Effective Approaches in Leadership and Management
There are many differences between the approach of the nurse leader and that of traditional management. While it is ideal for the nursing leader to also have strong management skills, nurse leadership and business management could be seen as having opposing orientation. Where the former seeks to empower the group to achieve an objective, the manager seeks control for the same purpose. It was with this in mind that I determined to better understand the issue of nurse retention, the shortage of nurses, and nurse turnover from both perspectives.
Shortage and retention in nursing
The problem of nurse retention and subsequent shortage is one that has been well known and discussed for decades, but little headway has been made. Nurses continue to be prone to burn out, job dissatisfaction and overwork. The results of this have been shown empirically to be related to increased mortality and decreased health outcomes (Aiken et. al. 2002). Many variables appear to be creating the negative environment for nursing that leads to high turnover, including group dynamics, organizational management and job satisfaction (Leveck & Jones 1996). Management style was shown to be critically related to all of these variables (Leveck & Jones 1996). Nurse leadership and traditional business management have differing underlying philosophies and orientation. Nurse leadership is firmly rooted in blossoming leadership from within nursing philosophy and science, and there are associated concepts such as empowerment. This came about over time, in part as a reaction to traditional “bottom line” management and thinking. The management theories which were driving the decisions in nursing did not take into account the needs of nurses or patients. It is perhaps this that created a rift between management and nursing, at least for the nurses. Certainly a lack of understanding between these disciplines is a contributor to difficult work situations which impact patient health outcomes.
Management approach to retention
Talent management is a term currently popular in management literature. This is a change from many previous human resource strategies. While the talent management model continues to stress control, it is control of the human resource situation rather than the individual (Oladapo 2014). Talent management is seen as a means of finding competitive advantage by increasing the capacity of the organization, and this therefore includes recruitment, development and performance in addition to retention (Oladapo 2014). Incentives for talent management include compensation, job satisfaction, work environment and potential for advancement. (Oladapo 2014). The theories underlying and based on talent management take a view of talent as an advantage which requires a competitive approach. Talent is in demand and short supply; this seems to be very much aligned with today’s nursing context.
Previous management theories were not always as positively disposed to workers in general. Scientific management and Taylorism had taken the view of selecting the best and monitoring performance. While this may have worked for some industries, in nursing this would not result in an ideal situation in the current times when nurses and the stability of nurses in their positions is very much needed.
The nurse leadership approach to retention
The nurse leadership literature, just as with the management literature, also recognizes the importance of a positive work context and incentives to retention. Nurse leadership recognizes the important of advocating for more positive outcomes by understanding the needs of patients and other nurses, identifying gaps and contributing to solutions. In the case of nurse turnover and difficulty with retention the gaps have long been identified as issues in the work environment, particularly the overwork and difficult management styles. Nurse leaders are therefore tasked with changing the situation by creating more positive work environments and ways of working. A specific study intended to measure the impacts of nurse leadership on the work environment and staff intention to stay (Duffield et. al. 2011). The Nursing Work Index-Revised survey inventory was used in addition to a questionnaire regarding self-reported satisfaction at work and intent to leave. Critical dimension of nursing manager considered to be nurse leaders were that they consulted when making decision, were accessible, and gave credit and recognition. The researchers noted that for a ward to have an overall all positive rating, all dimensions had to be positive. In nurse leadership it would appear that weakness in a single dimension has a disproportionate downward effect on the rating of the environment. This makes clear how important the nurse leader is, but it also makes the point of what a challenge it is to be an effective nurse leader (Duffield et. al. 2011). Clearly nurse leaders have an important role to play in terms of creating the environment that is positive for nurses and patients. This pursuit of nursing retention could therefore be defined by its antecedents, that being the positive work environment. Perhaps talent management is a more efficient way of identifying the task at hand.
I reflected on identifying the approach that best fits my personal and professional philosophy of nursing. Initially it seemed to be a case of choosing a side in a debate, however on further thought it seemed unnecessary to create unnecessary barriers, since it was possible to be informed by both approaches. I was surprised that I had let an ideological division define the framework for my thinking. It is unnecessary to make a choice; there is no reason why nurse leadership should be opposed to understanding and even adopting some best practices from business management. To that end, while not wavering from my intention to continue to learn and grow in the practice of nurse leadership, I find the concept of talent management to be a very attractive one.
The idea of talent management in contrast to nurse retention epitomizes the idea of empowerment versus control, but my assumption with regard to empowerment versus control oriented perspectives appears to be in error when it comes to this human resource issue. Talent management has subtle connotations that are preferable, in my mind, to the term “nurse retention”. The latter term brings immediately to mind all of the negative factors that cause high turnover of nurses. On the other hand, “talent management” shows an inherent respect for the capacity of nurses, and it lends itself to understanding the incentives and environment that would facilitate it. I would rather manage talent than fight to retain nurses, and it seems that the former paradigm reduces the instance of the latter.
The problem of nurse turnover, retention and work dissatisfaction is one that affects all stakeholders including patients, owners, policymakers, management and nurses. Proposing false ideological barriers can prevent different disciplines and specialties from communicating and consulting with one another and thereby gaining the benefit of the capacity and knowledge of the other. This is the case with regard to the difference in thinking between management theory which arises from the theories of business and leadership from the perspective of theoretical and applied nursing. In the case of the work environment and dissatisfaction which appears to be highly related to difficulties in maintaining nurses over time, there is no reason not to use every tool and all contributions towards resolving this longstanding issue, for the nurses, for their patients and for the community.
Aiken, L. H., Clarke, S. P., Sloane, D. M., Sochalski, J., & Silber, J. H. (2002). Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. Jama, 288(16), 1987-1993.
Duffield, C. M., Roche, M. A., Blay, N., & Stasa, H. (2011). Nursing unit managers, staff retention and the work environment. Journal of clinical nursing, 20(1‐2), 23-33.
Leveck, M. L., & Jones, C. B. (1996). The nursing practice environment, staff retention, and quality of care. Research in nursing & health, 19(4), 331-343.
Oladapo, V. (2014). The impact of talent management on retention. Journal of business studies quarterly, 5(3), 19-36.
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