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Main Post
Developing effective leadership skills within healthcare may be one of the most critical abilities for nurses. Nurses are often the glue that holds the interdisciplinary team together; without influential leaders, the team can fall apart. There are many different leadership theories and styles available to review and model. The purpose of this discussion post is to review two key insights gained through the review of scholarly resources on leadership and to describe real-life situations in which these leadership styles were exemplified, their effectiveness, and their impact on the workplace.
During my scholarly research on the topic of leadership theories and styles, there were a couple of different things I learned. I am already familiar with the transformational leadership style through previous classes at Walden University. Transformational leadership focuses on the encouragement of individuals, leading by example, and sharing goals and successes (Ferreira et al., 2022). Through my research this week, I learned more about alternative leadership styles. First, I learned about the servant leadership style (Malak et al., 2022). Servant leadership is a common style of leadership found in healthcare organizations (Malak et al., 2022). It focuses on the leader’s responsibility to serve those they lead and put the needs of others before themselves (Malak et al., 2022). Another insight gained through my research was the leadership style of transactional leadership (Poels et al., 2020). Transactional leadership focuses on rewarding or penalizing individuals based on the completion of tasks (Poels et al., 2020).ORDER A PLAGIARISM-FREE ESSAY HERE
Throughout my nursing career, I have seen many examples of leadership styles from various nursing managers and facility administrators. One example is my current administrator, who leads with a transactional leadership style. She is very task-oriented and bases rewards and disciplines of individuals on completing duties in a competent, timely manner (Poels et al., 2020). Although this is effective in getting employees to do their jobs, it does not inspire loyalty or shared goals. Employees do not feel they are valued as individuals and get the feeling that they are replaceable. Another example of leadership I have seen in person at my workplace is transformational leadership by my current director of nursing. She encourages individuals to perform at their best and pushes everyone to succeed. She pushes everyone to see themselves as part of a larger team and work towards shared goals but ensures that individuals know they are valued as people and employees. This leadership style effectively gets people to work together as a team and inspires more loyalty than any other form of leadership I have seen.
Overall, finding a leadership style that feels right for each person is essential to being a nurse leader. Although some take to leadership more naturally and eagerly than others, one can learn to be a leader. One can contribute to their team’s success if one can lead effectively and are confident in their particular leadership style.References
Ferreira, T. D. M., de Mesquita, G. R., de Melo, G. C., de Oliveira, M. S., Bucci, A. F., Porcari,
T. A., Teles, M. G., Altafini, J., Dias, F. C. P., & Gasparino, R. C. (2022). The influence
of nursing leadership styles on the outcomes of patients, professionals and institutions:
An integrative review. Journal of Nursing Management, 30( 4), 936– 953.
https://doi.org/10.1111/jonm.13592Links to an external site.Malak, H. M., Lorman, W., Rundio, A., Simion, D., & Simion, M. G. (2022). Predominantly
practiced leadership styles of Chief Nursing Officers in healthcare organizations. Journal
of Interprofessional Education & Practice, 28.
https://doi.org/10.1016/j.xjep.2022.100517Links to an external site.Poels, J., Verschueren, M., Milisen, K., & Vlaeyen, E. (2020). Leadership styles and leadership
outcomes in nursing homes: a cross-sectional analysis. BMC Health Services Research,
20(1), 1–10. https://doi.org/10.1186/s12913-020-05854-7Links to an external site.LEADERSHIP THEORIES IN PRACTICE
A walk through the Business section of any bookstore or a quick Internet search on the topic will reveal a seemingly endless supply of writings on leadership. Formal research literature is also teeming with volumes on the subject.
However, your own observation and experiences may suggest these theories are not always so easily found in practice. Not that the potential isn’t there; current evidence suggests that leadership factors such as emotional intelligence and transformational leadership behaviors, for example, can be highly effective for leading nurses and organizations.
Yet, how well are these theories put to practice? In this Discussion, you will examine formal leadership theories. You will compare these theories to behaviors you have observed firsthand and discuss their effectiveness in impacting your organization.
