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Roles and Responsibilities of the Nurse Leader - Signposts as to why leadership is important in nursing.

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Roles and Responsibilities of the Nurse Leader - Signposts as to why leadership is important in nursing.

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"Meeting patients expectations is 'biggest problem' facing nursing"

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"Meeting patients expectations is 'biggest problem' facing nursing"

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One of the prominent issues facing the NHS at present is the increase of change in public expectations. More than half of nurses say that their patients expectations cannot be met with existing resources, and that this is the 'biggest problem' currently facing nursing.

According to a survey of nurse opinion, 55% of respondents highlighted this issue as their biggest concern.

Other respondents reported that the biggest concern were those such as cuts to the nursing workforce, lack of support for those who raise concerns about quality of care, and pressure and lack of support for managers.

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According to a survey of nurse opinion, 55% of respondents highlighted this issue as their biggest concern.

Meanwhile 52% said cuts to the nursing workforce, both registered and non-registered, was the main concern facing the profession. A further 42% highlighted cuts to the registered nurse workforce and 41% inadequate care of older patients, such as issues of dignity and nutrition, in the NHS.

Lack of support for staff who raise concerns about the quality of care was cited by 35% of respondents and 27% thought the biggest problem was either lack of compassion in some nursing staff; inadequate care of older patients in the care sector; and pressure and lack of support for ward and community managers.

Nursing Times also asked nurses which issues facing the profession they found most concerning on a personal level.

The majority, 70%, highlighted staffing cuts that in their view endangered patient safety and 59% identified staffing cuts that significantly increased their workload.

Meanwhile, 56% said the inability to provide adequate care to their patients or government proposals to change NHS pension scheme and retirement age.

A further 43% highlighted concerns about changes to the NHS caused by the government's health bill being passed, and 38% cited attempts by trusts to reband nursing staff to a lower pay level.

One respondent said: "Nursing and quality care cannot be achieved in the same breath as cuts to staffing levels, downgrading of nurses, frozen posts etc. Why are nurses always the easy target for budget cuts when the NHS is a flood with managers many who will never encounter a patient throughout their career."

Another said: "Nursing has become a thankless task. Patients' expectations are high and cannot be met with the level of work required on the wards. Managers are implementing new ways of working with no training or support taking up time that could be spent delivering patient care. I worry for the future of nursing."

A number of high profile reports and cases involving poor nursing care have been given widespread media coverage recently.

Examples, include critical reports from the Care Quality Commission and the Patients Association focusing on dignity and nutrition standards for older patients, as well as more extreme cases such as the claims of patient abuse at Winterbourne View and police investigations into patient deaths at Stepping Hill.

Asked whether they thought the media's portrayal of nursing had changed over the past 12 months, 71% of respondents said it had got worse. Meanwhile 26% said it had remained the same and just 3% that it had got better.

One respondent said: "Nurses need to feel supported. Media attention mostly highlights bad practice. Nurses were once respected - what happened? Is the government partly to blame by continually freezing pay thereby suggesting nurses are not worthy of a pay rise?"

Another said: "Public and media perception of nurses is having a huge impact on nursing moral. As is staffing cuts and increased workloads. I don't think it is seen as much of a profession to enter into anymore which will impact greatly on nursing in the future."

A further respondent added: "I hate constantly reading in the media about bad nursing, I am constantly defending myself and colleagues. After all there are more good nurses out there than bad or indifferent ones, more nurses not less are needed."

The poll findings released today are the fourth and last instalment of results to come from an online survey of around 400 nurses carried out by Nursing Times over the past week.

The poll has asked nurses about the "big issues" currently facing the profession. It has looked at other key areas including workforce, the health bill and the current review of the Nursing and Midwifery Council.

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Meeting patient expectations is 'biggest problem' facing nursing

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According to a survey of nurse opinion, 55% of respondents highlighted this issue as their biggest concern. Meanwhile 52% said cuts to the nursing workforce, both registered and non-registered, was the main concern facing the profession. A further 42% highlighted cuts to the registered nurse workforce and 41% inadequate care of older patients, such as issues of dignity and nutrition, in the NHS.

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Today's NHS - our current challenges

The NHS is currently facing the biggest challenge in its existence.

While on a day-to-day basis most areas of the service are running perfectly well at present, we are already seeing signs of the strain the system is under in areas such as hospital care, A&E and GP services. The reasons for the service reaching this crisis point are many, but here are the main ones:

An ageing population

The NHS was set up to treat people with diseases. Many of the diseases that would have killed people 65 years ago, have been cured, which is brilliant. While that means people are living for longer, it also means that they are, probably, living with one or more illnesses (long-term complex conditions) such as diabetes, heart and kidney disease. In turn, that means ongoing treatment and specialist care.

Lifestyle factors

The way we live now is also having a negative impact on our health. Drinking too much alcohol, smoking, a poor diet with not enough fruit and vegetables and not doing enough exercise are all major reasons for becoming unwell and needing to rely on our health services. Increasing numbers of overweight children show us that this problem is currently set to continue.

The change in public expectations

Originally, tackling disease was the main job of the NHS. Now, we all expect so much more. From advice on healthcare management through to mental health and social care, contraception, antenatal and maternity services, vaccination programmes and the fast, efficient processing of our medication and appointments. All of this with a growing population due to living longer and higher birth rates with lower infant mortality.

Accident and Emergency departments

More and more people are visiting A&E departments and minor injury units – which is stretching the ability of the departments to cope. A lot of the visits are unavoidable, but some are visiting because of inconsistent management of their long-term health conditions, the inability to get a GP appointment or insufficient information on where to go with a particular complaint. Winter sees an even bigger rise in visitor numbers with staff finding it harder by the year to cope.

