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The nurses' ability to provide safe and quality care to patients is greatly impacted by the health care work environment. An unhealthy environment can create undue stress which can result in adverse events to the patients and nurses. A healthy work environment contributes to fulfilment, effective performance and greater patient outcomes. It is essential that nurse leaders and managers take responsibility for creating and sustaining a safe, supportive work environment for their staff and patients (Murray, 2017, p.271). There are barriers to a healthy work environment including; ineffective delegation, inadequate staffing, and lack of communication.
Leaders can use strategies to overcome barriers such as; fostering a trusting and respectful relationship, implementing appropriate technology, coaching staff members, and performance appraisals. There are many leadership theories that nurse leaders can use to enhance a positive and healthy work environment. Transformational leadership theory, is effective in promoting a positive relationship between team and leader while also addressing quality improvement aims of the healthcare setting. In comparison to other theories, this style provides benefit to the whole health care team and is found to be positively correlated with quality nurse work life.
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This paper addresses transformational leadership theory, barriers to a healthy work environment and strategies to overcome them.Part One Leaders must address quality improvement recommended and outlined by the Institution of Medicine (IOM) to create a safe and healthy environment for all. One of the provisions of the IOM addresses safe, effective, patient centered, timely, efficient, and equitable care (Murray, 2017, p. 49). Transformational leadership theory fits these aims well.
Jensen et al (2016) defines transformational leadership as holding the behaviors to create, share and maintain a vision in order to encourage employees to achieve shared goals (Jensen et al., 2016). These types of leaders are able to raise employee awareness to the importance of the goals and outcomes for success of the organization (Andersen, Bjrnholt, Bro, & Holm-Petersen, 2018). Transformational leadership is regarded as most effective because it recognizes the importance of rewards while also satisfying the needs of the staff by engaging the person emotionally and intellectually (Doody & Doody, 2012). This theory allows leaders and team members motivate each other to attain and achieve levels of success (Murray, 2017, p. 49). By analyzing and applying their own values and beliefs, the role of leader can influence the creation of a positive work environment. This type of leader will guide staff in creating an environment where all members of the team can contribute to meet the goals of the hospital. When a leader encourages input from all members, they encourage them to reach their highest potential and soar beyond expectations. In a study conducted in five Makassar City Regional Hospitals, 542 responses to questionnaires were obtained and the results of this study showed transformational leadership as increasing quality nurse work life by 28% (Suratno, Ariyanti, & Kadar, 2018). Though this may be, there are barriers that leaders face when trying to obtain a healthy work environment. One barrier to creating and sustaining a healthy work environment is ineffective delegation. Delegation can be a very challenging task for both parties involved. Ineffective delegation can compromise safe and quality care and can result in missed care. The responsibility of the nurse leader is to ensure there are strategies in place to diminish factors that may contribute to poor delegation (Murray, 2017, chapter 12). A lack of guidelines of who can delegate what to whom can contribute to this barrier. A transformational leader can use input from their team members to identify policies and procedures to support delegation, rights and responsibilities. Another barrier to a healthy work environment is inadequate staffing. The nursing shortage is a globalized issue that affects all areas of nursing. Appropriate staffing is essential to quality care in nursing as it effects the nurse ability to provide safe care. Nursing managers must understand the regulations that are required to provide adequate staffing and scheduling. Inadequate staffing is often the cause of poor patient outcomes in an unanticipated event. Transformational nursing leadership allows for managers to be effective to lead change when meeting the demands of the health care system (Murray, 2017, p. 239). A third barrier is lack of collaboration and communication. Communication is an important element in the leadership process and the way information is communicated can interfere with what is intended to be relayed to another (Andrade Vasconcelos, Caldana, Cantarella Lima, Marques da Silva, Bernardes, & Silvia Gabriel, 2017). You are not only communicating with patients but with staff, patient families and providers. Communication should be sensitive, responsive, understandable, and effective. There is a critical link between effective communication and patient safety. Poor