Challenges Facing Nursing Leadership - Research Paper

Introduction

In most health care settings, nurse managers are selected from various positions where they have past held and shown clinical expertise. Although past roles form the basis for promoting these professionals to leadership positions, most nurse managers generally lack the right knowledge to succeed as a leader and ensure quality care to patients. Moreover, some nurses take over leadership roles on a temporary basis or by chance. This in itself presents a myriad of challenges that can influence care delivery. With turnover as a current issue affecting care delivery, there is a need for nursing leaders to possess active leadership personalities and traits to create working environments where nurses are satisfied with their jobs. Therefore, with effective leadership traits and personalities, nurse leaders can reduce high employee turnover that not only affects nursing leadership but also lowers patient care.

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Explanation of the Problem

Nursing turnover is one of the current challenges of care delivery facing nursing leadership across the globe. Healthcare facilities need stable, competent, and fully occupied nursing staff to offer quality patient care. However, a rising decline in the number of qualified nurses has resulted in steady growth in the turnover rate among nurses. Reports have indicated that the turnover rate will increase further in the future because the high growth of the healthcare industry continues to put a strain on the existing supply of nurses (Antwi, & Bowblis, 2018).

High nursing turnover rate is a challenge to the nursing leadership across the globe due to labour migration, decreased number of females pursuing nursing profession, as well as, hostile work environments that has caused a steady decline in the competent and experienced nurses and young nursing workforce (Daly, Jackson, Mannix, Davidson, & Hutchinson, 2014). As a result of increased nursing turnover, nursing leadership struggles to fill the void, and this leads to high levels of frustrations and stress and ultimately that causes high turnovers. Further, even when the existing void is filled, the present nursing leadership is supposed to train new employees while still carrying out their responsibilities and duties related to care delivery. In fact, during the seasons of increased turnover, the quality of nursing care delivered often suffers because new nurses undergo their change process. With the current poor nursing leadership styles across healthcare facilities, turnover rates are expected to increase further unless the leaders realize that effective leadership is a critical element in creating a competent and experienced workforce ready to deal with complex issues that nursing staff face (Daly, Jackson, Mannix, Davidson, & Hutchinson, 2014).

Factors Fueling Nursing Turnover

Work environment and workload are the key factors that fuel nursing turnover. Deplorable and insecure work conditions full of safety issues including harassment and bullying detrimentally affect nursing retention (Matlala, & Van der Westhuizen, 2012). Similarly, nurses across the globe report that workloads or job demands surpass their capacity perform their responsibilities and roles. For instance, a recent review by Antwi and Bowblis (2018) revealed that nursing staff in hospitals across Australia complained of too much workload and burnout, lack of appreciation for exemplary work completed, decreased morale, lack of autonomy, safety issues and job dissatisfaction among others.

Globally, a baccalaureate education is often associated with better use of employees and improved nurse and patient outcomes (Mudallal, Othman, & Al Hassan, 2017). Nonetheless, burnout and dissatisfaction grow as the ability of nurses to offer basic primary care that patients need decrease and job satisfaction become a critical issue in their decisions to leave. Most hospitals and healthcare facilities across countries have a good number of competent and experienced nurses. Mazurenko, Gupte and Shan (2015) have reported that such professionals are barred from deciding about patient care, a critical component of the autonomous nursing responsibility. In practice, autonomy is essential in retaining employees, and the crucial aspect to this entails the ability of nurses to make decisions regarding their work and the manner it is accomplished.

Generally, a financial reward is not the fundamental factor that drives one to become a nurse, but the view of poor monetary returns and lack of recognition for the works completed has been reported to contribute to the inability of healthcare facilities to retain their employees (Mudallal, Othman, & Al Hassan, 2017). Moreover, every nursing staff requires respect from their nursing leadership. However, in most healthcare facilities, nursing staff are reprimanded in front of patients and relatives, this disappoints and demotivates them and makes them lose interest and pride in their jobs. Lack of support from nurse leadership also fuels nurse turnover. Antwi and Bowblis (2018) asserted that most nurse managers hardly pay attention to queries and problems that other nursing staff have and that they keep nurses under intense pressure to have the jobs done. This not only demotivates nurses but also makes them look for alternative employment with minimal stress.

Organizational structures and management systems are significant causal factors of nurse turnover. Usually, restructuring leads to decreased staff morale and reduced loyalty to firms thus potentially leading to high turnover rates (Mudallal, Othman, & Al Hassan, 2017). For instance, research by Antwi and Bowblis (2018) found that restructuring of units and wards leads to loss of competent nurses and subsequent increase in patient deaths. The study further reveals that in Canada and the US, trusting and being loyal to the employer has been lost through restructuring. In most cases, this loss turns to not only a loss to a given organization but also a loss to the profession as these competent nurses look for other employment.

