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Leadership, management and team working in community practice
• To explore the concept of leadership as a process
• To examine the skills of effective leadership
• To consider the leadership role in relation to teamwork and delegation
• To consider the leadership skills in the management of change
• To explore how the student nurse can gain leadership, management and team working skills within the community placement
Introduction
Within earlier sections of this book, reference has been made to the significant role of the community nurse in the co-ordination of care. This often includes undertaking a leadership role. One of the core conditions for developing community nursing, identified by the RCN (2010), in their policy position paper on the development of community nursing (Pillars of the Community), refers to leadership capacity.
Leadership, accountability and managing change
As healthcare delivery in the UK moves increasingly to the community setting, development of leadership skills becomes essential, given the complexity of services, multiprofessional working and the co-ordination of packages of care for individuals. The RCN position statement, Pillars of the Community (Royal College of Nursing, 2010: 7) for example, emphasises this need and states that:
Your community practice experience can provide you with many opportunities to observe community nurses undertaking a lead role in care. For example:
• The District Nurse can lead the multidisciplinary team for a client with complex needs and in the day-to-day organisation and delegation of home visits
• The Public Health Nurse may take the lead in the organisation of the multidisciplinary team for a family with special needs
• The Practice Nurse may take the lead in the development of a nurse-led clinic for a specific long-term condition such as diabetes
• The District Nurse may also play a significant leadership role in co-ordinating care with other services such as hospices, in the delivery of palliative care.
To be able to set a goal which focuses on leadership, it is important to have a shared understanding of what leadership is.
Defining leadership
Cooke (2001) defines a clinical nurse leader as a practitioner who is involved in direct patient care and who continuously improves care by influencing others. Leadership therefore includes not only specific skills but is also an ‘attitude that informs behaviour’ (Cooke 2001) Leaders act as ‘visionaries’ motivating, encouraging and supporting other practitioners to evaluate practice and plan for appropriate changes (Jooste 2004).
Northouse (2007) considers the following components to be essential within leadership:
Pointer’s (2006) definition leadership as:
He concludes from this that ‘leadership resides with a person rather than a position’ (Burton 2011: 205). This is an important observation because a student nurse can and must demonstrate skills in leadership to be able to qualify as a nurse (NMC Standards 2010). Although you may hear qualified nurses say that ‘she/he is a natural leader’ of a student nurse, when asked to explain why, they find it difficult to define. Being a ‘natural leader’ when it involves taking charge or responsibility for a group of patients in their care, may be one way of demonstrating this trait for some students, while for another student, it may clearly be evident in the way they take the lead in a ‘crisis’ situation involving one patient. Both situations require leadership skills but will require different leadership style to ensure a successful patient outcome.
Styles of leadership
There are several different types of leadership identified within the literature:
• Autocratic leaders, who set the agenda and goals without the involvement of others. They make the decisions and tell others what they are and what they have to do
• Transactional leaders is almost an authoritarian style whereby the leader establishes the outcomes required in the task and communicates this to the followers or subordinates and then monitors the performance during the delivery of these. (Burton 2011: 214)
• Transformational leaders are charismatic, visionary and inspire others, through shared values and most importantly trust
• Bureaucratic leaders rigidly adhere to rules, policies and regulations
• Laissez faire leaders leave people to identify and manage their own strategies to meet goals but without a clear direction of what is needed to be achieved
• Situational leaders adopt different styles of leadership to suit different situations.
A more detailed review of these various leadership styles can be found in the Further reading list at the end of this chapter.
Leadership skills
Leadership skills are often discussed in terms of their relevance to quite senior roles, however such skills are relevant to all practitioners especially to those working directly with clients and carers in their everyday practice. Adams (2010) outlines the leadership responsibilities that are required by community practitioners:
Adams (2010) emphasises the facilitative nature of leadership required by today’s NHS services, such ‘facilitative’ leadership includes the ability and skills to motivate staff, make appropriate decisions and encouraging staff to share and implement new ideas and practices. The leadership attributes of the senior charge nurse for example have been outlined by the National Health Service Education for Scotland (2011):
• Integrity, honesty and authenticity: Within your work you are continually observed by a number of people, clients, professional colleagues and managers and a lack of integrity, honesty and authenticity can be instantly identified
• Courage: Courage is required to make decisions, to play the role of advocate for your clients and to support your staff and colleagues
• Inquisitiveness: You recognise that you have a professional commitment to lifelong learning and support other colleagues with this
• Inspiration: Your passion and interest in your work motivates other colleagues
• Decisiveness: You prepare to make decisions and when necessary access advice before doing this
• Meticulousness: You are conscientious and address detail to achieve good standards and expect this of your colleagues
• Emotional attentiveness: You demonstrate sensitivity and understanding to others.
It could be argued that the skills of effective listening, understanding, accountability, empowerment, observation, networking and relationship building, which are built during initial professional training, are also essential within leadership. Adams (2010) argues that community practitioners who are clinical leaders also need to develop skills in:
Contino (2004) groups leadership skills into the following four specific categories:
1. Organisational management: which includes effective management of time, information, human resources and change.
2. Communication: leaders need to have good communication skills to disseminate and interpret information quickly and accurately; an ability to ‘inspire’ vision. Leaders need to be able to translate policies into practice; they can see the relevance of a policy in relation to practice and patient care and can communicate this to staff to demonstrate the relevance of strategic changes to improving patient care.
3. Analysis/strategy: leaders should be able to plan work to meet organisational objectives and to analyse data to make enable effective decision-making.
4. Creation and vision: leaders should be creative in finding solutions to problems; this includes utilising the skills and expertise of staff.
Above, reference was made to Contino’s (2004) categorisation of leadership skills, which included organisational management, the effective management of time, information, human resources and change.
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