Nursing leadership from crisis to postpandemic

Citations Over TimeTop 10% of 2022 papers

Abstract

For more than 2 years, health care systems all over the world have been struggling with the COVID-19 pandemic. Nurse leaders and their staff have had to make rapid decisions in unprecedented situations and swiftly change work programs and procedures. It has been a time of crisis leadership (Turnipseed & VandeWaa, 2022). In a concept analysis carried out pre-COVID-19, Kim (2021) defined the core attributes of crisis leadership from a nursing perspective as: clear, fast, honest communication; a high degree of collaboration; information sharing; decision-making and fair prioritization; trust building; and competency. More recent studies (Heide & Simonsson, 2021; Lake et al., 2021; Lord et al., 2021; Turnipseed & VandeWaa, 2022) have shown that communication is one of the most important competences for successful leadership during the pandemic. Clear, regular, authentic, effective and valid communication has been found to prevent panic, reduce the stress of the unknown, and create trust (Losty & Bailey, 2021). Communication is also one of the six standards recommended by the American Association of Critical-Care Nurses (AACN) for building a healthy work environment and is obviously desirable in health care professionals. The other AACN standards are true collaboration, effective decision-making, appropriate staffing, meaningful recognition and authentic leadership, and all six closely match the definition of crisis management given above (AACN, n.d.). So, can a healthy work environment be achieved for nurses with crisis leadership? Good communication has been a key issue and an indicator of successful management during the COVID-19 pandemic. Reciprocal communication is needed between leaders and staff, and clear, rapid, truthful, trustworthy and empathic communication has been seen to promote resilience in both leaders and staff during demanding circumstances, as well being beneficial to their work well-being (Turnipseed & VandeWaa, 2022). One lesson that surely has been learned over the last 2 years is that being attentive and studying communication skills, within basic nursing education, additional training at work and at universities, are necessary for current and future leaders. Coping with the pandemic has required effective collaboration, which also relies on good communication. Successful collaboration between nursing professionals, and with physicians and other professionals, is fundamental to the care of critically sick patients and results in mutual empowerment. In a healthy work environment, there is both good communication and constructive collaboration, with all professionals involved enabled to contribute to effective decision making. This can be regarded as professional governance (Kanninen et al., 2021; Porter-O'Grady & Pappas, 2022), which can come close to professional autonomy. During times of crisis, leaders may have to make decisions without the time to listen to their staff, and nurses have to respond directly to doctors' instructions during the course of frontline patient care. Clearly, this can be necessary if it is a question of life or death, for example, but in general, effective decision-making takes everyone's view into account, even if the final, official, decision is taken by one person. Many countries are also struggling with inadequate staffing. A challenging time has led many nurses to consider leaving the profession, and many have already left. At the same time, there is the question of how, if the war in Ukraine, other political crises, new pandemics or climate crises escalate, health services will manage when their nurses, and other health care professionals, are already exhausted. Those nurses who remain in the profession are getting older, as are the populations of developed countries, while the younger generation, the millennials, are showing less interest in nursing (WHO, 2020). Having a calling to nursing is no longer so common among young nurses (Kallio et al., 2022), and changes are needed that will make nursing an interesting and attractive profession. As well as developing better working conditions and salaries, attention also needs to be given to appropriate recognition for nursing. During the COVID-19 pandemic, with heavy workloads and a stressful working atmosphere, levels of recognition for the work carried out by nurses have been perceived as low (Jeleff et al., 2022). Meaningful recognition of the work carried out by staff is highlighted in a healthy work environment. Nurses greatly appreciate positive feedback from patients, which is important for job satisfaction (Seitovirta et al., 2018), but a lack of official recognition affects work motivation and can accelerate a nurse's intention to leave the profession. It is important for professionals to know that their good work will be recognized, and what reward strategy an organisation has. However, successful recognition involves both the individual and the entire workplace community (Seitovirta et al., 2018). Although we know that an appropriate salary and work evaluation scheme provide important types of recognition, nurses' personal wishes for recognition also need to be considered. Leaders of a healthy work environment have an authentic leadership style. One study with a large body of data about nurses and leaders (Raso et al., 2021) demonstrated this positive relationship during the pandemic. Could this follow after crisis leadership? Authentic leaders are genuine and honest and enable reciprocal communication between leaders and staff. Authentic leadership is on the continuum from transformational leadership, which for decades we have known is an aspirational leadership style that has still to be fully implemented in practice (Northouse, 2021). So, what should good leadership of postpandemic nursing look like? Nursing leadership appears to have taken a few steps back during the last 2 years, towards a more administrative, transactional style, where leaders say what and how things are to be carried out. Before any further development can be achieved, it could take some years to return to the same level of nursing leadership as before the pandemic. Relational leadership styles, such as transformational and authentic leadership, have previously been dominant styles, and both Feistritzer et al. (2022) and Grubaugh and Bernard (2022) suggest that complex relational leadership (CRL) is needed for postpandemic nursing, combining effective leadership with engaged clinical nurses who are accountable for decision-making. CRL is a leadership model that has been identified as a conceptual foundation for navigating Complex Adaptive Systems (CAS), in which nurses at all levels can function. CRL looks towards transformational leadership, where relations between staff, leaders and organisations can co-occur (Feistritzer et al., 2022). Strong relationships are therefore central to cocreating the future environment of nursing practice (Feistritzer et al., 2022). Specifically, nurse leaders need to focus on good communication, teamwork and professional governance (Porter-O'Grady & Pappas, 2022). Visibility and listening are key to communication, being and discussing with nursing staff in different spontaneous and organized meetings gives important information what is working well and eliminates rumours and misunderstandings. Encouraging, listening and welcoming contributions creates trust, openness and respect (Grubaugh & Bernard, 2022; Turnipseed & VandeWaa, 2022). While it is possible to participate in traditional shared governance, focusing on responsibility, where nurses and managers share locally based decisions, Grubaugh and Bernard (2022) suggest there is a need to move on and progress to true professional governance. This encompasses an expectation of real expertise, autonomy and participation in intraprofessional decision making (Kanninen et al., 2021). Building relationships, creating partnerships, and working with numerous teams is required in complex health care. It is also important to improve health care professionals' well-being through increased resilience and professional success after a crisis (Grubaugh & Bernard, 2022). In conclusion, it is currently unknown whether nursing leadership will return to a complex relational leadership style or remain in crisis leadership, in particular transactional leadership. However, there is strong pressure, especially from younger generations, to change the current work environment and dominant leadership styles. Ultimately, we need to remember why transformational leaders are needed: their work is transparent and empathic, they are visible, and communication with nurses is open. Transformational leaders empower nurses to achieve a high quality of care for patients, which is at the core of nursing and nursing leadership. None. None. None. Data sharing not applicable to this article as no datasets were generated or analysed during the current study.

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