Over the years, both as a clinician and as a nursing lecturer, I had the privilege of working with a number of senior nurses. Many of these colleagues ran hospital wards, community teams, specialist departments and even large hospital Trusts. All of these people demonstrated their own individual personalities in the way they organised and led their various teams. I don't think that there is one particular style of leadership that works for all people in all the different nursing and healthcare environments. However, as I reflect on the nurses in leadership roles whose team members were positive and the clinical care was organised and of a high standard, then there does seem to be a common principle—that of team ownership.
Avoiding the production-line mentality
During my last year at school, I had a part-time job working in a factory. There were a number of jobs that involved workers standing in front of a conveyer belt, along which travelled various components that either needed something adding, or had to be packed into a box. The people working the various conveyor belts became so competent at the different jobs that they could do them seemingly without concentrating on what they were doing—either talking to each other or looking totally bored. If the way that we organise our nursing profession, and individual nursing teams in particular, becomes the equivalent of a factory production line, then the individual nurses and care assistants will feel depersonalised and the nursing care they deliver will lack holistic understanding.
The value of encouraging responsibility and ownership
One way to help nurses and healthcare assistants to appreciate the part they play in the holistic care of their patients and the wider needs of running the department is to facilitate individual responsibility and ownership. The principles of this are fairly simple: identify the various ‘jobs’ that need to be done in the department—ordering dressings or laundry, liaising with the university about students, infection control liaison, planning off duty etc—and then allocate particular tasks to appropriate individuals. The result of this ‘delegation’ is that management roles are distributed across the team, rather than left as the responsibility of the nurse in charge, helping individuals to feel part of the holistic running of the unit.
Encouraging ownership
The theory of delegation is fairly simple, but putting it into practice is not so easy. If a team has got into a routine of one person undertaking all these ‘jobs’ and if individuals are content with their factory-line ethos of work, then they become reluctant to move away from what has become, for them, a relatively comfortable way of working. The key to team development is twofold: first, helping individuals to develop an area of interest and, second, supporting and motivating them to take on new roles. Each nursing team is going to be made up of individuals varying in age, experience, ability, motivation and enthusiasm and the dynamics of each team will be different. Take a few minutes to reflect on the people in the team you work with; how well do you know them as individuals? Do you know their strengths, their ambitions, the demands they have at home? How you approach your own team will have to be tailored to the people you have, the needs of the unit, your personality and the way you work. Here are a few ideas to help you identify a positive way forward:
- Take time to get to know your staff, meet with them on a one-to-one basis over coffee. Ask them about their ambitions, any particular clinical interests they have, what wider skills they have outside of nursing and any ideas on how they would like to organise their nursing practice
- Undertake an audit of all the routine management jobs that need to be done on your unit. Reflect on what skillset the person undertaking that role would require. If someone didn't have that skill, how could they acquire it?
- Try to identify the more specialist areas that need to be undertaken. Again, identify the skills required for these roles
- Building on the knowledge you have gained from your ‘one to ones’ with staff, try making a preliminary link between roles and people. Try to build the links on a positive attribute of the person so that they feel valued for their ability
- Think through the most appropriate way of taking this forward. Is it better to meet with people individually and discuss together any specialist roles you would like them to consider? Or is it better to see a small group of staff together according to seniority?
- The principle in helping people to accept delegated roles is to make sure they feel valued and they understand that you are building on their strengths rather than just giving them jobs you don't want to do.
Encouraging team ownership is not easy, some people will resist what they see as extra responsibility, but the benefits are considerable for you as a manager, for the staff that make up the team and, hopefully, for the patients receiving the team's care.