Leadership in Nursing and Midwifery in Africa

Leadership in Nursing and Midwifery in Africa Dr Dinah Chelgat Dean, School of Nursing Moi University, Eldorect Corresponding Email: 2nd “Building Capacity for Nursing and Midwifery Leadership in Africa” Conference, 13th & 14th June 2019

Presentation Outline • Introduction • Characteristics of a good leader • Leadership styles and their application • Nursing and Midwifery Leadership in Africa • Challenges facing Nursing and Midwifery leadership • Way forward • Conclusion.

Introduction. • Leadership is critical for the effective running of any health care system. • World Health Organization has included leadership as one of the building blocks for any successful health system. • Leadership is the process of influencing people to accomplish goals.

Int. Cont. • Nurses and Midwives will follow a leader who provides direction, walks the talk, values people, briefs followers on issues, and encourages future leaders. • An important component of nursing leadership is the clinical leadership

Int. Cont. • Nurse and Midwifery leaders in Africa are struggling to direct care amidst a number of challenges • Shortage of resources both human and material form the greatest challenge

Characteristics of a good leader • A good leader is visionary, inspirational, a role model, a mentor, champion of clinical excellence, courageous and receptive to new ideas • Has the ability to manage and coach the Nursing/Midwifery staff especially when challenges arise • Builds human relationships with co-workers

Characteristics of a good leader CT. • Nurse/Midwifery leaders must have a positive attitude • Good communication skills • Be able to undertake some introspection and self-reflection.

Figure 1. Nurse Unit Manager as Holistic Nurse Leader Role: Component Parts

Leadership Styles and their applications • Leadership styles of nurse managers plays a significant role in job satisfaction of the Nurses/Midwives and influences the quality of care provided to patients • There are five leadership styles which are applicable to Nursing and midwifery as it does to other professions and organizations.

Leadership Styles:Servant Leadership • The leader influence others by developing relationships and team member skills • Values and is open to diverse opinions • Cultivates culture of trust and have excellent listening skills • Thinks long-term and responds to the needs of individuals and groups.

Servant Leadership. CT • A servant leader wants to serve first • Adopts a bottom-up approach to leadership • Calm and focused on giving credit to others when an organization succeeds. • Places the importance and aspirations of the organization first before self

Servant Leadership. CTDisadvantage • Leaders must be willing to give up absolute authority. • This style of leadership does not work in all situations such as in cases of emergencies

Figure 2. Liden’s Dimensions of Servant Leadership

Leadership Styles:Transformational Leadership • A transformational leader creates valuable and positive change in individuals and social systems with a goal of developing followers into leaders. • Focuses on the needs of each individual follower • Challenges the status quo and takes risks

Transformational Leadership CT. • Is inspirational and motivates the followers by walking the talk. • Transformational leaders are role models for the change process. • Is an evidenced based theory used as a strategy and manifested as style for working within a complexity of care and multidisciplinary team

Transformational Leadership CT. • Has been embraced by nursing practice settings with great success • An example of how transformational leadership in nursing influences nursing practice positively is Taiwan NHI which is the most successful health model in the world.

Transformational Leadership CT. • The transformational leadership contributed significantly to supervisor support, job satisfaction, organizational commitment and improved quality of working life

Leadership Styles:Democratic Leadership • Democratic leadership fosters a participatory team work approach to problem solving or decision making. • Embraces the spirit of collegiality whereby everyone on the team feels valued in the problem solving process • Creates employee satisfaction and encourages innovations and creativity

Democratic Leadership CT • Democratic leadership makes use of communication techniques especially that of listening skills • Democratic style of leadership emphasizes on group participation, discussion and group decisions. A democratic leader takes on the role of a regular group member without doing too much of the work

Leadership Styles: Authoritarian or autocratic leadership • Every decision is made by the leader without the input of team members. • Negative reinforcement and punishment is common with such a leadership approach. • Authoritarian leader focuses on blame rather than continuous improvement.

Authoritarian or autocratic leadership CT • Tends to have traits that are not appealing to the majority of the workers. • more often task oriented, makes decisions independently and issues commands to their subordinates • Often effective during crisis or emergency when a decision has to be made urgently

Leadership Styles:Laissez-faire Leadership • This type of a leader provides little or no directionor supervision. • Leaders of this type do not address problem areas but they let things happen instead of causing things to happen. • Refuses to assume responsibility, gives no feedback or information

Laissez-faire Leadership CT. • This style of leadership is frustrating to the workers because there is no order in the organization but chaos • A dangerous style of leadership that should not be practiced by nurse/ midwife leaders.

Nursing and Midwifery leadership in Africa. • Aspects of all the leadership styles described above may be practiced currently by nurse/ midwifery leaders in Africa. • Nurse managers use different leadership styles depending on the situations being handled at any given time • The predominant leadership style in nursing like other sectors in 1960s, 970s and 1980s was that of command and control

Nursing and Midwifery leadership in Africa CT. • This autocratic style of leadership has been found to be ineffective . • Nurse leaders are now being encouraged to learn and practice the more contemporary styles of leadership such as the transformational leadership • Nursing and midwifery leadership in Africa has contributed immensely to the improvements in health delivery systems

Nursing and Midwifery leadership in Africa CT. • The role played by the nurse and midwifery leaders in clinical practice has brought about a remarkable reduction in the malaria, infant and maternal mortality rates • Nursing and Midwifery leadership in Africa has also been instrumental in the development of Nursing education .Nurses and Midwives have been trained to masters and PhD levels

Nursing and Midwifery leadership in Africa CT. • Much still needs to be done so as to increase educators and mentors. • Nurse and Midwifery leadership in Africa should promote the values of ‘’Ubuntu’’ which is characterized by respect, professional maturity, cultural sensitivity, solidarity, empathy and caring for others.

