The effectiveness of people management, organisation development strategies and interventions in a mental health setting

Table of Contents

Executive Summary

1 List of figures

2 Introduction

3 Literature review
3.1 Current perceptions of leadership in Nursing
3.2 The Argument for Transformational Leadership
3.3 Herzberg’s two-factor theory
3.4 Maslow’s Hierarchy of Needs

4 Findings and Conclusions

5 Recommendations and Implementation

6 References

7 Appendix A

List of figures

Figure 1: Herzberg’s Two-Factor Theory

Figure 2: Maslow’s Hierarchy of Needs

Executive Summary

This paper aims to find out why there is a high turnover rate amongst private mental health nurses in the healthcare industry by looking at influences of leadership style, particularly transformational leadership on job satisfaction, motivation and commitment to the organisation. It will initially look at the current scenario on a ward (Ward A) in a private mental health hospital (Company A) and then look at literature supporting possible ways of addressing problems in company A (See Appendix A).

Mental health nurses are said to face significantly different sets of challenges, mainly due to being subjected to violence, and aggression regularly by patients. Current leadership practices and organisational structures may not be supporting nurses enough in some settings, which could be contributing to facilitate unhealthy work environments and high nursing turnover.

Spending has been said to have significantly risen, approximately £327 million to £485 million in from 2012 to 2014 respectively, on recruiting temporary nurses due to nursing shortages. Budget cuts, low remuneration and low staff morale are said to have contributed to an over-reliance on temporary nurses which is said to be having a negative effect on continuity of care for patients and poor outcomes of quality.

Leaders with good interpersonal skills, actively carrying out staff supervision and adopting a transformational style of leadership may be the key towards increasing job satisfaction, motivation and reducing staff turnover amongst nurses. Nurse leaders need to understand their nurses in order to understand why so many are leaving.

1 Introduction

The Royal College of Nursing, (RCN, 2015), estimate that between 2013 and 2014, trusts within the NHS spent approximately £485 million pounds on temporary agency nurses from outside their organization. Budget cuts, low morale among nursing staff, leading to problems with staff retention is said to have resulted in over-reliance on the use of agency healthcare staff. RCN, (2015) argue that this can result in a lack of continuity of care as agency staff are not familiar with patients they are working with. This ultimately negatively impacts quality outcomes for patients and according to Djukic, (2011) increases costs to the organisation due to having to retrain new staff. Buchan & Aiken, (2008) also stress that low levels of staffing lead to poor standards of care for patients and ultimately impacts the organisation negatively. Heller et al., (2004) highlight nursing shortages worldwide as of vital importance to the healthcare industry. Nassar, Abdou, & Mohmoud, (2011) stress that one of the most effective ways to ensure quality outcomes and survival of healthcare settings is to ensure adequate levels of nurses and healthcare workers on hospital wards.

Mixed views exist amongst authors with regards to factors that help facilitate these shortages. Nassar et al., (2011) attribute this to inability of healthcare settings to implement effective staff recruitment and retention policies, and little support from leaders or opportunities for nurses to develop themselves. (Strong et al., 2008; Abualrub & Alghamdi, 2012; Brewer et al., 2016) cite lack of support and supervision from nursing leaders as one of the main factors resulting in nursing shortages. Negussie & Demissie, (2013) also believe that job satisfaction and thus willingness to leave is greatly affected by the leadership style employed by a manager. Abualrub & Alghamdi, (2012) add that leaders can implement effective retention strategies if they are able to understand what leads to nurse’s job satisfaction.

Heller et al., (2004) stressed the importance of leadership training and its necessity in addressing nursing shortages that are prevalent in healthcare. Similarly Curtis, de Vries, & Sheerin, (2011) stress that lack of sufficient leadership education, coupled with stressful work environments leads to styles of leadership that are ineffective resulting in negative outcomes for staff, patients and the organisation. McTiernan & McDonald, (2015) state that the challenges and stress that mental health nurses face and have to deal with are unlike other types of nursing. They argue that this stress, coupled with a sense of lack of personal achievement results in falling quality care standards. Curtis et al., (2011) add that that simply allocating a leader does not lead to effectiveness in a work setting. They argue that a leader needs to have sufficient knowledge about application of leadership skills in practice.