RESOURCES
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.To Prepare:
- Review the Resources and examine the leadership theories and behaviors introduced.
- Identify two to three scholarly resources, in addition to this Module’s readings, that evaluate the impact of leadership behaviors in creating healthy work environments.
- Reflect on the leadership behaviors presented in the three resources that you selected for review.
BY DAY 3 OF WEEK 4
Post two key insights you had from the scholarly resources you selected. Describe a leader whom you have seen use such behaviors and skills, or a situation where you have seen these behaviors and skills used in practice. Be specific and provide examples. Then, explain to what extent these skills were effective and how their practice impacted the workplace.
BY DAY 6 OF WEEK 4
Respond to at least two of your colleagues on two different days by explaining how the leadership skills they described may impact your organization or your personal leadership, or by identifying challenges you see in applying the skills described.
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Hello
I appreciate your insight on leadership styles. I think when it comes to nursing, transformational leadership model should be adopted instead of transactional. I find leaders who use transformational leadership style boost my moral as a nurse even when other working conditions such as staffing ratios and increasing workload are unfavorable. As a person, I feel valued when a leader recognizes me for me and appreciates and supports what I bring to the table. Kiwanuka and associates (2021) guarantee that the use of transformational leadership style by nurse managers guarantees a higher quality of nursing care.
A systematic review done by Speechia and associates (2021) also showed a positive correlation between nurse managers using transformational leadership and increased job satisfaction by nurses existed. While transactional leadership styles work in some settings, I believe people need compassion and support to excel in the health sector.
References
Kiwanuka, F., Nanyonga, R. C., Sak-Dankosky, N., Muwanguzi, P. A., & Kvist, T. (2021). Nursing leadership styles and their impact on intensive care unit quality measures: An integrative review. Journal of nursing management, 29(2), 133–142. https://doi.org/10.1111/jonm.13151Links to an external site.
Specchia, M. L., Cozzolino, M. R., Carini, E., Di Pilla, A., Galletti, C., Ricciardi, W., & Damiani, G. (2021). Leadership Styles and Nurses’ Job Satisfaction. Results of a Systematic Review. International journal of environmental research and public health, 18(4), 1552. https://doi.org/10.3390/ijerph18041552Links to an external site.
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Collapse SubdiscussionAudrey Okofo-Mensah Audrey Okofo-Mensah (She/Her)
Dec 21, 2022Dec 21, 2022 at 4:46pmLeadership Behaviors That Create a Healthy Working Environment
Leadership is an essential part of healthcare and dictates the type of culture present in any organization. There are several leadership theories, but three that are mostly observed and used in nursing are the behavioral leadership theory, transactional leadership, and transformational leadership theory. Gifford and associates (2018) reason that, behavioral leadership theory suggests that effective leadership may result in change-oriented, relation-oriented, and task-oriented behaviors; transformational leadership is the degree to which a leader inspires and motivates others to follow an ideal or a particular course of action while transactional leadership involves the provision of incentives, rewards, and monitoring to meet quality.
Gifford and associates (2018) also observed that dimensions of transformational and transactional leadership align with the leadership behaviors in relation-oriented and change-oriented conceptual categories. For example, in transformational leadership, attitudes are influenced through relations, and the team focuses on change through collective learning, support and recognition. The writers concluded that, whether in transformation or leadership behaviors, managers effected a positive influence because good communication skills, encouragement and support towards change and learning activities were exhibited.
Harris and Mayo (2018) assessed the transformational leadership model and used a study to determine how effective the transformational leaders model encourages and supports innovation, enhances patient-centered care, encourages excellence, and has ethical integrity.
