Interview
Beginning nurses show leadership by bringing their understanding of evidence‐based practices (EBP) and by implementing them at the bedside. They are part of committees and have a voice about unit and hospital policies. Every nurse, no matter if brand new or seasoned, brings leadership qualities to the bedside. In the Intensive Care Unit where I work, assessing changes in the patient's condition, communicating with physicians, and making sure something gets done to help the patient in a matter of minutes requires leadership. This is what we do to make sure patients get the best care.
Johnny Tazbir, RN, BSN
Crown Point, Indiana
Critical Thinking 1.1
Several characteristics attributed to leaders include:
Intelligence
Caring
Self‐confidence
Respectability
Determination
Trustworthiness
Integrity
Flexibility
Sociability
Review each of these characteristics attributed to leaders. Are these the characteristics you think are important for nurse leaders? To what extent do you portray each of these leadership characteristics?
Critical Thinking 1.2
Can professional nursing standards, such as the Code of Ethics for nurses, https://www.nursingworld.org/coe-view-only, accessed January 31, 2020, serve as a substitute for leadership?
Contemporary Approach
Contemporary approaches to leadership address the leadership functions necessary to develop learning organizations. Contemporary leadership approaches include charismatic theory, transformational leadership theory, knowledge workers, complexity leadership, and servant leadership.
Charismatic Leadership Theory
A charismatic leader has an inspirational quality that promotes an emotional connection from followers. House (1971) developed a theory of charismatic leadership that described how charismatic leaders behave as well as distinguishing characteristics and situations in which such leaders would be effective. Charismatic leaders display self‐confidence, have strength in their convictions, and communicate high expectations and their confidence in others. They have been described as emerging during a crisis, communicating vision, and using personal power and unconventional strategies (Conger & Kanungo, 1987). One consequence of this type of leadership is a belief in the charismatic leader that is so strong that it becomes almost an obsession that takes over, and the leader is worshipped as if superhuman. Charismatic leaders can have a positive and powerful effect on people and organizations. Martin Luther King, Lee Iacocca, former chief executive officer (CEO) of Chrysler Corporation, and Herb Kelleher, former CEO of Southwest Airlines, are all described as charismatic leaders. This type of leader can contribute significantly to an organization, even though all the leaders in an organization are not charismatic leaders. There are also effective leaders who do not exhibit all the qualities associated with charismatic leadership. Charisma seems to be a special and valuable quality that some people have while others do not.
Transformational Leadership Theory
Transformational leadership is one of the most prominent contemporary leadership theories. Transformational leadership is defined as a process in which “leaders and followers raise one another to higher levels of motivation and morality” (Burns, 1978, p. 21). Transformational leadership theory is based on the idea of empowering others to engage in pursuing a collective purpose by working together to achieve a vision of a preferred future. This kind of leadership can influence0 both the leader and the follower to a higher level of conduct and achievement that transforms them both (Burns, 1978). Burns maintained that there are two types of leaders: the traditional manager concerned with day‐to‐day operations, called the transactional leader, and the leader who is committed to a vision that empowers others, called the transformational leader.
Transformational leaders motivate others by behaving in accordance with values, providing a vision that reflects mutual values, and empowering others to contribute. Bennis and Nanus (1985) describe this leader as a person who “commits people to action, who converts followers into leaders, and who converts leaders into agents of change” (p. 3). According to research by Tichy and Devanna (1986), effective transformational leaders identify themselves as change agents; are courageous; believe in people; are value driven; are lifelong learners; are able to negotiate complexity, ambiguity, and uncertainty; and are visionaries. Yet transformational leadership may be demonstrated by anyone in an organization regardless of his position (Burns, 1978). The interaction that occurs between individuals can be transformational and motivate both to a higher level of performance (Bass, 1985).
Transformational leadership at the organizational level is about innovation and change. The transformational leader uses vision based on shared values to align people and inspire growth and advancement. It is both the inspiration and the empowerment aspects of transformational leadership that lead to commitment beyond self‐interest, commitment to a vision, and commitment to action that creates change. Transformational leadership theory suggests that the relationship between the leader and the follower inspires and empowers an individual toward commitment to the organization.
Case Study 1.1
A nurse is making rounds on her new postoperative laryngectomy patient. As the nurse enters the room, the patient begins to bleed from his neck incision. The nurse applies direct pressure to the patient's carotid artery with one hand and calls for assistance. Help arrives, and the patient is taken to surgery, with the nurse still maintaining pressure on the bleeding site. The patient's condition is stabilized and the patient is discharged to home a few days later.
How does nursing leadership and management on a patient care unit ensure good patient care in an emergency?
How can you develop your leadership and management skills to improve your ability to care for a group of patients?
Nurse researchers have described nurse executives according to transformational leadership theory and have used this theory to measure leadership behavior among nurse executives and nurse managers (Dunham‐Taylor, 2000; Leach, 2005; McDaniel & Wolf, 1992; Wolf, Boland, & Aukerman, 1994; Young, 1992). Additionally, transformational leadership theory has been the basis for the nursing administration curriculum and for investigation of relationships such as relationships between a nurse's commitment to an organization (Leach, 2005) and productivity in a hospital setting (McNeese‐Smith, 1997) and the ethical aspects of transformational leadership (Cassidy & Koroll, 1998). Barker (1990) also comprehensively discussed nursing in terms of transformational leadership theory. Of the contemporary theories of leadership, transformational leadership has been a popular approach in nursing and is well suited to the rapidly changing health care environment.
Most recently, the National Academy of Medicine (NAM) identified transformational leadership theory as a precursor to any change initiative and stated that transformational leadership can be a crucial approach toward achieving work environments that optimize patient safety (NAM, 2003).
Knowledge Workers
Nurses are knowledge workers. Knowledge workers are those who bring specialized, expert knowledge to an organization (Drucker, 2006, 1993, 1959). They are valued for what they know. Knowledge organizations, in which the knowledge worker is at the front lines with the expertise and the information to act, have become the dominant organizational type in the information age (Drucker,