How does Leadership effect quality of care in Nursing?

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How does Leadership effect quality of care in Nursing?

How does Leadership effect quality of care in Nursing?

Rationale

            The sensitivity to quality care among patients suffering from different ailments is a major point of focus in their treatment and recovery process. Aronson (2009) observes that medical errors experienced in hospitals are avoidable and much effort is necessary in the process of mitigating the errors in the provision of care to patients. The common errors experienced in the provision of patient care are the administration of wrong dosages, wrong drugs and the issuance of medicines at wrong schedules. As noted by Camire, et al. (2009), the hospital leadership ought to solve this problem from its route cause, which lies at the understanding of the welfare of the nursing staffs who are directly involved in the administration of drugs to the patients.

            Triggle (2013) notes that the concern for the quality of care and treatment at most hospitals in the United Kingdom (UK) is of major concern in the current century due to the high awareness level and demand for high quality care in the public domain. Medical errors are more prevalent among the patients in critical conditions due to the unresponsiveness of their state, hence the need to have the caregivers value and embrace high quality services. Almukhtar, Almatari and Alloubani (2014) recognize that in the process of trying to create an enabling environment that that enhances the conditions of working for the nurses, it is important that the leaders adopt transformational leadership styles. The researchers observe that through this form of nursing leadership, the leaders lead by example and delegate powers to the junior staff members while additionally supporting them in undertakings. The support and care accorded the nursing staffs by their leaders enhances their level of job satisfaction as their care and welfare becomes the first priority in a transformational type of leadership (Denker, 2014).

            The increase in the level of job satisfaction as observed by Kleinman (2004) is strongly anchored on the administrative styles and behaviors of the nurse leaders where in this case, those that adopt the transformational type of leadership enhance the staff productivity and retention levels. Nurses used to the operations of a given work environment can be very productive as they don’t require and orientation in the process of providing diligent service to the patients. Through an enabling leadership style, the nurses get their operational schedules moderated in such a way that they work through manageable duty hours to help them have more time to think of better operational ways resulting in enhanced creativity that leads to innovation. Job satisfaction at the same times helps overcome instances of burnout, thereby helping enhance the productivity of the nurses as they have more time to reflect in the need of their patients leading to the enhancement of the quality of care provided to the patients in a healthcare set-up.

            According to Almukhtar, Almatari and Alloubani (2014) high levels of stress among the nursing staffs can be witnessed when a hospital set-up keeps experiencing very high levels of patient influx without a corresponding increase in the nursing staff. The leadership and administration of hospitals facing such a scenario have to fight hard to maintain high levels of quality care as the nursing staffs may be too exhausted to maintain high quality care resulting in instances of avoidable mortality and morbidity. Draper, et al. (2008) propose several ways of enhancing quality care in hospital set-ups with the main point of focus being the degree of involvement and support accorded to the nursing staffs by their leaders.

The researchers note that when the leaders are supportive and involved, the nurses get empowered leading to increased levels of job satisfaction which consequently leads to increased productivity (Draper, et al., 2008). A leadership style that advocates for an enabling environment where service is understood to be a shared responsibility helps greatly raise the quality standards of a hospital set-up though it equally remains critically important that all the nursing staffs be informed of their accountability levels top their personal conduct (Draper, et al., 2008). Personal accountability to any deviations from quality service will help ensure that all the nursing staffs at a given service area do their level-best in administering drugs and other forms of care to the patients.

Methodology

Introduction

Leadership is the ability of a person or an organization to socially influence others with purpose of utilizing their potential maximally in an organized manner. The leadership incorporates the aspects of higher levels of physical power to control, ability to motivate, control communication and behaviour in an organization. Nursing leadership is a complex and multi-faceted in nature due to rapid advancement in modern healthcare system (Muallem, Hough, & Schmelzer, 2008). Nursing leadership requires someone with ability to effectively bring together human resources from various departments to allow maximum care to the patient by creating a good working condition. The nursing leader must be visionary, able to analyze situations and offer necessary solutions, offer guidance and mentorship to junior nursing staff and also act as liaison person between the staff and the various hospitals management rank (Wood, 2003).

