Nursing leadership aims at developing the skills of nurses and other healthcare professionals. Leaders are now faced with the challenge of “creating meaning for people” by helping to organize the large amount of information now available, making sense of it, integrating it into a meaningful vision of the present and future, and communicating that vision so people have a “buy in”, and want to participate in its realization.
To understand, recognize, and foster the leadership qualities in self and others it is vital to recognize what makes a person a leader. Not all leaders are alike. Each one has his/her own personality traits, methods, and talents. The leader becomes his/her own motivator, even though the leader may have been inspired by an outside influence.
In healthcare the needs of our patient population must be met. Creative means of accomplishing this within budgetary restraints drive the leader into action. Action requires power and by discovering what kinds of power are common among leaders we can develop the knowledge base, and skills which will give the leader’s followers some kind of power she/he did not have before.
Julia was hired as the Director of Nursing and had experience managing a healthcare facility with a bed capacity of 352 beds and was responsible for over 300 employees. She has a MSN degree with over eighteen years of nursing administration experience. She wanted to use her leader power to stimulate her nursing supervisors and nurse managers to work together in creating a climate of cooperation by sharing resources. Staffing the facility and decreasing the overtime was a constant challenge. She also had to make sure that “Joint Commission” standards were being implemented. Julia also had to ensure that as an organization what was said they did was being done according to established Policy and Procedures. Positive patient care outcomes had to be achieved in a safe and timely manner. Her leadership power influenced this group and helped them to create a common denominator so that they had the same goals and vision.
Julia was motivated in this new position to use four powers common in leaders. These are:
As a leader Julia used her “leader power” to develop “goal power” by assisting the supervisors and nurse managers. Administration officials wanted all employees to work in teams. They then wanted the teams to be given data about cost, quality, satisfaction, and access. Continuous improvement would be a corporate operating principle in creating an “organization of excellence” characteristic of their mission, vision, and values. She gave the Nurse Managers these goals, agreed to help them in deciding what to do, and gave examples of how to accomplish these goals. Julia recognized options and gave specific goals and then supported and helped her management team to accomplish these goals.
Julia offered her followers goal power and “follower achievement power”. The leader with follower power, regardless of how she became leader, maintains leadership by offering followers the opportunity to belong. Julia was strengthening the healthcare team and unifying them with common goals and the power to achieve them.
“Communication power” was needed for her to maintain follower power so that her management team would maintain a cohesive, productive, safe working relationship to accomplish their goals. To understand and practice effective listening, perception and trust was necessary. Julia had to enhance her communication power. She knew that even among effective ways of communicating there are varying degrees of effectiveness. The degree of follower understanding power that the follower receives from the leader depends on the skill of the leader in using their leader communication power.
Using these four powers Julia gave her Nurse Managers follower power and the willingness to want to follow. She believed that as a leader she wanted to “lead” her healthcare team to accomplish their goals. She did not want to “drive” them creating an atmosphere of discontent. She used these four powers as a leader to transmit certain follower powers.
Julia believed in Dr. Abraham Maslow’s Needs Hierarchy that leadership also consists of recognizing and filling the needs of the followers. These common basic needs are:
Once followers have their needs met by their leader they become willing and motivated.
Leaders must always be ready for unexpected situations to arise. This can occur when an employee suddenly has to resign or if an employee fails to perform as required by her/his job description. Julia and her followers learn to recognize problems before they become emergencies and have developed preventative actions and contingency plans. “Defensive leadership” actions may be as simple as recording information about encounters with people. A written record made immediately after an encounter is a more accurate reference later on then relying on memory. When having to converse with this individual again, the leader is more prepared and able to strive for a successful outcome. This record should consist of a date, location of meeting, subject of conversation, what was accomplished, what was learned from person, degree of this person’s openness, and other things that needed to be remembered for future encounters. Julia and her Nurse Managers knew that they may be dealing with union complaints and using defensive leadership techniques they would be prepared.
