Nursing Leadership and the Relation with Management Models Adopted in Healthcare

Monday, 9 November 2015

Andrea Bernardes, PhD, RN1
Daniele √Čllen Grivol1
Carmen Silvia Gabriel, PhD, RN1
Gisleangela Lima Rodrigues Carrara, RN2
Priscila Lapaz Baldo, RN1
(1)General and Specialized Department - Nursing, University of Sao Paulo, Ribeirao Preto, Brazil
(2)Nursing Department, University of Sao Paulo, Ribeirao Preto, Brazil

Introduction: The importance of leadership can be measured through the strength at which this theme has been shown in the academic literature. The professionals of nursing who are health teams’ leaders, develop not only a function of influence, but also collaborate on accomplishment of mutual goals of their teams(1). Objective: The study aims to analyze the contributions of the produced research on nursing leadership and management models adopted in the health services, published in national and international journals from 2003 to 2014. Methods: It was used Integrative Literature Review which is a research method that allows the search, critical evaluation and synthesis of available evidence about the researched theme(2). In this methodology were covered six distinct stages: issue identification, literature search, categorization of primary studies, assessment of studies included in the integrative review, interpretation of results and synthesis of knowledge evidenced(3). The main question of the research was developed through the PICO strategy, which represents the acromion Patient, Intervention, Comparison and Outcomes: what are the leadership styles used in health services when they adopt vertical management model or participatory management model? A form was used to collect bibliographic data, in which information was drawn on the identification of the authors, database where the paper was found, the study objective, methodology, type of research, findings, conclusions and level of evidence. The level of evidence was classified using the evaluation criteria established between one and seven, where level 1 is systematic review, with randomized controlled trials to level 7, which shows authorities of opinion articles or experts committees report(4). For the selection of articles the following databases were used: Latin American and Caribbean Health Sciences (LILACS), Medical Literature Analysis and Retrieval Systems Online (MEDLINE), SciVerse Scopus and CINAHL, published from 2003 to 2014. Were included primary articles extracted from the databases. Theses, dissertations, monographs, books and revisions of any style were excluded. The sample consisted of scientific articles found in the selected databases, published in Portuguese, English and Spanish, in national and international journals, located by controlled descriptors "leadership", "hospital management", "hospital management" and "nursing" beyond the uncontrolled descriptor "health management model."  Results and Discussion: The searching resulted in a total of 220 potential references; 168 excluded for being inadequate to the theme, 14 because they are not available online and 15 for being literature review. The study was then composed of 13 indexed articles dealing with the leadership styles used by nurses and the relationship with the management model adopted which met the criteria proposed in this study. In order to facilitate the interpretation of data, publications were grouped into three categories: "Contemporary leadership and participatory management model" which 07 papers stood out with key features to keep professionals in an atmosphere of partnership and trust, thus providing a healthy workplace and facilitator of the care process. The second category entitled "Contemporary leadership and vertical management model" highlighted 04 papers. This category seems paradoxical, since to adopt a more participatory leadership style, as the authentic and transformational, it is expected that the institution has established teamwork, collective decision and dialogical communication, contradictory to the assumptions of hierarchical management model. The third category called "Autocratic leadership and vertical management model" emphasized 02 papers that aimed to know the leadership styles developed by nurses and their influence on interpersonal relationships established between the nursing staff. Among the surveyed studies, three leadership styles stood out as the most used by nurses: transformational, democratic and authentic. These three styles have characteristics in common as all point out that in a nursing team there are people with different personalities and different technical level, and also emphasize that nurses should have a group vision, recognizing in each member the technical skills and simultaneously, helping them to overcome their difficulties. These styles also give more autonomy to the led about the decisions to be taken, and the nurse assumes a role of encouraging the development of his team activities. Besides the attention to contemporary styles of leadership, it emphasizes the autocratic style, also evidenced by the study. This style, although has some advantages, is targeted to inhibit employees' potential, since it ends up hindering creativity, participation and motivation. This style is characterized as non-dialogic, authoritative, and should be avoided as far as possible. However, the adopted leadership style is usually linked to the management model implemented in the institution. More innovative management models induce the use of more participative and transformational leadership styles. On the other hand, more vertical and hierarchical models suggest a more authoritarian leadership. Conclusions: In this study, it is observed that there is not a unique style which may be previously practiced by the leader, unless he knows the personal characteristics of his team. Thus, effective leadership demands knowledge by the leader about the management philosophy of the institution, as well as the virtues and difficulties faced by his subordinates. The study showed the need for further research with larger level of evidence, that enable the improvement of the quality of care through the use of more innovative leadership practices which encourage professionals to work more motivated and satisfied, and to be more collaborative and co-responsible with the results provided to patients. On the subject, the authors intend to continue the study through the development of field research with professionals working in services which adopt different management models and leadership styles.