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The importance of boundary management

Hampton, Debra PhD, RN, CENP, NEA-BC, FACHE

doi: 10.1097/01.NUMA.0000575308.00185.00
Department: Performance Potential
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Debra Hampton is an assistant professor and the academic program coordinator of the MSN leadership, DNP executive leadership, and MSN-to-DNP programs at University of Kentucky College of Nursing in Lexington, Ky.

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

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Nurse leaders at all levels encounter multiple roadblocks along the leadership pathway. For maximal effectiveness in leadership positions, we must be savvy in managing boundaries, including personal and professional boundaries. A boundary can be defined as a limit that's set related to what individuals will take responsibility for. Boundaries may include physical, mental, emotional, and spiritual limits. Dr. Henry Cloud clarifies that boundaries for leaders consist of a combination of “what you create” and “what you allow.”1 Leaders “define and create the boundaries that drive the behavior that forms the identity of teams and culture and sets the standards of performance.”2

Organizational boundaries can result in challenges of hierarchy, function, and ownership when individuals work in groups to achieve common goals, but they can also support the value of individuality and defined roles.3 This article addresses boundary spanning leadership and management of professional boundaries.

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Boundary spanning leadership

Boundary spanning leadership is the ability to establish direction, alignment, and commitment across boundaries within the organization to achieve goals.3 Direction involves establishing common goals, alignment relates to the coordination of effort to achieve these goals, and commitment necessitates being emotionally compelled to help achieve team success.3 It's been noted that the concept of boundary spanning evolved from systems theory, which involves the flow of information between subsystems and the environment.4 In the process of boundary spanning, leaders coordinate and regulate inputs into the system, such as people, materials, and other resources; manage throughputs; and drive organizational outputs to include products and service provided to customers.4,5

Leaders traditionally try to work with boundaries by managing vertically up or down the chain of command.6 However, a vertical management style may not work effectively in today's complex healthcare environment. It's critically important to manage across boundaries that include networks of people, information, and resources or beyond the structure of a traditional organizational chart.6 Technology has made it possible to accomplish work in new ways, such as through virtual workgroups (local, regional, national, or international), cross-functional teams, and cross-sector partnerships. Because of these new structures within organizations, traditional vertical chain-of-command models are likely to be less effective and may not result in a transformational culture.

An example of a boundary challenge in which different groups within the organization may have different goals relates to nurse staffing resource use. Clinical nurses may say that they don't have enough staff to provide the best possible care and “we need to increase staffing.” Executive leaders within the organization want to ensure that the best possible patient care is provided, but they need to consider various factors when evaluating staffing needs, including how effectively team members are working together, team member knowledge and expertise, management of variation, and efficient use of resources.

Nurses in middle management positions may understand the position of both executive leadership and frontline staff, allowing them to promote “across boundary understanding” by being intermediary communicators. However, one of the most effective ways to span boundaries in this situation is to form a resource/staffing team that includes clinical nurses and leaders from all levels within the organization. The group can establish common goals and together derive solutions that meet shared needs. In this situation, it's important for leaders at all levels to understand each other's perspective and especially staff members' viewpoints.

Organizational boundaries, whether between individuals or groups, can create challenges and impede change or, alternatively, be transformational. Boundaries may result in an “us and them” philosophy, as per our staffing example, that can have a significant negative impact within the organization.7 At the same time, boundaries can be considered as frontiers. New ways of doing things may be revealed through a better understanding of what boundaries exist, why they exist, and how they can be worked through.

Spanning boundaries that results in increased feelings of employee support can also be an energizing force and motivate team members to go the extra mile to achieve goals.8 In the staffing example, employees from all levels of the organization can define boundary issues, share insights that bring to light why the issues exist, and work through these challenges with discussion and team collaboration. Taking time to celebrate successes also fosters collaboration and helps overcome boundaries.

A three-step model for spanning boundaries includes “managing boundaries,” “forging common ground,” and “discovering new frontiers.”3 Strategies that can be used when spanning boundaries include making boundaries apparent, creating a “unifying team identity,” and building team cohesion.3 In our example, the staffing team can come together to help manage diverse boundaries, agree on common strategies, and discover new opportunities from working together that alone they wouldn't have envisioned.

Management dyads and triads are another example of a strategy that can lead to effective boundary management by bringing together the skills of various leadership experts who are adept at managing within the boundary for their area of expertise. A dyad or triad of individuals who are working together to accomplish the same shared goals can achieve more than they could if they were each working individually. Dyads may include the CNO and chief financial officer or the CNO and chief medical officer. An example of a triad structure includes a nursing leader, a finance leader, and a medical staff leader. Multiple other dyad or triad working partnerships can be established depending on organizational needs, which helps promote trust and collaboration within the organization.