Leadership is a social function and a leader has to depend on other people to get things done. A leader uses drawing power to establish and keep followers. Positive first impressions are vital and could be summed up into four elements called the four Cs. Leonard Zunin in his book Contact stressed that within four minutes of contact impressions are made with other people. These elements are:Confidence
Confidence is displayed at all times as the leader gives the impression of being in power and being in control. The leader has a quiet, unassuming attitude, and expects the best outcome of her/his efforts. This leader power comes from within with self direction, self confidence and an inner strength drawing followers who feel safe and secure.
Creativity entails the leader being able to read the other person and tune into his thoughts and feelings. Attention is given to the way a person dresses, facial expressions, vocabulary being used, and his overall impression. There could be signs of enthusiasm, boredom, confidence, self doubt, hope, indecision and a negative attitude. Once the leader has used his creativity power he can more appropriately approach his potential followers and achieve positive results.
Caring is used by most successful leaders who realize that people want to be heard and need to feel important and appreciated. A successful leader will listen to the other person regardless of who he or she is, young or old, rich or poor, successful or not. Leaders know that every individual is the most important person in the world to himself or herself. People are drawn to a leader who listens effectively and helps them to feel good about themselves, building their own inner self esteem.
Consideration includes creating confidence, creativity, and caring. Leaders know that if people are treated as if they are what they ought to be and are helped to achieve this that they will feel capable of accomplishing their goals. Successful leaders using their drawing power can rouse their followers to become better people and desire to be around their leader.
A power tool that Julia uses is remembering that the little things one does has a powerful impact on keeping her followers energized. She remembered that power tools used for expressing leadership can be categorized into: non-verbal power tools, verbal power tools, personal power tools, and operational power tools.
As a non-verbal power tool Julia uses sexuality by recognizing that men and women are different. In general men tend to rely on logic and women on being more intuitive. As an effective leader Julia seeks to complement her own inherent strengths with the inherent strengths of her followers and peers who are of the opposite sex. Being assertive Julia learned how not to lose her femininity and knew that trying to look and act like a man would lose many of her followers. Regardless of sex people need to feel important and recognized for their contributions to group achievement.
Julia displayed a positive leadership posture resulting from her attitude. As a successful leader she saw herself as immune to disparagement, not fearful of challenge, and beneath nothing and no one. She saw herself as she wanted to be and remembered that in her mind’s eye she was the successful leader and so she was. She acted the part of the successful leader and always had direct eye contact with people she interacted with while giving them full attention as they were speaking. She made her followers feel important.
As a leader Julia recognized her Nurse Managers’ accomplishments and shared their successes with others. One manager, Joyce, decided to give a bright nursing assistant who knew the work load and time requirements the job of working on the staffing sheet. Alice, the nursing assistant worked evenings and nights and realized the importance of making sure these employees who worked nights needed to get at least two nights/evenings off in a row. She knew the importance of not playing favoritism and had the respect of the staff and her nurse manager. If the nurse manager needed things done she asked Alice.
Staff members and their achievements on monthly bases were displayed with their pictures on a community bulletin board. Joyce attracted followers because she acquired “recognition power” by becoming a caring person and thus a more effective leader. Her staff felt important to themselves and a vital healthcare team member of the nursing unit.
Another Nurse Manager, Sharon uses Smile power which Dale Carnegie says in his book, How to Win Friends and Influence People that you must have a good time meeting people if you expect them to have a good time meeting you. Sharon was challenged with managing a Nursing Unit which was having a difficult time dealing with change and demonstrated through her actions that she cared about the patients and staff. Her smile power, warm sincere attitude and willingness to listen enriched the lives of those she came in contact with on a daily basis. Staff members strived with enthusiasm to reach their mutual goals of providing a positive community atmosphere and quality patient care.
