Developing the Role of Leader



Developing the Role of Leader


Michael L. Evans






The Challenge



Houston, known as the Bayou City, is accustomed to frequent flooding. Located 60 miles from the Gulf of Mexico, tropical storms and hurricanes are not uncommon for the region. On Tuesday, June 5, 2001, Tropical Storm Allison moved across the city and dropped 2.5 inches of rain, causing some street flooding. St. Luke’s Episcopal Hospital, a 948-bed tertiary hospital (26 stories high) in the Texas Medical Center, established an emergency command center in accordance with its emergency preparedness plan. Tropical Storm Allison then moved northward, and the skies cleared. On Friday, June 8, the storm turned and moved back over Houston, creating massive flooding and loss of power throughout the Texas Medical Center. Between 5 pm on June 8 and 5 am on June 9, 14 inches of rain fell; 36 inches of rain fell within 24 hours in northern Houston. The Bayou City was completely overwhelmed with this “500-year flood” as families fled to their rooftops to be saved by emergency personnel.


On the evening of Friday, June 8, St. Luke’s had approximately 600 patients, 110 of whom were critically ill; many were on life-support devices such as ventilators. I arrived at the hospital before flooding isolated the Texas Medical Center. I was the only senior executive on site. The evening staff was asked to stay and provide patient care, because the storm precluded the arrival of any additional help. In the early morning hours, authorities notified me that the facility would lose all electrical power within an hour. Amid an environment of crisis, isolation, and uncertainty, critical decisions needed to be made quickly. Should patients be evacuated? Who should be evacuated while elevators were still functioning? How could the safety of patients and staff be ensured? When everything is a priority, how do you decide what is truly a priority?


What do you think you would do if you were this nurse?




What Is a leader?


A leader is an individual who works with others to develop a clear vision of the preferred future and to make that vision happen. Oakley and Krug (1994) call that type of leadership enlightened leadership, or the ability to elicit a vision from people and to inspire and empower those people to do what it takes to bring the vision into reality. Leaders bring out the best in people.


Leadership is a very important concept in life. Great leaders have been responsible for helping society move forward and for articulating and accomplishing one vision after another throughout time. Dr. Martin Luther King, Jr., called his vision a dream, and it was developed because of the input and lived experiences of countless others. Mother Teresa called her vision a calling, and it was developed because of the suffering of others. Steven Spielberg calls his vision a finished motion picture, and it is developed with the collaboration and inspiration of many other people. Florence Nightingale called her vision nursing, and it was developed because people were experiencing a void that was a barrier to their ability to regain or establish health.


Atchison (2004) asserts that leaders have followers. An individual can have an impressive title, but that title does not make that person a leader. No matter what the person with that title does, he or she can never be successful without having the ability to inspire others to follow. The leader must be able to inspire the commitment of followers.


Covey (1992) identifies eight characteristics of effective leaders (Box 3-1). Effective leaders are continually engaging themselves in lifelong learning. They are service-oriented and concerned with the common good. They radiate positive energy. For people to be inspired and motivated, they must have a positive leader. Effective leaders believe in other people. They lead balanced lives and see life as an adventure. Effective leaders are synergistic; that is, they see things as greater than the sum of the parts and they engage themselves in self-renewal.




Healthcare organizations are complex. In fact, health care is complex. Continual learning is essential to stay abreast of new knowledge, to keep the organization moving forward, and to continue delivering the best possible care. There is an emphasis on organizations becoming learning organizations, providing opportunities and incentives for individuals and groups of individuals to learn continuously over time. A learning organization is one that is continually expanding its capacity to create its future (Senge, 2006). Leaders are responsible for building organizations in which people continually expand their ability to understand complexity and to clarify and improve a shared vision of the future—“that is, they are responsible for learning” (Senge, 2006, p. 340).


The roles of manager and leader are often considered interchangeable, but they are actually quite different. The manager may also be a leader, but the manager is not required to have leadership skills within the context of moving a group of people toward a vision. The term manager is a designated leadership position. Leadership is an abilities role, and it is most effective if the manager is also a leader. Management can be taught and learned using traditional teaching techniques. Leadership, however, can also be taught but is usually a reflection of rich personal experiences.


Management and leadership are both important in the healthcare environment. The problem facing healthcare organizations is that they are overmanaged and underled (Atchison, 1990). We can teach new managers, but our leaders are developed over time and through experience. Thus it is important that we value, support, and provide our leaders with the one thing vital for good leadership—good followership. Leadership is a social process involving leaders and followers interacting. Followers need three qualities from their leaders: direction, trust, and hope (Bennis, 2009). The trust is reciprocal. Leaders who trust their followers are, in turn, trusted by them.


The manager is concerned with doing things correctly in the present. The role of manager is very important in work organizations because managers ensure that operations run smoothly and that well-developed formulas are applied to staffing situations, economic decisions, and other daily operations. The manager is not as concerned with developing creative solutions to problems as with using strategies to address today’s issues. Covey (1992) believes that a well-managed entity may be proceeding correctly but, without leadership, may be proceeding in the wrong direction.



Leadership as an Important Concept for Nurses


Nurses must have leadership to move forward in harmony with changes in society and in health care. Within work organizations, certain nurses are designated as managers. These individuals are important to ensuring that care is delivered in a safe, efficient manner. Nurse leaders are also vital in the workplace to elicit input from others and to formulate a vision for the preferred future.


Moreover, leadership is key for nursing as a profession. The public depends on nurses to advocate for the public’s needs and interests. Nurses must step forward into leadership roles in their workplace, in their professional associations, and in legislative and policy-making arenas. Nurses depend on their leaders to set goals for the future and the pace for achieving them. The public depends on nurse leaders to move the consumer advocacy agenda forward.