Another model that offers guidance for effectively spanning boundaries is Posner and Kouzes's “Five Practices of Exemplary Leadership.”9 To be effective boundary spanning leaders, we must be able to “model the way” by unraveling “bureaucracy when it impedes action” and by putting up signposts “when people are unsure of where to go or how to get there.”9 We can also “inspire a shared vision,” “challenge the process,” “enable others to act,” and “encourage the heart” by keeping hope and determination alive in the organization—all behaviors that are the essence of transformational leadership.10-12

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Professional boundary management

Many nurse leaders have 24-hour accountability and responsibility for their department or unit(s). For leaders in healthcare settings who are responsible for departments that provide care 24/7, professional boundary management can be a challenge. Boundaries can be apparent and tangible or emotional and intangible.13 Professional boundaries have multiple benefits, including clarifying who has responsibility for specific work, preserving physical and emotional energy, and helping us set limits.13

A typical nurse manager's day may begin at 6:30 a.m. or earlier as he or she arrives at work and converses with nurses on the offgoing shift to learn about what happened over the past few hours and understand the unit's or department's needs for the day. The manager may have a 7 a.m. huddle with the oncoming day-shift staff and by 8 a.m. be required to attend a daily hospital leadership meeting. The remainder of the day may be filled with more meetings; quality improvement audits; patient rounds, which can take several hours depending on the size of the department; and multiple other tasks, such as addressing staffing needs, following up on concerns, and working on unit records/payroll/schedules. Five o'clock is here all too early and there's still work to do. At a point, boundaries need to be set, including a determination of what can be delegated, what can be delayed until the next day, or what's currently of lower priority.

To ensure that we're performing our best at work, leaders must remain healthy and resilient. Respecting the professional boundaries of others helps promote a culture of self-care within the organization. Stated simplistically, resilience is the ability to overcome challenges, keep a high level of energy, and remain positive. Leaders who are resilient maintain a “glass is half full” philosophy and see issues as opportunities. The ability to overcome challenges, while still having a positive attitude, is key to leadership success in today's challenging times.14 As leaders, we can be our own worst critics; we hold high performance expectations and don't include room for failure in our repertoire. Taking time to be proud of our accomplishments and celebrate our own successes, as well as those of our team, is very important. When things don't turn out the way we want and the outcome isn't ideal, being able to create a new plan and move forward illustrates resilience.

Gionta and Guerra identified four steps that leaders can follow to maintain professional boundaries and, in turn, help facilitate resilience.13 The first step is recognizing and identifying your limits through attention toward what you can tolerate compared with what makes you uncomfortable and stressed. For example, some leaders may be willing to accept working 10 hours a day, 5 days a week, but once work hours go up to 12 per day, including working on the weekend, it's past time to say, “I'm exceeded the limit and I'm drawing the line.” The second boundary setting step involves paying attention to your feelings. Red flag feelings include discomfort, resentment, and guilt. To gauge when boundaries need to be set, think of feelings on a continuum of 1 to 10. Once we feel that we're at midpoint or beyond in relation to experiencing negative feelings, it's time to start setting boundaries. Third, leaders need to give themselves permission to set personal boundaries and accept that they aren't perfect to reduce feelings of guilt. We may think we're expected to accomplish far more than our boss or organization expects us to. A fourth strategy is to consider the environment or situation. Of course, we don't want to leave a crisis or safety situation unresolved, but once the situation it stabilized, it's okay to think of your own health and emotional safety.

At times, you may need to have a meeting with your supervisor about the boundaries around your role in the organization. When preparing to have a negotiation meeting, first think about the outcomes you want to achieve and what you will and won't agree to.15 What's the minimal outcome you'll accept and what's your ideal goal? Practice or role-play the negotiation discussion you plan to have with your supervisor with a colleague you trust before you go to the meeting and talk with a mentor or refer to the literature to learn about how to be a successful negotiator.

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Success and resilience

Effective boundary management, whether being adept at spanning boundaries within the organization or setting limits related to work responsibilities, is a required competency for nurse leaders. While we and our organizational teams are setting boundaries, so are other individuals and teams. Being aware of what these boundaries are and where they exist is a must before you can manage them, as well as boosting your resilience. Leaders who are experts at managing and traversing boundaries will not only be more successful, but also more resilient.

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REFERENCES

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