As a leader Julia knew that a handshake was a communicating device and would analyze an individual on the way a handshake was given. People shake hands for numerous reasons and that a purposeful handshake accomplished more in less time. It should be as warm as a smile and firm, reflecting sincerity. A handshake that is limp like a dead fish, flaccid, or is flat and barely touching reflects indifference and lack of direction. If a handshake is wet it shows that someone may be nervous. Most successful women prefer a moderately firm handshake from a man. The main thrust of the grip should be on the hand, not on the fingers. The handshake is a power tool used by successful leaders of both sexes. Many directors no matter what the qualifications of an applicant will evaluate the handshake and make a final decision based on this.
Julia believes she needs to dress the role of a leader and does not fall prey to designer’s seasonal styles, but to what flatters her, fits well, and is suitable for the occasion making the most professional impact. She has a basic wardrobe which can be dressed up or down and chooses her outfits with care. Her accessories are not distracting but enhance the overall professional look. Julia knows that feeling sharp helps her to be confident and have the credibility she needs as a successful leader.
Verbal power tools when used can make or break a leader. It is by what is said and how it is said that people judge their leader. Communication is dependent on more than one person and depends on the sender and the receiver. The receiver should communicate back to the sender what was said and respond appropriately in a timely manner. If the return response is appropriate then the sender accomplished his/her purpose. Julia uses her email at work and requests a response within a specific time frame. She plans her conversation well by pre-planning, putting purpose into the conversation and editing what is being said so that it is sent to the right person or people. She converses with the right person who has authority to do something about a situation that needs to be addressed.
Julia knows when it is most appropriate to have a face to face conversation, telephone conversation or just email an individual. She also is aware that the setting/place a conversation occurs is important and can set the desired mood helping to make the other person receptive to what is being said. As a leader Julia has developed a sixth sense called, tact which involves empathy. This will influence a leader’s tone. Tact is used when:
You time when you talk, so that you are talking to the right person at the right time. A leader when pre-planning a conversation gives attention to purpose, editing, and timing receives high dividends in leader power. People notice and respect a person who can carry on an effective conversation with purpose and ease. Julia has learned to use her ability to perceive the other person by listening to what is being said and to obtain knowledge using all her senses to understand what is really being said. As a successful leader Julia uses this power of perception in every conversation to gain as much knowledge and understanding of what is being said and of the other person. What is not being said is important along with the speaker’s non-verbal signs such as facial expression, grooming, posture, etc.
Julia in her role as Director of Nursing is proficient at using Aggressive Perception which is controlling how people talk to you. When her managers are frustrated by union challenges, frequent call offs and increased patient needs emotional outbursts and rude remarks may occur. To defuse this Julia does the following:
Julia uses her “power of persuasion” to get followers to think the way she wants them to so that they have a common goal. Some persuasion tools she uses to bring people around to a leader’s point of view are:
Leaders are grouped into one of three personality types. This deals with “assertion”. A person is non-assertive, assertive, or aggressively assertive.
Julia is an assertive leader and has willing followers. She feels good about herself and is outgoing and self-enhancing without demeaning others. She makes her own decisions and most often achieves desired goals. When criticism occurs she discusses this with the person who has made the accusation and tries to make this a positive. She never becomes defensive.
An “assertive personality” is the only kind that develops into effective leadership. Assertive leadership verbally is enhanced by:
The key to a Leaders Verbal Power Tools is the ability to speak confidently, convincingly, and concisely. The tone of a voice can sound young, old, clear, vibrant and optimistic. The leader controls the effect. It is important to self-evaluate the way you speak which can be done by recording what you are saying. Negative characteristics include: speaking too fast, nasality, hoarseness, mumbling, slurring, lack of projection, too much projection, monotony of pitch, and speech tics such as “aa, oh’s, er’s, and ya know’s “.
Effective leaders use verbal power when they use vocabulary that allows the listener to understand what is being said. The leader uses words that are familiar to the listener, uses short words instead of long words, avoids pompous words, profanity, pronounces words appropriately, and watches for feedback from the people listening.
