Reference Article:Vesterinen, S., Suhonen, M., Isola, A., Paasivaara, L. & Laukkala, H. 2013. Nurse managers perceptions related to their leadership styles, knowledge, and skills in these areas a viewpoint case of health centre wards in Finland, ISRN Nursing, Volume 2013, Article ID951456: 1 8

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Application of appropriate leadership styles are important in the health care setting because of the dynamic environment of the health care practices as it is constantly undergoing modernization initiatives (Milward & Bryan, 2005). The health and social care often undertake changes due to the availability and use of new drugs and medication, upgragded technology in health care, new policies, new diseases and others that there is a need for effective leadership to deal with successful organizational development of (Kotter, 1990). Nurses particularly those at managerial level acting as head of the clinical ward are actively undertaking new and challenging roles, thus creating the need for them to become successful leaders with a clear strategic vision to lead their team towards accomplishment of their common goals (Addicott & Atun, 2003). I find this true because in the Operation Theatre, new drugs and medications, new machineries, new procedures and limitations as well as change of current practice due to directives from the top management have been experienced before and will continue to become change factors in this clinical setting. It is imperative that nurse managers do not focus merely on controlling the symptoms but give their attention to the underlying causes by creating processes to define problems accurately (Berthoin, Antal, Lenhardt & Rosenbrock, 2001). Nurse managers need to become transformational leaders with effective leadership styles to ensure that they are visionary, proactive, creative, innovative and supportive toward attainment of their common goals (Empey, Peskett & Lees, 2002). These were some of the leadership styles highlighted in Vesterinen et al. (2013).

The Operation Theatre where I am currently attached to as the Nurse Manager, requires knowledge and skills of leadership styles so that I am able to lead my team with effective and efficient clinical practice management and assures that high quality medical and healthcare is provided to the patients at all time. It would also contribute to evidence-based practice and serves as a reflective knowledge and skills for my junior staffs.

Theories of Effective Leadership and Leadership StylesCho (2007) stated that effectiveness is a popular topic in the field of human service organizations which also include the health care settings. Therefore, leadership effectiveness among nurse managers is an important consideration as they need to be able to multi-task, develop different mindset and create varied set of actions to create a strong sense of direction and to communicate the shared vision to others in the team (Densten & Gray, 2003). The research article by Vesterinen et al. (2013) explained that knowledge and skills of leadership styles is important to ensure that nurse managers are able to create appropriate organizational culture that encompasses high quality health care and patient/employee safety as well as highly developed collaborative and team building skills.

Cameron and Quinn (2006) explained the importance of organizational culture on personal leadership effectiveness using the Competing Values Framework (CVF) as shown in Appendix 1. The model provides insights on how leaders should think differently about value creation and how to clarify purpose, integrate practices and lead people. The CVF Model shows four predominant cultures: the hierarchy culture, the market culture, the clan culture and the advocacy culture.

The CVF Model implies that knowledge and skills of leadership styles can help nurse managers to determine which leadership style to use in a particular culture. For example, a hierarchical culture is characterized as formal and structured with emphasis on smooth running, stability, predictability and efficiency. This generally pictures how an operational theatre is managed. Formal rules and policies apply in this clinical setting. Therefore, using a leadership style that accommodates coordination, monitoring and organizing is needed. In comparison, a clan culture is seen as a family type organization that puts importance to shared values and goals, cohesion, inclusion, individuality and a sense of engagement. Leadership styles that promote teamwork, employee invovlement and corporate commitment to employees are needed in this setting as the leader must become facilitator, team builder and mentor. For an operation theatre, the advocacy culture is sometimes engaged as emergency may happen thus requiring the medical and health staffs to adapt quickly as well as being flexible and creative to deal with the immediate situation. Thus, leadership styles lean towards innovative, creativity and entrepreneurship (Cameron & Quinn, 2006).

Clark and Armit (2010) also stressed on the importance of competent workers in the health and social care practices. The Nurse Manager Leadership Collaborative Learning Domain Framework (NMLC, 2006) provided guideline specifically for nurse managers to predict their knowledge, skills and ability of leadership (see Appendix 2). Shirley (2006) stressed that authentic leaders must have self-discovery, self-improvement, reflection and renewal. Sherman and Pross (2010) stated that authentic nursing leadership assures a healthy work environment. According to Mahoney (2001), leaders must be visionary so that they are able to solve problem, maintain group effectiveness and develop group identification. Nurse managers need to be dynamic, passionate, able to motivate others, be solution-focused and seek to inspire others (Frankel, 2008). This is necessary to ensure that they win the respect and trust of their team members and lead the team to success as they become the source for inspiration and role models to other team players (Bondas, 2006).

Furthermore, nurse managers are often involved in one-to-one supervisory relationship during clinical instruction with junior nurses (Saarikoski & Leino-Kilpi, 2002). Therefore, nurse maangers as mentor must become a teacher, supported, coach, facilitator, assessor, role model and supervisor (Hughes, 2004; Chow & Suen, 2001) that knowledge and skills of leadership styles can provide them the competency to perform their multi-faceted roles (Frankel, 2008).