The quality of the service rendered by nurses has been of concern due to the flow of new nurses joining and leaving the field and also increases in the number of institutions offering the nursing training. The healthcare system has also undergone transformation globally due to technology being introduced in the medical field making hence improving the quality of the care (Montori, 2005). The advancement of science of nursing has led to emergence of evidence based practice where nurses are required to make rational decisions with support from literatures to avoid errors and also ensure quality in nursing practice (Hausner, et al, 2010). Nursing leadership has been identified to most probably play a major role in ensuring that nurses adhere to code of ethics and standards that govern the practice. Initial researches has suggested that better nursing leadership will ensure that quality services are rendered to patients while other researches has concluded that leadership has nothing to do with quality care. This literature review will offer the best tool which will be used to determine the truth of the matter (Hausner, et al, 2012).

The objective of this research is to identify the key strengths and weakness of the previous ones on this topic and also to document the current understanding of the relationship between the nursing leadership and the quality of care (Montori, 2005). The literature review will help to identify the areas in the field that may require future studies and also identify the recommendations that can be applied in the nursing leadership to improve the quality of care. The paper will outline how the review sources were identified and analyzed (Dieste & Padua, 2007).

PICOT template

The research question “How does leadership affect quality of care in nursing” was developed using picot template before conducting the full literature review. The key points which were used to come up with the research questions include leadership, quality, care and nursing. Nursing leadership was part of the template which was applied and linked to research question and the idea of quality nursing care (Montori, 2005). The use of PICOT template was appropriate as it makes the topic researchable, relevant and significant. It also gives the research topic a direction on how to carry out the literature review search and also focuses the study topic to specific issue. The research topic question also helps to come up key words which were used to search for the resource materials for review (Rios, et al, 2010).

Literature search plan

Identification of the research sources involves various steps which should be followed closely to ensure quality information and methodology to be adopted to carry out the research. The steps include developing literature search plan, identification of the key words which will be used, identification of the database from which the resource materials will be searched and the determination of the inclusion and exclusion criteria for the literature papers to be used (Boler, Buckley, & Proudfoot, 2007).

Key words

 When using a whole sentence in the database, the results are non-specific hence it is good to use key words which will give yield specific papers being looked.  The keywords when combined together will result to alteration of the sensitivity and specificity of the search results hence the need to be careful while searching the resource papers for review (Montori, 2005).  The use of single word or not more than three words is appropriate as it will ensure trustworthiness and quality while carrying out systematic review (Wood, 2003).

Furthermore, the use of terms such as OR and AND is encouraged to boost the balance between the accuracy of the search results (Dieste & Padua, 2007). According the question developed initially, the following keywords were found to be appropriate to use while searching the resource material for systematic review: table 1

Table 1: Key words

Databases

Most of the scholarly articles, journals and post are stored in various databases for future reference and use by future researchers to correct the mistakes that may have been done initially and also develop new area for research from search papers (O`Mathúna, 2010). There are several databases which are commonly used to get the resource materials for review. The resource materials that will be used in the study were obtained via Bucks Library search in Emerald Management, Pub Med, Ovid, EBSCOhost Electronic Journals Service and Wiley Online Library. The papers and their respective data bases are shown in the appendix 1.

                                             Inclusion and exclusion criteria

           The inclusion criteria included peered reviewed papers to avoid bias which can be introduced by various reviewer (Wood, 2003).  The study must have been published not more than 6 years ago and the researches must have been done either in United Kingdom or First World countries. The research papers must have been published in English language and must be addressing the issue of nursing leadership in relation to quality of care offered by the nurses. Moreover, the papers from peer-reviewed journals were found considered relevant and were given more weight due to the quality of the papers published in such journals (Muallem, Hough, & Schmelzer, 2008).