Two key insights that are evident in both articles are the supportive role the transformational leaders give to their teammates in a particular goal and the encouragement in pursuing excellence. Such leaders form such unique relationships with their teammates that, they feel supported in their role and give excellence work. One of such leaders I met was a manager I encountered for a couple of weeks on a travel assignment. This manager supported all her staff, defended her staff and the staff felt she was a bridge between them and the administration. She allowed access from all and was always in the loop of unit affairs and encounters. I met CNAs that worked with her and picked up extra shifts to accommodate staffing needs because she would work with their schedule in going to school. She supported those that had family challenges that affected their work such as allowing some to only work weekends or part time to accommodate family challenges. The way she managed the unit, she was fair and just. She joined in during day shift and would work as a nurse to help when the unit was tough. This leader had very little resistance when she implemented new policies on the unit. As a matter of fact, her unit was one of the first in the hospital to embark on evidence-based staff project. She had staff that had transitioned from CNA to RN. They feel supported and genuinely enjoyed working for her and with her. As a travel nurse I extended my contract for as long as I could because the environment was healthy the leader was transformational.
Based on her transformative leadership, she also had staff within the hospital transferring to her unit. She also had the lowest scores in fall reductions, CAUTIs and CLABSIs during the annual assessment. She is always receiving an applause for her exceptional leadership skills, and I think the hospital is very impressed with her.
Under transformational leadership, the importance of supporting and encouraging staff leads to compliance and commitment in achieving a desired goal was evident (Duggan et al., 2015; Gifford et al., 2018; Harris & Mayo, 2018). This type of environment is healthy because people thrive and can become better teammates.
References
Duggan, K., Aisaka, K., Tabak, R. G., Smith, C., Erwin, P., & Brownson, R. C. (2015). Implementing administrative evidence based practices: Lessons from the field in six local health departments across the United States. BMC Health Services Research, 15(1). https://doi.org/10.1186/s12913-015-0891-3Links to an external site.
Gifford, W. A., Squires, J. E., Angus, D. E., Ashley, L. A., Brosseau, L., Craik, J. M., Domecq, M.-C., Egan, M., Holyoke, P., Juergensen, L., Wallin, L., Wazni, L., & Graham, I. D. (2018). Managerial leadership for research use in nursing and Allied Health Care Professions: A systematic review. Implementation Science, 13(1). https://doi.org/10.1186/s13012-018-0817-7Links to an external site.
Harris, J., & Mayo, P. (2018). Taking a case study approach to assessing alternative leadership models in health care. British Journal of Nursing, 27(11), 608–613. https://doi.org/10.12968/bjon.2018.27.11.608Links to an external site.
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Collapse SubdiscussionMorgan Alicia Smith Morgan Alicia Smith
Dec 22, 2022Dec 22, 2022 at 6:43pmFirst Response
Audrey, great post this week! I enjoyed reading about your experiences regarding transformational leadership. Transformational leaders inspire others to achieve common goals (Broome & Marshall, 2021). It indeed sounds as though the manager you worked under on your travel assignment exemplified the traits of a transformational leader. She inspired loyalty in the same way that transformational leaders do and led by example. One of the most important qualities of transformational leaders is that they are willing to jump in and help the individuals they lead and never ask anyone to work harder than they are willing to do. The fact that she understood that her employees had lives and responsibilities outside of work and made them feel as though she cared about those responsibilities again makes me feel that she truly represented the best attributes of a transformational leader. Transformational leaders never make the people they lead feel as though they are replaceable, but instead that they are valued as individuals and cared about in an authentic way (Ferreira et al., 2022). This allows people to give their best and reach common goals. It certainly sounds like the unit benefitted greatly from the manager’s excellent leadership qualities. Well done!
