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Nursing Management:
doi: 10.1097/01.NUMA.0000403279.04379.6a
Feature: MAGNETIC PULL: SPECIALTY FOCUS MAGNET(R) HOSPITAL

Are you a transformational leader?

Smith, Mary Atkinson FNP-BC

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Author Information

Mary Atkinson Smith is a board certified nurse practitioner at Starkville Orthopedic Clinic in Starkville, Miss.

The author has disclosed that she has no significant relationship with or financial interest in any commercial companies that pertain to this article.

Healthcare in the United States is constantly changing and becoming increasing more complex. An essential portion of the recent Institute of Medicine report, The Future of Nursing: Leading Change, Advancing Health, focuses on the significance of nurses as leaders in healthcare.1 The American Nurses Association continues to encourage and support nurses to play a more proactive leadership role in the various settings in which they practice and at the state and national level.2

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Due to the continually metamorphic nature of this country's healthcare system, it's imperative for nurse managers to employ a transformational leadership style, which encourages adaptation to change. The transformational leadership style allows for the recognition of areas in which change is needed and guides change by inspiring followers and creating a sense of commitment. Adopting the qualities of a transformational leader will allow nurse managers to feel more comfortable and confident when engaging in the development of healthcare policies, the ever-changing components of healthcare technology, and the mentorship of new graduate nurses. Transformational leadership is also one of the five Magnet® components.

Transformational leadership is a theory that was developed by James McGregor Burns in 1978. He developed this theory to further address the aspects of an organization that lead to success, encourage enthusiasm among an organization's employees, and identify the values employees place on their work.3 The transformational leadership style inspires others to develop and implement effective leadership characteristics. The ultimate goal of transformat ional leadership is for the leader and the follower to discover meaning and purpose in relation to their work, in addition to growth and maturity.

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The roles

The roles of the transformational leader in the healthcare setting include promoting teamwork among staff, encouraging positive self-esteem, motivating staff to function at a high level of performance, and empowe ring staff to become more involved in the development and implementation of policies and procedures. The transformational leader portrays trustworthiness and serves as an inspiration to others, possessing an optimistic, positive, and encouraging outlook. A transformational leadership presence is vital, especially in clinical areas where new graduate nurses are present. Transformational leadership qualities promote a healthy environment for employees and staff, which will produce improved staff satisfaction, retention, and patient satisfaction.4

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The characteristics

Transformational leadership comprises charisma, inspiration, intellectual stimulation, and individual consideration.5 Charismatic leaders possess self-confidence, self-direction, and an absence of internal conflict. They have insight into their followers' needs and utilize this to positively influence their followers. An inspirational leader is motivational, sensitive, determined, and able to convey the organization's vision and encourage pride within the organization. Transformational nursing leaders in the clinical setting intellectually stimulate other nurses by encouraging the use of evidence-based practice and addressing the "why" and "how" of specific clinical actions. Four important characteristics of the transformational leader include being an effective communicator, possessing inspirational traits, having a trustworthy character, and promoting teamwork. (See Characteristics of a transformational leader.)

Effective communication. A leader who communicates effectively focuses closely on what other individuals are attempting to convey and what points are important to those individuals. Effective communicators adapt their communication style based on each individual person's ability to process and comprehend the interaction. This is important because each individual person possesses a different style of communication, and these styles vary greatly in the way incoming information is processed and perceived. It's also important to understand and have respect for diversity among various cultures. This will allow for adaptation of communication styles when interacting with people from different cultural backgrounds.

An effective communicator learns from previous experiences and applies these experiences to future interactions with others. This is also true for mistakes that have been made and realizing where a certain action should be done differently the next time around. Effective communication leads to a flourishing and vigorous atmosphere for employees and patients alike.4

Characteristics of an effective communicator include empathy, avoiding sarcasm, asking and not commanding, and avoiding talking down or up to individuals. Effective communication consists of having respect for what others have to say. This respect can be displayed by taking the time to be an attentive listener and giving others the opportunity to express their opinions, thoughts, and concerns. The Pareto Principle, also known as the 80/20 rule, states that 20% of people take up 80% of our time that involves some aspect of communication. Therefore, effective communication is vital for successful outcomes to be produced.6

Nurse managers who are effective communicators will routinely meet with the nursing staff so that complaints, concerns, recommendations, or general comments may be discussed. The nurse manager who communicates effectively will allow staff members to voice their concerns and have respect for their employees by taking the time to carefully listen to them. The nurse manager utilizing effective communication will avoid responding to staff in a sarcastic and defensive manner. This might require that you actively monitor yourself and the reactions of your staff to ensure no defensive behavior exists. Effective communication and the absence of defensive behavior will allow for the nursing staff to be more receptive to criticism and change.

Inspirational persona. During this time of healthcare reform, in addition to a strained economy, it's more important than ever for leaders to display an inspirational attitude. A survey of over 1,000 managers conducted by the British Department for Business Innovation and Skills revealed that 55% of individuals desired their leaders to possess an inspirational persona. In this same survey, only 11% of respondents said their current leader was inspiring.7

An inspirational persona consists of optimism, respect, passion, charisma, and honesty. These characteristics allow the inspirational leader to gain the confidence and trust of others, and this is crucial if a leader desires commitment and responsibility of their followers. The inspirational nursing leader possesses a very solid, patient-focused vision of where the organization or unit should be going in the future, which is clearly communicated to the staff. Commitment to a strong vision fuels and attracts winning individuals to strive to reach and maintain the vision.

