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Exemplary Nursing Leadership

David Anthony Forrester

This book is first and foremost about nursing leadership. But it is also a book about nursing’s distinguished history of activism and its impact on society. It is a collection of biographies of some of nursing’s most revered leaders. By sharing their stories, the contributing authors are inviting you to learn leadership by example from the exemplary leadership practices and behaviors of these nurses.

Today, more than ever, we need nurse leaders. One of the key messages of the Institute of Medicine’s (IOM’s) report The Future of Nursing: Leading Change, Advancing Health (IOM, 2011) is, “Nurses should be full partners, with physicians, and other health professionals, in redesigning health care in the United States” (p. 8). Whether on the front lines of nursing practice, administration, education, research, or policy making, nurse leaders are needed to transform the health care system and, therefore, advance the health of society. In the health policy arena, nurses must reconceptualize their roles to be policy makers and have a visible and vocal presence on advisory committees, commissions, and boards. Only then will nurses be full partners in advancing the nation’s health systems and improving patient care (IOM, 2011).

WHY STUDY EXEMPLARY NURSING LEADERSHIP WITHIN THE CONTEXT OF NURSING HISTORY?

Why not study nursing leadership within the context of nursing’s history? Nursing history is replete with examples of extraordinary achievements accomplished by nurse leaders who were oftentimes confronted by the most challenging of circumstances, and yet, not only did they manage to persevere, they actually succeeded beyond all reasonable expectations. Their lived experiences have value for us in that they advanced nursing and society in their times and, therefore, have had a lasting effect on us both as citizens and as nurses in contemporary society. We are, in fact, the “better future” they envisioned and inspired others to work collectively to achieve.

Early leaders in American nursing promoted the study of nursing history and advocated for its inclusion in nursing curricula. Among these early leaders were M. Adelaide Nutting, Lavinia L. Dock, and Isabel M. Stewart. They all became noted authorities on nursing history through their classic publications on the subject: A History of Nursing: The Evolution of Nursing Systems from the Earliest Times to the Foundations of the First English and American Training Schools for Nurses (Nutting & Dock, 1907), A History of Nursing: From the Earliest Times to the Present Day with Special Reference to the Work of the Past Thirty Years (Dock, 1912), A Short History of Nursing (Dock & Stewart, 1925, 1938), and The Education of Nurses (Stewart, 1943). They dedicated themselves to fostering a greater understanding of, and respect for, nursing’s distinguished history and believed that understanding and dealing with problems and trends in nursing practice and education requires nurses to be familiar with their history (Donahue, 1985).

If the study of history is necessary for our education to be effective citizens, then the study of nursing history is worthwhile and necessary for effective nurses who are, or wish to become, exemplary leaders. Historical knowledge of nursing’s leaders, even though they may have lived long ago and far away, constitutes a carefully and critically constructed collective memory for nursing. The way things are now in nursing and society descended from the way things were before.

Our history is our “collective memory” and by studying our collective memory in nursing, we have the potential of developing insight and, even perhaps, wisdom. It is this learned insight and wisdom that may permit us to better achieve our intended goals of advancing nursing, health, health care, and, ultimately, society. To achieve these goals, we must study our history and the leadership practices and behaviors of those who led us to where we are today.

There is one more reason to study nursing leadership within the context of nursing history—it is fun. By studying nursing history, we are given the opportunity to not only confront and make sense of complex leadership challenges encountered by nursing leaders long ago but also learn from them, their experiences, and the exemplary leadership practices and behaviors that helped them persevere and succeed.

WHAT IS LEADERSHIP AND WHAT IS EXEMPLARY NURSING LEADERSHIP?

Leadership, itself, is a topic about which much is written but little is actually known with any degree of certainty. We have difficulty actually defining leadership but are usually able to identify leadership when we have observed it or experienced it in our own lives.

The consensus view of the contributing authors of this book is that leadership is a set of specific intentional practices and behaviors for the purpose of influencing others and maximizing their efforts in achieving a valued and mutually agreed-upon goal. Key elements of this definition are that leadership (a) is an intentional process; (b) involves specific intentional practices and behaviors; (c) is purposeful in influencing others; (d) requires the active participation of others; and (e) includes a valued and mutually agreed-upon goal, not simply influence with no important or intended outcome. Exemplary nursing leadership is active, future oriented, and produces change. Exemplary nurse leaders are, therefore, activist agents of change who strive for a better future for nursing, health, health care, and society.

Assumptions About Leadership

In writing this book, the contributing authors made certain specific assumptions about the nature of leadership. These assumptions include the following:

WHAT IS THE DIFFERENCE BETWEEN NURSING LEADERSHIP AND NURSING MANAGEMENT?

In the nursing literature, there are often references to leadership followed by a discussion of management. Although nursing leadership and nursing management are related concepts and have several commonalities, they are not the same. Nursing leadership focuses on people and inspiring trust. Nursing leadership is concerned with identifying and communicating passionately held values and principles, modeling expected goal-directed behavior consistent with those values and principles, inspiring and communicating a shared long-range vision for the future, challenging the status quo through innovation and sometimes rule breaking, and facilitating and celebrating others’ successes. Nursing management focuses on organizational systems and structure and relies on control. Nursing management is concerned with a short-range view in accepting and maintaining the status quo through rule following and rule enforcement. Although many of the nurse leaders profiled in this book were also excellent nursing managers, it is through their exemplary leadership and their significant and enduring impact on the nursing profession, health, health care, and society that they are best known.

