Developing mentors to support students in practice, supporting students in practice, Part 10: Leadership (word count 4574)
Summary
There is a strong correlation between effective leadership in nursing and the provision of high quality care to patients (Harris et al 2014). Recent revelations in relation to poor care practices within the nursing profession, have highlighted the need for strong leadership in the healthcare setting (Francis 2013). Mentors and practice teachers are required to demonstrate leadership as part of both their nursing and facilitative role. In addition they are responsible for developing effective leadership skills within their students who once registrants, will be expected to demonstrate these skills in practice.
This article aims to provide guidance for both new and established mentors and practice teachers in relation to the domain of Leadership, specifically stage 2 Mentor and stage 3 Practice teacher, (the specific outcomes can be found in Box 1). How mentors can foster these skills will be discussed in relation to leading by example; the text will be interspersed with these outcomes for mentors and practice teachers where they apply. The activities indicated within this article will provide the opportunity for mentors and practice teachers to generate evidence in order to map this on-going development against the NMC Standards to Support Learning and Assessment in Practice (SSLAP 2008a).
Introduction
Although there are many definitions of leadership one which lends itself well to the mentor and practice leadership standard, is that of Rafferty (1993) who suggests that leaders inspire, facilitate, help and praise’. These are important facets of leadership when supporting student nurses within the learning environment and are indeed integral to the role of mentors and practice teachers. O’Driscoll et al’s (2010) study suggests that although other members of the team have responsibilities in terms of student learning, the mentor/practice teacher is the one who is primarily concerned with leading this on a day to day basis. Such skills involve effective communication and interpersonal skills, self-awareness and being able to time manage, prioritise and delegate appropriately (Craig and Smith 2015). Brimblescombe (2009) suggests resilience, empathy and trustworthiness are important in developing leadership skills. Moreover, these skills should be developed within students in order to enhance their own practice when they become registrants and then mentors / practice teachers themselves. More specifically students can observe and learn from those who facilitate their learning, identifying certain attributes which are influential in effective leadership (Ousey, 2009).
Craig and Smith (2015) emphasise the need to equip students of healthcare with the skills to recognise poor practice and to ensure good practice through change. Leadership is a skill crucial to the role of the nurse/practice teacher in clinical settings in that they are responsible for all aspects of the organisation of care; this organising of care allows the mentor/practice teacher to demonstrate clear leadership skills and behaviours (Craig and Smith 2015). Ailey et al (2015) assert that through the observation leadership skills in their mentor/practice teacher and others, students are able to learn and practice such skills within the context of a clinical environment. Furthermore, they are able to see how leadership can move from leading on individual patient care to that of the nursing team. Indeed Lord Willis (2012) identified the need to prepare future nurses for what would be expected of them in relation to leadership once qualified. Certainly, beyond registration future employers expect leadership qualities to have been already developed in newly qualified nurses (Foli et al 2014).
Why are effective leadership skills important?
The NHS’s forward view into action: planning for 2015/16 (2014) identifies effective clinical leadership as a necessity in implementing new care models in response to the changing needs of patients. Manley (1997 in Gopee 2010 pg 131) identifies a correlation between quality of care and effective nursing leadership; in addition successful leadership can enable practice development, and the empowerment of staff. In relation to practice teachers this applies to not only the delivery of evidence based practice (discussed in article 9 in this series), but also how practice teachers (and mentors) deliver and be a role model of best practice (Gopee 2010). The suggestion here is that leadership is not exclusive to leading teams in a managerial capacity, but rather can exist on an individual level. This involves working effectively with patients, being aware of and innovating to improve practice, and to also lead by example. The Chief Nursing Officer Jane Cummings (2015) asserts the need for nurses and midwives to work with and lead their patients in improving their health, by understanding what motivates their patients as well as offering support and advice to achieve this. Ousey (2009) suggests that through observation, students can learn the attributes of leadership as demonstrated by their mentor or practice teacher
(Ousey, 2009). Students observing the application of leadership skills in this context can provide a valuable learning opportunity. At this point is may be beneficial for the mentor/practice teacher to undertake time out activity 1 below , in order to establish their students’ thoughts and ideas about leadership.