Inspiring leaders regularly reflect upon themselves and have an insatiable desire for continued learning. They encourage their followers to do the same. Inspirational leaders are actively involved in the organization or unit from an actual "hands-on" perspective. They regularly make informal and personal contact with others throughout the organization or unit by talking with them, asking their opinion, encouraging feedback, and working with them directly.

Nurse managers who display inspirational leadership qualities will spend time actually working with the nursing staff. This will allow for the nurse manager to have more personal contact with staff members and encourage them to develop a sense of confidence and trust.

Trustworthy traits. Trustworthiness is a crucial trait of the transformational leader. Trust is the foundation of every healthy relationship whether it's personal or work-related. Broken trust leads to disorganization, chaos, and fear among one's followers. This is why it's imperative for transformational leaders to gain the trust of their staff. Developing and maintaining trust should be a top priority for the transformational leader. There are distinct and concrete principle elements that make up the basic foundation of trust, including integrity, courage, and stability.8

Integrity refers to having high principles, being reliable, and possessing honesty. Leaders who display integrity are consistent when it comes to their actions, values, and expectations. Courageous leaders face problems head on and don't allow fear to prevent them from doing so.9 They also protect their followers from malicious actions and are loyal to them. The principle of stability allows for the development of unquestionable confidence among staff. Stability is imperative in this constantly changing world of healthcare. The principles of integrity, courage, and stability will further encourage the evolution of trust between leaders and their followers.

A nurse manager can gain the trust of the nursing staff by avoiding dishonest actions and displays of favoritism when communicating. The nurse manager can also gain the trust of the staff by possessing honesty and sincerity. Nurse managers who demonstrate traits of trustworthiness are up front, realistic, and fair when it comes to addressing their expectations of the nursing staff. Nurse managers who possess trustworthy traits are more likely to gain the confidence of their employees.

Engagement of stakeholders. An extremely influential characteristic of transformational leadership in nursing is the act of engaging stakeholders in the leadership process. Stakeholders in healthcare include, but aren't necessarily limited to, healthcare providers, organizations, and institutions; state government representatives; healthcare industries; healthcare academia; and patients. Other stakeholders within the community who should also be engaged during times of transformation include individuals involved in healthcare administration, policy makers, media professionals, law enforcement, religious organizations, patient family members, and caregivers.

The CDC recommends the engagement of stakeholders as the first step in any type of program evaluation or potential change.10 According to the CDC, the identification and engagement of key stakeholders is vital when performing an initial program evaluation or considering reorganization because they'll ensure pivotal points are identified and addressed. This, in turn, ensures a greater likelihood of success.

A vital aspect of engaging leadership includes the promotion of teamwork and collaboration. This will create an environment in which communication is open and alternative ways of delivering healthcare services are encouraged, acknowledged, and welcomed.11,12 Engaging all members of the healthcare team fosters participation in the organization's vision, which will increase the likelihood of achieving the organization's goals. Teamwork is at the core of success.

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The implications

It's important for nurse managers to be familiar with the various nursing leadership theories that are currently discussed in the literature and determine which leadership style best reflects their own values. The leadership style utilized by nursing leaders in the clinical setting has a direct effect on nursing staff satisfaction, which ultimately has an effect on patient satisfaction.4 The presence of increased satisfaction among nursing staff leads to an overall reduction in staff turnover, improved retention, and an increase in patient satisfaction.4

With the current challenges healthcare is facing, it's vital for the nursing profession to be on the forefront of healthcare reform and fully engaged in the implementation of the changes that are expected to take place in our healthcare system.

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Characteristics of a transformational leader

* Charismatic

* Engaging

* Inspirational

* Stable

* Optimistic

* Encouraging

* Honest

* Motivational

* Respectful

* Positive

* Team oriented

* Effective communicator

* Empowering

* Reliable

* Trustworthy

* Empathetic

* Mentor

* Visionary

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REFERENCES

1. Institute of Medicine. The future of nursing: leading change, advancing health. http://www.iom.edu/Reports/2010/The-Future-of-Nursing-Leading-Change-Advancing-Health.aspx.

2. Trossman S. IOM report calls for more nurse leaders throughout health care. Am Nurse. 2010;42(6):14.

3. Barker AM, Sullivan DT, Emery MJ. Leadership Competencies for Clinical Managers: The Renaissance of Transformational Leadership. Sudbury, MA: Jones and Bartlett; 2006.

4. Robbins B, Davidhizar R. Transformational leadership in health care today. Health Care Manag (Frederick). 2007;26(3):234–239.


6. Maxwell J. Leadership 101: What Every Leader Needs to Know. Nashville, TN: Thomas Nelson, Inc.; 2002.

7. Costigan G. Research council institutes, centres, surveys, and units: a review of governance issues. British Department for Business Innovation and Skills; 2006.

8. DeGraaf D. You can trust me: five characteristics of a trustworthy leader. http://www.arrowleadership.org/alpages/services-products/articles/you-can-trust-me.shtml.

9. Hogg B. 5 key ingredients of courageous leaders. http://www.billhogg.ca/5-key-ingredients-of-courageous-leaders.

10. CDC. Evaluation manual: step 1—engage stakeholders. http://www.cdc.gov/getsmart/program-planner/Step1.html.

11. Govier I, Nash S. Examining transformational leadership approaches to effective leadership in healthcare settings. http://www.nursingtimes.net/nursing-practice/clinical-specialisms/prescribing/examining-transformational-approaches-to-effective-leadership-in-healthcare-settings/5001102.article.

12. Marshall E. Transformational Leadership in Nursing. New York, NY: Springer Publishing; 2011.

© 2011 by Lippincott Williams & Wilkins, Inc.

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