Leaders have “personal power tools” which they use to establish and maintain their effectiveness in any group. These power tools could be grouped into the six Ps: possibility thinking, political sense, prior achievement, poise, pliability, and principles (Tramel, Reynolds, 1981).
Possibility thinking sees opportunities and alternatives in any situation. Helen Keller once said “When one door closes, another opens; but often we look so long at the closed door that we do not see the one that has been opened for us.” Julia has to help every employee realize the importance of working in teams. She has encouraged her nurse managers to also work together and share with their employees data about cost, quality, and satisfaction along with access to patient healthcare needs. Having the nurse managers’ work collaboratively she knows this will reflect on their own employee’s success. Nurse Managers as effective leaders using possibility thinking look for the best, expect the best, and work enthusiastically for the best.
Political sense is important to maintain leadership effectively. Julia had to recognize when politics was being used by others and the potential effect they could have on accomplishing the established goals. She was aware of the political games people play and knew how to neutralize their effects. These games are the following:
Precautionary steps to develop group unity are:
Prior achievement helps to create a leaders’ momentum to achieve the next goal, which fuels a person’s creativity. Reputations arise from previous achievements and followers ensue. Leaders are hired based on past accomplishments which a leader describes in resumes and in interviews.
Poise is essential for an effective leader. The person who is not able to handle herself/himself in any given situation is in a poor position to lead others. Self discipline related to emotions is also vital to be an effective leader. Leaders learn that if they cannot change a situation they can change their response to the situation.
Pliability related to constant change is vital. A leader has to be able to handle change in her/him and in followers. There are constant changes in technologies, science, moral codes, and economics. Leaders have to be able to change to meet these changing demands placed upon the leadership of their followers. Other areas that involve change are in areas of communication, leader-group relationships, power relationships, success channels, conflict management, and problem solving.
Principles concern what the leader determines is right and wrong and if integrity and firmness is kept when promises are made, decisions implemented, and acceptable standards followed. Leaders have to beware of:
Researchers developing a behavior theory assessed a successful leader along with the actions of that particular leader and a leader who has failed. Researchers then made assumptions that the traits and the leadership qualities are not inherited and they can be learned and mastered by any person. This behavioral theory meant that leaders are not born, leaders can be made. While researching, patterns of behavior researchers found that leadership styles could be developed. The Four styles of leadership based on the behavioral theory are:
There are three leadership theories.
Researchers found that leaders emerged as a result of different challenging situations. Leadership qualities were developed depending on the situation. Some researchers believe that there are different styles of leadership which changes the situation. Three basic things in a situational leadership; the foremost thing is that the relationship between the followers and the leader must be healthy. Followers must like the leader and support her/him in her goals. The second thing is that the task which is to be accomplished must be clarified, and the leader should set the goals as per the task to be done. Along with the tasks to be accomplished, the methods and standards to accomplish the task must be specified in details. This will make a positive impact on the followers. To strengthen the position of the leader the organization must confer the responsibilities of the task upon the leader.
This leadership theory depends on the fact that one thing is traded for the other thing. The transactional leader knows what she wants from the work and ensures that her followers perform well for giving the expected output. When the expected output is accomplished by the people of the organization, the leader must exchange rewards and make future promises for the people's efforts. The leader must see to it that the immediate self-interests of the people are met when required work is completed.
In the transformational theory of leadership, the assumption is that people are inspired from the leader and the leader must have passion about her/his leadership. This is a great way of putting in enthusiasm and energy in the followers to get the work done. Followers are encouraged, and converted into potential followers and future leaders.
There is a difference between theory and style of leadership. According to Moiden (2002), theory represents reality, while style of leadership is the various ways one can implement a theory of leadership—the way in which something is said or done. Organizations should aim for a leadership style that allows for high levels of work performance, with few disruptions, in a wide variety of situational circumstances, in an efficient manner (Moiden, 2002). Similarly, there is a difference between management and leadership. Managers plan, organize and control, while leaders communicate vision, motivate, inspire and empower in order to create organizational change (Faugier & Woolnough, 2002).
