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Leadership and Management Problems of Nursing and Their Affects on Provision of Quality Healthcare

Leadership and Management Problems of Nursing and Their Affects on Provision of Quality Healthcare


Abstract

Leadership in nursing continues to be ignored despite the growing evidence of their potential contribution in the provision of healthcare. Also, by ignoring the problems currently faced by nurses, the healthcare sector is seriously compromising many areas of
healthcare. The lack of support and allocation of adequate quantities of funds is leading to financial breakdown of many healthcare institutes. Oklahoma is among the hardest hit states. The application of nursing leadership and management principles can help in overcoming many of the current healthcare crises. Oklahoma is one of the early examples to the gradual destruction of healthcare system of America. By understanding the problems and issues of Oklahoma healthcare and nursing home care, strategies can be devised so as to reverse and prevent any more damage from occurring.


Case of Oklahoma

Chapter I: Introduction
The concept of leadership and management has been a part of nursing profession for a long time now yet still this concept is thought to be new in the field by others. Perhaps this delay in the identification of this trait amongst nurses is due to the fact that nurses have been working under the doctors and such professionals in the healthcare sector. With time, as nurses evolve in their roles and extend their net of services within and outside the hospital boundaries, it is easier to see their role in the provision of proper healthcare to the community. Nursing therefore is a profession demonstrating leadership and management qualities, though it may have been recognized late.

As Clemmer (1999) has aptly said, "Leadership is a verb, not a noun. Leadership is action, not a position. Leadership is defined by what we do, not the role we are in… in today’s fast changing world, we all need to be leaders." (Clemmer, 1999)

The introduction of leadership and administrative management qualities are not only aims of the current nursing profession, but also the future requirements for the profession of nursing. Therefore, more and more nursing programs and initiatives are underway that are ensuring the application of nursing skills within the nursing profession. One of the goals that leadership in nursing is hoped to attain is the assurance of provision of quality care within the nursing profession.

But like any other profession, nursing requires support in many ways to ensure its quality provision of care. This support may be moral, financial, and educational and research based and institutional and governmental in placing the nursing staff as an equal contributor in the field of healthcare. Without including these important members of the healthcare system, no significant advancement can take place in it.

So what quality is there that makes us assert that nursing is indeed a leader's profession. A leader is able to visualize how to create realities from visions. They are able to identify what is the need of the situation or the environment and are able to materialize the needs to change them as are desired by the circumstances. Not only is a leader focusing on the present, but also the future and its effects, and therefore, would mean that a leader is able to objectively provide solutions to the problems by evaluating the past. It is said that no future can be planned unless we learn from our past mistakes. The nurse leaders therefore are expected to show the qualities of reflection and introspection, with the drive, ambition and vision to create achievable and challenging goals that ensure a positive future for the nursing profession. (Kitson, 2001)

In the past the administration and leadership issues in nursing have been used to define the roles of nurses in designing, managing and facilitating methods to ensure proper patient care delivery. Nurses played leaders in planning, organizing and implementing care across a broad spectrum of healthcare settings. Other issues of nursing administration included quality outcomes, staff development, strategic planning, research and management. These roles are gradually expanding with the expansion and development of the healthcare sector and the addition of various players in the healthcare game. (Galganski, 2005)

All in all, the needs of the nurses are simple. Nurses focus all their attention in providing their patients with the best care within the healthcare settings, where they aim to provide dignity and respect to their patients. They aim the institution of a system where the individual as well as group needs are met. Nurses also need recognition in part of what contributions they give to the healthcare sector and the community in taking care of the patients. These needs have been met with mixed responses around the world. While some healthcare systems of the world now integrate the nursing staff as one of their equals and include them in the various aspects of decision and policy makings, other systems have shown a marginal interest in identifying the nurses' role in the decision making processes of the health care system. (Schaag, 2001)

