Many believe that the current health care system is broken and unsustainable. Health care providers are faced with challenging increased costs, decreased quality nursing care, high turnover rates and increased medical errors while attempting to balance the ever growing demand for improved healthcare value from patients and other stakeholders. To create positive change, healthcare providers must learn how to effectively lead staff.
A significant amount of burnout and attrition of nurses occurs in health care systems. Nursing leadership has a significant impact on these factors. Poor leadership within health care systems can cause toxic symptoms that adversely impact organizational work cultures and staff satisfaction and lead to burnout, staff turnover, dissatisfied workers, critical medical mistakes and labor disputes.
Nurses have a significant impact on overall patient quality care and organizational effectiveness. When nurses leave, the quality of nursing care may decline due to the loss of expertise. Novice nurses may not have the commitment to the organization or the ability, intuition, and confidence of an expert nurse. Dissatisfied nurses and high turnover of nursing staff can also be extremely costly to the organization.
The estimated cost of replacing a medical-surgical nurse is $42,000 and a specialty nurse is $64,000. These figures include the cost of recruitment, orientation, precepting and lost productivity. The cost of lost productivity alone is nearly 80 percent of the total turnover cost.
Health care organizations cannot afford to lose valuable nurses. In the United States alone, the projected workforce shortage for nurses may exceed 500,000 by 2025. Additionally, an estimated 30-50 percent of all new nurses choose either to change positions or leave nursing completely within the first three years of clinical practice.
Confrontation time
There are several changes that need to be confronted in the health care industry; however, leadership is paramount to fixing some of the core issues. Modern health care has become a technologically complex working environment where a myriad of human interactions and personalities are responsible for life and death situations, and are the building blocks of effective health care leadership. The traditional health care models of leadership have failed and the results are demonstrated by increased medical errors and organizational failures.
Nurse job satisfaction has been directly linked to turnover, quality of care, patient outcomes and patient satisfaction. Research has shown that job satisfaction decreases when management fails to develop effective teamwork, there is an imbalance in work allocation, low staff engagement and participation in decision making, reduced staffing levels, and overall benefits.
Nurses have indicated that managerial support, responsiveness to correcting problems, and doctor/nurse relationships were significantly correlated with burnout and job dissatisfaction. Ultimately the dissatisfaction of nurses directly corresponded to patient satisfaction. Patient satisfaction is much lower in institutions where many nurses feel burned out and dissatisfied with their work conditions than in other institutions. It may be possible to improve patient satisfaction and avoid other adverse patient outcomes while also improving nurse satisfaction and retention by improving working conditions for nurses.
Leadership models
There are several leadership models which health care leaders can utilize: transactional, adaptive, transformational and servant. Servant leadership may be the best model for health care organizations because it focuses on the strength of the team, developing trust and serving the needs of patients.
Servant leadership takes place when leaders serve their fellow workers. Servant leaders develop people and help them flourish. Some authors of servant leadership state that leaders should “love” their subordinates, peers and superiors, as well as their competitors, a notion not normally thought to be present in today’s competitively driven business world — however, the philosophy has successfully been implemented in numerous large corporations throughout the United States.
Basically, servant leaders show concern for others and put the needs and interests of others first.
A considerable body of empirical research has shown that servant leadership is associated with a variety of favorable employee outcomes, including improved psychological well-being (through reduced emotional exhaustion), favorable job attitudes (through greater job satisfaction, affective commitment and decreased intention to leave), improved job performance (through better job performance and organizational citizenship behavior) and decreased workplace deviance (through decreased organizational and interpersonal deviance).
As servant leaders, health care employees may be best equipped to make changes in the organization and in the provider-patient relationship to improve the value of care for patients.
Jeff Belsky is owner of Rising Leaders located in Pittsburgh Pennsylvania, an organization specializing in individualized leadership coaching and development, strategic planning, and small business consulting.
