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This is a critical analysis of leadership in the intensive care unit (ICU). According to van Schijndel and Burchardi, scholars have not paid much attention to practical management in the intensive care medicine (van Schijndel & Burchardi, 2007). As a result, there is little evidence-based research to support management practices. In most cases, only anecdotal accounts from healthcare providers exist. ICUs are critical parts of healthcare facilities because they account for a significant part of resources allocation, including human resources. Therefore, it is imperative for ICUs to have effective management and leadership.
ICUs consist of multidisciplinary professionals collaborating to ensure that critically ill patients receive quality care and positive outcomes. Therefore, physicians, nurses and other specialists must form an integrated team to ensure a coordinated care to patients. One major challenge in the ICU is to ensure that a multidisciplinary team with different specialists work together to deliver a rapid and effective care to a critically ill patient (van Schijndel & Burchardi, 2007). In addition, several activities within ICUs show that ICU leaders have many tasks to coordinate.
Conflicts are bound to happen in such situations. Conflicts in the ICU may affect all stakeholders, including patients, healthcare providers or even family members. The best approach is to solve such conflicts before they derail the quality of care that patients receive. In many cases, poor communication has been cited as the most frequent and common challenge in ICUs. Ineffective communication is responsible for mistakes and conflicts within the unit level.
When conflicts occur, a nurse leader must resolve them through communication. This requires the leader to possess skills of interpersonal communication and ensure collaboration within the team. According to researchers, effective communication can be a major obstacle in the ICU because of high stress and workload (van Schijndel & Burchardi, 2007). In this regard, leaders must use effective tools of communication in the ICU. Close communication is critical among team members. This would ensure collaboration to promote positive patient and healthcare providers outcomes. At the same time, effective communication in the ICU promotes professionalism, learning, satisfaction and lessens stress-related challenges.
Reader, Flin, and Cuthbertson (2011), established that intensive care unit senior physicians reported using a variety of leadership behaviours to ensure high levels of team performance (p. 1683). On this note, Linton and Farrell (2008) found out that there were five interrelated elements in ICU leadership. These aspects of ICU leadership included leading by example, communication, ability to think outside the management square, knowing staff and stepping up in times of crisis (Linton & Farrell, 2009, p. 64). The researchers have shown the essence of nursing leadership in ICUs and the need to equip nurses with the required leadership styles for a multidisciplinary team (Linton & Farrell, 2009; Reader et al., 2011; Sherman & Pross, 2010).
van Schijndel and Burchardi (2007) noted the need for situational leadership in ICUs. In this regard, they identified task behaviour and relationship behaviour as elements of situational leadership in ICUs. Task behaviours ensure that a leader adjusts to the required tasks. A leader must define and organise tasks of a multidisciplinary team in ICUs and explain all duties to be undertaken. The ICU team requires standard operating procedures when attending to patients and therefore, the leader must ensure that such guidelines are available. Relationship behaviour promotes a good working relationship within the team.
Effective communication and personal relationships must persist between the leader and the entire team. Healthcare providers in ICUs experience high-levels of stress and the challenges of meeting the complex needs of critically ill children and their families (Bratt, Broome, Kelber, & Lostocco, 2000, p. 307). These are factors, which threaten quality of care to patients. A multidisciplinary team in the ICU requires effective communication and listening and emotional support from the leader.
One must recognise that leadership qualities are rare in many organisations. Leaders, therefore, must strive to match their unique styles of leadership with the prevailing circumstances. This is a situational leadership style, which allows a leader to apply various styles in different situations, including with various teams. van Schijndel and Burchardi (2007) notes that when a team becomes competent and mature, then the leader may change the leadership approach to delegating style. Delegation leadership approach can motivate healthcare providers, enhance self-confidence and promote individual commitment.
Healthcare workers who are competent in their roles due to experiences, skills and knowledge are most likely to be committed in their duties and ensure effective services and personal responsibilities. A leader, however, must establish a system to manage and control all delegated roles and ensure effective feedback. A leader in the ICU must acknowledge that delegation is effective and does not weaken leadership position and responsibilities in the ICU (van Schijndel & Burchardi, 2007).
In ICUs, leaders must be highly flexible to accommodate unprecedented events. For instance, an emergency may force the leader to change from delegation to task responsibility (van Schijndel & Burchardi, 2007). ICU leaders must have clear guidelines for such situations so that team members understand their roles and the reason for sudden changes. Leaders must be present and take responsibilities in emergencies because of potential mistakes due to the multidisciplinary, time-critical nature of care and vulnerability of the patients (Haerkens, Jenkins, & van der Hoeven, 2012, p. 39).