The excluded papers include those which had been published more than six years ago (bellow 2010), published in language other than English, never addressed the role of leadership in relation to nursing quality of care (O`Mathúna, 2010). The papers which contain personal opinions, overview by various scholars and subject reviews were also considered as irrelevant for the study. The studies which had been conducted outside the desired countries were not considered.

                                                             Search Results

More than 50 papers were retrieved from the databases, however most of them were considered unsuitable for this study as they were not relevant to the research topic or they never mate the inclusion or exclusion criteria (see Table 2). The research papers were obtained through snowballing technique where one paper acted as a lead to the next paper which relates to it             (“Software and hardware techniques for string searching in serial document databases," 1988).  Advanced search techniques were applied by using Boolean Operators, such as “or”, “and”| to combine or exclude research resulting in more productive and focused research, which helped to reduce the number of papers to six (Dieste & Padua, 2007). Those which did not meet the research requirements were considered irrelevant and rejected. The research made sure than only papers which will adequately address the study question and objectives were selected from the database. Three research papers were drawn outside United Kingdom since there were no enough materials in UK that would enable the researcher to conduct literature review. The literature review was extended to first world country as USA, Canada, Australia and Europe. The three papers met all inclusion criteria. (O`Mathúna, 2010).

Table 2: Research Results:

 Theme 1: Strategies used by leaders to Influence the quality of care in Nursing.

     In the recent years, focus on enhancing the quality of nursing care as a means of reducing the levels of medical errors that result in the deterioration of the patient conditions across different healthcare set-ups is high (Asiedu, 2015). The quality of nursing leadership is an important component of the efforts that enhance the quality of nursing care on patients suffering from chronic diseases and other ailments. Medical errors are the mistakes of medical personnel in providing medication to patients that could result in some serious or minor danger to the patients (Valentin, et al., 2009). Nursing leaderships understands the need to develop various mitigation strategies to help enhance the quality of patient care through the reduction of medical errors from the nursing staffs and other relevant medical personnel (Leape, 2009). The adoption of efficient leadership strategies helps boost the quality of care and attention offered by the nursing officers on the patients with life threatening diseases, those in the intensive care unit and those who require ordinary routine care (Sagias, 2015). The efficiency of leadership strategies employed in nursing care to help empower the nurses and provide them with the ability and confidence manage various medical conditions in addition to helping strengthen the quality of care provided to the patients.

            Haycock-Stuart and Keane (2012) in their analysis of the impact of the quality of leadership on enhancing the care for patients in a community setting observes that leadership indeed matters a lot in the process of enhancing the care for patients in the healthcare sector. The researchers note that the quality of care provided to the patients within the community set-ups should be high level and the quality agenda has to be the main point addressed by efficient nursing leadership. The modern dynamic economic times require transformative leadership skills and Appleby et al. (2010) argues that the efficient nursing leadership has to advance the quality agenda at the lowest possible cost. The study of Haycock-Stuart and Keane (2012) uses the qualitative study method with thirty-nine participants in its evaluation of the impact of leadership in nursing care in a community set-up. The study was comprehensive and reliable given its diligent selection of relevant study participants, quality study method, and reliable data analysis process. The main weakness of this study was the use of a very limited number of participants and the reliability of only the frontline nursing staff in the provision of the required data.

            Luis and Maria (2016) in their analysis of the influence of leadership on the quality of nursing care note that all healthcare providers are very concerned about the provision of quality healthcare to their patients. In the modern era, the researchers note that patient safety is an integral issue and thus nurses need to develop increased responsibility and commitment towards the advancement of the quality agenda. As observed by Burhans and Alligood (2010), the nurses are the hands on caregivers in the various healthcare set-ups, hence the need for efficient nursing leadership to help enhance the development of the quality agenda on the nursing practice. Luis and Maria (2016) note that nursing performance and efficient decision making is strongly associated with the quality of care provided to patients, hence, the need to ensure proper leadership to help develop the an enabling environment that boosts the nurses commitment to work. The researchers observe that some of the most important leadership roles in the nursing sector are the advancement of the nursing retention process to help ensure that the nurses are better versed with the operations of particular health facilities, hence, advances their levels of service delivery. The study of Luis and Maria (2016) is a quantitative study using descriptive statistics on a study sample of 184 participants, with the main strength being the reduction of bias in the questionnaire response rate. However, the study faced the challenge of using a single health unit, hence difficult to generalize.     