This lack of identification of the nurses' role is one of the continuing battles that nurses face for their identity. The nurses now believe in asserting themselves as equals to medical healthcare providers rather than acting as subordinates. Therefore, the current trends in nursing administration, training and education, all involve a major theme of leadership and management and aim to make these concepts get noticed within the healthcare systems and ministries. This leads to the topic of focus in this paper; the role that nursing managers and leaders play in the provision of healthcare and the lack of identification of their role in the healthcare sector. The paper will look in to the various problems that nursing profession is currently facing and how leadership and management in nursing can lead to changes. It also aims to identify the current areas of problems within nursing in the USA. The literature review will aim to identify the problem in context of nursing care provision in Oklahoma City. It will outline the different areas of concern in healthcare within nursing, and the different efforts that are being put together in order to identify and manage the problems. The conclusion will outline the requirements of the current Oklahoma healthcare and especially the nursing care sector and what can be done to ensure improvement in the areas. It is hoped that the paper will be able to clarify concisely the issues of nursing leadership and management and predict the future trends in the provision of quality care.


Chapter 2 - Introduction to Concept of Leadership and Management and How they Apply to Nursing Profession

Leadership and management are not very hard to integrate within the nursing profession. When viewing the responsibilities of a nurse manager in the healthcare system, the most pressing challenge is the provision of quality healthcare that is applicable to the system as well as the patient. The method of healthcare delivery and the quality of delivery is one of the prime concerns that fall under the care of the nurses. This coupled with the effects of situations such as economy, budgeting, and individuality amongst the patient's needs of the different healthcare areas according to locations and the availability of the staff, all contribute to the overall management in the nurse's supervision. Other players in the game are the consumers and healthcare plans, businesses and industries who now more than ever are one of the leading contributors and players of the system. (Schaag, 2001)

A nursing leader can be said to demonstrate the following qualities. He or she is an advocate for quality care, who knows the different aspects of nursing, ethics and values that are the hallmark of the nursing profession. A nurse leader is a mentor and a role model to those who are junior to him or her. He or she is a collaborator, a communicator, a risk taker and a visionary, aimed and focused in improving the quality of nursing quality in the institute. They are focused in empowering nurses to become the key players in the clinical settings and to remove perceptions about their inadequacy or lack of understanding about patient care and handling. (Priest, 2005) The list of requirements for being a nursing manager is large and includes many diverse aspects, and this list will continue to grow as nurses continue to take on more responsibilities and roles and strive to address their challenges.

These leaders ensure the provision of a patient centered care that is based on the establishment of professional as well as caring relationships between the patient and the nurse. The care is carried out in a creative and innovative manner, where individual needs and requirements of the patients are understood, appreciated and practiced. The nurses are expected to identify with the cultural diversity that is now one of the most debated and sensitive themes in the healthcare provision of patients. The nursing managers are responsible to provide to their patient evidenced based care, and ensure the application of sound scientific principles, deductions and observational skills. Nursing managers and leaders are therefore one of the bridges in connecting various components of the healthcare system. (Priest, 2005)

Much of these leadership and management qualities can be taught within the learning systems. It is therefore no surprise that the current nursing education syllabi include exclusively learning methodologies related to leadership and managements. Other methods include post graduate type programs and learning skills programs. Senior nurse managers and leaders can play a vital role in assuring the provision of education within the nursing system in these areas. They are the main forces to provide the future nurses with identity and caliber. But more importantly nurses are responsible to make authorities sit up and take notice about the need for more funding and better education standards and levels needed for future nurses. The introduction of incentives and scholarship programs within nursing education will ensure more leaders and managers in nursing who in turn will further propagate the profession of nursing. Introductions of commission and allocation funding in these areas will ensure good resource allocations for the nurses. (Erickson et al, 2001)

The nurses become responsible in planning ways and policies that are able to provide the patients with the best possible care while addressing the demands of the economy, the consumers and partners, the healthcare standards and the legal parameters. The situation therefore is a complex framework of ideologies, theories, facts and environmental influences, as well as the maintenance of the integrity of the nursing profession. The problems therefore run deep. Not only are these nurse managers expected to provide to all the challenges mentioned above, but also are required to maintain and enhance these performances, keeping up with the current trends as well as the future directions.

