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Different styles of leadership are needed in order to accomplish not only the demands of following a financial budget in order to be profitable, but to do so without risking the safety of the staff and residents, while continuing to meet their needs for quality of life. These leadership styles portrayed by those in charge often change and adapt to the situation and may be displayed differently in times of need.
Long Term Care (LTC) is an area of healthcare that undergoes constant change. The process of LTC ownership change often causes physical and mental unrest and uncertainty for employees. Dorgahm & Al.Mahmoud (2013) comments on the importance of the Nurse Leader role by stating, “The role and influence of first line nurse managers are becoming increasingly important in today’s complex and continually changing health care organizations” (pg.71).
A LTC buyout is one example of such change. During the transition of change of ownership in LTC, Huber (2014) relates, “the amount of change and the rapidity of change disrupt and disorganize people “(p.45) in such a way that inevitably it results in stress as they try to cope. Different leadership styles can be helpful in facilitating change of ownership, easing the transition.
Authoritarian Leadership
As the nurse leader, there are times when the authoritarian type of leadership is required. The plan for staffing the facility must be determined by the new owners according to the acuities and at the Per Patient Day (PPD) allowance. After a review of current patterns, decisions are made in which the staffing pattern for every unit on each shift is decided upon and then put into practice. Discussions with the new owner’s center around what they feel is adequate staffing numbers from a financial standpoint. The Nurse Leader must find ways of how to turn those numbers into reality. After the schedule is implemented, it is then determined if the staffing pattern meets the needs of the residents. A strong quality assurance program can point to areas needing adjustments.
After the decision of which staff would be rehired by the new owners, it is up to the administrative staff to inform the employees of the intent to rehire or not. As difficult a task as it is, the authoritarian leader must display tact, diplomacy and consistency in the process. There should be no discussion initiated regarding how the decisions were made, nor any bargaining to change the decision. It is a firm decision with a straight forward conversation of either “Here is your letter of employment offered” or “I am sorry to inform you of the decision to not rehire you”. Either way, emotions played a large part in the stress of the situation that can be carried through to the day of transition.
Democratic Leadership
There are a few instances in which decisions made by the Nurse Leader allow for the Democratic Style of Leadership to be utilized. An expression of the new transition being a “team” effort can pull everyone on the same side to work together in a democratic fashion. Choice of vendors can be one example of the use of this leadership style in which the decision is made between both the new owners and the administrative management. Allowing both current and prospective vendors to present their services and demonstrate the products they have with new proposals to the newly formed organization may offer the opportunity for a voice and a vote from both sides. Compromising of sorts begins, and at times the adage of agreeing to disagree is where it is left.
Proposals are presented to the new owners of the changes needed to promote quality of care for the residents. A second Automatic External Defibrillator (AED) machine in the building, or switching the medication administration system from the pharmacy to a modified unit dose system or bubble pack card instead of the unit dose pill box are examples of such proposals. As the new owners are just that, new to the facility, they listen to the arguments and offer a compromising solution to the issue at hand. A collective agreement is reached to allow a second AED machine to be purchased, but from the new owner’s choice of vendor and changing of medication administration system is left up to the Director of Nursing as there is no cost to the facility.
Laissez-Faire Leadership
Laissez-Faire may be the preferred style of leadership during certain periods of the transition. This leadership style can be utilized at times when the stress level resulting from change is high. Once staff have expressed their concerns, a new plan of action can be implemented. Allowing the employees to express their concerns may be what is needed to handle high anxiety demonstrating a positive relationship between staff, administration and new owners.
An example would be the implementation of new staffing pattern with the reduction of the number of staff on each shift. Allowing the employees input on how to best plan for new staffing utilization to complete the assignments is one way the Laissez-Faire leader gives back. After instituting this change, Nurse Leaders periodically check for efficiency. Any identified areas of concern are addressed with the staff and changes implemented.
Monitoring the situation should continue for a period of time with conversation involving employees as it will keep them invested in the process assuring them their voice matters. The Laissez-Faire leader gives the employees a voice and/or some control in the new staffing patterns. This is a win-win situation and everyone involved feels as though their opinion counts.
In order to earn and maintain the respect of the employees, nurse leaders must adapt their leadership styles to the individual situations at hand. “Clinical decision making is an essential component of professional nursing care, nurses’ ability to make effective clinical decisions is the most important factor affecting the quality of care,” (Dorgham & Al.Mahmoud, 2013, p. 71). Nurse Leaders must use their decision making skills to continue to provide leadership to their staff to achieve patient, staff and institutional goals. There cannot be just one leadership style that can be utilized in every decision to be made during the transition of a sale of a Long Term Care Facility.
The staff is at a very vulnerable stage when it comes to continuing to work together as a team in order to maintain a sense of order. This is extremely important so as not to disrupt the lives of the residents who reside in the facility. The staff look to the Nursing Leaders to find the stability needed to come to work every day with the right attitude in order to complete the tasks at hand. In utilizing the different leadership styles, the staff finds comfort in observing their leader taking control of the situations and keeping order during the transition. The Nurse Leader is the liaison between them and the new owners in order to convey their emotions invested in their jobs at the facility, while looking for the strength to help them through this emotionally stressful time.
“Traits alone don’t define leadership, rather, leadership is based on individual characteristics, approaches to situations, and the ability to handle change” (Perkins, pg. 36). Experience is a characteristic of a leader that is not inherited, but rather gained through trial and error. There are no perfect solutions to leading through a transition. There are those managers who emphasize the leader’s need to control others in order to accomplish the goals, but in reality it is the leaders who motivate the staff in order to obtain the desired results (Perkins, 2013).
Leaders cannot exist without their followers, and in order to effectively lead, one must adapt to the tasks at hand.