Thyer, (2003) and Negussie & Demissie, (2013) believe that leadership in nursing follows a transactional style and Thyer (2003) believes this to be the main reason nurses leave the profession. Gabel, (2012) however states that in order to achieve the objectives of healthcare settings, leaders need to have strong interpersonal skills coupled with the ability to actively listen and communicate effectively with staff. These skills, which are elements of transformational leadership, he argues, will empower leaders to align staff values and beliefs with those of the organisation or healthcare setting. This case study aims to examine the effectiveness of transformational leadership in nursing and its effectiveness in increasing job satisfaction and motivation and ultimately helping to retain nursing staff in a private mental health setting, Ward A (See Appendix). It will also discuss Herberg’s, (1959) two factor theory and Maslow’s, (1949) theory of motivation in relation to mental health nurses, job satisfaction and motivation.

2 Literature review

2.1 Current perceptions of leadership in Nursing

Gabel, (2012) believes that large organisations often employ bureaucratic, authoritarian and hierarchical leadership approaches. This is in contrast to studies by Thyer, (2003) and Negussie & Demissie, (2013) who believe that leadership in nursing follows a transactional style. Transactional leadership was said to be the most effective method of leadership prior to the introduction of transformational leadership (Bass et al, 2003). Transactional leadership is said to rely on clear aims and objectives and utilizes rewards and punishment to ensure compliance. Bhatti et al., (2012) however point out that there is no universal style of leadership and argue that this depends on the type of organization.

It could be said that manager A appears to utilize a Laissez-Faire management style most of the time due to being absent and a transactional leadership style when he is present. Yang, (2015) argues that previous literature wrongly views laissez-faire leadership as ineffective and as an absence of leadership. He however states that sometimes team members prefer to be autonomous without the interference of managers. He further adds that minimal or no supervision by managers sometimes enables staff members to feel a sense of autonomy and respect. Nurses are registered professionals with extensive knowledge in their field and are accountable for their actions (NMC, 2015) Therefore in theory, a laissez-faire leadership approach may seem like an appropriate style of leadership for managers to employ at times (Yang, 2015). However as Cummings et al., (2008) pointed out, nurses work in highly stressful environments and may need to feel supported by their manager. Studies (Sellgren, Ekvall, & Tomson, 2007; Abualrub & Alghamdi, 2012) have been conducted, examining the link between leadership and nurses leaving the profession. Brewer et al., (2016) cite a lack of support from nursing leaders as one of the main factors resulting in nurses leaving the profession. Strong et al., 2008) highlight the significance of clinical supervision for mental health professionals and argue that it is it usually carried out in an impromptu manner or not of a good enough standard. This was evident in Ward A, particularly with the lack of supervision meetings between manager A and nursing staff which should be carried out monthly. Strong et al., (2008) add that clinical supervision results in a system of support for staff as well as ensuring best methods of practice which ultimately benefit patients and the organisation.

2.2 The Argument for Transformational Leadership

Curtis, de Vries, & Sheerin, (2011) argue that nurses who are motivated and empowered are eager to carry out their practice to a high standard. They argue that transformational leadership which mainly utilizes effective communication is the key to motivating nurses. Bass, (1998) stated that elements of transformational leadership include the ability to gain admiration and respect and inspire followers to be enthusiastic about their practice. Other skills include the ability to increase and impart knowledge while also showing empathy and concern for their followers (Curtis et al., 2011)

