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Literature review of nurses experience of communication nursing essay

Effective governance is crucial to efforts to maximize effective management of care in the hospital setting.

  • A new health system for the 21st century;
  • Such an action would combine bar code medication administration technology at the point of care with real-time medication surveillance of therapeutic goal attainment, enhanced adverse drug-event alerts, and adverse event-surveillance information;
  • The researchers would like to thank all nursing students and instructors who contributed to the study;
  • Role of hospitals in contemporary health care Globally, hospitals are under increased strain and scrutiny;
  • Harvard School of Public Health;
  • Epub2013 Dec 19 Goldberg, D.

Emerging from this complex literature is the role of leadership in the clinical setting. The importance of effective clinical leadership in ensuring a high quality health care system that consistently provides safe and efficient care has been reiterated in the scholarly literature and in various government reports. Recent inquiries, commissions, and reports have promoted clinician engagement and clinical leadership as critical to achieving and sustaining improvements to care quality and patient safety.

In this discursive paper, we discuss clinical leadership in health care, consider published definitions of clinical leadership, synthesize the literature to describe the characteristics, qualities, or attributes required to be an effective clinical leader, consider clinical leadership in relation to hospital care, and discuss the facilitators and barriers to effective clinical leadership in the hospital sector.

Despite the widespread recognition of the importance of effective clinical leadership to patient outcomes, there are some quite considerable barriers to participation in clinical leadership. Future strategies should aim to address these barriers so as to enhance the quality of clinical leadership in hospital care. Service design inefficiencies, including outmoded models of care contribute to unsustainable funding demands. While some progress and reforms have been achieved, numerous experts point to the need for further system change if services are to be affordable and appropriate in the future.

This transformation will require leadership — and that leadership must come substantially from doctors and other clinicians, whether or not they play formal management roles.

Communication Barriers Perceived by Nurses and Patients

Clinicians not only make frontline decisions that determine the quality and efficiency of care but also have the technical knowledge to help make sound strategic choices about longer-term patterns of service delivery. It is a requirement of hospital care, including system performance, achievement of health reform objectives, timely care delivery, system integrity and efficiency, and is an integral component of the health care system. Indeed, hospitals are very costly and diverse environments that vary in size and complexity, determined literature review of nurses experience of communication nursing essay part by their overall role and function within the larger health care system.

The services provided by individual hospitals are determined and driven by a number of mechanisms, including government policy, population demographics, and the politics and power of service providers. It is at this point where consumers are recipients of hospital care and where they witness and experience how the system functions, observing the strengths and inefficiencies of the health care system and conflict and collegiality between and among groups of health professionals.

It is also at this point that clinicians, defined as any frontline health care professionals, have opportunities to fulfill leadership roles. For consumers of health care to achieve optimal health outcomes and experience optimal hospital care, many believe effective clinical leadership is essential. In this paper, we discuss clinical leadership in contemporary health care, definitional issues in clinical leadership, roles of hospitals in contemporary health care, preparation for clinical leadership roles, and the facilitators and barriers to effective clinical leadership in the hospital sector.

Clinical leadership in contemporary health care The importance of effective clinical leadership in ensuring a high quality health care system that consistently provides safe and efficient care has been reiterated in the scholarly literature and various government reports.

Announcements

In the more recent Francis report 7 from the UK, a recommendation was made for similarly positioned ward nurse managers to be more involved in clinical leadership in their ward areas. In the United States, clinical leadership has also been identified as a key driver of health service performance, with the Committee on Quality of Healthcare suggesting considerable improvements in quality can only be achieved by actively engaging clinicians and patients in the reform process.

For example, Schyve 5 claims aspects of governance are sui generis in health care, noting healthcare organizations also have a rather unique characteristic. In healthcare, because of the unique professional and legal role of licensed independent practitioners within the organization, the organized licensed independent practitioners — in hospitals, the medical staff — are also directly accountable to the governing body for the care provided.

So the governing body has the overall responsibility for the quality and safety of care, and has an oversight role in integrating the responsibilities and work of its medical staff, chief executive, and other senior managers into a system that that achieves the goals of safe, high-quality care, financial sustainability, community service, and ethical behaviour.

This is also the reason that all three leadership groups — the governing body, chief executive and senior managers, and leaders of medical staff — must collaborate if these goals are to be achieved Schyve 2009: There is recognition of the challenges associated with health care governance, evidenced by significant investment internationally in building systems for leadership development in health care. This points to the realization that the cost and consequences of poor clinical leadership greatly outweigh the costs and potential benefits of provision of formal programs to enhance clinical leadership capacity ideally in a multidisciplinary health care team context.

In addition to challenges associated with resources and demand, episodes of poor patient outcomes, cultures of poor care, and a range of workplace difficulties have been associated with poor clinical leadership, 8914 and these concerns have provided the impetus to examine clinical leadership more closely.

