Nursing Leadership: Two Paradigms
In its earliest incarnation as a profession, nurses were often conceptualized as attendants and helpers to physicians and patients, not as leaders. However, nurses over the years have attempted to eke out a unique sphere for themselves within the healthcare profession in the manner in which they integrate a patient's physical, social, psychological, and environmental needs. Today nurses are increasingly called forth to take on leadership positions within organizations, often as a result of cost-cutting efforts that shift responsibilities to nurse leaders that were once relegated to doctors and administrators.
The current available leadership models offered to nurses and to the leaders of healthcare organizations are numerous, and often draw from the literature of the business world as well as healthcare. "Now more than ever nursing needs vibrant and dedicated leaders…Leadership does not rest merely with administrators and high-level managers, but also can be developed and implemented at the bedside" (Valentine 2002). Nursing leadership must take place on every level of administering care -- nurses must fulfill new leadership positions, particularly when mentoring new nurses and other healthcare leaders must be more responsive to the needs of nurses.
Review of existing literature
One of the most radical, paradigm-shifting models of leadership is that of a learning organization, a participatory model which suggests parity between all members of an organization at every level in terms of how they can make a contribution. Rather than conceptualize leadership as a top-down model, leadership is seen as a dialogue. All members of the organization make a contribution with the information and ideas they offer. Learning organizations are defined as providing "continuous learning opportunities; use learning to reach their goals; link individual performance with organizational performance; foster inquiry and dialogue, making it safe for people to share openly and take risks; embrace creative tension as a source of energy" and respond to the environment (Smith 2001). A good example of this occurs when new nurses are mentored by other nurses. In the stressful environment of healthcare, there is some evidence in the literature that nurses have a tendency to 'eat their young' or to be hostile or nasty to new nurses. Experienced nurses must ask themselves: "Were you supportive? Did you encourage that person to gain and develop new skills and offer learning experiences to help the person grow as a nurse? Or did you create an environment that was infected with horizontal violence" to counteract this tendency (Roy 2007). Learning organizations both learn from and respect employees and encourage employees to respect and teach one another.
Mentorship programs specifically designed to foster ties between old and new nurses has the potential to reduce horizontal violence. Additionally, learning organization supports the desire of current nurses to add to their credentials and to expand their knowledge. In a constantly-changing healthcare environment, where new technology is always being incorporated into systems and processes, this is essential. In "today's changing environment that very rapid changes are seen in different areas of science and technology and the increasing complexity and dynamics of environmental factors, the only organizations that can survive and remain capable of growth are those with active adaptation (dynamic equilibrium). [A] learning organization is an organization where people constantly increase their capabilities. The new patterns of thinking develop and staffs learn how to learn together" (Yaghoubi et al. 2010). Rather than managers always dictating in a top-down fashion to nurses, in a learning organization managers learn from their staff members about the needs of patients, the best ways to deliver care, and ways to improve efficiency and nurses are in the ranks of management. When nurses are stressed and overscheduled and management does not listen to the unique concerns of nurses, patient care is inevitably compromised. The conception of a learning organization suggests that nurses in the field can provide invaluable sources of information about patient needs and why care deficits are occurring For example, organizational...
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