Morgan Smith
References
Broome, M., & Marshall, E. S. (2021). Transformational leadership in nursing: From expert
clinician to influential leader (3rd ed.). New York, NY: Springer.Ferreira, T. D. M., de Mesquita, G. R., de Melo, G. C., de Oliveira, M. S., Bucci, A. F., Porcari,
T. A., Teles, M. G., Altafini, J., Dias, F. C. P., & Gasparino, R. C. (2022). The influence
of nursing leadership styles on the outcomes of patients, professionals and institutions:
An integrative review. Journal of Nursing Management, 30( 4), 936– 953.
https://doi.org/10.1111/jonm.13592 Links to an external site. -
Collapse SubdiscussionPauline Atianjoh Pauline Atianjoh
Dec 23, 2022Dec 23, 2022 at 3:42pmAudrey,
In addition, I have also learned that healthcare leadership is essential in playing roles of organizing, planning, controlling, implementing, budgeting, and analysis. It establishes means to utilize and achieve the organizational goals professionally. Therefore, effective leadership is an essential element for implementing reforms and shaping the corporate culture in the healthcare sector (Restivo et al., 2022). Several healthcare organizations entrust leadership roles to specified people who are certain of accomplishing the vision of the organization. The leaders are important in providing an understanding of the hospital’s goals which is to reach the potential of quality care and safety. These leaders collaborate with other healthcare team members to help in achieving the organizational goals. The achievable visions are refined by the communication skills which should be present in a leader to implement useful strategies within the healthcare organization (Gannotta, 2022). The leaders are also important in determining the potential of different employees who can be delegated to perform a specific function.
References
Gannotta R. J. (2022). Changes in the Healthcare Environment Prompt Leaders to Think Digitally. Frontiers of health services management, 38(3), 24–30. https://doi.org/10.1097/HAP.0000000000000131
Restivo, V., Minutolo, G., Battaglini, A., Carli, A., Capraro, M., Gaeta, M., Odone, A., Trucchi, C., Favaretti, C., Vitale, F., & Casuccio, A. (2022). Leadership Effectiveness in Healthcare Settings: A Systematic Review and Meta-Analysis of Cross-Sectional and Before-After Studies. International journal of environmental research and public health, 19(17), 10995. https://doi.org/10.3390/ijerph191710995
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Collapse SubdiscussionLeslie Sandoval Leslie Sandoval
Dec 21, 2022Dec 21, 2022 at 5:28pmLes Sandoval
Discussion Post Week 4
The first principle for leadership is that leaders must be grounded in ethical principles that guide human behavior and actions. No matter how brilliant the strategy or how productive the steps are, if leaders do not hold the trust and act in the best interests of those they serve, they are not competent. (Marshall & Broome, 2021). Marshall & Broom (2021) define leadership as the discipline and art of guiding, directing, motivating, and inspiring a group or organization toward common goals. It includes the engagement and management of people, information, and resources. The authors define transformational leadership as a process through which leaders influence others by changing their understanding of others of what is essential. Transformational leaders inspire others to achieve what might be considered extraordinary results. (Id.)
Transformational leadership is viewed as the most effective model of leadership because, while it recognizes the importance of rewards, it goes further to satisfy the higher needs of the follower by engaging this person emotionally and intellectually. (Doody & Doody, 2013). This type of leadership is needed in the nursing profession, which is facing unprecedented levels of burnout. Circumstances such as inadequate support or leadership within the workplace can aggravate burnout even more. The World Health Organization (WHO) recognizes nurse burnout as an “occupational phenomenon.” The WHO defines nurse burnout as “resulting from chronic workplace stress that has not been successfully managed.” (World Health Organization, 2019).
Our text describes transformational nursing leaders such as Florence Nightingale, Clara Barton, and Dorothea Dix. (Marshall & Broome, 2021). There is a rich history of transformational nursing leaders to reflect upon. However, transformational leadership is still needed in the nursing profession. Leaders who involve staff, encourage teamwork and motivation, and reward good work performance can improve job satisfaction and impact the quality of work life. A transformational leadership presence is vital, especially in clinical areas where new graduate nurses are present. Transformational leadership qualities promote a healthy environment for employees and staff, producing improved staff satisfaction, retention, and patient satisfaction. (Smith, 2011).