Definitional issues in clinical leadership Within the health care system, it has been acknowledged that clinical leadership is not the exclusive domain of any particular professional group.

While effective clinical leadership has been offered up as a way of ensuring optimal care and overcoming the problems of the clinical workplace, a standard definition of what defines effective clinical leadership remains elusive. A secondary analysis of studies exploring organizational wrongdoing in hospitals highlighted the nature of ineffectual leadership in the clinical environment. The focus of the analysis was on clinical nurse leader responses to nurses raising concerns. Three forms of avoidant leadership were identified: Similarly, McKee et al employed interviews, surveys, and ethnographic case studies to assess the state of quality practice in the National Health Service NHS literature review of nurses experience of communication nursing essay they report that one of the most important insurances against failures such as those seen in the Mid-Staffordshire NHS Trust Foundation is active and engaged leaders at all levels in the system.

Synthesis of the literature suggests clinical leadership may be framed variously — as situational, as skill driven, as value driven, as vision driven, as collective, co-produced, involving exchange relationships, and as boundary spanning see Table 1.

Effective clinical leaders have been characterized as having advocacy skills and the ability to affect change. Table 1 The characteristics of clinical leadership and the attributes of clinical leaders Notes: Edmonstone notes following the implementation of numerous clinical leadership programs in the UK the little research undertaken has largely focused on program evaluation, rather than the nature or outcomes of clinical leadership.

Role of hospitals in contemporary health care Globally, hospitals are under increased strain and scrutiny. Increased demands and fiscal pressures have increased the pressures on all health professionals as well as clinical and non-clinical staff.

1. Introduction

A number of nationally and internationally influential reports 6 — 8 have resulted in changes in visibility, scrutiny, and accountability in relation to hospital care.

This scrutiny has increased the emphasis on the role of health professionals, including nurses, in monitoring standards, developing and evaluating better ways of working as well as advocating for patients and their families; and led to a substantial momentum in the quality and safety agenda, including the promotion of various strategies such as promoting evidence-based practice. In the hospital sector, the demands placed upon leaders have become more complex, and the need for different forms of leadership is increasingly evident.

To derive cost efficiency and improve productivity, there has been intense reorganization. Coupled with these reforms has been increasing attention upon improving safety and quality, with programs instituted to move attention beyond singular patient—clinician interpretations of safety toward addressing organizational systems and issues of culture. In part, this shift has been in response to growing recognition that while designated leaders in positions of formal authority within hospitals play a key role in administration and espousing values and mission, such leaders are limited in their capacity to reshape fundamental features of clinical practice or ensure change at the frontline.

This type of work engagement requires forms of citizenship behaviors that are focused literature review of nurses experience of communication nursing essay improving clinical systems and practices. Hospitals are complex socio-political entities, and the ability for engagement and leadership among clinicians can be hampered by power dynamics, disciplinary boundaries, and competing discourses within the organization.

The tension inherent between clinical and administrative discourses is evidenced in the findings from the evaluation of clinical directorate structures in Australian hospitals, with close to two thirds of medical and nursing staff surveyed reporting the primary outcome of such structures was increased organizational politics.

Edmonstone 11 cautions that without structural and cultural change within institutions, the move toward clinical leadership can result in devolution of responsibility literature review of nurses experience of communication nursing essay clinicians who are unprepared and under resourced for these roles. Evidence emerging from the NHS suggests particular value in leadership coalitions between managers and clinicians. As Gagliano et al comment, there is some evidence that health service provider groups are attempting to address issues pertaining to leadership issues through design and implementation of leadership development programs.

Other countries have developed education and professional development programs in clinical leadership for doctors, nurses, and allied health professionals working in their respective health systems. Some of these programs have similar features to UK NHS leadership frameworks and associated strategies. For example, in New Zealand medical schools are working to provide leadership training in their undergraduate medical curriculum. Much has been written in the organizational and health care literature about employee work engagement and the benefits derived through promoting work engagement.

Considerable evidence confirms positive associations between constructs such as job satisfaction, work performance, improved productivity, and engaged employees. Although considerable discussion has occurred on the need for clinical leadership, and large scale pubic inquiries evidence the considerable patient harm that has occurred in the absence of such leadership, 78 there continues to be a major disconnect between clinicians and managers, and clinical and bureaucratic imperatives.

The debate over who is best positioned to lead service delivery and the place of clinicians in governance continues. Conclusion Effective clinical leadership is associated with optimal hospital performance. It is allied to a wide range of hospital functions and is an integral component of the health care system. Developing clinical leadership skills among hospital nurses and other health professionals is of critical importance.

However, despite the widespread recognition of the importance of effective clinical leadership to patient outcomes, there are some quite considerable barriers to participation in clinical leadership. As the focus on hospital performance intensifies, leadership to increase efficiencies and improve quality will be of increasing importance.

Disclosure The authors report no conflicts of interest in this work.