on organisational restructuring as the key lever for change as indicated by the ninety nine health care provider mergers in England between 1996 and 2001. (Fulop, Protsopsaltis, King, Allen, Hutchings, and Normand, 2004) However, in many cases, mergers have unexpected consequences and drawbacks including problems in integrating staff, services, systems and working practices, clashing organisational cultures and poor leadership capacity.

This essay considers leadership and management in the context of a problematic merger of services from two hospitals onto one site. The essay focuses on the change management process within one department to highlight key leadership, team, and cultural issues that negatively affected the newly merged department. The microcosm of the department mirrors similar occurrences across the two merged hospitals. The essay concludes with a comment on the organisational consequences if a macro intervention is not implemented.

Confidentiality has been preserved by anonymising the identity of the hospitals and departments concerned. Nursing Leadership And Management Essay

BACKGROUND

This essay explores a recent change process involving the creation of a psychiatric liaison team based in a NHS hospital Accident and Emergency Department. (A & E) in January 2004.

The change occurred because of the merger of two hospitals that resulted in a number of structural changes, including the amalgamation of a traditionally split emergency service into a one site A & E department. The liaison team replaced the existing deliberate self-harm service which had operated in the one hospital for two decades.

The new liaison team consisted of eight newly appointed G-grade mental health nurses, a team leader, and a consultant psychiatrist who had both previously worked in the deliberate self-harm service. The hours of operation initially were 08:00 to 22:00 and there were two nurses on duty on early and late shifts. Nursing Leadership And Management Essay

During a four week induction period, the team participated in team building and training exercises and developed into a cohesive, effective group. The team created clear key performance indicators specific to the psychiatric liaison team, established an action plan to achieve the set objectives, and planned to carry out six-monthly reviews. The team developed a shared vision to provide high quality, person centred care to the A & E department without breaching government’s four hour targets (DOH, 2001). The team leader’s leadership style was democratic, and she fostered collaboration and involvement within the team (Walton, 1999). The team members considered her an expert in the field, and respected her for it.

In July 2004, the service manager attended a monthly team meeting. At the meeting she was informed that a major change was expected to the hours of operation. The service would be extended to a 24-hour service starting in September 2004. In order for the liaison team to cover a 24-hour roster there was initially be a reduction in the number of nurses on duty, however, more staff would be recruited if necessary after a six month service review. An exact date for the review was not given. The change had not been communicated as part of the strategy for the greater merger. Nursing Leadership And Management Essay

The Department of Health (DOH) modernisation agenda for the NHS, (DOH, 2002) sets out to modernise services in the NHS, and introduced a three star rating scale against which each NHS Trust’s performance is compared against benchmark standards. Funding in turn is dependant on the star rating achieved. One such standard relates to delays in A & E departments, and stipulates that mental health patients should have 24 hour access to services, and that patients should be assessed and treated within four hours of arrival. (DOH, 2001) The underlying rationale for the change was therefore that the psychiatric liaison service had to provide a 24-hour service in order for the hospital to comply with the benchmark. Management of the merged hospitals did not consider staff shortages or how the four hour target might affect the quality of service provision, particularly when staff are under constant pressure to discharge patients before they exceed the benchmark standard. (RCP, 2004) In the service described above, reaching the necessary 98 % four hour target proved impossible, because the staff numbers did not match the requirements of the service. Nursing Leadership And Management Essay

The service was therefore to be expanded without additional staff, implying not only changes in hours and shifts, but also changes in work patterns. The team members reacted negatively to how the change process was introduced. Concerns were expressed about the reduction in staff numbers and questions were raised as to how the staff would be able to cope. The sense of security and continuity were put at risk. (Walton, 1999) The service manager was not available to address the concerns due to an increased scope of responsibility because of the merger that was beyond her normal remit. Lack of two way communication between the manager and the employees meant that the manager lost a valuable opportunity to resolve the negative reactions, and laid the foundation for resistance to change (Johnson, Scholes, and Whittington, 2005). Nursing Leadership And Management Essay

Within a month of the announcement, the team leader had resigned. A new team leader was appointed and was tasked to lead the team through the change. The team started gradually becoming fragmented, staff sickness rates soared, and morale plummeted. The situation reached a crisis point by December 2005, by which time two more staff members had resigned. The majority of staff had taken sick leave, and the psychiatric liaison service was left uncovered for several days. A number of mental health patients in A & E waited for hours, sometimes all night, to be seen by a mental health professional. The A & E department laid a formal complaint about the liaison team’s performance.