Rising costs

The current financial crisis, rising costs of services, energy and supplies; innovations and technological breakthroughs that require more investment – along with higher numbers of people to cater for – all spell out a huge economic disaster for the NHS.

It is estimated that without radical changes to the way the system works, as demand rises, and costs rise too, the NHS will become unsustainable, with huge financial pressures and debts. If we make no changes we face a £30 billion funding gap for the NHS nationally by 2020 .

Advances in medicine and technology

The great news amongst all of this gloom is that there has never been a better time to face an overhaul. Huge advancements in medicine and surgery, alongside IT and technological innovations mean that there is a wealth of ideas and efficiencies that could potentially be implemented to bring our NHS up to modern standards to meet the needs of us all in the 21 Century. Utilising these new approaches within a major restructure the NHS could go on to be a reassuring source of health care and wellbeing, as well as an inspirational model of good working practice for years to come.

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Kouzes and Posner (1987) - The characteristics and behaviors of leaders

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Our Mission

Empowering families to navigate the immigration system more confidently, rapidly, and affordably.

We are a team of immigrants and experts who have struggled with our own journeys through the complex, high-stakes U.S. immigration system. Just like millions of other families, we've had to choose between paying thousands of dollars in legal fees or spending months trying to figure out how to do everything ourselves. We knew there had to be a better way. That's what we're building, after hundreds of conversations with families, immigration lawyers, and government officials - a trusted partner and guide for your entire immigration journey.

Team Boundless

Want to make a meaningful difference in people's lives? Join our team!

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Our Mission Empowering families to navigate the immigration system more confidently, rapidly, and affordably. We are a team of immigrants and experts who have struggled with our own journeys through the complex, high-stakes U.S. immigration system.

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Taken from the NHS Leadership Academy Healthcare Leadership Model (2013)

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Taken from the NHS Leadership Academy Healthcare Leadership Model (2013)

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Taken from the NHS Leadership Academy Healthcare Leadership Model (2013)

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Taken from the NHS Leadership Academy Healthcare Leadership Model (2013)

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NHS 5 Year Forward - STP - sustainability and transformation plan

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NHS 5 Year Forward - STP - sustainability and transformation plan

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NHS 5 Year Forward - STP - sustainability and transformation plan

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Delivering the Forward View - NHS Planning Guidance The practical implementation of the five year forward Sustainability and Transformation Plan

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National Health Service Leadership Academy

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National Health Service Leadership Academy

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Behaviours approach to leadership for ALL staff. Leadership is not restricted to those in managerial positions, and is most sucessful when leadership is 'shared' or 'distributed' by everyone using these behaviours:
1. Inspiring shared purpose
2. Leading with care
3. Evaluating information
4. Connecting our service
5. Sharing the vision
6. Engaging the team
7. Holding to account
8. Developing capability
9. Influencing for results

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NHS Principles; putting the patient at the heart of everything we do.

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About RCN Leadership

RCN Leadership is a suite of bespoke programmes, giving you the confidence to lead positive and effective change within your organisation.

RCN Leadership supports staff at all levels; from individuals beginning their leadership career, to experienced leaders wishing to refine specific skills.

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Leadership programme | Royal College of Nursing

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RCN Leadership is a suite of bespoke programmes, giving you the confidence to lead positive and effective change within your organisation. RCN Leadership supports staff at all levels; from individuals beginning their leadership career, to experienced leaders wishing to refine specific skills.

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Great Man theory

Suggests that leaders have qualities and characteristics inherent in their personality that make them great leaders. Assume good leaders are born rather than made.

Exclusive ideology - suggests that only a select group of people 'have what it takes' to become leaders.

Convinced of their own superiority, these types of leaders  are susceptible to Fundamental Attribution Error and Self Attribution Bias (Heider 1958), whereby they take the credit for successes but apportion blame to other team members when things fail to go well.

Goodman (2016)

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How to start a movement..

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How To Start Your Movement - TED Video - Lessons in Being a Leader - FUNNY & POWERFUL!

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Do you want to START a MOVEMENT? Take 3 minutes to laugh and learn about starting a revolutionary movement in your town. Thanks TED!

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Cunningham & Kitson (2000) evaluated RCN's clinical leadership course

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Cunningham & Kitson (2000) evaluated RCN's clinical leadership course

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Key areas of developing leadership:
1) Managing self - self awareness; knowing strengths/weaknesses/personal & professional values, ego, emotional intelligence. Goodman (2016) asserts 'knowing yourself'.
2) Managing team - theories about working with people? Understanding of 'good' teamwork; assumptions; power dynamics.
3) Patient centred - (See The King's Fund doc)
4) Networking - who? What is the value? Does it require skill?
5) Political awareness - what policies currently affect your work? How might they affect the future?

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Key findings

The leadership of the NHS at a national level needs to create conditions in which local organisations have the freedom to deliver consistently high standards of care and where the needs of patients come first.

The quality of care provided by NHS organisations should, first and foremost, be a corporate responsibility under the leadership of boards, who must lead by example by focusing on the quality and safety of care.

Leaders need to value and support frontline staff and ensure the main focus is on patients and their care.

Leadership development should give priority to supporting leaders at all levels to be patient-centred and to ensure that staff have the time and resources required to deliver high-quality care.

Patient leaders should work alongside NHS leaders to support the transformation called for in the Francis Inquiry report.

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This report summarises the main findings of the Francis Inquiry into the failings of care at Mid Staffordshire in relation to NHS leadership and culture. It sets out what needs to be done to avoid similar failures in future.