The nursing managers are one of the most important members in making a successful nursing team. They are the examples and the models which are observed, critiqued, impersonated and copied by the future nurses. The responsibility therefore is great, and it becomes even more important to ensure that nurses are properly trained in handling these issues. Schaag (2001) claims the most important of these qualities to be communication skills. It is easy to understand why, as nurses are the most approached persons with in the medical staff by all, including patients and their attendants, doctors and senior and junior medical staff etc. A good nurse is able to communicate in a most efficient manner and is able to deal with all the issues and problems that arise in dealing with these entities. The managers are looked up as holders of standards of care, maintain competency standards and keep self and others up to date with the recent developments. (Schaag, 2001)

The biggest influence that the nurses have been faced with is economy. Economical issues have led to many problems and changes within the outlook and approach of the healthcare system. With inflation of healthcare costs around the world it is not hard to expect actions such as cut downs, budgeting and allocations of funds to take place. Also, decreasing the amount of manpower and services with time has started to become a common routine measure when considering economy. The sad part is that it is usually the nurses who are the scapegoat for these economic reforms and revision policies. The management of such issues is also now a part of the jobs of the nursing managers, who have to ensure the minimum amount of input with maximum amount of output without jeopardizing the integrity of the health system's needs. The nursing managers are therefore expected to provide more with less and handle these economic and other such pressures with maximum quality of care for the patients. (Schaag, 2001)

So now to briefly outline, it can be stated that there are four areas of genuine interest and concern among the nursing managers. These critical risk management issues include delegation, staffing levels, staff competencies, and documentation systems. (Schaag, 2001)


Delegation

Delegation has become a more common term as reduction in the nursing staff increases. There are many reasons for this shortage. The reduced amount of recruitments that the healthcare systems are carrying out combined with increased job demands and decreased job satisfaction, reduced growth potentials and overall reduction in the interest in opting for the nursing profession are complicating nursing care providence around the world. This means that the nurses are now asked to do more with less time, manpower and resources, all the while ensuring proper medical care provision. Another problem lies in the difficulties that nurses face in delegating responsibility to others. This is a very sensitive assignment of responsibilities that have to be carried out with care. This increased burden of responsibility is the reason why nurses now employ non registered nursing staff as their aids in the performance of duties. This is not the right solution to the problems, as the nurses continue to point out to the authorities in vain. There is a large difference between the levels of nursing care that is provided by both. Registered nurses are superior to the non registered nurses as they are more familiar with the environments in which they carry out the provision of care, and understand the various issues of staffing and healthcare delivery. The difference in the learning styles is very obvious among the two. And therefore the current nursing management challenge lies in the abilities of the nurses in knowing how to delegate responsibility, who to assign it, and when not to do so at all. Apart from the skill factor that is so needed in the healthcare department, the managers are also required to look into other aspects such as the legal implications of assignment of duties (Schaag, 2001)

For a nurse manager to be a successful delegate, he or she must be "able to understand and apply the principles of management, have a chain of command, span of control, ascertain the licensure of the assistant personnel, determine nursing versus professional tasks, liabilities, mentorship, evaluation, and continue quality improvement." (Erickson et al, 2001) The nurse managers will be able to create an environment where delegation will be encouraged and supported, and where positive outcomes can be attained.


Staffing

One of the most important issues that are present in the current nursing scenario is the reduction of the overall nursing staff around the world. On top of that, due to economical restrictions, the number of nurses' recruitment has also decreased. This creates a challenge for the nursing manager as he or she has to ensure the provision of adequate numbers of RN and non RN staffs in every shift and maintain supply according to the needs of the facility. It is also sad that nurses in the past had not been included when it came to recruitment and staffing issues. Many short term solutions have been proposed in the past. These included sign-on bonuses, relocation coverage and premium packages. (Erickson et al, 2001) These solutions have shown mixed popularity trends, but have not helped in addressing the shortage issues. Current solutions of hiring part time and full time staff to work extra hours have no backup plans in case these options run out. The only solution understandable becomes recruitment of the staff outside of the faculty. The problems that these issues cause for the nursing managers are not so difficult to imagine. (Schaag, 2001) Even this solution is fraught with many problems and complications due to "increased patient acuities, increased medical errors, and decreasing numbers of ancillary personnel" (Erickson et al, 2001)