communication and lack of collaboration can lead to conflict and compromised patient safety. Transformational leaders can be highly effective in communicating and collaborating with their team. By actively involving their team members they allow for open communication. These barriers can make sustaining a healthy work environment difficult, but an effective nurse leader holds the key to knocking down these barriers. Part twoFurthermore, a nurse leader's job is to find strategies to overcome barriers to creating and maintaining a healthy work environment. Recognizing the barriers is the first step to overcoming them. Fostering a trusting and respectful relationship, implementing appropriate technology, coaching staff members, and performance appraisals are key strategies that can help nurse managers overcome barriers to a healthy work environment. New research has shown that understanding the complexity of the nurse role is essential in developing changes to support a healthy work environment. Nurse Managers should foster a trusting and respectful relationship among RNs, LPNs, and UAPs. This empowers the staff to express concerns or questions when providing patient care. Research from Huddleston (2014) showed that a healthy work environment occurs when there is a strong sense of trust among the staff and when leaders foster respect, value and fair treatment for all positions in the organization (Huddleston, 2014). Transformational leadership theory is an effective theory for empowering nurses which allows them to have a sense of autonomy, self-efficiency, job satisfaction and commitment to the organization (Huddleston, 2014). Next, implementing appropriate and evidence based technology is a strategy to promote a healthy work environment. Any new or redesigned technology should be developed for the purpose of making nursing care easier and safer. Nurses use technology every day to monitor and document patient care. In today's complex work environments, technology is needed to support nurse decision making (Ebright, 2010). In addition, technologies that allow for safe patient handling improve outcomes in events such as transferring. Nurses need to spend more time focused on patient care than on filling the gaps of the system. A transformational leader can advocate for staff to have the appropriate technology for safe care. Coaching staff members is another strategy nurse leaders can use to foster a healthy work environment. Coaching is noted to be an art that guides an individual toward their future to accomplish and achieve their goals. A coach helps develop and prioritize viable solutions and then act on them. By using motivation and assistance for improving work performance, transformational leaders can enhance a healthy work environment. Part of coaching includes observing employee performance and providing ongoing feedback and constant encouragement. This coaching relationship should also be built on trust and respect (Murray, 2017, p. 220). Lastly, Nurse Managers and leaders need to ensure that their staff has the knowledge, skills and attitudes that are needed to perform their responsibilities. A performance appraisal is conducted by the nurse leader as a formal evaluation of work performance. Constructive feedback encourages and supports the employee to succeed rather than discouraging them. An effective appraisal can foster staff growth and development which is a key in maintaining a healthy work environment (Murray, 2017, p. 221). Transformational leadership theory is one of the most effective in all of these strategies. These leaders are able to lead staff where they need in order to meet the demands to the healthcare work environment. SummaryThe American Nurses Association (2016) defines a healthy work environment as one that is safe, empowering, and satisfying (American Nurses Association, 2016). There are many elements that contribute to sustaining a healthy work environment and a nurse leader is essential in incorporating these elements. Transformational leaders involve all nurses in the decision making and it is viewed as an effective type of leadership for nurses to lead a change necessary to meet the demands of the current health care system. By addressing barriers such as ineffective delegation, lack of staffing and poor communication nurse leaders can develop strategies to overcome them. Trusting and respectful relationships, new technologies, coaching the staff, and performance appraisals are ways the transformational leader can knock down these barriers to create and sustain a healthy environment. From this research, I learned that a healthy work environment is an essential component to safe, quality care as well as staff satisfaction. The nurse leader has an important role in maintaining and sustaining this environment. An effective nurse leader evaluates their beliefs and values to empower their staff in order for them to reach their highest potential. Although transformational leadership theory is a great style of leadership that has been proven to enhance nurse quality work life, a nurse leader must be flexible in applying different styles of leadership in order to create a healthy work environment.
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