Leadership and management are highly researched areas in nursing due to their close association with organizational performance and quality of care. While the two concepts are often used interchangeably, scholars view them as distinct based on their scope when integrated into practice. Given that leadership and management are considered different concepts based on organizational relationship and decision making, it is expected that nursing leaders might face unique challenges, including subjectivity to multiple tasks, interference in their work, inadequate resources, and lack of organizational support.
Differences Between Leadership and Management
While leadership and management appear to overlap, they are different in terms of the nature of the relationship between managers, leaders, and subordinates. Based on theory X of management, it is proposed that managers provide detailed instructions to their workers due to incapacities, such as laziness, which may exist among the latter (Lawter, Kopelman & Prottas, 2015). Hence, managers often hold a pessimistic view toward their subordinates. As such, money is often used as the primary motivation for positive behavior under this theory of management. Contrarily, leadership is based on positive relationships between leaders and subordinates, where the former develops ways of motivating employees and facilitating the achievement of organizational goals. For instance, the transformational theory of leadership proposes that leaders inspire and lead people in a way that considers their abilities (Korejan & Shahbazi, 2016). Unlike in management, motivation in leadership is triggered intrinsically by developing the workers’ capabilities. Based on the two theories, it is evident that the nature of relationship between workers and superiors is a basis of distinction between leadership and management.
In addition to the nature of relationships, leadership and management are also different in the sense that management is based on short term achievements while leadership focuses on long term objectives. One of the philosophies of management, according to the scientific theory, is that workers should be given formal training and specific instructions to perform prescribed tasks (Gull, 2017). Evidently, managers delegate responsibilities to workers to facilitate daily operations, which is a short-term goal within an organization. Additionally, managers may not be directly involved in performance of the activities because they should lead, coordinate, and monitor. On the other hand, the participative theory of leadership emphasizes on consultative behaviors among leaders before making ultimate decisions (Lumbasi, K’Aol & Ouma, 2016). This implies that unlike management, leadership is associated with strategic decision making; hence, employees’ views are considered.
Although nurse managers and leaders facilitate the achievement of organizational goals, they may handle similar situations differently. For instance, a few weeks ago, a new project was launched in my clinical setting. The initiative was aimed at transforming the way healthcare services are offered in the organization to improve the quality of care among patients. Notably, the program involved clinical rounding in various departments to reduce the number of falls in the hospital among patients in the facility. For effective implementation, several stakeholders, including licensed practical nurses (LPNs), registered nurses (RNs), and emergency room nurses were involved in different stages of the project’s life. While the program was based on a common objective of utilizing the existing workforce to reduce hospital falls, nursing managers and leaders may have handled the situation differently.
A manager would have planned the project and then offered directions to the different stakeholders on specific activities to be undertaken. Literature shows that managers “focus on formal directing and controlling of their assistants, resources, structures, and systems” (Algahtani, 2014, p. 74). Hence, a manager would have formally directed the practice and provided detailed instructions on the role of each nurse in the project. Contrarily, a leader would have involved the stakeholders in evaluating the initiative to determine some of the challenges that may arise during implementation. Besides, such a leader would have requested the nurses to present their views concerning the project before execution. Studies show that leaders focus on motivation, inspiration, and passion among employees to foster long term goals (Algahtani, 2014). Therefore, a leader would have chosen to trigger an optimistic attitude among nurses in an attempt to enhance positive reception of the initiative. With support from the workforce, the program tasks would not only have been completed within the pilot stage but also incorporated as a culture in the organization.
Despite the contrast in their approach to the situation, both the manager and the leader would have exercised their power and utilized their skills to influence the nurses to participate in the project. Literature proves that leadership and management involve influence and working with people to achieve a common goal (Algahtani, 2014). In addition to using a formal strategy of delegating duties, the manager would also have utilized authoritarian power to influence the nurses to undertake their activities. Similarly, the leader would have influenced the nurses to embrace the proposed practice by using his/her inspirational skills.
Challenges Facing Nursing Leaders in the Healthcare Setting
The fact that nursing leaders and managers use different approaches to leading implies that they may also face distinct challenges in practice. One of the difficulties that nursing leaders face today is subjectivity to multiple tasks, which makes it difficult for them to conduct their duties effectively. According to Tingvoll, Saeterstrand, and McClusky (2016), some of the activities that the leaders are expected to undertake are often unrelated to nursing leadership, thus compelling them to re-prioritize urgent matters. For instance, nursing leaders are not only required to assume their professional responsibilities, but also human resource tasks that were delegated initially to employees in other positions. An informant in the study conducted by Tingvoll et al. (2016) noted that nurse leaders’ errands stretch from contacting patients’ next of kin, coordinating operations in the facility, and providing guidance to staff on sick leave, among other activities. Being tasked with such numerous responsibilities is a challenge to leaders, and most of them suffer from fatigue as a result of work-related pressure.
Interference in work is also a significant challenge that faces nurse leaders in the contemporary clinical setting. Adatara, Nyefene, Asamani, and Nyande (2018) stated that the initial chain of command in healthcare, which involved supervision by one superior, has changed significantly. Today, a significant fraction of the nursing leaders report to various superiors, making it difficult to undertake their duties independently. For instance, one of the participants in Adatara et al. (2018) study asserted that there exist many interferences in leadership roles by other nursing managers, a practice that creates confusion among subordinates and other leaders (Adatara et al., 2018). Failure of nursing leaders to enjoy independence in their positions is a great challenge, which not only interferes with their work but also reduces their morale to lead others.
Today, nursing leaders are also faced with the issue of inadequate resources, which poses a challenge when facilitating activities in the clinical setting. Notably, Adatara et al. (2018) aver that inadequate staffing has become a problem in some of the hospitals. Recent studies prove that the nurse’s turnover rate has risen significantly over the years, limiting the capacity of workforce that nursing leaders can use to coordinate operations in the healthcare facilities. For instance, research shows that the rate of turnover among RNs, LPNs, and CNAs in the United States is 56%, 51%, and 75%, respectively (Gutsan, Patton, Willis & Coustasse, 2018). Given that nursing leaders are expected to facilitate quality care in their respective departments, it may be challenging to do so in an environment characterized by inadequate human resources.
In addition to inadequate resources, some of the nursing leaders today also lack organizational support from their superiors. According to nursing leaders, support from administrators and human resource managers is often limited, making it difficult for them to facilitate and coordinate activities delegated to them (Gustan et al., 2018). In other instances, proposals made by the leaders may lack buy-in from the concerned authority, leading to ineffective implementation of urgent changes. Without the aid of different stakeholders in the clinical setting, it may prove difficult for nurse leaders to undertake their roles effectively.
Overall, leadership and management are distinct concepts based on organizational relationships and decision making. Nursing leaders and managers handle similar situations differently due to the existing variation in their approach towards leading others. Unlike leaders, managers focus on giving formal directions and having tasks completed. In their practice, nursing leaders face numerous challenges, which include subjectivity to multiple responsibilities, interference in their work, inadequate resources, and insufficient organizational support.