The current statistics are very disturbing as approximately one third of the practicing nurses have crossed the age of 50 years, with an increase in the average workforce age to 49 years. The problem lies in the fact that up till now there have been no concrete plans to address this issue. The job satisfaction in the recent years has also decreased due to loss of flexibility in timings; decreased time offs and reduced sabbaticals. (Erickson et al, 2001)

With the progression of time, nurse managers are now forced to take into consideration other trends and changes taking place amongst the nurses. Nurses now demand more off days, more time to interact with their families, less stressful jobs, integration of home and work lives, more autonomy and increased collaborative managements. If nurse managers are to ensure the maintenance of the nursing staff, they must ensure they are able to provide these demands to their employees. (Erickson et al, 2001)

This nursing shortage is also increasing within the nursing leaders. This shortage is putting extra pressure on the nursing leaders who are now looked up to change the perilous situation nursing is facing. This lack of increased awareness about their problems, there is lack of dynamic and dedicated leaders who are fighting in the higher echelons of governments for their rights and demands. This lack of leadership has resulted in the fall of popularity of the profession among the younger generation as well. The current leaders are looked up to provide leadership amongst themselves as well as to those who are junior in the profession. (Valentine, 2002)

Many theories of leadership in nursing are currently the hot topic of debate. The quantum, transformational and dynamic leader-follower relationship model theories are the first group of theories that are finding their place within the modern nursing concepts. All these theories point to the need among the nursing leaders to change, adapt and embrace new qualities that are essential to provide dynamic and successful leadership in the nursing profession. The transformational theory claims that increasing the communication between the leader and follower nurses and giving leadership control to some extent among the employees will ensure proper growth among the nurses. Current leaders are thought to be able in both the clinical as well as the administrative issues. The leaders are required to apply the theories in the clinical settings to the best of their capabilities and ensure the provision of best healthcare. (Valentine, 2002)


Competencies

The assurance of nursing competency has become one of the core issues is the current quality nursing practice scenario. Competency has become one of the most common areas of disputes and legal problems related to healthcare. It becomes the nursing managers responsibilities that staff recruited fulfills the current requirements of the nursing competency and help them bring up to date with the current trends in nursing profession. Whether these are review classes or exams or reassignments, the managers are responsible to handling issues of competency care within nursing. (Schaag, 2001) There are many literatures available that look into the various aspects of competencies within nursing, but to concisely put it, it is the nursing leader and manager's responsibilities to ensure competency within the system.


Documentation

Although a much recent addition, documentation of the various clinical procedures and records of the patients have become another responsibility of the nursing managers. The system introduced has many benefits, as it ensures quality care, fulfilling requirements of the nursing licensure committees, ensuring payment receipt for care, maintenance of voluntary accredition, and managing risks. (Schaag, 2001)

Documentation has been a bane of work for nurses as it consumes increased amounts of time in the clinical work setting. The complications arise due to the various regulatory and legal documentation procedures in addition to the patient record maintenance and progress reports. The nursing managers are now actively participating in attempts to reduce paper load and increase ease of documentations of all types. For this purpose the managers are assumed to have expertise in handling documentations, risk managements and reimbursement issues. A good documentation system will be time saving, and will help in increasing the productivity levels of nursing.


Development of Nursing Administration a Brief Review

Nursing administration has its roots from the time of Florence Nightingale, who was the first to systematically organize patient care. Another major contributor in the field is the work of Herman Finer, who was keen on creating methods that ensure better patient care delivery. Both these contributors have helped in the development of modern nursing, which now is composed of "clinical nursing care, collaborative practice, and management theories and concepts". Recent additions in lieu with current trends now include political and current market issues, and increasing consumer demands. (Galginski, 2005)

Recent developments in the nursing profession have led to the division in the managers with respect to the responsibilities they carry out. These are the first line managers or the primary care nurse managers directly engaged in producing nursing services. Following these are the coordinators, clinical nurse managers or case managers, who are responsible to coordinate the work of several units. The third category is made up of nurse executives who look after the overall operations of patient care services. (Galganski, 2005)

All these help in the provision of quality care as mentioned earlier. The nursing management knowledge is a rich knowledge of various aspects of care that includes information apart from basic scientific medical terminologies. It is in fact this humane factor of the knowledge of nursing that makes nurses proud of their nursing heritage. And it is this knowledge that in fact leads to the provision of the actual nursing care. There are many models of care present, and usually it the nursing leader who determines which method to carry out and how to do so. Nursing research is now the biggest contributor in the progress of the field.