            The need for advanced patient care through improved nursing service delivery is the main point of focus in the papers of Haycock-Stuart and Keane (2012) and Luis and Maria (2016). Nursing leadership is regarded an integral part of the success of the fast growing agenda of quality patient-care in all healthcare facilities around the world. In the community healthcare sector as analyzed by Haycock-Stuart and Keane (2012), the quality of quality of nursing care is observed to be closely related to enhanced patient-care outcomes. Luis and Maria (2016) on their part observe that patient welfare is the centre of focus in the modern healthcare practice and efficient leadership strategies help grow and establish this agenda. As a result, the researcher observes that through transformative leadership that helps build a collaborative and effective environment for nursing practice and decision-making, the quality of service delivery to the patients is enhanced. Proper nursing leadership as observed in the two studies thus culminates in the advancement of the quality of patient care as the nurses enhance their level of keenness to patient requirements.

            Van Bogaert et al. (2015) in their analysis of the experiences and perceptions of nurse managers on the empowerment of the nursing staffs observe that a lot of researchers already opine that the creation of an enabling nursing environment plays a critical role in enhancing the productivity of the nursing workforce. The researchers observe that earlier researchers such as Yang et al. (2013) found out that the structural and psychological empowerment of nurses enhances their level of job satisfaction resulting in the increased service output. The nurse managers note that nurse empowerment through various processes such as the provision of balanced workloads and enabling independent decision making platforms help grow their levels of job satisfaction resulting in enhanced patient care (Hurst, 2006). The nurse managers note that the nurse empowerment process is critical in increasing the level of job satisfaction and service output among the nursing staffs though the tightness of their schedules tend to hinder the empowerment process. The adoption of the change idea is thus noted to be difficult in most patient-care set-ups due to the tight nursing schedules and reluctance from older nurses. Hence, Van Bogaert et al. (2015) observe that the main challenge facing the nursing empowerment process is the objection from the senior nursing staffs and the tightness of the various healthcare schedules. However, through proper nursing leadership, schedules can be restructured to help empower the nurses, enhance their job satisfaction levels and result in increased levels of patient-care.

            Nurse empowerment refers to the practice of providing enabling environment for nurses to freely exercise their duties with authority and confidence in a manner most likely to boost their levels of job satisfaction (Van Bogaert, et al., 2013). In the process of providing empowerment to the nursing staffs across various healthcare regions, research indicates that the quality of service delivery to the patients improves greatly as they major in enhancing the welfare of the patients. Empowering nurses means giving them ample time to be more innovative and device best methods of operation to help improve their passion for their job, which results in enhancing their concern for the care of patients leading to advanced levels of patient-care (Wang and Liu, 2015)

In their analysis, Haycock-Stuart and Keane (2012) note that nurse empowerment through the adoption of efficient leadership in the various healthcare set-ups helps provide ample care to patients in the modern patient-centred service era. Luis and Maria (2016) on their part note that the nurse empowerment process through the provision of conducive environments helps them making stable and more informed decisions that help enhance the quality of patient-care. To help advance the empowerment process in the nursing practice, effective leadership is recognized as a very important feature.

            Leadership, therefore, is observed to be a critical pillar in the realization of improved healthcare to patients under the care of nurses. Nursing leadership ought to be transformative to help the nursing staff get empowered to excellently perform various tasks. Through proper leadership, nurses and other hospital caregivers develop better skills to manage and handle various circumstances that help enhance the quality of patient care (Wong and Laschinger, 2013). Through the adoption of better leadership strategies, research indicates that the quality of patient care is improved as the nurses develop given enabling schedules that help them develop more focus to the care of specific patients of need (Li, et al., 2007). Proper leadership thus helps ensure that the nurses in various healthcare set-ups are well coordinated in their service delivery process to help realize improved patient-care.