Improving care may be borne out of poor or inadequate practice and leaders must be in possession of the skills and confidence to initiate the required changes. Furthermore those who facilitate student learning must demonstrate confidence as a leader in order to give effective instruction and support to the learner (Craig and Smith 2015). It is expected that students through observation of such behaviours in practice, will adopt these through emulating the practitioners to whom they seek to be like (Perry 2008). Although students may be taught leadership theory and skills within the academic setting by those with a clinical background, the influence from the academic perspective is less well documented (Baldwin et al 2014) , therefore emphasising the need for strong demonstration in the practice setting.
By undertaking Time out activity 2 below the mentor/practice teacher can provide evidence for the following. Provide practice leadership and expertise in application of knowledge and skills based on evidence
What makes the mentor/practice teacher an effective leader?
The literature presents a plethora of characteristics or traits within an individual which are a prerequisite for the effective leader. Maxwell (1999) suggests there are 21 qualities including positive attitude, charisma and competence, however Mullins (2002) argues there is not a set or list of traits common to all effective leaders. He goes on to suggest that general characteristics can be identified, such as self –confidence, intelligence and initiative as being those which contribute to effective leadership. In terms of leadership style there is a broad classification, examples being autocratic, democratic and lassez-faire. Mullins (2002) describes these as follows:
· Autocratic- The focus of power is with the leader who is the one who makes the decisions and exercises authority.
· Democratic- The focus of power is with the group, there is a greater interaction within the group and the leader is much more part of the team. Group members involved in the decision making process.
· Laissez-faire-Focus of power is passed onto the group members; the leader will not interfere but is available if help is needed.
Goleman (2000 cited in Gopee 2010 p 134) asserts that to be an effective leader one must be able to adopt and combine any one of these styles depending upon the situation. However mentors and practice teachers need to be aware of their own leadership style in terms of how this may influence learning (Kinnell and Hughes 2010). Students therefore may benefit from observing adaptable leadership styles in differing situations, which Sellgren et al (2006 p. 349) refer to as ‘situational leadership’ whereby a leader’s behaviour adapts to certain situations.
In addition Gallagher and Tschudin (2009) suggest the leadership styles conveyed by staff may, have a lasting impression on students in terms of the institution; it is therefore of some importance that fairness and justice are interwoven whatever the leadership style. It is fair to suggest that the leadership styles displayed in the practice setting by the mentor/practice teacher can have an impact upon the learning environment and subsequently the students learning. Kinnell and Hughes (2010) assert that an autocratic approach can convey an environment which is controlled; students may feel at risk of feeling devalued in that their opinions or suggestions are overlooked, similarly some students may well feel intimidated by this approach. Furthermore a Laissez-faire style, although may present a relaxed atmosphere, may lead to a disorganised placement area. This seemingly disordered approach potentially could have a negative impact on student learning and give rise to anxieties about placement and therefore not be conducive to learning. Finally the democratic approach is one which could be viewed as one which is based on team decisions, can have a positive effect on student learning (Kinnell and Hughes 2010). Here the student could experience being part of the team and be involved in the decision making process, therefore feeling they have some value within the team.
Having established the merits and pitfalls of each style of leadership there will be situations where one style will be more effective than another. In the healthcare context, emergency situations may require an authoritarian style, where risk and safety is not an issue a more democratic approach may be just as effective (Gopee and Galloway 2009). Whichever approach is adopted and in whichever circumstance, it is important for the mentor/practice teacher to explore with their students the reasons for a particular leadership style, given that some circumstances require a certain approach. As Craig and Smith (2015) assert, effective leaders are able to justify their decision making as they are able to see the wider picture. Through explanation students have a greater opportunity to not just explore the reasoning
behind a particular approach, but to also observe how this is delivered in practice.
