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lww naq naq200189 february 29 2012 14 7 nurs admin q vol 36 no 2 pp 147 154 c copyright 2012 wolters kluwer health lippincott williams wilkins thetransformative power of ...

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              LWW/NAQ        NAQ200189       February 29, 2012    14:7
                                                                       Nurs Admin Q
                                                                       Vol. 36, No. 2, pp. 147–154
                                                                               c
                                                                       Copyright  2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
                           TheTransformative Power of
                           Personal and Organizational
                           Leadership
                              KarenDrenkard,PhD,RN,NEA-BC,FAAN
                               Transformational leadership has both personal and professional domains. Key concepts and re-
                               search related to transformational leadership are explored, as well as a framework for personal
                               and professional leadership, in relation to leadership of self, leadership in relation to others, and
                               leadership in relation to systems. A review of the issues and trends facing nurse executives results
                               in identification of the research gaps in personal and professional leadership as it impacts nursing
                               practice, and suggestions about potential research agenda items for executive nurse leadership in
                               practicearediscussed.Keywords:nursingadministration,researchagenda,transformational
                               leadership
                                HE PACE AND fundamental shifts in                3. Identification of the research gaps in
                           Thealthcaredelivery models and systems                   personal and professional leadership as
                           that are currently facing health care providers          it impacts nursing practice
                           call for increased focus and emphasis on ex-          4. Suggestions about potential research
                           ecutive nursing leadership. Executive nurses             agenda items for executive nurse lead-
                           and administrators will need evidence-based              ership in practice
                           leadership methods and processes to meet
                           future needs of patients across the contin-
                           uum of care. This article recaps the remarks       KEYCONCEPTSANDRESEARCH
                           presented at the June 16, 2011, North Star         RELATEDTOTRANSFORMATIONAL
                           Summit held at the University of Pennsylva-        LEADERSHIP
                           nia School of Nursing about transformational
                           leadership and the personal and professional          The Great Man theory of leadership was
                           domains of leadership. The article shares in-      the primary concept guiding all leadership
                           sights about 4 key points:                         literature prior to the 1900s and was based
                              1. Key concepts and research related to         on the thought that the masses were led
                                 transformational leadership                  by a superior few leaders.1 These leaders
                              2. A framework for personal and profes-         shapedtheinstitutionsandorganizationsthey
                                 sional leadership, in relation to leader-    led, and it was only through their high de-
                                 shipofself,leadershipinrelationtooth-        gree of intelligence, energy, and moral force
                                 ers, andleadershipinrelationtosystems        that the masses were led. As a response to
                                 (Figure 1)                                   Great Man theories, trait and behavioral the-
                                                                              ories began to emerge, followed by theorists
                                                                              analyzing situational and environmental fac-
                           AuthorAffiliation: American Nurses Credentialing                        2,3
                           Center, Silver Spring, Maryland.                   tors in leadership.     More recently in the
                           The author declares no conflict of interest.        latter half of the 1900s, integrative theories
                           Correspondence: Karen Drenkard, PhD, RN, NEA-BC,   that include goal attainment, change theory,
                           FAAN, American Nurses Credentialing Center, Silver contingency theories, and people and situ-
                           Spring, MD 20910 (karen.drenkard@ana.org).         ations have been developed.4,5 This article
                           DOI: 10.1097/NAQ.0b013e31824a0538                  focuses on the transformational leadership
                                                                                                                         147
                           Copyright © 2012 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
              LWW/NAQ        NAQ200189       February 29, 2012    14:7
                        148     NURSING ADMINISTRATION QUARTERLY/APRIL–JUNE 2012
                        Figure 1. Conceptual framework for personal and professional leadership. Copyright 2011 American
                        Nurses Credentialing Center. All rights reserved.