The most productive type of leadership in the nursing healthcare sector is that which allows for the provision of an enabling environment to help the nurses make independent and reliable decisions (Laschinger, et al., 2004). When the nursing leaders provide for transformative leadership, they delegate to them various responsibilities in addition to providing them with room to manage their time and schedules independently resulting in enhanced patient care as the nurses have adequate time to plan for the routine care. Leadership thus has a direct impact on the quality of care provided by the nurses in the healthcare set-ups as they help develop conditions suitable for the development of various nursing skills that boost their competence.

            Patient care is described as the service provided to patients by nurses and other healthcare personnel to help them through the recovery process. The modern healthcare service delivery process is strongly anchored on the concern for the care of the patients. The quality of patient care has been observed to be critical to the recovery process of patients suffering from ailments such as chronic illnesses and other conditions (Mendes, and De Jesus José, 2014). All patients admitted in various healthcare facilities and those in emergency units require specialized care that can only be provided nurses.

            The demand for quality nursing care and the tight schedule requirements of the nurses contravenes the demand for quality in the process of providing patient care. As a result, researchers observe that there is need to adopt efficient leadership strategies to help improve the quality of healthcare services for enhanced patient outcomes. The patient-care process is largely dependent on the type of service delivered by the healthcare professionals with major emphasis being on the nurses. Nurse empowerment is considered important in the improvement of the quality of services delivered to the patients. The empowerment process boosts the job satisfaction levels of the nurses in addition to boosting their morale to work resulting in increased commitment to work.

             Nursing leadership is an integral part in the realization of increased patient care. The modern world is more concerned about patient safety, hence, demanding that nurses provide high quality services to help enhance the survival chances of various patients. Effective leadership in the nursing departments is regarded a key point of focus in the process of ensuring high quality service delivery as the leaders evaluate the main points of weakness and strength, ascertains the skill level of various nurses and checks on the modern trends of patient care demands. Leadership thus directly impacts on the quality of nursing care as the underperforming nurses are noted and warned or released while the outstanding ones are adequately rewarded.

            The empowerment of the nurses results in the creation of effective operational environments where the nurses can freely interact, share ideas and make decisions for the sake of improving their levels of service delivery. Empowered nurses have the freedom of being innovative and developing new service delivery mechanisms to help boost their level of service delivery. The promotion of the nursing service provision through this process encourages the nurses to think about the best methods to provide for patient care resulting in advanced patient care.

 Theme 2: The effect of different leadership styles on quality of care in Nursing

        The health system has over the years strived to ensure quality healthcare and safety of the patients. One of the ways has been through enhancing good administration in the system. The importance of such directions cannot be overstated. A transformational form of leadership is explained as one which causes change in individuals as well as the societal systems. (Mendes et al, 2014). |It ensures continuous quality initiatives usually result to objective quality and safety outcome measures. Good leadership is described by Mendes et al, 2014 as the root component of effective behaviour. It is required to build trust and healthier work environments specifically to the nurses who make up a large percentage of the health workforce (Wong, et al, 2013)

            Bisset, et al (2013), explains safety culture as the specific ideological experiences of the health employees which explain why keeping the environment safe is pursed in the manner shown within the particular organization. In a health system that has been faced by various cases of errors, it becomes important to enact measures that protect the patients (Mendes, et al, 2014).

            In the paper, The Importance Of Leadership Style And Philosophical Work Environment To Staff-Assessed Quality Of Care: Implementation For Home Help Services, Westerberg and Tafvelin (2013) try to explore the relationship between transformational leadership style and care quality. It focuses on the perceived support from colleagues and organization, job control as well as the workload.

