A significant factor affecting what happens within the workplace is culture. ‘It's the way we do things round here’ is often how people will describe organisational culture. Warrick (2017) likened culture to precious treasures, saying that culture can be an organisation's greatest treasure (asset) and, therefore, it needs to be cared for and nurtured. The role of a leader and their impact on the organisation's culture is one that is widely acknowledged; if leaders do not attend to their greatest treasure, it can become vulnerable and become the organisation's greatest weakness.
Effective work relationships, and therefore teamwork, are essential to establish an organisational culture where all staff feel valued and where the provision of effective, high-quality and safe person-centred care is the norm.
Understanding the roles and responsibilities of all those within the team is a key factor in enabling effective teamwork and therefore a positive workplace culture. Failure to understand the roles of all those within the team can potentially lead to tension, misconceptions and poor communication, which ultimately negatively impact on both staff experience and the quality of patient care.
As a member of the nursing team, the registered nursing associate (RNA) role has been designed to bridge the gap between the registered nurse (RN) and the health and care assistant (Willis, 2015). The role of the RNA is seen as one centred in the delivery of high-quality, person-centred care for people of all ages in all health and social care settings.
In addition, the Nursing and Midwifery Council (NMC) Standards of Proficiency (NMC, 2018a) also require RNAs to have the ability to manage their own workload and to delegate tasks appropriately. Furthermore, they are expected to play a proactive role in multidisciplinary teams, act as role models, supervise others and provide constructive feedback. These proficiencies identify that the RNA is expected to have a level of ability in clinical leadership practice at the point of registration, suggesting that the RNA can have a positive impact on patient experience and the quality of care, as well as on teamwork and workplace culture.
Although in days gone by it was considered that leadership came with a job title (ward manager, nurse-in-charge), it is now more widely accepted that anyone can develop the skills and qualities needed to be an effective leader. The NMC (2018a) has made it clear that leadership is an expectation of the RNA; however, for RNs, their proficiencies (NMC, 2018b) clearly identify the need for leadership and management skills.
‘Leadership is considered a multifaceted process that inspires, influences and motivates individuals towards a common goal … a positive workplace culture that supports the delivery of effective, high-quality and safe person-centred care’
Often, when we consider the skills and qualities needed to be an effective manager or leader, management will be described in terms of skills and activities or jobs, whereas leadership tends to be described more in terms of qualities and behaviours. Although there will be some crossovers with the description, management is generally considered to be about a set of processes that ensure the organisation functions; the focus is generally on the tasks that need to be achieved. Leadership, however, is considered a multifaceted process that inspires, influences and motivates individuals towards a common goal. The goal, in this case, is a positive workplace culture that supports the delivery of effective, high-quality and safe person-centred care. The RNA, as a respected team member, may have as much power over the workings of a team as those in a position of power due to their job title.
There has been much debate over the skills and qualities needed to be a leader, along with discussion and debate over different styles of leadership. In addition, there is the nature versus nurture debate: is leadership something you can learn, or is it dependent on innate qualities and behaviours? This is an interesting debate when we consider the RNA and where learning can occur. It was advocated by Van Dam and Ford (2019) that nursing leadership is developed through the day-to-day experience of social interaction. When considering seminal work such as that by Benner (1984), it can be seen that much of the learning for nursing and about nursing is achieved via experiential learning.
The knowledge, skills and behaviours needed to deliver safe and effective patient care are learnt and developed in the clinical environment. With the fast-paced nature of current health care, continuous learning, growing and adapting is a key feature. The question, however, is ‘how does this learning actually occur’?
The NMC (2018c) requires RNAs to continually reflect, develop and address areas for improvement as part of the revalidation process. Considering this requirement to actively engage in reflection, developing self-awareness may be a good starting point for looking at leadership skills and qualities.
Conducting a self-assessment to develop an understanding of one's own skills and qualities is the first step towards leadership development. Obtaining feedback from others, formally or informally, is useful to help gain insight into how the RNA is viewed by others; receiving constructive feedback can support the RNA to grow in confidence by identifying strengths and in competence by identifying areas for development.
It is important that the journey does not stop here. Identifying strengths and development areas is important, but then an active decision is needed in relation to building on the strengths and developing new or improved behaviours and skills. Although the RNA needs to be a role model and supervisor, identifying their own role models and supervisors will support them in developing their practice. Within the workplace, clinical leadership practice can be developed and applied within context with continual reflection to facilitate professional development and personal growth (Van Dam and Ford, 2019).
Leadership is a fundamental feature of the role of the RNA, to support effective, high-quality, safe person-centred care and teamwork. Being a confident and competent leader is not going to follow from one teaching session on leadership or from one day applying the theory to practice; connecting with people within the workplace to gain feedback or observe as role models will support the journey.
The NMC (2018a) makes it clear that the RNA has a responsibility to develop and apply leadership skills and qualities to practice. In addition, there is the requirement for the ongoing development of these skills and qualities through reflection to support ongoing practice and revalidation. Confidence and competence will come with applying the skills and behaviours to everyday practice over time.