In March 2005, following discussion with a union representative, the team took out a grievance against the team leader. The key issues of concern were the way the change process had been introduced, lack of two-way communication and the team leader’s unsuitable task-oriented, directive leadership style. The team leader was suspended and the Trust commenced a lengthy investigation into the change process. The investigation continues to date. Nursing Leadership And Management Essay

ANALYSIS

Cameron and Green (2004) suggest McKinsey’s 7S model as a diagnostic tool to identify interconnected and related aspects of organisational change. The model is problem rather than solution focussed, and hence useful for pointing out retrospectively why change did not work. The weakness of the model is that it does not explicit identify drivers from the external environment and accordingly key forces have been described by way of explanation. According to Burke and Litwin (1992), the external environment is any outside condition or situation that influences the performance of the organisation. Nursing Leadership And Management Essay

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Systems, Staff and Strategy

Systems refer to standardised policies and mechanisms that facilitate work, primarily manifested in the organisation’s reward systems, management information systems, and in such control systems as performance appraisal, goal and budget development, and human resource allocation. (Burke and Litwin, 1992) Systems are the mechanisms through which strategy is achieved. Strategy is how the organisation intends to achieve a purpose over an extended time scale. Johnson, Scholes, and Whittington (2005) link it directly to environment (industry structure), organisational structure, and corporate culture. Leaders are the executives and managers providing overall organisational direction and serving as behavioural role models for all employees. (Burke and Litwin, 1992)

The systems that the service had in place to support the staff prior to the merger had functioned efficiently. The psychiatric liaison team had monthly team meetings, weekly ward rounds and supervision, and twice daily handovers to ensure high quality service. Nursing Leadership And Management Essay

Teams in this context mean a group who share a common health goal and common objectives, determined by community needs, to the achievement of which each member of the team contributes, in accordance with his or her competencies and skill and in co-ordination with the functions of others. (WHO, 1984) Under the previous team leader’s management, the team had achieved a mature and productive level of performance that fell within Tuckman’s model of team development of a performing team. (Mullins, 2002) The leader demonstrated characteristics of an effective team leader (e.g. good communication) and ensured that the team members’ views were passed on to the management. (Marquis and Huston, 2003) Nursing Leadership And Management Essay

The team also developed team specific performance indicators to fit the Trust’s strategy, such as the goal to provide high quality care within four hours of service users presenting to the A & E department. However, the new management of the merged hospitals did not take into account that the reduction in staff numbers would make it difficult for staff to find time to attend ward rounds and to supervise care. Lack of supervision had a negative impact on the quality of care provided, and staff shortages meant that the team did not reach the four-hour targets in A & E department. The change process indicated a lack of sincere stakeholder consultation which would have alleviated the crisis in the department. (Iles and Sutherland, 2001) Nursing Leadership And Management Essay

Structure and Style

Structure is the arrangement of functions and people into specific areas and levels of responsibility, decision-making authority, communication, and relationships to assure effective implementation of the organisation’s mission and strategy. (Burke and Litwin, 1992) The NHS Leadership Qualities Framework (DOH, 2002, p34) suggests leading change through people with effective and strategic influencing is essential in a merger environment. This is supported by Johnson, Scholes and Whittington (2005) who suggest that strategic, transformational leadership is a key element within an organisation staffed by professionals and that a collaborative style is required to achieve transformational, lasting change. However, the new team leader’s leadership style was autocratic and the team members were no longer consulted about matters concerning it, which was inappropriate in team nursing approach associated with collaborative patient centric care.

Marquis and Huston (2003) suggest that a democratic leadership style works best with a mature experienced team with shared responsibility and accountability. The change in leadership style meant that the team felt disempowered and uninvolved in decision making which did not allow ownership of the change process to emerge. Furthermore, the flow of information to the team slowed down and the team’s concerns about the change did not reach top management implying that communication channels in the new organisational structure were not functioning efficiently. Nursing Leadership And Management Essay

Management style equally affects culture. Johnson, Scholes and Whittington (2005) state that culture is the taken for granted assumptions that are accepted by an organisation or team. These work routines are not explicit, but are essential for effective performance. Ignoring these as the new team leader did, reduces motivation and performance, and stiffens resistance to change.

