Stephen Forte Sarah Parker Melinda Winans

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Stephen ForteSarah Parker

Melinda Winans

Leading The Way

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There are many Most mentioned: transactional, transformational, laissez-faire James MacGregor Burns (1978) transactional and transformational mutually exclusive Bernard Bass (1985) stated two styles are separate but can possess both-4

components transformational: -idealized influence-inspirational motivation-intellectual stimulation-individualized consideration

Kouzes & Posner (2007-2009) expanded transformational furtherExemplary Leadership Model:

-encouraging the heart (individual’s values recognized)-enabling others to act (trust, collaboration)-modeling the way (inspirational role model)-inspiring shared vision (shared goal)-challenging the process (creativity, ideas)

Leadership Styles and History

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Transactional focus on day-to-day operation

Transformational focus on empowering staff power to staff=more power to leader

Currently transactional most common in health care

Changing to transformational-more applicable in today’s dynamic health care system

Both types of leadership styles may be used

Current Vs. Future Leadership Styles

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Literature states best leadership model for changing health care environment

Other styles shown not to working in chaotic changing environment

Need skills and knowledge of larger number of staff (involvement of everyone)

Leader needs to be ahead of change (proactive) requiring vision, creativity, and style empowering staff

Focus on Upward, lateral, diagonal communication

Studies show positive correlation with perceived group effectiveness, job satisfaction, patient outcomes

Why this move toward transformational leadership?

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Effective communication lessens frequency of clinical errors

Most leadership focus on downward communication-only commands and directions (from superior to subordinate) no active receiver of message

Transformational encourages lateral, diagonal, and upward communication-staff interacts in a participatory environment: shared governance decision-making, suggestions, “open door” policy.

Transformational Communication

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Early AAN study (1980’s): no shortage where nurses were respected, valued and had “voice.”

International Journal of Nursing Studies (2009) systematic review of 53 studies

-link characteristics of nursing work environments (ex: nurse/physician relationship) to patient adverse events and mortality-Negative or positive leadership has indirect impact on patient

outcome-Studies support relationship/people focused leadership to

improved outcomes in nursing workforce, work environment, productivity, effectiveness of health care organization

-Transformational leadership focus on people/relationships to achieve common goal, motivates to do more than originally intended or thought possible-Transformational leaders use: idealized influence, inspirationalmotivation, intellectual stimulation, individualized consideration-Transformational leadership had decrease in workforce turnover, anxiety, emotional exhaustion, stress and increased organizational

commitment , role clarity

Transformational Leadership Success & Satisfaction Supported by Research

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No more traditional command-and control style of staff supervision

Movement towards leadership enhancing motivation, morale, and performance=culture of engagement

Nurse’s quality of work life positively predicts work engagement (vigor, absorption, dedication) increasing work performance and client satisfaction important to organizational success

QWL positively correlated to distributive and interactional justice-positively correlated to transformational leadership

(Gillett et al., 2012)

Transformational leadership and Organizational Success

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Studies are correlational not causal

Common method bias

Interpretations often are dichromatic

Success based on individual integrity

Culture may affect leadership style effect

Important to always be open to new methodology and perspectives

Remember…

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Begins with VISION

Empowers staff-self-confidence leads to action, encourage enthusiasm

Collective purpose-all team members work together toward shared goal, sense of commitment

All team members (nurses, staff) take active role in evaluating and establishing changing policies, give feedback, active in CHANGE

Find meaning, purpose, growth, maturity in work

Goals of Successful Transformational Leadership

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Overall collaborate more, support new leaders, adapt to & implement change in environment by: Embracing change Rewarding staff Developing self-aware staff motivated to improve Guiding staff in understanding roles in organization Guiding staff in understanding importance of organization Possessing: Self-confidence, self-direction, honesty, energy,

charisma, optimism, respect, trustworthiness, inspiration, loyalty, commitment, motivation, empathy, reliability, determination, ability to develop/implement vision

Qualities of Transformational leaders

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A voluntary credentialing process set by the ANCC to recognize nursing excellence ◦ Acknowledges successful nursing practice and strategies ◦ Recognizes quality patient care, nursing excellence and

innovations in the professional practice, provides benchmarking to measure quality of care

Based on the ANA Nursing Administration: Scope and Standards of Practice (2009)

14 Forces of Magnetism◦ 5 overarching Global Issues

This Lead Us Into Magnet Designated Hospitals

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The 5 main components Transformational

Leadership

Structural Empowerment

Professional Practice

Knowledge, Innovation, & Improvements

Empirical Quality Results

Creates a vision for the future, necessary for change

Gives staff the strength to grow and accomplish desired outcomes

Exemplary professional practice of nurses in the application of knowledge and evidence

Quality Improvement for the future

Benchmark data to show desired outcomes

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These leaders have the vision and atypical approaches to influence change

Strong clinical knowledge and expertise in professional practices

Futuristic thinking and emergent changes with the fast changing health care system

Encourage staff to contribute and add to the culture of the change

Hold nurses accountable for decision making and teamwork

Provide supportive creative opportunities for nurses to increase competencies

Transformational Leadership “In Magnet Terms”

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6.78% of hospitals in the US have ANCC Magnet Recognition status

Low RN turnover rates (approx 10%) Average length of employment (10 years)

◦ Decrease tendency to hire traveling nurses 48.8% with BSN

◦ Tendency to hire BSN over ADN 37.8% with ADN

Statistics for Magnet Organizations

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In 2010, 8/10 (80%) of the top rated medical centers were ANCC Magnet recognized, 6/8 (75%) of the top Children’s Hospitals were ANCC Magnet recognized