            The paper makes develops the understanding that a transformational form of leadership is necessary in a psychosocial environment. It assists the relevant authority to create an enabling environment where the patients, and in this case, the elderly, are able to gain access to quality healthcare. The staff in home help services deserves equal treatment as their counterparts in health clinics and hospitals. Variables such as workload and peer support are seen to have an impact on the quality of care the staff give to the patients. The authority needs to be actively involved in these variables through enhancing their regulation to make sure that the patients are accorded the right treatment. A solitary working environment with no access to manager or colleagues during the working day can result in a perceived lack of support. Such factors are shown to have a vital link between the transformational leadership and quality care especially in home help services.

            McFadden, Stock and Gowen (2014) in their work Leadership, Safety Climate, And Continuous Quality Improvement: Impact on Process Quality and Patient Safety show the relationship between transformational leadership and objective quality. The authority form is described as an approach that causes change in individuals and social systems, therefore, able to invoke and create various forms of change in the people. (McFadden, et al, 2015). Patient safety aims at preventing various errors and adverse effects to those in hospitals (Mendes et al, 2014)

            A transformational leadership calls for taking into consideration the needs of the staff through ensuring that they are not victims of any form of pressure or frustration (Grooves, et al, 2009). It goes a long way to creating a safe climate for them. The research affirms that there is need to enforce quality control through leadership and safety climate. These virtues are important in the hospital setting as they help ensure that the mortality rates associated with the errors are reduced (Grooves, et al, 2009). The safety of the patient needs to be guaranteed in hospitals (Stern, et al, 2014). This can be enhanced through continuous quality improvement in the hospitals. It is manifested in the total quality management theory which affirms that the employees need to do things in the right way, at the right time and at the right costs while incorporating best practice (McFadden, et al, 2015). Consequently, it reduces the defect rates.

            The two papers demonstrate a complete understanding of the importance of a healthcare system based on quality. The system needs to emphasize on quality as it deals with human life (Hutchinson & Jackson, 2013). The papers focus on the need to mediate important variables such as good leadership and safety climate to ensure quality healthcare. They agree on the role of nurses in the health system and the need to provide an effective work environment for them. Nurses make up a huge percentage of the hospital workforce making them vital to the system (Hippler, et al, 2012).

            Additionally, the papers put great emphasis on the need for a transformational leadership where all the employees are actively involved. They demonstrate a good understanding of this kind of authority which involves proper treatment of both the staff and the patients. The staff can be involved in policy making processes so as to air out their grievances and make sure they are considered during implementation (Eyer, 2016). The management can also be involved through reducing the workload of the nurses, increasing influence and enhancing peer and leader support.

            A safe climate for the patients will only be guaranteed if the nurses and doctors are effectively handled. These staff members constantly interact with the patients and play an integral role in the healing process (Eyer, 2016). A good leadership program will ensure their satisfaction, hence, quality services (Demeh and Rosengren, 2015). It also protects the reputation of the healthcare systems as well as increasing the public confidence in it.

            It is important to understand the leadership skills involved in the healthcare system to ensure quality services and patient safety (Hippler, et al, 2012). Moreover, they understand the importance of a wide range of participants to help authenticate the results. The studies also both employed questionnaires as the fundamental survey method. Questionnaires help the participant express themselves freely and provide the required information for the research (Stern, et al, 2014).

            Nevertheless, the two research papers contradict on the range of participants. The first paper focuses on assistant nurses as the major participants while the research while the other paper focuses on the hospital as the main unit of analysis (McFadden, et al, 2015). It eliminated other non-hospital institutions such as clinics in its analysis. Use of hospitals as the main focus in the research is important since it represents the major unit used by patients across the world (Westerberg and Tafvelin, 2014). The problems seen in the unit can easily be related to various other units in the world. It, therefore, assists authenticate the research through ensuring its importance as well as the overall adoption. It makes the approach better than the other research.

            Moreover, the first paper explains the impact in the home help services while the second emphasizes on the inpatient services in hospitals. The differences in focus areas help highlight the common problem in the health profession despite the unit of focus. It develops the understanding that there is a common problem in the profession and, therefore, need for a transformational leadership in both the hospitals and the home help services. Therefore, policy implementers in the sector will be able to know which areas to focus on rather than concentrating only on hospitals.