Skills

Skills are the distinctive capabilities of key people. (Cameron and Green, 2003) The nature of the team membership implied a range of key skills interdependent on the other for effective performance. A problem area in the skills portfolio was information technology skills. The Trust managing the merged hospitals had introduced a Trust wide electronic patient record system in accordance with NHS requirements. (DOH, 2003) This was implemented simultaneously with the decision to extend the working hours. The change aimed to improve the service user experience by allowing staff a 24-hour access to service user’s care and crisis plans. (DOH, 2003) The staff shortage meant that team members did not receive appropriate training on the system and the use of the electronic patient record system became a source of frustration and confusion. Lack of computer skills contributed to staff’s frustration and negative attitudes with the change process. Nursing Leadership And Management Essay

Superordinate goals

Superordinate goals are the longer term vision of the organisation and the shared values and guiding principles that that shape the future of the organisation and motivation achievement of strategy. (Cameron and Green, 2003) The team’s superordinate goals were initially created during the four-week team building period and aligned with those of the larger organisation. The team’s vision was to provide high quality, service user centred care. The team also considered change as a natural part of organisational development. However, the team became increasingly resistant to change when it felt that the organisation did not really care about its employees, their concerns, and the ultimate reason for the organisation’s purpose, being the patient. Nursing Leadership And Management Essay

DISCUSSION OF CHANGE PROCESS

Change management is art of influencing people and organisations in a desired direction to achieve an agreed future state to the benefit of that organisation and its stakeholders. (Cameron and Green, 2003)

A number of models can be used to model a change management process. A popular model is Kurt Lewin’s forcefield analysis. A forcefield analysis is a useful tool to understand the driving and resisting forces in a change situation as a basis for change management. This technique identifies forces that might work for the change process, and forces that are against the change. Lewin’s model suggests that once these conflicting forces are identified, it becomes easier to build on forces that work for the change and reduce forces that are against the change (Cameron and Green, 2003). The difficulty is the assessment of strength or duration of a force, partlicularly when the human dimension is considered. The key resisting force in the change process was a lack of staff and poor leadership. Nursing Leadership And Management Essay

The change process under discussion was largely motivated by external factors. However, due to poor project planning, Trust management failed to consider the internal factors that had a major impact on the change. In particular, the management failed to involve the necessary stakeholders at a local level to increase ownership of the change thus failed to consider the human dimension (Walton, 1999 and DOH, 2004). The new team leader’s autocratic leadership style did not fit the requirements of the task, or the culture of the team and thus sowed the seeds of resistance to change. (Hogg and Vaughan, 2002). The poorly managed change process became costly to the Trust due to the loss of human resources, reduced staff morale and lowered the credibility of the management. The change left the psychiatric liaison team feeling betrayed, and individual team members traumatised. Nursing Leadership And Management Essay

As the change process progressed, it became evident that a thorough analysis of current resources and various dimensions of organisational change had not been carried out (Johnson, Scholes and Whittington, 2005). The management had not prepared a clear plan for launching and executing the change at a local level.

The NHS Modernisation Agency Improvement Leaders’ Guide (DOH, 2004) stresses the importance of taking into consideration the human aspect when planning a change project. Similarly, Walton (1999) argues that change initiatives should be thought through and planned as far as possible taking into account the psychological bonds that staff form with their work groups and their organisation as a whole. Nursing Leadership And Management Essay

It follows then that no precautions had been taken to address resistance to change. Johnson, Scholes and Whittington, (2005) state that there should be a clear communication plan to state how information about the change project will be communicated inside and outside the organisation. The team members were not given an opportunity to challenge and test the change proposal, or clarify what aspects of the change they could or could not influence. (Walton, 1995) Nursing Leadership And Management Essay

Fulop, Protsopsaltis et al, (2004) suggest that change project should be presented as an opportunity to improve the quality of performance and that clinicians should should be involved on a consultative basis. Team members were aware of the consequences of extending the hours of operation without increasing the resources, however, there were no systems in place to communicate these views to the Trust management, a key aspect of the change process. The lack of key stakeholder involvement in the change meant that the management did not have access to the psychiatric liaison team’s valuable experience on the immediate and wider implications of cutting down resources. (Henderson, 2002) Nursing Leadership And Management Essay

