Page 33 - ACCCN's Critical Care Nursing

10 S C O P E O F C R I T I C A L C A R E

and ‘transformational’ and sometimes by using leader- ● satisfied staff, with a high level of retention
ship characteristics. Regardless of the terminology in use, ● development of staff through an effective coaching
some common principles can be expressed. Desired and mentoring process. 81,86
leadership characteristics include the ability to:
Effective clinical leaders build cohesive and adaptive
84
● articulate a personal vision and expectations work teams. They also promote the intellectual stimula-
● act as a catalyst for change tion of individual staff members, which encourages the
● establish and implement organisational standards analysis and exploration of practice that is essential for
● model effective leadership behaviours through both evidence-based nursing. 85
change processes and stable contexts
● monitor practice in relation to standards and take cor- Clinical leadership is particularly important in contem-
rective action when necessary porary critical care environments in times of dynamic
● recognise the characteristics and strengths of indivi- change and development. We are currently witnessing
duals, and stimulate individual development and significant changes in the organisation and delivery of
commitment care, with the development of new roles such as nurse
● empower staff to act independently and practitioner (see this chapter) and liaison nurse (see
interdependently Chapter 3), the introduction of services such as rapid
● inspire team members to achieve excellence. 80-85 response systems, including medical emergency teams
(see Chapter 3), and the extension of activities across the
Personal characteristics of an effective leader, regardless care continuum (see Chapter 4). Effective clinical leader-
of the style, include honesty, integrity, commitment and ship ensures that:
credibility, as well as the ability to develop an open, trust-
85
ing environment. Effective leaders inspire their team ● critical care personnel are aware of, and willing to
members to take the extra step towards achieving the fulfil, their changing roles
goals articulated by the leader and to feel that they are ● personnel in other areas of the hospital or outside the
valued, independent, responsible and autonomous indi- hospital recognise the benefits and limitations of
85
viduals within the organisation. Members of teams with developments, are not threatened by the develop-
effective leaders are not satisfied with maintaining the ments and are enthusiastic to use the new or refined
status quo, but believe in the vision and goals articulated services
by the leader and are prepared to work towards achieving ● patients receive optimal quality of care.
a higher standard of practice. The need to provide educational opportunities to develop
80
Although all leaders share common characteristics, some effective clinical leadership skills is recognised. Although
elements vary according to leadership style. Different not numerous in number or variety, programs are begin-
styles – for example, transactional, transformational, ning to be available internationally that are designed to
authoritative or laissez faire – incorporate different char- develop clinical leaders. 79,87 Factors that influence leader-
acteristics and activities. Having leaders with different ship ability include the external and internal environ-
styles ensures that there is leadership for all stages of an ment, demographic characteristics such as age, experience,
organisation’s operation or a profession’s development. understanding, stage of personal development including
A combination of leadership styles also helps to over- self-awareness capability, and communication skills. 80,82,87
come team member preferences and problems experi- In relation to clinical leadership, these factors can be
enced when a particularly visionary leader leaves. The developed only in a clinical setting, so development of
challenges often associated with the departure of a leader clinical leaders must be based in that environment.
from a healthcare organisation are generally reduced in Development programs based on mentorship are superbly
the clinical critical care environment, where a nursing suited to developing those that demonstrate potential for
leader is usually part of a multidisciplinary team, with such capabilities. 80
resultant shared values and objectives. Mentorship has received significant attention in the
healthcare literature and has been specifically identified
CLINICAL LEADERSHIP as a strategy for clinical leadership development. 88-90
Effective critical care nurses demonstrate leadership char- Although many different definitions of mentoring exist,
acteristics regardless of their role or level of practice. Lead- common principles include a relationship between two
ership in the clinical environment incorporates the people with the primary purpose of one person in the
general characteristics listed above, but has the added relationship developing new skills related to their
91,92
challenges of working within the boundaries created by career. Mentoring programs can be either formal or
the requirements of providing safe patient care 24 hours informal and either internal or external to the work
a day, 7 days a week. It is therefore essential that clinical setting. Mentorship involves a variety of activities directed
leaders work within an effective interdisciplinary model, towards facilitating new learning experiences for the
so that all aspects of patient care and family support, as mentee, guiding professional development and career
well as the needs of all staff, are met. Effective clinical decisions, providing emotional and psychological support
leadership of critical care is essential in achieving: and assisting the mentee in the socialisation process both
within and outside the work organisation to build profes-
● effective and safe patient care sional networks. 89,91 Role modelling of occupational and
● evidence-based healthcare professional skills and characteristics is an important