Vesterinen et al. (2013) explained that nurses work in the health centre ward is stressful both in terms of physical and mental that it becomes imperative to use leadership skills to ensure that nurses continue to be satisfied with their work and clinical practice (Cowden et al., 2011). Farg et al. (2009) implied that the ability of the nurse manager to use different leadership styles showed competency of leadership skills which is observed through the use of combined tasks and transaction behaviors that can influence staffs to achieve their common goals (Huber et al., 2000). According to Goleman et al. (2000), primal leadership leads to to type of leadership: resonant and dissonant. Resonant leadership styles are further divided into visionary, coaching, affiliate and democratic styles whereby dissonant leadership styles comprise of pace setting and commanding styles. Most leaders use the combination of both resonant and dissonant leadership styles.

Application of Leadership Styles Knowledge and Skills in the Operation TheatreI have worked in the Operation Theatre (OT) as a Nursing Sister with 26 years of working in large district hospital. I was posted to OT since 1991 as Sister-in-Charge of the Surgical Procedures Section. Currently, I am head to six OT staff nurses and managing two operation rooms with an average of one major case and four minor cases in both rooms on a daily basis. The stress level in terms of physical and mental activities in the OT is high with a combined culture of clan, hierarchical and advocacy based on the CVP Model. Therefore, the application of best fit leadership styles that suit the culture of the OT is necessary for the effective clinical practice management.

As such, the use of appropriate leadership styles as mentioned in Vesterinen et al. (2013) is important and need to be practiced in my present clinical practice whereby as the Nurse Manager, I need to become the facilitator, mentor and team builder to my staffs to drive commitment, communication and development among thr staffs. Nurses working in the OT must have clear communication to ensure that decisions are made based on accurate information. Often, I noticed that failure to share information and obtain accurate information timely can lead to work conflict, successful operation and cost-effective healthcare measures for the patients. Vesterinen et al. (2013) stressed that nurse managers must use visionary leadership to lead the staffs to attain goals and give motivating influence to their staffs. Nurses who are able to reflect, understand and change their leadership styles can assure the work units success and employees job satisfaction, therefore assuring commitment from the staffs.

Additionally, nurse managers must also adapt their leadership styles to suit the hierarchy culture as the OT is generally run with proper rules and procedures to ensure precision of work practice. Therefore, using the commanding leadership style is necessary to provide coordination, monitoring and organization. This assures that there is consistency and uniformity of the regular OT procedures. As the Nurse Manager in charge of the Surgical Procedures, I may have been too attached to using the commanding leadership style. However, Casida and Parker (2011) stated that competency of leadership skills means the use of combined leadership styles and not dominated solely by one particular style. Often, it is necessary to use coaching, democratic and affiliate styles to ensure that effective and efficient teamwork is achieved. Upenieks (2003) explained that a democratic leadership style means that nurses are more involved in making decisions about patient care delivery. At the OT, nurses must be involved in making decisions particularly at times when simultaneous major surgical cases are happening at the same time.

ConclusionA popular adage states, leaders are not born but made implies that leadership skills are learned and transferable. As the Nurse Manager in a health care practice, knowledge and skills of appropriate leadership styles that can be adapted to the current organizational culture of the workplace can assure delivery of high quality health care delivery and at the same time enhances job commitment and satisfaction in the team. The research article highlighted that four leadership styles are considered important by the nurses: visionary, coaching, affiliate and demoratic. They have also estimated that their knowledge and skills in leadership styles is adequate to ensure the success of their work unit and assures job satisfaction (Vesterinen et al., 2013). Although the other two leadership styles commanding and isolating were not considered important by the nurses, I believe that in the OT where precision of procedures is important, it is still a valid application of leadership style to achieve the stated goal. Rego et al. (2007) explained that there is no single leadership style that is correct but attainment of goals require combined leadership styles.

Conclusively, the research article stresses on the importance of knowing and applying appropriate leadership styles in a particular situation. I agree on this because the OT itself is a dynamic work environment that constantly changes its culture depending on the situation in the ward at a particular time. As a Nurse Manager, it is critical to have leadership competency which means use of approriate combination of leadership styles in a particular situation. I found that this article helped me to reflect on the present knowledge and skills of leadership styles, and in the process, create an awareness to continuously improve my leadership skills and coach my staffs to improve their leadership skills too.

Reference ListSherman, R. & Pross, E. 2010. Growing future nurse leaders to build and sustain healthy work environments at the unit level, Online J. Issues Nurs. 15(1)

T. Cowden, G. Cummings, and J. Profetto-Mcgrath, Leadershippractices and staff nurses intent to stay: a systematicreview, Journal of Nursing Management, vol. 19, no. 4, pp. 461477, 2011

Nurse Manager Leadership Collaborative. (2006).NMLC learning domain framework.Retrieved December 4, 2009 from www.aone.org/aone/resource/NMLC/nmlcLEARNING.html

Shirey, M.R. (2006). Authentic leaders creating healthy work environments for nursing practice.American Journal of Critical Care, 15(3), 256276

Frankel, A.(2008) What leadership styles should senior nurses develop? This is an extended version of the article published inNursing Times; 104: 35, 23-24Bondas, T.(2006) Paths to nursing leadership.Journal of Nursing Management; 14: 332-339Mahoney, J.(2001) Leadership skills for the 21st century.Journal of Nursing Management; 9: 5, 269-271.

Appendix 1: The Competing Value Framework Model

The Competing Value FrameworkSource: Cameron & Quinn (2006)

Appendix 2: The Nurse Manager Leadership Partnership Learning Domain Framework

Source: Sherman & Pross (2010)