Compassionate, collective or transformational nursing leadership to ensure fundamentals of care are achieved: A new challenge ornon‐sequitur?

Abstract

Aims This discursive paper draws on three key leadership theories with the aim of outlining how styles of leadership impact the provision of fundamentals of care. Design Discussion paper. Data sources key leadership theories, leadership and fundamentals of care literature. Implications for Nursing The conceptualization of fundamentals of care is viewed through the lens of nursing leadership, and collective, compassionate and transformational leadership theory. The cognitive dissonance that nursing leaders encounter when trying to reconcile organizational, patient and nurses' needs is considered, and the pressure to deliver high‐quality fundamentals of care presents a challenge to nurse leaders. Conclusion Leaders must align nursing and patient outcome data to drive forward and prioritize fundamental care. Focusing on key elements of relational leadership styles will ensure a workforce fit to provide fundamental care, which in the current climate must be an organizational and global nursing priority. Impact This discussion attempts to draw together overlapping leadership theories, emphasizes the importance of relational leadership in ensuring the provision of the fundamentals of care and acknowledged the impact of the COVID‐19 pandemic on nurses and nursing care, with leadership implications outlined, such as a need for role‐modelling, understanding shared values and giving nurses a voice. It will have an impact on nurse leaders, but also on those nurses providing direct care by issuing a challenge for them to confront their own nurse leaders, and to ask that they better resolve competing needs of both the nursing workforce and patients.

Fundamental care: An evolutionary concept analysis

“…Given the role played by nursing leaders in guiding clinical nurses and providing a connection between frontline staff and achievement of organizational goals (Parr et al, 2018), it is necessary to further explore how nursing leaders perceive and promote fundamental care to plan interventions that can facilitate this knowledge and application into clinical practice (Kitson et al, 2019). Nursing leaders have a responsibility in determining the levels of skill mix and staffing and in distributing the workloads and responsibility of patient care, which are factors have an effect on the delivery of the fundamental care (Pattison & Corser, 2022). Furthermore, we ought to explicitly embed fundamental care in policies, safety, quality and educational standards and research offers.…”

“…Therefore, nursing leaders should be aware of how their role can shape the way fundamental care is delivered (Conroy, 2018). For example, relational leadership has been shown to be effective in supporting the provision of fundamental care (Pattison & Corser, 2022). Given the role played by nursing leaders in guiding clinical nurses and providing a connection between frontline staff and achievement of organizational goals (Parr et al, 2018), it is necessary to further explore how nursing leaders perceive and promote fundamental care to plan interventions that can facilitate this knowledge and application into clinical practice (Kitson et al, 2019).…”

“…Indeed fundamentals of care ought to be taught more explicitly to nursing students, through identified conceptual frameworks that explain the principles more fully, and through use of concordant terminology, learning appropriate clinical skills, structured debriefings and opportunities for students to play the role of the patient (Feo, Donnelly, et al, 2018). However, it is important to point out that the reason for not providing fundamental care is not always and necessarily due to the devaluation of these tasks or to the attention in conducting nursing care, but this could also be due to overload and several other factors such as work environment, nurse staff level and burnout (Liu et al, 2018; Pattison & Corser, 2022). Furthermore, fundamental care is often associated with missed care, since the most frequent nursing tasks that are left undone, when staff or time shortage occur, are elements of fundamentals of nursing care (Ball et al, 2018; Palese et al, 2021).…”

The essentiality of nursing in modern health systems

“…In The State of the World's Nursing 2020 report presented for the World Health Day, the WHO made "a stark reminder of the unique role that nurses play and a wakeup call to ensure they get the support they need to keep the world healthy". 3 However, the problem of excessive workload and sta ng continues to be the "two elephants in the room" (i.e., those problems that everyone knows but prefers to ignore) 4 that can only be solved by investments, scienti c evidence, and nursing leadership 5 .…”

“…and the WHO jointly recommend more urgent signi cant investments in the nursing profession in order to fully express its potential, which is not exclusively con ned to hospitals, but also in contexts of home care and community settings 5,6 . To become the "essential nurses" that the healthcare systems demand today, nursing leaders should give equal importance to both patient and nurses' outcomes 4 . Researchers have su cient data to demonstrate the signi cant relationship existing between the nurses' and patients' outcomes; for example, a poor work environment, determined by excessive workload and nursing burnout, is highly likely to translate into adverse patient outcomes 7 .…”