Impacts of Nursing Turnover on Patient Care

Nurse turnover usually impacts hospital services, managerial processes, staffing process and hospital revenues. In healthcare facilities, it increases costs associated with hiring and training new staff. Regarding patient care, turnover lowers patient care because the skills and competencies of replaced or new nurses in most cases do not meet the required standards. Further, new nurses need orientation and adaptation process. However, during these periods, they are likely to commit medical errors that at times can increase mortality rates. Further, services offered by replaced or new nursing staff are likely to be of low quality due to communication barriers that exist between new and senior nurses or another profession (Antwi & Bowblis, 2018). Other effects that nurse turnover have on hospitals and healthcare facilities encompass loss of trained and experienced nurses, nurse shortages, as well as, the unfair composition of replaced and the remaining nursing staff. Principally, those staffing challenges cause problems in planning work and setting schedules thus lowering self-drive of the existing nurses.

Apart from affecting hospitals, nurse turnover affects patients, doctors, and nurses. Most patients often acknowledge regular nurse replacements as they feel that they are being handled by an incompetent nurse leading to the patients' decreased trust satisfaction and numerous complaints launched against nursing services offered. Antwi and Bowblis (2018) reported that senior nurses are unwilling to take over increased workload caused by nurse shortages. Adaption process of newly replaced nurses generates myriad of issues including challenges in working relationship, building trust and working with teams.

Traits and Qualities of Nurse Leaders to Handle Turnover

Transformational leadership theory is the best leadership approach for successfully handling nurse turnover. The theory states that leaders should encourage and inspire employees to attain organizational objectives by creating a trust (Xu, 2017). To establish trust, the leaders must be open, reasonable and honest with employees and motivate them to make independent decisions about actions aimed at improving organizational performance. More importantly, leaders must communicate effectively, have high self-confidence, and firmly believe in their vision to accomplish their set goals and objectives (Xu, 2017).

According to transformational leadership theory, to successfully deal with nurse turnover, nurse leaders should create a good working relationship and support with other nursing staff, as this will reassure nurses about leaders' trust and respect for them (Hughes, 2017). Secondly, nurse leaders should communicate effectively, be effective communicators. In particular, when communicating to other nursing staff, they should pay attention to views of nurses because it is prudent to identify nurses' concerns and needs (Daly, Jackson, Mannix, Davidson, & Hutchinson, 2014). Nurse leaders should also have passion and commitment by leading by example. More importantly, they should appreciate every effort or achievements realized by nurses and provide them with adequate training and opportunities for personal growth.

Future Effects of Nurse Turnover on Health Care Delivery

Failing to resolve nurse turnover successfully will lower future health care delivery. Reportedly, a high level of nurse turnover leads to inadequate nursing staff and severe organizational consequences. Continued turnover will cause nurse shortages and interfere with nurse wellbeing that consequently will lower the quality of health care delivery (Antwi & Bowblis, 2018). Principally, inadequacies will increase over time, workload, as well as, the hiring of temporary nursing staff. Intuitively, the consequential nurse fatigue, as well as low competencies of nursing staff hired on a temporary basis will lower the quality of care delivery and increasing cases of patient safety cases. More importantly, overloading and overtime work are likely to demotivate remaining nursing staff, which consequently will cause a turnover.

Conclusion

In conclusion, nurse turnover is a critical challenge affecting nursing leadership and care delivery across the world. Although nurses play crucial roles in the financial performances of most healthcare facilities, these facilities continue to experience difficulties in attracting and retaining competent and experienced nursing staff needed to attain the least staffing levels - factors such as poor working conditions and ineffective nursing leadership fuel nurse turnover. Therefore, possessing and using appropriate leadership qualities and traits will assist nurse leaders to deal with nurse turnover successfully.

References

Antwi, Y. A., & Bowblis, J. R. (2018). The impact of nurse turnover on quality of care and mortality in nursing homes: Evidence from the Great Recession. American Journal of Health Economics, 4(2), 131-163.

Daly, J., Jackson, D., Mannix, J., Davidson, P. M., & Hutchinson, M. (2014). The importance of clinical leadership in the hospital setting. Journal of Healthcare Leadership, 6, 75-83..

Hughes, V. (2017). Leadership strategies to promote nurse retention. Scientific Journal of Nursing& Practice, 1(1), 1-5.

Mazurenko, O., Gupte, G., & Shan, G. (2015). Analyzing US nurse turnover: Are nurses leaving their jobs or the profession itself?. Journal of Hospital Administration, 4(4), 48.

Mudallal, R. H., Othman, W. A. M., & Al Hassan, N. F. (2017). Nurses' burnout: the influence of leader empowering behaviours, work conditions, and demographic traits. INQUIRY: The Journal of Health Care Organization, Provision, and Financing, 54, 0046...