Nursing and Midwifery leadership in Africa CT. • The principle of Ubuntu should be transmitted into nursing and midwifery leadership and management practice especially for younger leaders who are more individualistic in their approach to work and life in general • The nurse midwife leader should be aware that her /his leadership can not be sustained without people, values of brotherhood and that collective unity should be practiced.

Challenges facing the Nursing and Midwifery leadership in Africa • Many nurses promoted to leadership positions lack the necessary experiences, critical thinking skills and education • Many lack contemporary leadership models like the transformational leadership. • High turnover of nurses and midwives in many hospitals

Challenges facing the Nursing and Midwifery leadership in Africa CT. • Shortages of nurses/ midwives due to poor working conditions, poor salaries and negative attitudes by managers • High burden of disease to include emerging and re-emerging conditions • Poor governance which interferes with the way health care organizations are runned

Challenges facing the Nursing and Midwifery leadership in Africa CT. • Economic issues, poor distribution of resources and political instability. • African Health care system is fragile and weak • Africa has for long developed a dependency syndrome where funds to run the health care • There has been little focus on promoting nursing leadership • The lack of transformational leadership

Challenges facing the Nursing and Midwifery leadership in Africa CT. • Nurses in most cases have been known to view themselves as inferior compared to their counterparts despite the fact that nurses are the largest workforce in every health care setting. • Leadership in most cases is only geared to specialty areas • lack of support for upcoming nurse/midwife leaders

Challenges facing the Nursing and Midwifery leadership in Africa CT. • No mentorship and support for those who are young and getting into leadership positions both in the clinical areas and the teaching institutions • Nurses are further underrepresented in organizations and in policy making institutions

Challenges facing the Nursing and Midwifery leadership in Africa CT. • A survey in 2010 indicated that only 6% of Nurses were in board member seats compared to the physicians who were at 20%. • Nurses are reported to lack knowledge of political power and are not prepared to negotiate with the other members of the health care team in protecting their space in the health sector

Challenges facing the Nursing and Midwifery leadership in Africa CT. • When nurses do not participate in formulation of legislation, the patients and the profession will surfer because nurses are the patients' advocate.

Way forward for a transformative leadership in Nursing and Midwifery in Africa • All nurses must be leaders in the design, implementation, and evaluation of, as well as advocacy for, the ongoing reforms to the system that will be needed. • Nurses will need leadership skills and competencies to act as full partners with physicians and other health professionals in redesign

Way forward for a transformative leadership in Nursing and Midwifery in Africa CT. • Nursing research and practice must continue to identify and develop evidence-based improvements to care, and these improvements must be tested and adopted through policy changes across the health care system. • Nursing leaders must translate new research findings to the practice environment and into nursing education and from nursing education into practice and policy.

Way forward for a transformative leadership in Nursing and Midwifery in Africa CT. • Being a full partner transcends all levels of the nursing profession and requires leadership skills and competencies that must be applied both within the profession and in collaboration with other health professionals.

Way forward for a transformative leadership in Nursing and Midwifery in Africa CT. • Being a full partner in care environments involves taking responsibility for identifying problems and areas of waste, devising and implementing a plan for improvement, tracking improvement over time, and making necessary adjustments to realize established goals.

Way forward for a transformative leadership in Nursing and Midwifery in Africa CT. • Serving as strong patient advocates, nurses must be involved in decision making about how to improve the delivery of care. • Nurses should have a voice in health policy decision making, as well as being engaged in implementation efforts related to health care reform.

Way forward for a transformative leadership in Nursing and Midwifery in Africa CT. • Nurses should also serve actively on advisory committees, commissions, and boards where policy decisions are made to advance health systems to improve patient care

CONCLUSION • Nursing and Midwifery leadership is critical for effective running of health systems in Africa and the world at large • Visionary leadership produces transformation in health care organizations

CONCLUSION CT. • Nurse leaders should participate in policy formulation to ensure that the interest of the nurse (the patients advocate) today and in future is given its rightful position • Leadership is about change and takes people from one point to another

CONCLUSION CT. • Nurse leaders set the tone and pace for their team members in their areas of operation therefore leaders need to be what they want to see in their followers • There is need to prepare, mentor and support young nurses/midwives who display leadership skills to enable them takes the leadership role.

Conclusion CT • With appropriate identification, support and development of future nurse leaders, an acknowledgement of the shifting paradigm of leadership theory and the context in which future nurse leaders are destined to grow, the ultimate goal of the nursing profession – excellent in person-centered care – can be achieved.

Conclusion CT • It is essential to the future success of the nursing profession that informal, negative “leaders” be discouraged and positive leaders, possessing the evidence-based qualities of leadership be identified and nurtured to lead the profession.

Conclusion CT • As Nurse Leaders we cannot go back and change the past in our health care organizations and settings, but we can start where we are today and change the future

THANK YOU

Leadership in Nursing and Midwifery in Africa