Perilous Healthcare Condition of Oklahoma

Oklahoma is a state containing a population of 3, 547,884 residents, of which about 75% of the population is white alone. This is a state with a median age range of 36 years. (Oklahoma People Statistics, 2006) Oklahoma shows poor statistics when it comes to nursing care. The 2002 consensus showed that the number "of covered days of care for skilled nursing facility services used by Medicare beneficiaries" with part A, per 1,000 beneficiaries was 1,140, which ranks 45th in the total counting of the states. The patient staff ratio has increased dramatically, with 20:1 ratio of patients to staff in night shifts at some nursing homes. (Carter, 2001)

Oklahoma demonstrates one of the most compromised healthcares within America. This is especially the case of nursing homes. More than 80% of the nursing homes fall short in fulfilling the requirements of federal health and safety standards. The recent reports have also shown that more than one out of six nursing homes are seriously violating laws and causing actual harm to the residents. (Report to Carson, 2001)

There are many reasons for these problems. There is a serious lack of staffing in the Oklahoma nursing homes, which are leading to crippling compromises in the healthcare delivery to the patients. This neglect is affecting the overall health of the residents, including the increase in incidences of bedsores and weight loss. Currently 90% of the nursing homes are demonstrating staff shortages. With time the number of elderly admissions in the nursing homes is expected to increase dramatically. With the current problems that are visible in the nursing homes, there is concern about the future prospects of nursing care in the near future. There have been serious violations reported about many nursing homes of Oklahoma. The percentage is as high as 86%. Current reports detail that the patients in Oklahoma nursing homes receive less than 2 hours of nursing care compared to the minimum of 3.45 hours that must be given to each individual.(Report to Carson, 2001) This neglect has led to four times increased risk of developing bedsores among the patients and twice as likely to lose weight. The question that was raised by many of the reports was the possible correlation between low staff levels and the lack of quality in the provision of care. The reports also claim that the true results and statistics may be worse than stated, as many nursing homes employ volunteer staff at the time of inspection. (Report to Carson, 2001)

The report made for Carson was carried out during the time when Oklahoma was facing its scandal in the healthcare sector. The conviction of a former deputy director and a nursing home operator highlighted the increasingly complicating problems that are taking place in the healthcare sector in Oklahoma. (Carter, 2001) For many analysts, Oklahoma is an example of what is to follow, not only in the state itself, but in the rest of the states as well. Many nursing home operators may be forced to consider leaving due to the increasingly business and regulatory climate that is present in Oklahoma. Bribery and elderly neglect have been present to some extent in these nursing homes in Oklahoma, although it was in 2001 that it was actually taken seriously in to account. However, there are concerns that a zero tolerance policy that is usually adopted within the nursing homes evaluation can lead to more problems in the correct analyses of the problems. Fines that are usually imposed on small insignificant violations can be in fact more damaging to the overall working of the nursing homes. The current problem therefore is not identifying discrepancies or imposing fines, rather, it is to correct them by taking measures that prevent any problems from recurring. (Carter, 2001)

Current problems in the Oklahoma nursing care system are due to the low Medicaid reimbursements and high turnovers. The Medicaid reimbursement for each patient each day amounts to $71.77 per day compared to the $66.75 per day allocation currently presented. This is significantly different from the other states near Oklahoma where the Medicaid payment average comes to $83 per day. If Oklahoma is to match the other states’ levels, it needs $27 million from the legislature, apart from the $66.6 million from the federal funding. (Carter, 2001)

The comparison of Oklahoma with other states show marked differences in liability insurances. For example, the liability insurance per bed per year in Oklahoma is only $240 when compared to Florida, where the insurance is about $13,000 per bed per year. All these show that decreased funding, shortage of staffs and neglecting staff issues are the primary reasons for the down fall of the nursing healthcare provision in Oklahoma.


