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Compassionate leadership: what it means for nurses

Compassionate leadership: what it means for nurses

Richard Burnell unpicks three common myths about compassionate leadership in everyday practice 

The most recent NHS People Plan set out an expectation that organisations will use compassionate leadership to build and create a sensitive and inclusive culture for all staff and patients.1

Compassion is at the core of the ‘6Cs’ model of nursing but it is a nuanced and potentially complex concept to apply in practice. Furthermore, when compassion is spoken about in the context of
leadership, it is easy to think that it applies only to staff at senior levels. 

However, compassionate leadership is something that applies to all nurses regardless of their role. The way compassion is expressed will vary depending on the type of job a nurse does, but the fundamental principles are the same for everyone. 

All nurses are leaders
A leader can be defined as someone who has charge over a group or organisation. They are a person others look to for advice, knowledge and instruction, and also someone who can be confided in and trusted. 

While care is always given with consent, patients and service users still see nurses as people in positions of authority. They rely on nurses to give them good care, offer them advice, keep them safe and act in their best interests. They trust nurses with deeply personal information and they allow them into their homes, often when they are at their most frail.

In addition to being seen as leaders by patients, all nurses also have a duty of candour that can require them to lead in the workplace. This may involve raising concerns if there are clinical incidents, speaking up as a patient’s advocate and, in certain circumstances, even whistleblowing. These actions all entail taking the lead, and compassionate leadership should be at the core of every nurse’s practice.

It is clear that compassionate leadership is an important attribute for nurses in senior roles, but it is important to remember there is considerable leadership overlap that all nurses at all levels share.

Why is compassionate leadership important?
There is a belief that too much compassion can be a weakness and that those practising it become vulnerable to exploitation. However, this is a social construct for which there is little supporting evidence.2 By contrast, there is overwhelming evidence of a significant benefit to healthcare staff, organisations and managers where compassionate leadership is a consistent feature of everyday practice.³

There are three predominant myths that surround the idea of compassionate leadership; unpicking them can be valuable in terms of defining the term itself and in clarifying how nurses can use this attribute in practice. 

Myth 1

Compassionate leadership requires nurses to keep the patient happy by giving them what they want
According to West3, ‘compassion is sensitivity to suffering in others with a commitment to try to alleviate it’. This makes clear that the aim is to help those in distress. However, for nurses in community practice, the concept of suffering has to be understood in a broader context. 

Suppose a family member has requested three extra daily visits from the community nursing team for an elderly relative who is already receiving adequate care. If the team leader agrees to the extra visits it will compromise the team’s ability to provide home visits for other patients. 

It is true that a compassionate leader is sensitive to suffering and is committed to alleviating it. However, for nurses, this may not simply apply to the person in front of them but to the wider service. The family member may want the extra visits but, providing the patient is being adequately cared for, compassion in this case will involve consideration of other patients. While it may not be easy for a nurse to say no the person in front of them, they will demonstrate compassionate leadership by balancing the needs of the community as a whole.

Myth 2

Challenging a colleague about standards of practice and behaviour is never an act of compassion, especially if they are likely to become upset

It is never pleasant to see somebody become angry or upset as a result of a conversation we choose to have with them, but this isn’t a good enough reason to avoid doing so when important principles are at stake. 

Having the courage to hold conversations with colleagues about their performance, if done correctly, is a compassionate action. We must have the emotional intelligence to recognise any benefit accrued from the conversation will not always be instantly visible, but that our duty of candour compels us to intervene. 

Speaking to someone about poor performance does show compassionate leadership, for three main reasons: 

Reason one If no one tells a nurse they are not performing to the right standards, they are denied an opportunity to learn, grow and excel in their practice. Their mistakes may continue and potentially cause suffering to patients and colleagues. A compassionate leader looks at these potential impacts from all angles and takes action by having conversations to prevent the problems they may cause.
Reason two Imagine a reception worker in a GP practice has poor personal hygiene. If the problem is left unchecked indefinitely, the receptionist is likely to be the victim of cruel remarks behind their back, the subject of complaints by colleagues and potentially be socially ostracised. A compassionate leader will protect the receptionist from this humiliation by having the uncomfortable conversation with them. Compassion in this case is recognising that the short-term discomfort of broaching a difficult topic will help resolve the issue and prevent distress for the receptionist and their colleagues. 
Reason three When poor standards of behaviour and practice are called out instead of tolerated, a ‘just and fair’ culture is created. This in turn enhances psychological safety and improves workplace morale and motivation.4 Simply put, staff like working in an environment where rules are fairly and consistently applied, and suffer in environments where this is not the case. Compassionate leadership requires the setting of boundaries, upholding of standards and promotion of good practice among staff. Leaders who do this create a positive workplace with mutual support among staff.

Myth 3

Compassionate leadership superficially focuses on staff: it doesn’t change the things that matter in organisations

As mentioned above, the definition of compassion has the easing of suffering at its heart. Currently, staff workloads and burnout levels are extraordinarily high.5 Compassionate leaders work co-operatively and collaboratively, creating the conditions for a culture that is appreciative, caring and rewarding for staff.

Clearly, senior leaders need a deep understanding of the principles of compassionate leadership and a strategy to instill them in practice. However, the idea that compassionate leadership only relates to individual conversations and interactions is false. It can be embedded within the culture of an organisation, in the way that staff are managed, the way that staff are appreciated, and the way that people interact with one another on a daily basis.

If organisations commit to compassionate leadership at all levels, a total overhaul of working practices and management techniques is likely to be required. Radical change and compassionate leadership go hand in glove. 

Compassionate leadership is a vast topic underpinned by extensive scientific research. It has been proven to save money, improve staff wellbeing, improve quality of care for patients and save lives. 

Defining some basic principles and dispelling the myths that surround the concept are small but significant steps in working towards developing an approach where all staff share in a compassionate leadership approach to practice. This will help nurses to link their daily behaviours with the objectives of the NHS People Plan and support them as they work in the community and GP practices at a challenging time.

Richard Burnell is a trainer in the NHS and a specialist in conflict management, leadership development and effective communication for health professionals

References

  1.  NHS England. People Plan for 2020/21 – action for us all. London: NHSE, 2020
  2.  Trzeciak S and Mazzarelli A. Compassionomics: The Revolutionary Scientific Evidence That Caring Makes a Difference. 2019. Pensacola, US: Studer Group.
  3.  West M. Compassionate Leadership: Sustaining Wisdom, Humanity and Presence in Health and Social Care. 2021. London: Swirling Leaf Press.
  4.  Dekker S. (2017). Just Culture: Restoring Trust and Accountability in Your Organization. 2016. Boca Raton, US: CRC Press.
  5.  GPs are at “breaking point” and in need of respite, leaders warn. BMJ 2021;373:n1139

 

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