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Transform your leadership

Waterbury, Susan, MSN, ACHPN, FNP-BC

doi: 10.1097/01.NUMA.0000488866.63732.dd
Department: Performance Potential

Susan Waterbury is a geriatric nurse practitioner for Alpha Bridge Clinicians in Melbourne, Fla., and a faculty member at University of Phoenix.

The author has disclosed no financial relationships related to this article.



In today's rapidly changing healthcare environment, it isn't enough to have a vision and mission; organizational leaders must also practice this vision and mission daily. The role-modeling of desired behavior sets the standard for performance and gets team buy-in for initiatives and innovations. We don't just have the title of leader; rather, we must be passionate about the vision and mission, and have the ability to convey our excitement so that our direct reports see the value. However, training is often focused on management aspects of the leader role, with little preparation for transformational leadership.

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Be emotionally intelligent

In addition to expert clinical skills, nurse leaders must also be able to navigate interpersonal issues and organizational priorities, creating a team of dedicated and engaged followers. Emotional intelligence (EI) plays a major role in the ability to adapt to the challenges and pressures of an often chaotic environment while meeting the needs of our direct reports. EI is defined as “the ability to integrate cognitive processes and feelings to intelligently adapt behavior and manage situations.”1 This requires a self-awareness of strengths and weaknesses, self-management skills, adaptability, and self-confidence. Interpersonal relationships that develop trust are essential.

The qualities of good followers include judgment, work ethic, competence, honesty, discretion, loyalty, and ego management.2 These qualities must be identified and developed because your high-performing direct reports are your organization's future leaders. To maintain high-quality nursing, a supportive practice environment must be established. Characteristics of a supportive nurse practice environment include:3

  • teamwork between nurses, physicians, and ancillary staff is promoted and encouraged
  • nurse leaders are present at the policy-making table (RN administrators)
  • frontline nurses are present in unit and organizational decision making
  • staffing policies have been improved
  • there's continuity of patient care assignments
  • double shifts and long work hours are avoided
  • in-services and continuing-education programs are offered
  • high standards of nursing care are expected.

The Robert Wood Johnson Foundation implemented Transforming Care at the Bedside to improve patient care and the hospital work environment.4 Recommendations include changing the culture in which nurses practice so that frontline staff members are valued for their innovations and ideas about improving patient care and increasing job satisfaction. Improvement processes focus on transformational leadership, safe and reliable care, vitality and teamwork, patient-centered care, and value-added care processes.4

Accurate evaluation of leadership abilities and self-assessment are the foundations of improvement. From assessment, a plan to cultivate leadership competencies and EI can be developed. Leaders should be evaluated by a wide variety of team members, such as through a 360-degree evaluation process.4 The feedback gained can be used to improve practices.

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Be transformational

Transformational leadership is a Magnet(r) model component that promotes quality nursing management and leadership.5 It encourages direct reports to reduce their differences and increase unity for a common goal. A shared governance model can be used to empower frontline employees to get involved and become agents of change. The Institute of Medicine's Future of Nursing report recommends that nurses work with physicians and other healthcare providers as full partners.6 Nurses must be prepared and empowered to take leadership positions, from the bedside to the boardroom.

Transformational leaders are charismatic and confident, possessing a high degree of EI. They have a vision that they're passionate about and cause others to become excited about it, too. This motivates staff members to perform at a high level, fosters involvement and accountability, and improves patient satisfaction and clinical outcomes.7 Transformational leaders are easily accessible and develop nurturing relationships with their direct reports. They role-model the behaviors they want their team to exhibit and are consistent in their words and actions. A strong sense of advocacy for patients and team members is evident. Transformational leaders genuinely take responsibility for the organization as a whole while valuing individual contributions.

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Be forward thinking

New approaches are needed to recruit and retain the talent necessary to support growth and innovation. A strong corporate culture with a professional nursing practice environment helps promote increased nurse recruitment and retention. The six components of great corporate cultures are vision, values, practices, people, narrative, and place.8 An organization must define each of these components and their significance. Careful assessment of current corporate culture, with accurate feedback from all levels, is the first step in creating a strategic plan for change. Twenty-first century leadership techniques and practices put an increasing emphasis on individual contributions to an organization, along with promotion of leadership and succession management. Healthcare organizations must learn lessons from successful innovators in various sectors. For example, Google encourages a culture in which “everyone is a hands-on contributor and feels comfortable sharing ideas and opinions.”9

Mentorship of team members is essential for retention and leadership development. A mentor helps the new employee navigate through the process of becoming a productive team member and promotes problem-solving and critical-thinking skills. Mentors also play an important role in succession management by identifying and developing future leaders. A mentor provides a safe environment for team members to feel free to verbalize questions and concerns without fear of exposure or retaliation. The mentor-mentee relationship should be goal-directed and have a process for evaluation in place.

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Be effective

To be a good leader, one must first be a good follower. Nurses hold various positions during their careers: some as a follower, some as a leader, and some as leader and follower. It isn't necessary to have an official management title in an organization to become an effective leader. There are leaders at all levels. Who are the go-to people? Who are the experts? Who are the people who act as the mouthpiece for the group? Who are the ones not happy with the status quo? These questions can help identify the leaders, both official and unofficial. Once leadership skills are identified, they need to be nurtured and developed in preparation for future leadership roles.

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1. Foltin A, Keller R. Leading change with emotional intelligence. Nurs Manage. 2012;43(11):20–25.
3. Flynn L, Liang Y, Dickson GL, Xie M, Suh DC. Nurses' practice environments, error interception practices, and inpatient medication errors. J Nurs Scholarsh. 2012;44(2):180–186.
4. Lee B, Peck C, Rutherford P, Shannon D. Transforming Care at the Bedside How-to Guide: Developing Front-Line Managers to Lead Innovation and Improvement. Cambridge, MA: Institute for Healthcare Improvement; 2008.
5. American Nurses Credentialing Center. Announcing a new model for ANCC's Magnet Recognition Program.
6. Institute of Medicine. The future of nursing: leading change, advancing health.
7. Spano-Szekely L, Quinn Griffin MT, Clavelle J, Fitzpatrick JJ. Emotional intelligence and transformational leadership in nurse managers. J Nurs Adm. 2016;46(2):101–108.
8. Coleman J. Six components of a great corporate culture.
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