            The research paper, Authentic Leadership and Nurses` Voice Behavior and Perceptions of Care Quality, by Wong, Laschinger and Cummings(2013) tests a theoretical model linking authentic leadership with staff nurses trust in their manager, work engagement, voice behavior and perceived unit care quality (Wong, et al, 2013).

            Ethical skills are important in any organization. They help regulate the job responsibilities and actions expected of any individual. Additionally, they assist the colleagues to build and maintain relationships between each other and the people they serve. The skills helps these workers develop virtues relating to honesty, trust and integrity which are important if there is to build a leader-follower relationship. Leaders should ensure that they have the confidence of their employees to create a lasting relationship amongst themselves (Stern, et al, 2014). Belief in the health profession can be built by influencing nurses’ perception of the credibility, benevolence and integrity of the leader (Wong et, al, 2010).

            The relevant leader, therefore, is responsible for this through improving his interpersonal skills that help define the relationships. It also includes aspects of the leaders relating to the followers with openness and truthfulness. They should involve their employees in policy making processes so as to ensure that their grievances are considered during implementation. It allows for the free exchange of knowledge, ideas and information in the workplace. Consequently, the workers can work with minimal supervision since the management trusts their ability to deliver quality work in time.  The paper succeeds in demonstrating this aspect, hence, a major strength on its part.

            The limitation is seen in the cross sectional design when measuring the impacts of the managers on the employees. It is important to use longitudinal design when handling self-report measures which have a risk of common method variance (Mendes et, al, 2014). The study should also have focused on other variables to create enough content.

            The third paper takes a modest approach with regard to leadership when compared to the first two. However, the common factor in the research papers is their use of questionnaires as the major survey methodology. Qualitative methods help get more accurate results (Hippler et, al, 2012). The method has various advantages which they seem to have effectively mastered hence, its wide use in the studies. They also agree that leadership and in particular authentic leadership is important in a health system. The virtue translates to quality care through various mediating aspects.

            A common factor in the papers is also seen in their belief in a transformational leadership style and its impact on both the employees and the patients. They explain that the form of authority helps in the creation of a safe climate as well as translating to quality service. Additionally, it allows the creation of a leader-follower relationship through creation of a good relationship build on trust, honesty and integrity.

            The research papers also develops the understanding on the importance of nurses in the healthcare system, therefore, working towards ensuring their satisfaction. They understand the benefits of having them in the profession, hence, calling for a transformational leadership style which directly benefits them.

            The third paper, nevertheless, makes us understand that is important to build relationships with colleagues in the nursing profession, something that is not seen in the first two papers. Such acts help enforce confidence within the unit, making it easy to achieve the required results in the organization. The first two papers are seen from a third person point of view, whereas, the third paper explains from the nurses’ perception. Here, it allows the nurses to relate with the problem being addressed since it is explained by one of their own. The research, hence, becomes easy to implement.

            Authentic leadership is an important aspect in healthcare. This is because it is responsible for various outcomes which translate to quality care. It is important that the nurses are subjected to this kind of leadership by the relevant authorities to help improve the general welfare of the patients as well as providing a safe climate. The leaders on their part need to have a full rasp of particular virtues such as integrity which help form lasting relationships and make the nurses trust them. The papers, hence, enlighten us on the importance of having a particular form of authority with regard to the profession. In this case, good and authentic forms of leadership are explained. They help enforce radical measures in the systems which lead to an overhaul and development of values that are critical to the profession. The papers also build on the need to value the lives of the patients once they are in the nurses’ care. It makes it easy to forge a good name in the profession and make it admirable in the industry. The measures proposed, hence, need to be effectively implemented to ensure that there is a formidable health system.