Included in this book are the life stories of some of the most renowned nurse leaders in history. These women were activist agents of change not only within the nursing discipline but also within our larger society. The many accomplishments and outcomes achieved by these nurse leaders transcend the contexts of time and place. The impact of their many contributions on contemporary nursing and society make their stories as relevant today as when they were actually being lived out so long ago. Not only are they relevant today, these nurse leaders’ stories provide us with guidance in imagining the future of the nursing discipline and potentially the future of health, health care, and society.

WHAT ARE THE ESSENTIAL TRAITS OR CHARACTERISTICS OF EXEMPLARY NURSE LEADERS?

Some contemporary leadership theories emphasize the actions of leaders more than their personal traits or characteristics. But at least pondering the notion that some individuals are possessed of certain innate traits/characteristics that contribute to their success as leaders is irresistible. Underlying the trait/characteristic approach to identifying leaders, or people with leadership potential, is the assumption that some people are “natural” leaders and that they are somehow endowed with certain personal traits/characteristics not possessed by others. Whether true or not, the contributing authors who wrote the biographies of the nurse leaders profiled in this book all agree that these nurses were all activist agents of change, possessed of certain characteristics essential to exemplary leadership, such as the following:

These exemplary leadership characteristics are referenced time and time again throughout this book. Perhaps you will want to add to the list as you learn more about the nurse leaders whose stories are told here.

FIVE PRACTICES OF EXEMPLARY NURSING LEADERSHIP

According to Kouzes and Posner (2012), there are five evidence-based practices of exemplary leadership: (a) modeling the way, (b) inspiring a shared vision, (c) challenging the process, (d) enabling others to act, and (e) encouraging the heart. These practices are evidence based in that they are derived from more than 25 years of research and observations of leadership behaviors by scholars from around the world. Embedded in each of these exemplary leadership practices, there are at least two sets of essential behaviors or actions that leaders must demonstrate in order to lead (Kouzes & Posner, 2012). Kouzes and Posner refer to these behaviors/actions as the “ten commitments of exemplary leadership” (Kouzes & Posner, 2012, p. 28). These five practices and 10 commitments of exemplary leadership serve as a framework for analyzing the leadership practices and behaviors of the nurse leaders included in this book.

Of course, there are inherent risks in using a contemporary leadership model as a framework to analyze the leadership practices and behaviors of nurse leaders who lived long before the model existed. We know that leadership, like all things, occurs within its time and context. But as Kouzes and Posner (2012) note, although the context of leadership may change dramatically, the content of leadership does not. The fundamental behaviors and actions of exemplary leaders remain essentially the same—past, present, and future. So, the life stories of the nurses included in this volume are just as relevant today as when they were lived out so many years ago.

Modeling the Way

By “modeling the way,” exemplary nurse leaders create and model standards of excellence, thus setting an example for others to follow. Modeling clear values and principles is essential in establishing expectations for the nurse leader and others. Communicating a clear set of values is essential for building a vision for the future and is the basis for everything else an excellent leader will do. Setting the example by actually living one’s values and principles is essential in establishing credibility as a nurse leader. Complex change can be overwhelming, and nursing leaders may have to set interim goals so that “small wins” can be achieved while working toward meeting larger objectives—“victories.” Exemplary nurse leaders often must unravel bureaucracies when the bureaucracies impede action and progress toward shared aspirations. By modeling shared values and behavioral expectations, they put up “signposts” showing others where to go to achieve a shared vision and how to get there (Kouzes & Posner, 2012).

Exemplary Leadership Commitment 1: Clarifying “Values by Finding Your Voice and Affirming Shared Values” (Kouzes & Posner, 2012, p. 42)

Exemplary nurse leaders provide opportunities for their constituents to hear, observe, and understand their values. A clearly understood and communicated set of values provides a foundation on which a vision of the future can be built. In the process of value clarification, effective nurse leaders must first engage in the introspective process of looking inward and taking the time to identify and prioritize their values. Leaders then create shared values by “finding their own voice” and communicating their guiding values and principles in language and behaviors that can be modeled for others so that they are easily understood. Exemplary nurse leaders ensure that others know what they represent by speaking passionately in their “own voice” (Kouzes & Posner, 2012).

Exemplary Leadership Commitment 2: Setting “the Example by Aligning Actions With Shared Values” (Kouzes & Posner, 2012, p. 42)

Exemplary nurse leaders “live their values,” by integrating them into everything they do. To ensure a clear understanding of their values, they engage others through open communication, seeking input by asking and answering questions, providing meaningful feedback, and reflecting on what they learn. Effective nurse leaders continuously refine their values and the manner in which they model them. They model actions consistent with their values simply by doing what they say they will do. Nurse leaders encourage others to share their values and model the way by setting a credible example, sharing stories and examples that illustrate their values, and identifying behaviors and situations that are inconsistent with their shared values (Kouzes & Posner, 2012).

Florence Nightingale (British; 1820–1910)

The most famous nurse leader in nursing’s distinguished history, Florence Nightingale (Chapter 2), certainly engaged in the exemplary leadership practice of modeling the way and abided by the first two leadership commitments of clarifying values and leading by example. Nightingale came to be acclaimed as the founder of modern nursing. A pioneer as well as celebrated social reformer, Nightingale performed a mission of service to humanity throughout her life. She became prominent for training nurses and providing nursing care to British soldiers during the Crimean War. In fact, her persona as the “lady with the lamp” making nighttime rounds of wounded soldiers made her an icon of Victorian culture. But Nightingale made numerous other contributions, including sanitary reform in India, reform of the military health care system in Great Britain, hospital planning, pioneering work in statistics, and the development of a formal nursing educational program based on sound professional standards. She accomplished all of these things in spite of the strict social restraints placed on women in Victorian England.

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