Leadership as a Primary Determinant of Workplace Satisfaction


Nurse satisfaction within the workplace is an important construct in nursing administration and healthcare administration. Turnover is extremely costly to any work organization in terms of money, expertise, and knowledge, as well as care quality. Thus being mindful of nurse satisfaction is an economic, as well as professional, concern.


An analysis of several dozen interviews of healthcare workers (including physicians), when asked what followers desire from leaders, produced the following responses in rank order (Atchison, 2004):



The effective leader in healthcare settings needs to be aware of these important facets of work life that influence followers. The leader should also work with followers to find a way to actualize these important aspects of work life.


The leader, not the manager, inspires others to work at their highest level. The presence of strong leadership sets the tone for achievement in the work environment. Effective leadership is the basis for an effective workplace, and therefore creating leadership succession is an important consideration. This means that, in addition to supporting current leaders in their roles, new leaders must be encouraged and developed.




The Practice of Leadership


Leadership Approaches


How one approaches leadership depends on experience and expectations. Many leadership theories and styles have been described. Two of the most popular theory-based approaches are transactional leadership and transformational leadership. (See the Theory Box above.)




Transactional Leadership


A transactional leader is the traditional “boss” image. In a transactional leadership environment, employees understand that a superior makes the decisions with little or no input from subordinates. Transactional leadership relies on the power of organizational position and formal authority to reward and punish performance. Followers are fairly secure about what will happen next and how to “play the game” to get where they want to be. A transactional leader uses a quid pro quo style to accomplish work (e.g., I’ll do x in exchange for your doing y). Transactional leaders reward employees for high performance and penalize them for poor performance. The leader motivates the self-interest of the employee by offering external rewards that generate conformity with expectations. The status quo is continually reinforced in organizations in which transactional leadership is practiced (Weston, 2008).



Transformational Leadership


Transformational leadership is based on an inspiring vision that changes the framework of the organization for employees. Employees are encouraged to transcend their own self-interest. This style of leadership involves communication that connects with employees’ ideals in a way that causes emotional engagement. The transformational leader can motivate employees by articulation of an inspirational vision; by encouragement of novel, innovative thinking; and by individualized consideration of each employee, accounting for individual needs and abilities. The result of such leadership is that both leaders and followers have a higher level of motivation and a greater sense of purpose (Weston, 2008). Covey (1992) states, “The goal of transformational leadership is to transform people and organizations in a literal sense, to change them in mind and heart; enlarge vision, insight, and understanding; clarify purposes; make behavior congruent with beliefs, principles, or values; and bring about changes that are permanent, self-perpetuating, and momentum-building” (p. 287).


Kouzes and Posner (2007) identify five key practices in transformational leadership, as follows:



A transformative leader seems particularly suited to the nursing environment.


There is additional evidence in the literature that transformational leadership produces very positive results in the workplace. Robbins and Davidhizar (2007) link transformational leadership qualities with staff satisfaction, staff retention, and patient satisfaction. Raup (2008) found that nurse managers with effective leadership skills are an essential component to addressing the nursing shortage because lower staff turnover resulted from transformational leadership, although no correlation existed between leadership style and patient satisfaction. Another study found that there was great benefit in spending resources to develop clinical leaders. After transformational leadership development, the nursing team derived benefit because the more effective leadership promoted effective communication, greater responsibility, empowerment, job clarity, continuity of care, and interdisciplinary collaboration (Dierckx de Casterle, Willemse, Verschueren, & Milisen, 2008).


Another study found that a transformational leadership style was closely associated with followers’ working conditions, namely involvement, influence, and meaningfulness. This study also found a direct path between leadership behavior and employee well-being (Nielsen, Yarker, Brenner, Randall, & Borg, 2008). Marchionni and Ritchie (2008) found that the presence of a supportive culture in which learning is valued, coupled with transformational leadership, is a key factor in the implementation and sustainability of best practice guidelines.


Positive outcomes are derived from effective leadership in organizations. Transformational leadership is hard work; investment of time and energy is required to bring out the best in people. Transformational leadership is not unique to nursing as the Research Perspective on p. 41 illustrates.



Leadership is the ability to influence people to work toward meeting certain goals. Often this influence requires an ongoing commitment to role-modeling and reinforcing behaviors. The intensity of repeating such influence multiple times can be wearing. In the chaos of health care, nurse leaders face constant change and many challenges. The leader who lasts through these relationships is influential.



Barriers to Leadership


Leadership demands a commitment of effort and time. Many barriers exist to both leading and following. Good leadership and good followership go hand in hand, and both strengthen the mission of the organization.



False Assumptions


Some people have false assumptions about leaders and leadership. For example, some believe that position and title are equivalent to leadership. Having the title of Chief Executive Officer or Chief Nursing Officer does not guarantee that a person will be a good leader. Inspired and forward-moving organizations often select these executives specifically because of their ability to forge a vision and lead others toward it. However, a good executive is not necessarily a good leader. Furthermore, assuming a management or administrative role does not automatically confer the title of leader on an individual. Leadership is an earned honor and an action-oriented responsibility.


Others believe that workers who do not hold official management positions cannot be leaders. Some nursing units are managed by the nurse manager but led by the unit clerk. Leaders are those who do the best job of sharing their vision of where the followers want to be and how to get there. Many new nurse managers make the mistake of assuming that along with their new job comes the mantle of leadership. Leadership is an earned right and privilege.

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Aug 7, 2016 | Posted by in NURSING | Comments Off on Developing the Role of Leader

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