The team members felt that their concerns about the lack of resources had not been taken seriously, and this inevitably led to a feeling that the Trust did not care about it’s employees or their views. Strong emotions such as anger and frustration were expressed by the team members. The lack of formal communication channels, meant that the team members took them out on each other. Johnson, Scholes and Whittington, (2005) confirm that at times of change, rumours, gossip and storytelling increases in importance and that team members engage in countercommunication, thus unconsiously spreading distrust, suspicion and negativity which leads to lowered staff morale and job satisfaction. Nursing Leadership And Management Essay

Although the rationale for change was clear to everyone, the change was executed at such short notice that the team members did not have time to develop strategies to deal with it. The NHS Improvement Leaders Guide to Managing the Human Dimension of Change (DOH, 2004) suggests that clinicians go through phases of shock, denial, anger, betrayal, conformance and understanding before they finally develop comitment to the change. The team members were left in a state of shock after the service manager’s initial announcement of the impending change in July 2004 and then moved into a state of denial. The general opinion was that the management would sooner or later realise that the change could not be executed without increasing the resources and accordingly delayed the change process until more staff would be employed. When there was no indication of this in the weeks that followed, the team members became demotivated. The team failed to move on to the next stages in their reactions to change, and commitment to the change process did not develop. Nursing Leadership And Management Essay

The team leader’s task-oriented leadership style did not suit the context of the change process, and partly contributed to it’s failing. Cameron and Green (2003) suggest that leadership will be most effective when the leader’s leadership style, the subordinates’ preferred leadership style and the requirements of the task fit together. A directive leadership style therefore is ineffective if the subordinates’ preferred leadership style is democratic, even though the task is well defined within tight parameters. In addition, Hogg and Vaughan (2002) argued that the most effective leaders are those who are able to combine task and socio-emotional leadership styles, and organise team members to work towards achieving goals at the same time promoting harmonious relationships. The new team leader paid no attention to the team culture and failed to communicate to management about the impending issue. Nursing Leadership And Management Essay

Johnson, Scholes and Whittington (2005) suggest that power is a key element in a change process. Power is the ability of individuals to persuade or coerce others into following a course of action. The new team leader’s source of power was based on his hierarchal position in the Trust rather than on expertise or knowledge as shown by the previous team leader. The team members did not consider that the new team leader possessed appropriate expertise or personal characteristics. The team leader exercised coercion which was met with resistance by the team and for this reason the team members lacked respect for him. He was seen as an executor of decisions made by the management. Nursing Leadership And Management Essay

The new team leader appeared to be more concerned about a successful completion of the change, was target driven and lacked sensitivity to employees feelings and concerns. The team leader used his positional power in a negative way, filtered information and gave the management a distorted view of how the staff were coping with the change process.

The relationship between the team leader and the staff members eventually deteriorated to a point where communication broke down. Two staff members went on a long term sick leave, and two other staff members resigned. Following a meeting with a union representative in March 2005 the team members, including those who had resigned, made a decision to take grievance out against the teamleader. The key issues brought up in the meeting were the way the change had been introduced, poor project management and the team leader’s autocratic management style (Walton, 1999). Nursing Leadership And Management Essay

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CONCLUSION

In conclusion, lack of stakeholder involvement, poor project planning and the teamleader’s unsuitable leadership style lead to the psychiatric liaison team becomimg fragmented, and resistant to change. No systems were put in place to ensure two-way communication with the employees. Lack of communication reduced the staff’s commitment to, and ownership of the change, and lead to a lower quality service provision and increased long waits in A & E. The poorly managed change process became costly to the Trust due to loss of trained human resources, staff morale and credibility of the management. Similar incidents occurred in other areas of the hospital indicating that the change processes associated with the merger had created organisational wide problems that were indicative of failure at a top management and strategic level.

