Overcoming Barriers to Leadership at the Bedside
Front-line nurses must be engaged in transforming their own work environment while simultaneously taking accountability for improving patient outcomes. One example of how this has been operationalized is through programs such as the UK Releasing Time to Care™ (RTC™) and the American Organization of Nurse Executives' (AONE) Transforming Care at the Bedside (TCAB). RTC™ and TCAB are both quality process improvement programs for healthcare delivery that engage bedside nurses to improve processes of care using a variety of straightforward tools and techniques such as rapid-cycle redesign and tracking quality patient metrics. This allows bedside nurses more time with patients and at the same time provides opportunities for them to demonstrate their contributions to patient outcomes.
Since 2008, many hospitals across the UK, Canada and the USA have utilized these programs to involve front-line clinicians in the design and delivery of care on their units with positive results for both staff and patients. When nurses at the bedside share in the decision-making authority in their work environments, front-line leadership emerges. In addition, Besner and colleagues suggest "employers and managers must engage health professionals in discussion of distinct and shared responsibilities among team members to promote effective collaborative practice, improve role clarity and enhance quality of care." Finally, neonatal nurses themselves must recognize and articulate their informal leadership capabilities. For example, in their daily work-life, contributing during patient rounds, organizing care, patient advocacy and participating on unit and corporate-level committees all demonstrate informal leadership.
mplementary to the previously discussed approaches, Nurse Managers have a key role to play in elevating leadership within the micro-system. Traditional notions of legitimate power must be challenged so that linear models can flourish. Thompson (2009) asserts, "she or he must be willing to surrender control over decision-making and support the staff in taking ownership for their practice." In this participative leadership style, all nurses can contribute to leadership on the unit. Several studies illustrate that enhanced nurse autonomy contributes to a healthy work environment and to the ability of nurses to reach their full potential.
Nurse Managers should engage their staff in 360° (multi-rater) evaluations to identify each nurse's strengths and areas of improvement so that appropriate support can be given. In research examining how to develop nurse leaders, it has been ascertained that the single greatest barrier for nurses in accessing professional and leadership development opportunities was getting time away from unit-level responsibilities. Nurse Managers should invest in their staff leadership development and make such opportunities for staff attendance an important priority.