As of November 2010 there are 378 Magnet designated hospitals

Statistics for Magnet Organizations

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Created to address needed changes in health care system

Increase quality, accessibility and affordability Promote wellness, disease prevention Make primary, preventative care main focus Payments based on value

Institute of Medicine's Future of Nursing

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Key messages Practice to full extent of education/training Achieve higher levels of education Become full partners with others Implement effective workforce planning


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Practicing to full extent of education and training

Barriers: scope of practice variation from state to state; transition from school to practice

Solutions: Feds can promote reforms, incentivize adoption; nurse residency programs In both acute and ambulatory care settings Turnover rates reduced from 35% to 6% over 12

months


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Achieving higher levels of education Patients are sicker, more chronic disease

management, prevent acute care Fill more primary care roles Coordinate care with other team members (who

often have advanced degrees in their fields of practice)

Calls for BSN for entry level nurses Plan for graduate work


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Full partners with other team members in redesigning health care system

Identifying problems, areas of waste Devising and implementing plans for

improvement Tracking improvements over time Making necessary adjustments for established

goals Taking part in policy changes

Shaping policy instead of “letting it happen” Serve on committees, commissions, policy boards


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Full partners (continued) Leadership competencies fostered through

education Mentoring Professional organizations Attaining professional degrees in other fields


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Effective workforce planning Lack sufficient data on numbers, types of nurses

available; projected needs Impacts from bundled payments, medical

homes, accountable care organizations, Shifts to team based care


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Recommendations Remove scope of practice barriers Expand opportunities to collaborate on

improvements Greater implementation on residency programs Increase BSNs and advanced degrees Promote lifelong learning


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• Do you prefer idealized influence, inspirational motivation, intellectual stimulation and individual consideration?

• Do you prefer to reward performance and effort?

• Do you prefer to let well enough alone just as long as performance goals are met (only to intervene before trouble happens)?

• Do prefer to cede control to a team (only to intervene after trouble happens)?

What type of leader are you?

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“Leaders who merely give directions and expect them to be followed will not succeed

in this environment” –Future of Nursing

IOM's Vision for Nurse Leaders

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Two sets of leadership competencies Common set:

Knowledge of care delivery systems Collaboration within and across disciplines Knowledge of medical ethics Patient advocacy Advocating for safety improvements


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Two sets of leadership competencies Nursing focused set:

Becoming a “full partner” Collaboration Holding other team members accountable

regardless of discipline, training, rank Reduces preventable adverse events Medication errors


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Leadership at every level Student nurses

Faculty obligation to career placement/degree Health Students Taking Action Together

(HealthSTAT) Promotes being active in the health community a

professional habit Workshops in political advocacy Media training Networking Fundraising http://www.healthstatgeorgia.org/


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Leadership at every level Student nurses (continued)

Understand and anticipate population trends Other degree considerations: public health, law Consider dual majors in business/engineering


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American Nurses Credentialing Center (2013). Retrieved from http://www.nursecredentialing.org/ Cummings, G. G., Macgregor, T., Davey, M., Lee, C., Wong, C. A., Lo, E., Muise, M., & Stafford, E.

(2009). Leadership styles and outcome patterns for the nursing workforce and work environment: A systematic review. International Journal of Nursing Studies, 47(3), 363-385.

Dawes, D. (2011, April 11). The foundations of nursing leadership. Retrieved from http://www.nursingleadership.org.uk/test1.php

Den Hartog, D. N., Van Muijen, J. J., & Koopman, P. L. (1997). Transactional versus transformational leadership: An analysis of the MLQ. Journal of Occupational and Organizational Psychology, 70, 19-34.

Finkelman, A. (2012). Leadership and management for nurses: Core competencies for quality care. Upper Saddle River, NJ: Pearson Health Science.

Gillett, N., Fouquereu, E., Bonnaud-Antignac, A., Mokounkolo, R., & Colomat, P. (2012). The mediating role of organizational justice in the relationship between transformational leadership and nurses’ quality of work life: A cross-sectional questionnaire survey. International Journal of Nursing Studies doi: 10.1016/j.ijnurstu.2012.12.012.

Hutchison, M. & Jackson, D. (2012). Transformational leadership in nursing: Towards a more critical interpretation. Nursing inquiry, 20(1), 11-22.

Institute of Medicine (2011). Summary. In The Future of Nursing: Leading Change, Advancing Health (pp. 1-16). Retrieved from http://www.nap.edu/catalog.php?

Institute of Medicine (2011). Transforming leadership. In The Future of Nursing: Leading Change, Advancing Health (pp. 221-251). Retrieved from http://www.nap.edu/catalog.php?

Messmer, P., & Turkel, M. (2010). Magnetism and the nursing workforce. Annual Review Of Nursing Research,28233-252. doi:http://0-dx.doi.org.opac.sfsu.edu/10.1891/0739-6686.28.233

References

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Selanders, L., Crane, P. (2012). The voice of Florence Nightingale on advocacy. OJIN: The Online Journal of Issues in Nursing, 17(1).

Sherman, R., Pross, E. (2010). Growing future nurse leaders to build and sustain healthy work environments at unit level. OJIN: The Online Journal of Issues in Nursing, (15)1.

Smith, M. A. (2011). Are you a transformational leader? Nursing Management, 42(9). Thomspon, J. (2012). Transformational leadership can improve workforce competencies.

Nursing management, 18(10), 21-24.

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Stephen Forte Sarah Parker Melinda Winans

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