Strategic leadership is a key element of the change process. A successful merger will only be achieved with consistent communication and the establishment of a vision that percolates throughout an organisation as a basis for effective change to realise the stated benefits of all stakeholders. Nursing Leadership And Management Essay

Effective Leadership and Management in Nursing According to Sullivan and Decker (2009), leadership is influencing others into working toward accomplishing a common goal. Some people are born with an innate leadership quality within them. Others require learning leadership and management skills. It takes a certain personality trait that makes them a natural leader. Intelligence, personality, and abilities are three categories of the trait theory that is a part of the profile of successful leaders (Sullivan & Decker, 2009). I will discuss my personal views of leadership. It will…show more content…
Characteristics of an effective leader An effective leader can create a working environment that satisfactorily supports the staff members so he or she can productively perform in his or hers’ assignments. The top three characteristics of an effective leader are the ability to communicate well, fairness to everyone on the team and are knowledgeable in his or hers’ field of practice. An effective leader must be able to communicate well with others to maintain and promote open communication among the team. When leaders deal with employee conflict, an effective leader is fair. These leaders motivate their nursing staff to work toward a greater good in creating a positive change (Dunham & Klafehn, 1990). An effective leader should be knowledgeable about his or her leadership role as well as those he or she is supervising. Nursing Leadership And Management Essay
Conclusion
Leadership and management are similar; however, have different definitions. Some leaders have an innate ability to learn whereas others may have to learn how to lead. A manager may not be an effective leader. A leader must possess certain characteristics to be effective. Communication, fairness, and leadership knowledge are the top three characteristics of an effective leader.

Leadership is essential to the successful management in the field of nursing. However, nursing leaders and employees have different views on the type of leadership style to be adapted for best results. Owing to the challenges in the nursing leadership, re-evaluation of current managerial tactics is necessary. A nurse leader must master delegation because it constitutes a critical portion of the effective leadership and success in the patient care. Since we live in a multi-cultural nation; good leaders should consider all aspects of a person including cultural diversity. Time management skills, self-efficacy and assertive communication are the other significant qualities of nurse leaders. All the attributes of a nurse leader influence the quality of care provided to the patients. Nursing Leadership And Management Essay
One of the nursing leadership approaches is transformational style. A transformational leader is the one who employs good and qualitative styles associated with improvement in patient care. This style inspires the others to develop and implement leadership qualities. It comprises charisma, self-confidence, inspiration, intellectual stimulation and individual consideration. The transformational leader motivates the other nurses; he is sensitive to the needs of his subordinates and communicates effectively. This style of leadership increases the staff satisfaction leading to an overall reduction of nurse turnover and an increase in patient satisfaction (Smith, 2011). Though transformational leadership promotes nursing excellence, the difference in the interpretation of the nursing styles between the nurse leader and the staff is often associated with decreased satisfaction with the leadership (Andrews, 2012).
Several studies have been done to establish a relationship between managerial competencies, personal characteristics and leadership style of the nursing leaders. Managerial competencies refer to the ability of the nursing leaders to manage the other nurses well. The managerial competencies of nurse leaders consist of characteristics like visionary leadership, conflict resolution, effective communication, problem solving abilities and teamwork. The issues requiring apt management by nursing leaders include conflict resolution and addressing the laziness of employees. A leader must, therefore, have qualities or competencies that help in problem solving and conflict resolution. A leader who is a great manager is the one who is long-sighted. A leader must be a person who considers the future and not just the present. The leader must know that future healthcare depends on the present health care. Another important attribute of a nurse leader is delegation. Delegation of work by the leaders increases the satisfaction amongst the employees and nurses working under them. All these characteristics and attributes positively correlate with the patient care both in the short- and the long-terms (Lorber & Savic, 2000). Nursing Leadership And Management Essay