Rouse (2009) focused on understanding how healthcare providers in the ICU reacted to ineffective leader participation. The researcher noted that there was a need for active participation from leaders. In addition, unit nurses showed their dissatisfaction when leaders were perceived as absent or incompetent (Rouse, 2009, p. 463). Moreover, ineffective leadership affected nurses morale and resulted in low productivity.
Ineffective leadership in the ICU bears implication for nurse leaders and nursing management. Haerkens et al. (2012) noted that, intensive care frequently resulted in unintentional harm to patients and statistics did not seem to improve (p. 39). As a result, there has been increased pressure on healthcare facilities to improve patient safety outcomes. The current system requires nurses to reduce adverse effects on patient variability.
This would ensure safe care under standard guidelines and procedures. Nurse leaders should have checklists, schedules and safety procedures for the ICU. Healthcare providers, however, have not improved healthcare outcomes in ICUs and human errors have persisted. Therefore, adverse outcomes have been severe in ICU environments. In most cases, patients in ICUs have severe, multiple conditions that need critical reviews, tests, evaluation, invasive interventions and intravenous medication. As a result, human errors may be common and could have greater effects on patients because of vulnerability. Moreover, nurse leaders must understand data from different sources to facilitate decision-making.
Data may make them to lose focus on the real issue. Therefore, a multidisciplinary team must plan and decide on critical elements of ICU patient management, particularly time-critical issues. Nurse leaders face critical challenges in identifying time-critical elements in ICUs. According Haerkens et al. (2012), human factor is a major factor to consider in the ICU. In this regard, there have been calls to ensure effective leadership in ICUs.
Nurse leaders have responsibilities of recruiting and developing effective leadership in their units. Healthcare facilities that focus on productivity should also ensure effective nurse leadership and communication. At the same time, ICUs should promote nurse morale, mentorship and leadership development through modelling. All members of a multidisciplinary team should conduct leadership assessment to identify areas of potential improvement.
Given the importance of human factors and related medical errors in ICUs, it is imperative for nurse leaders to understand effective guidelines that could reduce human variability. Safety and standard guidelines developed by a nurse leader and the team should guide all activities in ICUs. Nurse leaders should focus on effective communication and methods of enhancing collaboration and team performance in ICUs. While limited evidence may exist about medical errors and other challenges in ICUs, Haerkens et al. (2012) recognised that effective training of nurses in ICU standard guidelines could improve patient outcomes and promote leadership. Studies show that there are many opportunities for leaders to recognise and improve leadership and administrative practices.
Leadership in ICUs has become a critical factor for nurse leaders. Failure to offer leadership in ICUs has negative impacts on patient outcomes and healthcare providers performances. Given diverse patients needs in ICUs, nurse leaders should understand that developing leadership is a long-term quest that requires critical planning. It is therefore imperative for healthcare providers in ICUs to develop leadership skills and competencies to ensure effective patient outcomes.
Nurse leaders are responsible for developing appropriate leadership behaviours and relationship behaviours based on a given situation. While situation leadership is effective in some cases, ICU leaders must delegate roles to members of a multidisciplinary team, facilitate communication, collaboration, conflict resolution and improve outcomes. It is important for current leaders to take responsibilities, lead the team and develop future leaders. ICU nurses require active participation from their leaders to avoid job stress, dissatisfaction and poor patient outcomes. At the same time, there is a need for further studies to understand administrative activities in ICUs. Such studies should focus on ICU leadership structures, styles and leadership process that develop positive work environments.
References
Bratt, M., Broome, M., Kelber, S., & Lostocco, L. (2000). Influence of stress and nursing leadership on job satisfaction of pediatric intensive care unit nurses. American Journal of Critical Care, 9(5), 307-317.
Haerkens, M.,, Jenkins, D., & van der Hoeven, J. (2012). Crew resource management in the ICU: the need for culture change. Annals of Intensive Care, 2, 39. Web.
Linton, J., & Farrell, Maureen. (2009). Nurses perceptions of leadership in an adult intensive care unit: A phenomenology study. Intensive and Critical Care Nursing, 25(2), 6471. Web.
Reader, T., Flin, R., & Cuthbertson, B. (2011). Team leadership in the intensive care unit: The perspective of specialists. Critical Care Medicine, 39(7), 1683-1691. Web.
Rouse, R. A. (2009). Ineffective participation: reactions to absentee and incompetent nurse leadership in an intensive care unit. Journal of Nursing Management, 17(4), 463-73. Web.
Sherman, R., & Pross, E. (2010). Growing Future Nurse Leaders to Build and Sustain Healthy Work Environments at the Unit Level. OJIN: The Online Journal of Issues in Nursing, 15(1), Manuscript 1. Web.
van Schijndel, S., & Burchardi, H. (2007). Bench-to-bedside review: Leadership and conflict management in the intensive care unit. Critical Care, 11(6), 234. Web.
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