                        theory, an integrative theory that is transfor-    where an exchange of incentives occurs for
                                                           6                                           8
                        mational and value-based. Burns      and later     desired accomplishments.      This movement
                                         7
                        Bass and Avolio are considered the semi-           from transactional leadership to transforma-
                        nal theorists of transformational leadership.      tional leadership is based on an exploration
                        Burns defined transformational leadership           of characteristics that move beyond the trans-
                        as a “process whereby leaders and followers        actional mode of relationship. Transactional
                        raise one another to higher levels of morality     leadership was defined by Burns as having
                        and motivation.”6(p19)                             anemphasisonworkstandards,assignments,
                          Burns was one of the first leadership the-        task orientation, and task completion. Trans-
                        orists to further the notion that true trans-      actionalleadershipstyleincludedrewardsand
                        formative change occurred as a result of the       punishments based on this compliance-based
                        relationship between the leader and a fol-         form of working. While Burns proposed that
                        lower. “The genius of leadership lies in the       leadership is both a transactional and trans-
                        manner in which leaders see and act on             formational process, it was Bass, followed by
                        their own and their followers’ values and                             6 whoidentifiedthecharac-
                                                                           otherresearchers,
                        motivations.”6(p19) The evolution of transfor-     teristics of transformational leadership. Trans-
                        mational leadership emerged from an under-         formational leadership is formally defined
                        standing of leadership based on transactions,      as “a leadership process that is systematic,
                        Copyright © 2012 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
              LWW/NAQ        NAQ200189       February 29, 2012    14:7
                                        The Transformative Power of Personal and Organizational Leadership               149
                           consistingofpurposefulandorganizedsearch                                                12 andthe
                                                                              LeadershipQuestionnaire(MLQ-5X)
                                                                                                           13
                           for changes, systematic analysis, and the          AnticipatedTurnoverScale.      Astratified,ran-
                           capacity to move resources from areas of           dom sample of 1500 RNs across the United
                           lesser to greater productivity to bring about      States was surveyed. Data analysis included
                           a strategic transformation.”8(p34) Burns de-       a 28% response rate. The only demographic
                           scribestransformingleadershipas“transcend-         variable that was statistically significant was
                           ing leadership that is dynamic leadership in       whether the organization was Magnet desig-
                           the sense that the leaders throw themselves        nated or seeking Magnet status, as the nurses
                           into a relationship with followers who will        in those work settings had a lower antici-
                           feel ‘elevated’ by it and often become more        pated turnover rate than those organizations
                           activethemselves.”6(p20) Thequalitiesoftrans-      that were not Magnet designated or seek-
                           formational leadership, as described by re-        ing Magnet status. The transformational lead-
                           searchers, include the following:                  ership characteristic that had the strongest
                              1. Individualized      consideration—the        correlation to reduced anticipated turnover
                                 ability of a leader to treat each person     score was idealized influence (r =−0.39,
                                 equally, but differently, to give personal   P < .0001), the ability of the leader to pro-
                                 attention; functioning as a coach or         vide vision and a sense of mission, instilling
                                         9
                                 mentor.                                      pride, respect, and trust in the workplace.
                              2. Intellectual stimulation—the ability of      Anticipated turnover decreased as the pres-
                                 the leader to ask questions and find          ence of transformational leadership charac-
                                 waystoproblemsolve,toencouragefol-           teristics increased. The higher the score on
                                 lowers to create solutions and try new       the leadership assessment of the nurse man-
                                 ideas; questioning assumptions, refram-      ager,thelesslikelythestaffnursewastothink
                                 ing problems, and approaching old situ-      aboutleaving.Inpractice,theimplicationsin-
                                                     10
                                 ations in new ways ; including the fol-      clude screening and coaching and mentoring
                                 lowers in the generation of solutions.       leaderstodemonstrateskillsofidealizedinflu-
                              3. Charisma—a leader’s ability to gener-        ence, including acting in ways that build re-
                                 ate excitement and provide vision and a      spect, talking about values and beliefs about
                                 sense of direction.                          patient care, emphasizing the importance of
                              4. Inspirational motivation—the com-            the mission in daily work, and considering
                                 munication of the shared vision on the       moral and ethical consequences of decision
                                 part of the leader to the follower; mo-      making. In this study, staff nurses were less
                                 tivating and inspiring others by provid-     likely to leave when they had more trans-
                                 ing meaningandchallengetofollowers’          formational leadership styles evident in their
                                      11
                                 tasks.                                       nurse manager, providing evidence that the
                              5. Idealized influence—a leader’s ability        leadership style of nurse managers is an im-
                                 to behave as a role model and emulate        portant factor in reducing staff turnover.
                                 high ethical standards.