Strengths and Limitations

            In this review, the research question anchored on the ascertainment of the impact of leadership on the quality of nursing care provided to patients in various hospital set-ups. The literature accessed a great wealth of resources, documenting the relationship between the quality of hospital and nursing leadership and the care standard provided to patients. The ability of this research to access relevant literature with regard to the research question was a great strength. The available literature presented evidence of the impact of the quality of leadership on the standards of care provided to the patients in various hospital set-ups. The practical ascertainment and experiments conducted in the United Kingdom and other parts of the world on the impact of leadership styles on the quality of nursing care in the current decade is additionally a great strength as it boosts the validity and relevance of the prepositions if this literature review.

This study accessed quality findings from various authors and amalgamated their findings to help bring forth a very reliable document on matters to do with the evaluation of the relationship between leadership and quality of nursing care. As a result, it is important to note that other researchers can refer to this review in the future due to its rigorous and reliable findings. The reviews’ use of materials and resources from different parts of the world outlines the universality of the findings, hence helping the study portray a global perspective and not just a UK based study. The most noticeable limitation of this study was its focus on the use of good leadership styles to attain improved nursing care in hospital set-ups (Dawson, 2014). The review failed to capture other additional factors that could lead to the enhancement of quality service `provision in the hospital settings. It is important to analyze other potential factors because it is possible that there are hospitals with poor and intimidating leadership styles yet e3xoperiencing high quality service provision levels from their nursing staffs.

Implications/Recommendations for Practice

            The review noted that the healthcare practice experiences instances of incompetence leading to the deterioration of the quality of service offered by the nursing officers to the patients. As noted by Wolf et al. (2009), medical errors are a common occurrence in various healthcare set-ups and the process of mitigating them involves an enhancement in the quality of nursing care provided in the various healthcare settings. Tang et al. (2007) notes that to help mitigate the medical error menaces experienced in various hospitals, it is important the nurse leaders allow the new nurses a considerable amount of time to be acquainted with the medical operations in the wards especially in issuing of drugs. Thus, it implies that the nurse leaders ought to adopt enabling mechanisms to help the inexperienced new staffs acquire sufficient experience to help them reduce on errors resulting from instances of inexperience. Additionally, the hospital administration should develop enabling environments that boost the staff satisfaction levels to help enhance their levels of nurse retention (Chiok and Loke, 2001). Through this process, the nurses with adequate experiences can serve in hospitals for long resulting in the reduction of medical errors resulting from inexperience.

            The review observed that all patients and the public are sensitive to the quality of care provided in various hospitals. As a result, the administration of all hospitals ought to factor the need to improve their level of nursing care through processes such as the recruitment of qualified and experienced nursing staffs. The recruitment of qualified and experienced staff members serves as a remedy to the medication errors associated with inadequate experience while the regular re-training of all staff members in various hospital operations helps improve the overall quality of service delivery in the hospitals. Low ranking of hospitals with regard to their levels of nursing-care hampers a hospital’s public image resulting in reduced confidence on its levels of service delivery.

            Nurse leadership is a critical element in the process providing nursing care to the patients. Nurses being the core caregivers in the healthcare settings thus require enabling leadership strategies to help enhance their levels of job satisfaction and overall output (Clavelle, et al, 2010).  To help advance the quality of nursing care, it is important the whole nursing staff goes through mandatory trainings on the best practice methods to help them achieve enjoy a harmonious and enabling environment that helps them grow their skills and expertise in delivering quality nursing care to patients. The junior nurses can be coached to take up leadership positions such that everybody feels directly involved in the administration process of the healthcare facilities (Chan, 2002).

Additionally, it is advisable that the nurse leaders in their trainings adopt more practical and suitable administration methods such as the use of transformational leadership in place of some archaic mechanistic leadership styles that are dictatorial (Bass and Riggio, 2006). However, for all the nursing staffs to enjoy harmonious operations, they additionally need to be involved throughout all the decision making processes, hence enhancing their association to the health facility. The involvement helps the nurses grow in confidence in their service delivery process, leading to the enhancement in the quality of nursing care as they stay motivated and committed to the provision of high quality services.