Chapter III - Nursing Implications and Interventions

The biggest and the most ignored issue within the leadership issue in nursing is that nurses at many times are not adequately ready to take up managerial or leadership roles. There is very little effort placed in psychologically preparing nurses for their roles in the higher positions. In many cases, the nurses may be good in nursing but not so in managing. The lack of identification of leadership potential among the nurses and thereby placing unfit personnel in higher posts is very risky and very problematic. This problem clearly identifies that nurses have to be properly trained through education and training before entrusted with the jobs of management and leadership. It also means that nurses must be selected for the posts keeping in mind the leadership qualities he or she possesses. (Hamel et al, 1995)

In order for nurses to actively assert their position in the healthcare sector, it is essential that they make their issues known by announcing and creating awareness about their issues. Nurses must ensure that the media not only reflects the positive contributions that nurses provide in the healthcare, but also highlight the problems that they are currently facing and what are the needs to improve the status of nurses. The nurses, especially the leaders within the profession must raise the concerns of the profession and increase the value of the profession by demanding respect from the public and the healthcare professionals. They should discuss the increased variety of contributions that nurses now provide in the field, and the nursing leaders must introduce organizations that are devoted to increasing awareness in the society. Such campaigns and advertisement strategies can also help in creating interest among the younger generation to choose nursing as their profession of choice. In the present media world, campaigning, advertisement and promotion can do wonders in putting nursing profession on the track. (Erickson et al, 2001)

It is essential to appreciate the roles that nurses play in the provision of healthcare to the patients and the community on the whole, and none can promote it or appreciate it more than the nursing managers and executives. The nursing managers now must learn new strategies, skills and methods that appreciate and value the nursing staff. Integration of human re-sourcing can help in creating a more positive image for the institute and thereby increase the image of its staff. Nursing managers are now realizing that part of a successful health care within a hospital will depend upon the costing and budgeting and incentives provided to the nurses in making them stay within the institute. Nursing managers therefore must understand and provide to the various needs of the nurses in order to ensure their job satisfaction and ensuring more recruitments in the future. Nursing managers are now realizing that opinion matters, and working for the benefit of nurses would mean communicating with them about their needs and concerns. A good job plan that caters to the needs of the nurses will be a successful one.

Nursing managers should also provide training programs to nurses in order to increase their potentials and to increase their growth within the profession. By helping nurses decide and promote their fields of interests, nurses will derive more satisfaction from their work.

Age diversity is another issue that is becoming and increasing concern for the nursing leaders. Age diversity is currently present and will continue to do so in the years to come, and with it will come the differences and the inspirations one can draw conclusions from. Currently there are four generations that are working within the profession of nursing, the veterans, the baby boomers, the generation X, and the millennial generation. These differences are not only limited to age, but to the different realities and changes that took place in times and there by the different perceptions that they have regarding life and different experiences. It becomes the nurse leader's responsibility in balancing the various qualities of the four generations and giving them adequate role and say in the different areas of nursing care and decision making. The newer generations of nurses look for the qualities of honesty, motivation, positive approach and communication skills, knowledge and support among the others in their leaders. The leaders are responsible in creating communication and resolving conflicts between the different generations so as to produce a more productive nursing unit. (Sherman, 2006)

Similar lack of application of nursing models and techniques show the demise of the Oklahoma healthcare system. Oklahoma is just one of the first states to demonstrate the pressures the current nursing homes are facing in America. This lack of resources and more utilization of the resources are going to increase, when the baby boomer population starts to become part of the nursing home admissions. Current medical recourse allocation is very low and Oklahoma demonstrates the problems it can lead to.

The identification of the issue has led to many changes and strategies within the Oklahoma healthcare sector. The Oklahoma House of Representatives have since 2002 make healthcare a priority. The state agencies have been ordered to reduce their current year expenditures by 2.1 percent. However, challenges still remain as the costs of healthcare continue to rise with time. This is mainly due to the increasing numbers of aging population with time. (Carter, 2002)

The efforts have begun to show results in some areas of healthcare. For example, the overall rankings in women healthcare provision have risen, although they are still in the low order. Many hospitals in Oklahoma have been recently converted in to critical access hospitals. The action has led to the reduction of financial losses, and increase in revenue gains in some others. The improvements in the bottom line hospitals have shown improvements and recoveries up to 81%, with the influx of positive cash flow in many cases.

