Leadership Improve the Nursing Shortage
Constant turnover in healthcare organizations is an issue experienced by health care systems worldwide. Healthcare is a high-pressure and stressful work environment that affects overall job satisfaction among nurses. Burnout and job dissatisfaction reflect negatively on the quality of patient care, patient outcomes, productivity, job commitment and the financial condition of the institution.
The purpose of this paper is to examine the impact of nursing leadership on nurses’ job satisfaction. The problem Nurses are the largest group of healthcare professionals that is involved in direct patient care. The U.S. healthcare system experiences a shortage of registered nurses. According to Hunt (2014), the national RN vacancy rate is 8.1 percent and the turnover rate is as high as 14.1 percent. Over the last 50 years, there has been a rapid change in the demographics of the nurse workforce. According to the American Association of Colleges of Nursing (2017), about 55 percent of the nurse workforce is 50 years of age or older. There is a significant increase in the percentage of hospital nurses who are approaching or above retirement age: from 17 percent in 1980 to 33 percent in 2008.
How it works
The Health Resources and Services Administration estimates that during the next 10 to 15 years period another million or more nurses will approach their retirement age. Besides the population aging, there are other factors that contribute to the shortage nursing field. Some of the causes that advance the problem are job dissatisfaction, burnout, geographical location, technology and/or violence in healthcare settings. A high percentage of newly licensed nurses determine, shortly after starting their working career, that nursing is not what they expected it to be. Studies have shown that 13 percent of newly graduated nurses had to change their jobs after 12 months, and 37 percent have declared their readiness to change jobs. Within the first two years of practice, 25 percent of nurses leave their first job and about two percent leave the nursing profession.
High turnover rates have a negative impact on the organization and patient care in the form of experienced workforce loss, the time needed for new staff orientation, decreased production during staff transition and the cost of recruitment and training of replacement staff. After years of turn over climbing rates, the numbers leveled up recently, and currently, the national average turnover rates are between 8 to 37 percent – contingent on nursing specialty and state. With an increasing shortage in the nursing workforce, there will be an increased demand for nurses due to the following factors:
- more individuals with an access to healthcare services as the result of the Affordable Care Act
- aging Baby Boomers generation
- healthcare reforms emphasizing primary care, preventive medicine, wellness, and chronic disease management
- the growth of community-based health care
- development of nursing specialties such as care coordination or nursing informatics (American Nurses Association, 2018).
Nurse job satisfaction
Job satisfaction is an employee’s subjective view of his or her job and the workplace where he or she performs the job and it is related with received pay, work benefits, recognition, advancement opportunities, the support from management and coworkers, work conditions, the type of work performed, job security, leadership style and demographics such as age, gender, race, the level of education, marital status and number of children. For years job satisfaction levels among registered nurses has been an issue because job satisfaction among hospital employed RNs is lower than all workers in the US and it remains low despite attempts to improve it. In the nursing field job dissatisfaction is associated with various issues such as autonomy, nurse-physician collaboration, stress and burnout, inconsistency with expected and actual work schedule, management style and institutional empowerment. Job satisfaction is important and consistent with nursing practice because a negative work experience creates resignation and abandonment of the profession. According to Courvoisier and colleagues (2011) nurses who experience dissatisfaction with their job express their intention to leave, have higher rates of absenteeism and turnover, are burned out, dissatisfied with their quality of life, cope with work-related stress and their work performance suffers.
Nursing profession is continuously evolving in its attempt to keep up with today’s constantly transforming healthcare environment. The great challenges that nursing is facing nowadays, call for strong nurse leaders – people who can be inspiring role models and mentors. Nurse leadership theories need to be examined to ascertain their relevance in nursing practice. When future nurse leaders are properly identified, and their development is supported, the essential nursing goal – outstanding patient care can be accomplished along with an advancement in nursing profession itself.
Leadership can be defined as the ability to influence others through guiding, motivating and counseling in order to attain organizational effectiveness. Studies and leadership literature emphasize that effective leadership plays a major role in promoting and sustaining a healthy work environment and therefore creates positive patient outcomes, increases overall nurse job satisfaction and helps to advance an organization. With a proper and effective leadership support, constructive intra-professional relationships and healthy work settings, nurses are not compelled to leave their current jobs, and may in the future be willing to assume leadership roles. As new leaders, they will replace retiring old leaders and continue working toward improving both nursing practice and patient outcomes.
There are various leadership models in nursing that can be useful tools in guiding the staff into the creation of a dedicated and enthusiastic team that exceeds the requirements of the job.
Autocratic or authoritarian leadership (micromanaging)
In this leadership model that leader has the power to make all the decisions with no consideration to other input. The power and the knowledge are retained and kept at the top. The individual staff member is always to blame for any issues but never the system or process. Authoritarian leadership strictly enforces organizations’ policies but does not attempt to promote trust and/or communication. This style of leadership works well in emergencies or chaotic circumstances that require immediate decision making.
Democratic leadership model is best described as the opposite of authoritarian leadership. Democratic leaders encourage every team member to take their part in the decision-making process. They facilitate open communication and make sure everybody’s opinion is heard. Team members are given the responsibilities and are held accountable for their performance. This strong feature of this leadership style is open communication and its effectiveness in improving organizational processes and the quality of service.
This kind of leadership is also called the absence of leadership because of its hands-off approach which means little or no direction, guidance or immediate supervision. This model of leadership can be effective when working with highly skilled and highly motivated individuals. On the downside, it can be destructive to unit socialization and it is often blamed for creating a culture of blame. There is no leader decision-making, changes implementation, and quality improvement is rather of a reactive than proactive character. Laissez-faire leadership style is most commonly practiced by either new and inexperienced leaders or the leaders who are at the end of their careers. The latter exhibit I don’t care attitude since soon the things will change and the issues will be addressed by their replacement leaders.
Transactional leadership model is mainly focused on the role of supervision and team performance results. It accommodates the established framework of an organization and measures the results using the organization’s rewards versus penalties system. Transactional leaders defend the organization’s status quo because in their opinion the changes should take place slowly and steadily. The characteristic feature of transactional leaders is their formal authority within an organization. Transactional leadership is strongly based on order and structure, and usually, it is not the desired leadership model in places and institutions where creativity and originality are valued. Transactional leaders are driven by short-term goals, follow rigid policies and procedures, are not flexible and relish efficiency. This leadership model proved effective in emergency/crisis situations and situations when a task needs to be performed in a certain pattern.
Transformational leadership, because of its adaptivity and flexibility is a better fit for constantly changing and dynamic systems and organizations. It is a style of leadership in which the leader recognizes that desired change, comes up with a vision to introduce the change by inspiring the followers and executes the change with full commitment (Marshall & Broome, 2010). A transformational leader is not only concerned with day to day operations, but she/he is interested in the advancement of the organization by envisioning the organization’s future and creating strategic plans to achieve the goal.
Transformational leadership: The gold standard
Transformation leadership includes four key characteristics: individualized consideration, intellectual stimulation, inspiration and charisma. Individualized consideration of a transformational leader is a characteristic that demonstrates in a concern for individual follower’s needs which, in terms, supports the development of the followers’ skills and helps them in reaching desired outcomes. Intellectual stimulation aims to promote intelligence and rational thinking development of employees which in turn fosters independent problem-solving. The third characteristic, inspiration is the way for the leaders to communicate high expectations and to strengthen team members efforts to achieve common goals. Lastly, transformational leaders are described as charismatic leaders with their vision of an innovative change and a mission of the future growth and success of the company.