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There is no dearth of knowledge regarding the appropriate leadership styles for nursing fields. However, inappropriate leadership styles are used by the nursing leaders in many healthcare set-ups. Therefore, a uniform and unique healthcare model for all institutions must be formed so that the country can properly facilitate the reforms needed in the healthcare system or sector. The country must also facilitate the competency evaluation and consistent monitoring of the leader’s work so that the results can be seen and appreciated. The leaders that do not furnish appropriate results may be denied their leadership roles (Lorber & Savic, 2000).
The definition of leadership is multi-faceted. All sectors in the society, from the business to the financial sector and even the nursing or the healthcare sector require good leadership for greater productivity. According to Giltinane (2013), leadership in the working environment is of utmost significance. Direct involvement of the leadership is advised because leaders motivate the employees to go beyond the call of duty. The leader’s role is to ‘elicit effective performance from others.’ The leader influences and guides others towards positive results and productivity. They empower the employees and, therefore, increase organizational loyalty, job satisfaction and reduce sickness levels. The direct involvement of nursing leaders in the actual work of taking care of patients encourages the other nurses to work and to take care of the patients in a better way. Hence, the nursing leader must have personality traits, emotional intelligence and apt cognitive responses that are able to inspire others to work harder and better in their work stations. Thus, a positive productivity is associated with good leadership styles. Effective leadership also requires trust between the leader and the staff. Therefore, the leader should treat them fairly and acknowledge individual achievements. A good leader shows interest in the working of the staff, listens to their problems and helps them in decision making (Giltinane, 2013).
The leader is a person who can inspire those behind him. This means that the followers should be able to agree with their leader, and the leader should be able to make them see the things the way he sees them. Overall, there should be an agreement between the leader and the followers regarding the goal(s). A respectful leader is the one who inspires the subordinate(s) to achieve the positive and effective results of the laid plans (Boyle & Kochinda, 2004). The registered nurses are trained to use techniques of the goal-oriented path to delegate more effectively to the patient care tasks. Delegation is an entry level skill and is the ability to be able to assign duties well to the respective people. Lack of delegation skills is a potential cause for negative and adverse outcome(s) resulting from ineffective supervision (Boyle & Kochinda, 2004). Nursing Leadership And Management Essay
A good nursing leader must learn the skill of delegation through educational and practical experience. Thus, a nursing leader can’t live without the delegation power, and every success of a registered nurse will depend on their power to effectively delegate duties well. Delegation has the major role in leadership and has the determination of how the leaders perform their duties. The results in positive or negative outcomes in patients measure the level of delegation in nurses. Therefore, a successful leader is the one who possesses the qualities to delegate duties well to the subordinate staff (Dunham-Taylor, 2000).
Confidence is the value of self-belief that a nurse should possess to be able to delegate patient care tasks. Research shows that demographic variables, registered nurses leadership skills and confidence in delegation are related to the outcomes of patient care in a community teaching hospital. The level of confidence is vital in the process of delegating duties among the registered nurses. The low level of confidence affects the delegation of tasks by the nurses adversely and may result in poor patient outcomes. Therefore, the level of confidence in the nurse leaders directly influences to the productivity in the health centers (Saccomano & Pinto-Zipp, 2011).
In a recent study, it was hypothesized that registered nurses who demonstrated a supportive leadership style will report more confidence in delegating patient care tasks than the ones with either directive or participative styles. The hypothesis failed to hold from the research conducted and thus, the level of confidence was not justified as a measure to alter the delegating process. The level of confidence was then correlated to the delegation of duties by the nurses. In a healthcare setting, some departments help to develop the delegating skills while others do not. Therefore, the skill may or may not develop in the leader. Also, the level of confidence in the nurses will help in increasing the productivity level as they are aware of what they are doing and are not undertaking a trial process. If the nurses undertake their duty with confidence, their productivity levels are bound to increase (Saccomano & Pinto-Zipp, 2011). Nursing Leadership And Management Essay
The nurses serve the patients with very distinct cultural beliefs. Some of the issues that face the nurses due to such occurrences include the language barrier in cases where the nurse is serving a patient from a different ethnicity or with communication problems. Secondly, there can be the cases of prejudice. They may serve the patients with their belief about the patient or what they think rather than taking keen interest in the problem faced by the patient. Thirdly, they could be ethnocentric. The issue is more problematic where a nurse is serving patients from a country that has different ethnicities, religion and/or cultural beliefs. The nurse may serve in favor of some ethnic groups, religions or communities. In the case, a hospital is not in the position of solving the issue of biasness, the simple acts of favoring one group of patients and not-favoring the other group(s) may settle an institutional trend. This type of trends may lead to the loss of nurses as well as the healthcare organization(s). Therefore, much needs to be done about the issue of cultural competence in nursing students and faculty. Psychological empowerment is considered as the best option to enhance the cultural competence. Nurses should be trained on how to give equal treatment to the patients of different backgrounds. They should have the capacity of understanding that every patient is as important as the others and the services and resources should be allocated equitably and not by bias of issues such as ethnicity, religion or race. A perception is very powerful and can lead to justice in any service. The decisions of nurses should be autonomous with a professional basis in the decision making process. This can be installed by bringing in such study fields in nursing schools as well as seminars in places of work. The nurses should be empowered by the knowledge and not pressure (Dreher, & MacNaughton, 2002; Lipson & Desantis, 2007). A nursing leader has several roles in a culturally diverse healthcare system. In any hospital setting with culturally diverse nursing workforce, the nurse leader should be fair and unbiased towards all the staff members irrespective of their background. Leadership directly affects the staff retention, level of motivation and quality of the care provided. Therefore, a good leader should be able to generate and maintain a diverse workforce for the provision of culturally relevant care. Nursing Leadership And Management Essay
According to Skim and Miller’s theoretical framework (1999),(I could not find this reference??) there is a given process of achieving a sensitive process of changing the perception of a nurse or healthcare provider. The process involves the steps mentioned below:

