The knowledge organization shares, provides, and grows the information necessary to work efficiently and effectively. In organizations such as these, the ideas of leadership at the top and leadership equated with the power of a position are obsolete notions. Knowledge workers with the expertise and information to act are the organization's leaders. They provide the service, interact with the customer, represent the organization, and accomplish its goals.
Knowledge workers work in the information age, where the rapid, instant access to information makes information the medium of exchange. Knowledge workers are valued for what they know. The development of new knowledge and innovation and meaningful interpretation and application becomes the source for transactions with patients and staff. Nursing's transition to the information age has occurred in the context of rapidly advancing technology and nanotechnology and been influenced by three key trends: mobility, virtuality, and user‐driven practices (Porter O'Grady, 2001).
Mobility refers to the ability to do work in convenient places using telehealth rather than working at fixed places, which may or may not be convenient. Technology has enabled mobility with the development of the small computer chip. Nurses work in a variety of settings today and use portable computers in wireless phones and computers at the bedside.
Virtuality means working through virtual means using digital networks, where the worker may be far from the patient but present in a digital reality. Telemetry monitoring and telehealth care by nurses are examples of virtuality.
User‐driven practices mean that, at a time when digital mediums have given us more access to information and therefore more choices, the individual acts more independently and is increasingly accountable for those choices and actions. Nurses use electronic devices for self and patient education and teach patients to use digital monitors for self‐care.
Nursing leadership practices are evolving to match nurses' work within this mobile, changing environment, with nurses as knowledge workers who can make decisions and take action. This is facilitated by the growth and sophistication of nursing research, the application of nursing science, and the translation of available evidence into evidence‐based nursing practice. Nurses are able to display the rich and valuable contribution that their knowledge and expertise make to the quality of patient care and to quality health care outcomes.
Using Knowledge
Good nursing leadership and management of patients includes getting to know the patients; spending time assessing normal behavior, physiological and psychological responses to illness and hospitalization; and using knowledge to recognize even subtle changes in the patients' conditions and further evaluate them. Another key aspect of using knowledge is developing the ability to anticipate patient care problems. When a nurse intervenes with a postoperative patient who is bleeding from his incision by applying pressure at the site, the nurse minimizes the amount of bleeding. Using knowledge and anticipating such complications assists a nurse to intervene correctly. Thinking in advance about what should be done if a particular complication should occur, and then monitoring the patient to assess and identify complications early or, when possible, to prevent them, is one way that nurses apply their knowledge. Another aspect of using knowledge for good leadership and management on the patient care unit is to have the right type of personnel and the right amount of personnel; in other words, having patient care unit staffing with enough registered nurses, licensed practical nurses, or nursing assistants on the unit, so that they all can fulfill their roles appropriately with enough people to adequately care for the patients.
Nurses develop their leadership and management skills with continuing education and by increasing their knowledge and expertise in caring for a group of patients by taking care of those patients regularly. The more experience a nurse gains in caring for a population of patients, the more opportunity the nurse has to learn to recognize patterns that occur with these patients. These patterns can include the type of symptoms that are common, possible complications or emergencies, and actions that can help prevent complications or negative outcomes. Planning in advance, prioritizing time and attention, determining actions needed and what can be delegated to others are ways that nurses manage a group of patients.
Knowledgeable nursing leadership and management on a nursing unit fosters good patient care by providing a supportive environment for nurses to deliver care. A supportive leadership and management environment is characterized by a clear chain of command, clear job descriptions, evidence‐based patient care standards, appropriate staffing, accessible Internet and library resources, and continuing education support. This allows the nurse to set goals, seek a mentor, and continue employment in a setting that is supportive of high quality, safe, patient‐centered care.
Complexity Leadership
Margaret Wheatley, in Leadership and the New Science (1999), says, “There is a simpler way to lead organizations, one that requires less effort and produces less stress than the current practices.” She presents a new view of leadership, one encompassing connectedness and self‐organizing systems that follow a natural order of both chaos and uncertainty, which is different from a linear order in a hierarchy. The leader's function is to guide an organization using vision, to make choices based on mutual values, and to engage in the culture to provide meaning and coherence. This type of leadership fosters growth within each of us as individuals and as members of a group. A new model of leadership and understanding health care organizations and patient care units as Complex Adaptive Systems (CAS) has emerged from these ideas. CAS are complex, nonlinear, interactive and self‐organizing systems with the capacity for self‐renewal. The environment in a CAS is unpredictable and control is distributed with simple rules as the basis of operation. CAS are able to learn and adapt as a network of interacting, interdependent agents who cooperate in common goals and create new patterns of operating (Plowman & Duchon, 2008).
Complexity leadership is the new model where leadership is described as transformational, collaborative, self‐reflective, and relationship based. Complexity leaders see people in organizations as self‐organizing and self‐renewing and envision work occurring through relationships. This optimizes autonomy at all levels because the relationships among the individual and the whole are strong. For nursing, such relationships might provide the infrastructure that will foster interprofessional decision making and strengthen the connection with other health co‐workers.
In Wheatley's subsequent book, Finding Our Way: Leadership for an Uncertain Time (2005), she discusses how humans learn best when they are engaged in relationships with others and can exchange knowledge and expertise through informal, self‐organized communities. Wheatley refers to these as communities of practice and encourages us to develop new leaders using communities of practice. Her notion of a community of practice represents several elements nurses are familiar with, that is, forming informal groups, using a group process of organizing, using principles of learning, and sharing information. What is unique in her description of these communities of practice is that they form via self‐organization. They come together naturally. What makes these communities of practice different from informal groups is Wheatley's characterization of a community of practice built from relationships and participation in a way that connects nurses and allows the creation of meaning from information or the exchange of knowledge. One example of the concept of a community of practice is a group of nurses and physicians who work together to identify the best evidence to establish efficient patient flow through the emergency department to admission to the hospital. In work done for the Center of Creative Leadership, communities of practice are described as being different from the ideas or experiences we have had with groups, teams, and collective forming, because communities of practice emerge from shared activity, shared knowledge, and ways of knowing that create meaning and thus a culture of engagement, participation, and relationships (Drath & Palus, 1994). Wheatley directs nurses to name these communities of practice that bring people together, support these connections, nourish the community, and illuminate their work. These exciting notions hold great promise for health professionals as we learn how to collaborate within and across disciplines and countries to advance health care practices.
Servant Leadership