Leaders need to evaluate their own leadership style and realize that their management style can change. Leaders see themselves as separate from their organizations and the people of their organization, and they question established procedure and develop new concepts while inspiring followers. They are concerned with results while maintaining their own integrity.
Leaders seek out and evaluate risks, and options, especially when rewards are high. They dislike and avoid mundane tasks and are concerned with achievement of personal goals. When relating to people/followers they do so in an intuitive and empathetic way. Leaders are found at any level in the healthcare organization and derive power through personal relationships.
Leaders are change agents who are not comfortable with the status quo of established organizational goals and policies. They enjoy innovation and the challenges that change brings into organizations. Leaders are not merely those who control others, but they act as visionaries who help employees to plan, lead, control, and organize their activities (Jooste, 2004).
The 21st century is a new timeframe and different timeframes demand different leadership approaches. A different kind of leader will emerge to lead in a new way, different from those leadership styles that we have known in the past. However, the basic attributes of great leaders still are the foundation of effective leaders. Today, in the healthcare arena Nurse Leaders are constantly asked to do more with less and must be innovative relying on teamwork at all levels of management and patient care. They learn to develop and maintain a working climate that will stimulate rather than stifle employees. Leaders have to assign the same priority to human resource development as they do to finance while meeting the mission, values, and vision of the healthcare organization.
CEUFast, Inc. is committed to furthering diversity, equity, and inclusion (DEI). While reflecting on this course content, CEUFast, Inc. would like you to consider your individual perspective and question your own biases. Remember, implicit bias is a form of bias that impacts our practice as healthcare professionals. Implicit bias occurs when we have automatic prejudices, judgments, and/or a general attitude towards a person or a group of people based on associated stereotypes we have formed over time. These automatic thoughts occur without our conscious knowledge and without our intentional desire to discriminate. The concern with implicit bias is that this can impact our actions and decisions with our workplace leadership, colleagues, and even our patients. While it is our universal goal to treat everyone equally, our implicit biases can influence our interactions, assessments, communication, prioritization, and decision-making concerning patients, which can ultimately adversely impact health outcomes. It is important to keep this in mind in order to intentionally work to self-identify our own risk areas where our implicit biases might influence our behaviors. Together, we can cease perpetuating stereotypes and remind each other to remain mindful to help avoid reacting according to biases that are contrary to our conscious beliefs and values.
Carnegie, D, How to Win Friends and Influence People, New York, Simon and Schuster, 1936. P.68.
Faugier, J, Woolnough, H. (2002). There is a difference between theory and style of leadership. ... benefits of transformational leadership. Retrieved April 5, 2010 from (Visit Source).
Gabriel, H.W., Twenty Steps to Power, Influence, and Control over People, New Jersey, Englewood Cliffs, Prentice-Hall, 1962.p. 38.
Jooste, K. (2004). Leadership: A new perspective. Journal of nursing management, 12(3), 217-223. Retrieved April 3, 2010 from (Visit Source).
Mahoney, J. (2001). Leadership skills for the 21st century. Journal of Nursing Management, 9: 269-71. Moiden, N. (2003). A framework for leadership. Retrieved April 2, 2010 from (Visit Source).
Maslow, A. Motivation and Personality, New York, Harper & Row. 1954.
Moiden, N. (2002). Evolution of leadership in nursing, leadership style and theory. Nursing Management - Issue 7, Volume 9, 01 November 2002. Retrieved April 3, 2010 from (Visit Source).
Nash, S. (2009) Examining transformational approaches to effective leadership in healthcare settings. Nursing Times; 105: 18, early online publication. Retrieved April 4, 2010 from (Visit Source).
Tramel, M., Reynolds, H. (1981) Executive Leadership: how to get it & make it work. New Jersey. Prentice Hall. Inc.
Zunin, L, Zunin, N. Contact: The First Four Minutes, New York, Ballantine Books, 1972, p. 12, 106.