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Journal of Nursing Administration:
doi: 10.1097/NNA.0b013e31826193d2
Departments: Magnet(R) Perspectives

Transformational Leadership: Visibility, Accessibility, and Communication

Clavelle, Joanne T. DNP, RN, NEA-BC, FACHE

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Author Information

Author Affiliation: Vice President, Patient Care Services/Chief Nursing Officer, St Luke’s Health System, Boise, Idaho.

The author declares no conflict of interest.

Correspondence: Dr Clavelle, St Luke’s Health System, Treasure Valley, 190 E. Bannock St, Boise, ID 83712 (

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The chief nursing officer of a Magnet® organization is a dynamic, transformational leader who develops and communicates a strong vision for nursing excellence and creates a foundation for exemplary nursing practice and excellent patient care. Transformational leadership is a core component of the Magnet Model®. The 3rd subcomponent—visibility, accessibility, and communication—is the focus of this article.

The Magnet Model®1 and the American Nurses Association Scope and Standards of Nursing Practice for Nursing Administration2 describe transformational leadership (TL) as striving for open communication and fostering change in an environment of shared leadership and decision making. A TL style, first identified by Burns3 and later Bass and Riggio,4 is aligned to 5 leadership practices: modeling the way, challenging the process, encouraging the heart, inspiring a shared vision, and enabling others to act.5 Enabling others to act and modeling the way are top practices of Magnet chief nursing officers (CNOs), ensuring that nurses work in an empowering environment while leading by example.6,7 The CNO must develop and communicate a clear vision, build effective structures for shared decision making, foster innovation, and lead the organization forward to meet strategic priorities.8-10 Chief nursing officer communication style and effectiveness influence nursing performance, work environment, and patient care outcomes through the CNO-nursing relationship.11-13

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Chief nursing officers are increasingly challenged to be visible and accessible with frontline nursing staff in today’s environment of rapid change and increasing complexity.

As CNO for St Luke’s Health System Treasure Valley for the past 5 years, I would like to share tactics that have been beneficial in balancing these demands with a focus on relational transparency in communications and ways to increase visibility and workforce commitment through structural empowerment for nursing engagement.

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St Luke’s Health System

Founded in 1902 as a 6-bed frontier hospital in Boise, Idaho, St Luke’s Health System Treasure Valley is comprised of 2 hospitals (548 beds), 90 provider-based clinics, 5 regional cancer centers, home care and hospice services, and 3 ambulatory surgery centers serving a population of approximately 750 000. St Luke’s is a 3-time Magnet®-designated organization with 2060 RNs.

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CNO Visibility and Accessibility

To achieve face-to-face visibility, I round with nurse leaders on a weekly basis (rotating campuses) and attend staff meetings to present content and facilitate roundtable discussions. I lead and/or attend monthly shared governance meetings for the Nursing Practice, Leadership, Education, Quality, Operations, Coordinating, and Research Councils, as well as core team meetings (eg, Magnet and HCAHPS). I also attend local and regional nursing specialty conferences, nursing retirement celebrations, and new employee orientation. Nurse’s Week provides opportunities to emphasize the role of the CNO and the vision and strategic plan for nursing. It is also a great time to celebrate accomplishments and inspire the nursing workforce.

In addition to personal interaction, I utilize mailings to nurses’ homes to enhance my CNO reach. Examples include the Nursing Annual Report, congratulations cards to certified nurses and nurses with top tier performance appraisals, and those referenced in patient letters. Posting my picture on posters for patient care areas, including a summary of the Nursing Strategic Plan and hand hygiene posters, has enhanced CNO recognition. The use of video productions to present the Nursing Annual Report and kick off major nursing initiatives, such as the new nurse scheduling system, has proven to be a powerful tool to convey presence. Recently, I stopped using face-to-face employee forums to present the Nursing Annual Report in favor of video productions, augmented with the unit leader facilitating discussion and providing me with feedback from the session. In addition, e-mail is more effective than a blog to connect more personally with nurses who wish to do so.

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Communication and Direct Care RN Engagement

Shared decision making has a positive impact upon workplace relationships,10 and the foundation of St Luke’s Magnet culture has been the structural component of nursing shared governance. Through the engagement of hundreds of direct care RNs, St Luke’s has been fortunate to experience steady improvements in all scores related to nursing engagement, productivity, patient satisfaction, and nursing sensitive measures. Through staff nurse input, nurse-to-patient ratios were improved in more than 80% of inpatient care areas this year, concurrent with recognizing more than $3 million in staff efficiencies over the past several years.

In being fully present through focused visibility and accessibility, the CNO supports a professional practice environment fostering shared decision making and creates the mechanism for direct care nurses to shape and influence nursing, patient, and outcomes. Through the implementation of several tactics to improve communications, the CNO is able to effectively address strategic priorities and transform healthcare to meet future demands.

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1. American Nurses Credentialing Center. Magnet Recognition Program® Application Manual. Silver Spring, MD: American Nurse’s Credentialing Center; 2008.

2. American Nurses Association. Nursing Administration: Scope and Standards of Practice. Silver Spring, MD: American Nurses Association; 2009.

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12. Shirey MR. Authentic leaders creating healthy work environments for nursing practice. Am J Crit Care. 2006; 15 (3): 256–267.

13. Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing at the Institute of Medicine. The Future of Nursing: Leading Change, Advancing Health. Published October 5, 2010. Institute of Medicine of the National Academies Web site. Available at Accessed April 18, 2012.

© 2012 Lippincott Williams & Wilkins, Inc.