Brewer et al., (2016) conducted a survey of 1037 nurses aimed at examining whether transformational leadership was correlated to nursing turnover, satisfaction with the job and how committed nurses were to their organization. They found that transformational leadership was not directly related to job satisfaction and a nurses wish to leave however it was positively related to commitment to the organisation. A wish to leave the organisation was said to be positively related to a nurse’s commitment to the organisation, job satisfaction and opportunities for promotion. Brewer et al., (2016) argue that previous studies did not include the variable of ‘commitment to the organisation’. This is important, because a nurse who feels valued increases their commitment to the organisation (Curtis et al., 2011). Strengths of this study include a large population size and selected nurses had more than 7 years’ experience. A previous study by Lin et al., (2015) however found that transformational leadership was strongly related not only commitment to the company but to job satisfaction. Their study consisted of a large sample size of 651 nurses in private and public hospitals in Taiwan. The authors suggest that the results of the study could have been influenced by other elements such as physical health of the respondents, family issues and the work environment. They further add that age and gender could also affect a nurse’s decision to leave but these important variables are not factored into previous research. (Lin et al., 2015)

Negussie & Demissie, (2013) also attempted to examine the link between job satisfaction and leadership methods in a specialised hospital. Their study was carried out over 6 months by way of a questionnaire which was aimed at 186 full time nurses with more than a year’s experience in nursing. They concluded that nurses preferred a transformational style of leadership over a more transactional method of leading. An interesting aspect of this study is that nurses perceived ‘contingent rewards’, which is an element of Transactional leadership as an element of Transformational leadership. They go on to explain however that nurses are not usually rewarded or recognized for exceptional practice. Another finding was that nurses had low job satisfaction with regards to salary and work environment and transformational leadership was positively related to intrinsic factors of job satisfaction. One limitation of this study are that it had a relatively smaller sample size and some nurses only had a year’s experience. Abualrub & Alghamdi, (2012) found similar results in their study which aimed to find a link between leadership, job satisfaction and staff retention. Their study utilised questionnaires which were distributed to 308 nurses in Saudi Arabia. They concluded that nurses were happier in their jobs with a transformational leadership style. Aboshaiqah et al., (2014) also advocate the utilization of transformational leadership, however their study of 272 nurses also found that staff nurses in one hospital perceived their managers as using a combination of transformational and transactional leadership. They also found that combining leadership styles was an effective way of reaching desired outcomes. These outcomes included increased effectiveness amongst nurses, job satisfaction and a greater perception of capability of management.

Sellgren, Ekvall, & Tomson's, (2006) study focused on opinions of nurse manager’s views on leadership and the perceptions of nurses on their manager’s leadership abilities. Sellgren et al., (2006) believe that leadership style in nursing, is crucial to a nurse’s acceptance of change and motivation towards achieving visions of the organisation and high standards of care. The study of 66 managers and 426 nurses found that the role of some leaders was ambiguous and that what managers believed their leadership to be was far below expectations of what nurses expected. It also found that nurses prefer a leader to be clearer in terms of objectives and the overall vision of the organisation. One limitation of this study is that it only included 3 men. However Sellgren et al., (2006) argue that nursing is a profession dominated by women who are more likely to use a transformational leadership style. In contrast to this, Sellgren et al., (2006) found that none of the managers were perceived to use a transformational leadership style. They suggest that recruitment of nurse managers should focus on people who fit the profile of transformational leaders.

2.3 Herzberg’s two-factor theory

O’Brien-Pallas et al., (2006) viewed nursing turnover as sometimes beneficial to the healthcare industry, particularly when it involved recruiting new employees who may have new ideas or more innovative methods of practising. They however believe that increasing levels of nursing turnover, especially when efficient and effective staff decide to leave, results in decreased productivity and an increase in risk. Nassar et al., (2011) believe that in order to maintain quality outcomes in healthcare, hospitals need to be adequately staffed with nurses. O’Brien-Pallas et al., (2006) further added that nursing turnover was initially seen as something that recruitment strategies could address, even though it was increasingly being perceived as a result of low job satisfaction. Djukic, (2011) argues that turnover, especially amongst newly trained nurses presents a significant cost to an organisation due to having to allocate more funds to induct and train them. Herzberg’s two-factor theory of motivation, (See Figure 1), states that factors such as salary, relationships with colleagues and supervision (hygiene factors) will result in general job satisfaction amongst employees. He also stated that in order to achieve higher levels of satisfaction, commitment and motivation, motivator factors such as sense of achievement, recognition, challenging work and opportunity for growth and promotion were necessary (Herzberg, Mausner, & Snyderman, 1959).

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