                              In an unpublished research study con-           FRAMEWORKFORPERSONALAND
                           ducted in 2005 (K.D., unpublished data,            PROFESSIONALLEADERSHIP
                           2003),therelationshipofthetransformational
                           leadership variables of idealized influence,        Personal leadership: Leadership of self
                           intellectual stimulation, individualized con-
                           sideration, and inspirational motivation was          Socrates said “Know thyself.” Without
                           examined in inpatient nurse managers to de-        knowledgeofones’ownleadershiptraitsand
                           termine the impact of leadership characteris-      behaviors, it is difficult to understand what
                           ticsonanticipatedturnoverofRNstaffnurses.          gaps or complementary skill sets might be
                           Thetoolsusedtoassesstransformationallead-          neededtocreateahighlyeffective leadership
                           ership characteristics were the Multi-Factor       style. In this context, to “knowthyself”means
                           Copyright © 2012 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
              LWW/NAQ        NAQ200189       February 29, 2012    14:7
                        150     NURSING ADMINISTRATION QUARTERLY/APRIL–JUNE 2012
                        recognizinganddistinguishingbetweenwhat               In addition to managerial partnerships,
                        you know and what you do not know. There           mentorship and succession planning are key
                        are many assessment tools in the literature        components of leadership in relation to oth-
                        that can adequately help nurse leaders assess      ers. There are multiple leadership roles that
                        their skills and strengths, as well as personal-   canbetakenonbothtoserveasamentorand
                        ity characteristics. Whether it is the Meyers-     to create a system that supports succession
                        Briggs or some other assessment tool, hav-         planning. For example, an individual nurse
                        ing data about personal leadership traits and      executive can serve as a role model, could
                        behaviors is essential to being an effective       demonstrate coaching behavior, or serve as
                        leader.                                            aninformalmentor.Thedemonstrationofap-
                                                                           preciation and recognition can range from in-
                        Professional leadership: Leadership in             formal support to the creation and develop-
                        relation to others                                 mentofmoreformalrecognitionprogramsin
                                                                           organizations. The role of serving as a formal
                                6
                          Burns was the first theorist to link the          mentor is a possibility that would assist the
                        traits and behaviors of a leader to those of       next generation of nurse executives in plan-
                        the follower, and it was this partnership be-      ning career transitions more carefully.
                        tween the two that is the basis for under-
                        standingleadershipinrelationtoothers.Lead-         Professional leadership: Leadership in
                        ership of organizations takes place both in        relation to systems
                        relation to others and in relation to the sys-        The ultimate outcome of strong personal
                        tem.Oneofthemostinterestingperspectives            leadership is the ability of the leader to work
                        about leadership of organizations in relation      within a system to create transformational
                        to others is the concept of managerial part-       change. This transformative power is un-
                        nerships. In “The Psychodynamics of Organi-        leashed only through the partnership of the
                                        14
                        zations,” Krantz   shares the concept of the       leader with the team, and moving large sys-
                        managerial partnership. Krantz suggests in-        tems through change is critical to creating a
                        cluding the superior-subordinate relationship      transformed practice environment. Nurse ex-
                        as a unit of analysis. He shares that both mem-    ecutivesmustbecomeeffectivechangeagents
                        bers of the managerial couple must accom-          and create a space where innovation can oc-
                        plish a job, but neither can control that job      cur. We need to move to demonstrating ac-
                        individually. Therefore, each must trust each      tual effectiveness through improved patient
                        other while coping with feelings of depen-         and organizational outcomes based on lead-
                        dence on the other. Krantz suggests that the       ership characteristics. It is no longer enough
                        managerialcoupleasaunitofanalysisisgener-          to work within the system as it is; in health
                        ally underrepresented, understudied, and not       care today, transformative changes need to
                        well understood. Krantz explains characteris-      happen for the future requirements of qual-
                        tics of successful managerial couples, as well     ity, cost, and service excellence. Nurse exec-
                        asfactorsthatinfluenceandimpactsuccessof            utives must have the skills and capability to
                        this 2-person field within an organization. We      transform the system, to take it to a place
                        knowthishasimplicationsfornursemanagers            where it may not want to go. One system
                        and their effectiveness on improving patient       change that many hospital nurse executives
                        outcomes. Only through a strong managerial         have taken on is to transform their nursing
                        unit will shared objectives be achieved. This      services through the process of the Magnet
                        should be a consideration in developing a re-      Recognition journey.
                        search agenda within the world of nurse ex-
                        ecutives, and the often-times neglected role       Becoming a transformational leader requires
                        of the number 2 spot in nursing executive          thoughtfulness, inclusivity, good listening skills,
                        practice.                                          flexibility, and resiliency. Whether convincing
                        Copyright © 2012 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
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...Lww naq february nurs admin q vol no pp c copyright wolters kluwer health lippincott williams wilkins thetransformative power of personal and organizational leadership karendrenkard phd rn nea bc faan transformational has both professional domains key concepts re search related to are explored as well a framework for in relation self others systems review the issues trends facing nurse executives results identication research gaps it impacts nursing practice suggestions about potential agenda items executive practicearediscussed keywords nursingadministration researchagenda he pace fundamental shifts thealthcaredelivery models that currently care providers call increased focus emphasis on ex ecutive nurses lead administrators will need evidence based ership methods processes meet future needs patients across contin uum this article recaps remarks keyconceptsandresearch presented at june north star relatedtotransformational summit held university pennsylva nia school great man theory wa...

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