• Understanding cultural diversity: Learning different cultural practices from other countries from where the practitioner might get clients.
• Increasing cultural awareness: It involves teaching the nurses to be mild on cultural decisions and not acting in the favor of some patients at the expense of others.
• Minimizing cultural sensitivity by uniting the community: This means that the patients work together with the medical practitioners in improving health standards. They communicate well and try to understand each other.
• Eradicate cultural competence behavior in the individual(s): In cases of cultural differences, the different cultures may be competing on usage of health resources. Nurses are not supposed to be a part of this fight. Therefore, they should remain neutral. Nursing Leadership And Management Essay

Such a process has the capacity of making a nurse act more professionally and avoiding being biased (Dreher, & MacNaughton, 2002).
In a study conducted in Australia, there was much effect of diversity on medical practices as well as medical practitioners and patients. Biases were noted in the nursing practice, and the patients with chronic diseases were very much affected in terms of the provided healthcare. Therefore, medical professionals need training on how to be of higher importance to such patients. The patients include diabetics, cardiovascular patients and others chronic disease patients. These patients need medical training on how to manage the illnesses and conditions when the medical practitioners are not around. The healthcare of these patients may be adversely affected if they are subjected to bias. Hence, the medical practitioners are needed to ensure a diverse cultural understanding of the community they are dealing with (Pardue & Morgan, 2008). Nursing Leadership And Management Essay
Another study was done in three different first world countries viz. the USA, Canada, and Switzerland. In all the three countries, the research gave a positive report about the diversifying services in the medical sector. Such diversities included overcoming language barriers. One of the best examples of the study was in the USA, in a clinic where physicians were facing a little challenge with language problems with some of their patients. They were not in a position to communicate perfectly with other patients other than the ENL speakers (ENL- English Native Language). The researchers brought interpreters of other languages and communication flow was improved. The result was evident from the customer satisfaction analysis. It proven that the services were appreciated 140% of the previous level of appreciation, an implication that diversifying cultural practices, such as teaching nurses different languages is of utmost significance to service improvement process in hospitals as well as clinics and also medical practices at homes (Pardue & Morgan, 2008).
Cultural diversity has been discussed as a way of improving the services of nurses and medical practitioners. It is of high importance to consider communication. To get better services, a nurse or any other practitioner must be in a position of understanding the language of the patient quite vividly, implying that the practitioner will be able to know the problem faced by his or her patient. For example, if a French speaking patient who does not communicate in fluent English is assigned to an American nurse, a communication breakdown is expected since most American health workers are trained in English (Flores, 2006). Nursing Leadership And Management Essay
In order to come up with a better understanding, medical practitioners should have cultural diversities. They should understand several languages and, therefore, be able to serve patients better. There is also a possibility of working with interpreters. It is, however, not only a matter of spoken language; the dumb might also need to be served in a hospital. They communicate using sign language. Interpreters of such signs should be available to ensure communication between the patient and the nurse (Gerrish, Chau, Sobowale & Briks, 2004).
Patients and medical practitioners need to work together interactively. Hence, there should be a clear understanding of communication from both sides. The nurses need psychological preparations that are of importance to them during the process of providing medical services to patients. Language barrier and other issues due to culture should be dealt with; they are a barrier to communication as well as efficient medical services. Patients with chronic diseases need attention and well stated instructions, since in the absence of doctors and medical practitioners they are supposed to nurse themselves. The process of treating them, therefore, needs to be communicated well to them, to avoid misunderstanding due to cultural differences including the language barrier (Flores, 2006). Nursing Leadership And Management Essay