The efforts continue to be developed and undertaken but there is still a long way to go for the healthcare system of Oklahoma. (Carter, 2002)


Chapter IV Summary

Current the U.S.A nurses are faced with "increased use of casual or part time nurses, and obstacles in their role so as to become a full member of the healthcare team" (Peterson, 2000) nurses in the USA are now taking active part within and outside of the country to raise awareness about the issues that face the nursing profession today. The American Nursing Association is one of such efforts, and it is currently active in collaborating with other organizations internationally. It aims to address issues such as understaffing of the nurses, safety and health issues related to the nursing profession, economic issues, workplace issues and rights of the nurses, and the provision of nursing education and competency. (Peterson, 2000)

The nursing profession is one of the major contributors in the healthcare system and the lack of recognition is leading to many complications in the quality provision of care. These in addition to the decreasing allocations of funds and increasing costs of healthcare, are making tremendous impact on the profession of nursing. Now more than ever, is the need for the government to identify and eliminate the problems faced by nurses? More investments in terms of funds and education as well as research and policy decisions are required to ensure proper health care provision. The nurses face many problems including the lack of allocation of funds, under appreciation of their contributions and neglect in recognizing their potentials, and discouraging their potentials of leadership and administration. Nurses if properly trained are very adept in handling situations of great stress and demand, and failing to recognize their potential is a serious misgiving in part of the healthcare authorities. The problems related to nursing affect all, as is evident from the example of Oklahoma nursing care system. It is very important to realize that this trend is present and continues to extend in various levels throughout the country. The authorities need to listen to the problems that nurses face today and ways to tackle them. Also they need to identify the areas of weaknesses within the nursing profession and provide solutions to their problems. Now more than ever, nurses can play an active role in providing solutions for proper healthcare provision. It is in these areas where they can exercise their leadership and management skills and help in coming up with solutions that can benefit all. Current solutions to all nursing issues now more than ever depend on a dynamic and strong nursing leadership. The nurses are now one of the key players in the provision of healthcare. It becomes the responsibility of the nurse leaders to ensure that their voice is heard and appreciated, for them and for the future generations of nurses.




References

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Alicia Priest, 2005. Born Leaders. Nurses Association of British Columbia.

Carol J. Galganski, 2005. Mapping the Literature of Nursing Administration. Journal of Medical Library Association. 2006 April; 94 (2 Suppl): E87-E91

Cheryl Peterson, 2000. Nursing International. American Journal of Nursing 2000 January Volume 100 Issue 1.

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Hamel and Glen, 1995.The Perils of Staff Promotion. Nursing Homes. Cleveland, Mar 1995. Vol. 44, Iss. ; Pg 25. 3 Pgs.

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Short and Long Term. Online Journal of Issues in Nursing Vol 6. No.1 http://www.nursingworld.org/ojin/topic14/tpc14_4.htm Accessed, 3 February 2007

Jim Clemmer, 1999. Growing the Distance: Timeless Principals for Personal, Career and Family Success. TCG Press.

Oklahoma People Statistics, 2006.
www.statemaster.com Accessed, 3 February 2007

Report prepared for Brad Carson, 2001. Nursing Home Staff Levels are Inadequate in Oklahoma. http://oversight.house.gov/Documents/20040830114759-88739.pdf
Accessed, 3 February 2007

Ray Carter, 2002. OKC Medical Briefs, January 30, 2002. Journal Record, The Oklahoma City.

Ray Carter, 2001. Our Problems Are Just Beginning? Journal Record, The Oklahoma City, 2001.

Rose O. Sherman, 2006. Leading a Multigenerational Nursing Workforce: Issues, Challenges and Strategies. The Online Journal of Issues in Nursing Vol 11, No. 2 Manuscript 2. www.nursingworld.org/ojin/topic30/tpc30_2.htm Accessed, 3 February 2007

Susan O. Valentine, 2002. Nursing Leadership and the New Nurse, University of North Carolina, Charlotte. Copyright University of Arizona College of Nursing.
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