Theories and models of leadership applied to the roles of mentors/ practice teachers
Leadership can be described as either transformational or transactional, Burns (1978) noted that transactional leadership highlights the relationship between the leader and their followers, and whereby there is a basis of authority, work tasks, outcomes and as a consequence rewards and punishments for followers (Mullins 2002). An example is where promotion or bonuses are exchanged for loyalty and effort in achieving objectives by the followers; instilling self-esteem and personal fulfilment in followers is less of a feature in this leadership style (Chemers 2009). Here the mentor/practice teacher, when working with students and their specific learning objectives, they are in position to motivate the student with the promise of reward (passing their outcomes) or censure depending on the students’ performance whilst in placement. Whilst we can see this approach to leadership may apply according to Burns explanation, to adopt this approach in isolation could be detrimental to the student’s development. Barr and Dowding (2008) highlight criticisms in that the transactional approach to leadership is much less effective where there is a necessity for creativity in complex working environments. Here alternative approaches to leadership would be more effective in engaging followers in exceeding their own interests and undertaking more than was expected (Hartley and Bennington 2010)
Transformational leaders in contrast are much more encouraging and motivating towards their followers. Gopee and Galloway (2009) suggest that these leaders aim to engender in their followers, commitment to an organisations ideals, as well as their own aspirations and aims for the organisation. Furthermore Sellgren et al (2006, p.349) portrays transformational leaders as a ‘gardener’, shaping a growing culture by empowering staff to think creatively and giving them the freedom to grow and innovate. By both observing and engaging in this dynamic process within teams, students are exposed to the values and behaviours associated with this approach to leadership.
Transformational leadership therefore is seen as a desirable feature in healthcare where there is a perpetual need for creative problem solving (Barr and Dowding 2008). This is in response to perpetual change, some of which is stipulated by the Department of Health, however ‘emergent’ change where, for example, reviews of nursing practice may identify areas for change (Kinnell and Hughes 2010). Transactional and transformational theory of leadership can seem less than concrete, however it becomes important when facilitating learning as we consider what will best demonstrate the sort of leadership to be emulated in our learners upon registration. Will they simply implement care, or will they attempt to work with and lead on that care closely with the values and concerns of patients. If transformational leadership is preferred in clinical practice, then it is necessary to discuss with students and explore exactly why this is. We must also consider the style of leadership that we use with the student when supporting them in practice. Transformational leadership requires us to learn a great deal more about student values and beliefs than a transactional style of leadership would. The transformational mentor/practice teacher would seek to work closely with the student’s learning agenda, and blend this with what is professionally required to achieve registration. Now consider time out activity 3.
The transformational approach could be described as ethical leadership. Gallagher and Tschudin (2009 p. 224) describe this approach as one which ‘aspires to good ends and to the kind of change that contributes to the flourishing of other human beings, as well as towards the good of other species and the environment ‘From a mentor/practice teacher perspective this includes not only applying this assertion to work colleagues and the organisation, but to that of facilitating student learning and development’.
Effective leadership for Mentors and Practice Teachers
In order to lead, a leader requires at least one other follower, and to lead effectively is to have a greater influence on those followers (Stanton and Chapman 2010). Within the clinical setting Stanley (2006) identified through his study into effective clinical leadership, a number of attributes demonstrated by effective leaders. These qualities include clinical knowledge and competence, an effective communicator and decision maker, and one who is approachable. Hayes (2011) highlights some of the minimal attributes for an effective leader including having a goal, having respect for others and being able to recognise and utilise the resourcefulness within the team. Such resources may not just be found within the placement area, but also external to the organisation, University Link Lecturers (ULL) can provide valuable support to individual facilitators or the practice team as a whole. Their role is primarily related to supporting placements with issues, but also to discuss and share good practice. The opportunity arises here for the individual mentor and practice teacher to forge stronger links with the university through the ULL (Demonstrate the ability to lead education on practice, working across practice and academic settings -Practice Teacher). This function may in some cases be exclusive to the person who tends to liaise with the university in relation to completing the audit and receiving and disseminating allocations and student evaluations. Now complete time out activity 4