In my nursing career, I have seen one transformational leader that tried to make a difference by involving staff and encouraging teamwork and motivation. This leader was a traveling acute care nurse practitioner whose specialty was cardiology. The regular leadership at the hospital I worked for did not care about educating or encouraging staff nurses. The standard practice was to let the more experienced nurses eat their young and treat them however they wanted to. This leader would travel to and from Houston, Texas, every week. His motivational talents made me look forward to the days I would work with him, and one could feel his absence during the days he would go home to Houston. He was a wealth of knowledge and always did his best to teach staff nurses how to do things and why we do things. He never made staff feel stupid and had the patience level to tolerate staff nurses me asking questions until they fully understood the concepts. His demeanor promoted a healthy environment and improved our willingness to stay late or help out whenever he asked. As a result of his leadership skills, the younger staff nurses’ attitudes improved, improving patient satisfaction and care.
References
In-text citation: (What Is Nurse Burnout? | Nursejournal.org, 2021)
What is Nurse Burnout? /Nursejournal.org. (2021, September 29). Nursejournal. org/https://nursejournal.org/resources/nurse-burnout/#. :text=Circumstances%20such%20as%20not%20having%20effective%20support%20or.
Giltinance. (2013). Leadership styles and theories. Nursing Standard, 27(41).
World Health Organization. (2019, May 28). Burn-out-an “occupational phenomenon”: International classification of diseases. World Health Organization. https://www.who.int/news/item/28-05-2019-burn-out-an-occupational-phenomenon-international-classification-of-diseases Links to an external site..
Doody, O., & Doody, C.M. (2013). Transformational leadership in nursing practice. British Journal of Nursing, 21(20), 1212-1218. https://www.magonlinelibrary.com/doi/full/10.12968/bjon.2012.21.20.1212.
Smith, M. A. (2011). Are you a transformational leader? Nursing Management (Springhouse), 42(9), 44-50. https://doi.org/10.109701.numa.0000403279.04379.6a Links to an external site..
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Collapse SubdiscussionPauline Atianjoh Pauline Atianjoh
Dec 21, 2022Dec 21, 2022 at 5:41pmImpact of Leadership Behaviors
The nurses must work in a healthy working environment that is satisfying, empowering and it is safe to provide quality patient care. Leadership behaviors have a direct impact on creating a healthy working environment for nurses. the two main insights I heard from the article are that leaders should play an important role in creating work environments that influence the experience of the employees and the subsequent health and job-related outcomes (Vidman & Stromberg, 2020). A positive leader should be typified by honesty, self-awareness, integrity, and empathy for the employees to create a positive working environment where nurses feel empowered.
Positive leadership behaviors reduce the possibility of burnout and dissatisfaction. Therefore, leadership behaviors should empower the nurses to utilize the acquired skills and knowledge to control their work and in increasing job satisfaction, with a commitment to work and high-quality care (Suratno et al., 2018). Additionally, the leadership theories help to empower the behaviors by enlightening and showing concern for caring for nurses’ feelings hence minimizing exhaustion. For instance, the transformational leadership style promotes a healthy working environment where nurses feel committed to work.
The leadership styles are capable of helping employees to develop their potential and empowering individuals to make changes. Leaders that advocate for teamwork usually involve their staff in decision-making, rewarding excellence, encouraging motivation ad increasing the satisfaction of employees hence impacting their work-life (Nilsson & Nilsson, 2021). For instance, a transformational leader inspires followers through motivation to maintain loyalty.
Application of Leadership Behaviors and Skills
The situation where I have encountered the leadership skills and behaviors that create a healthy working environment is how a nurse in-charge of the medical-surgical unit dealt with a nurse who constantly slept during duty. The manager talked to the nurse and convinced him to be serious about the job. During the conversation, the manager did not criticize the nurse but reassured him that he trusted and respected him and reminded him also that he was neglecting his duties which could affect the nurse’s outcome. The leader supported the nurse to improve their commitment to care. Thereafter, the nurse became more committed to work and stopped sleeping during shifts hence the goals of the organization were achieved.
Effectiveness of the Skill
In this case, the skill used by the manager was effective in enabling the nurse to recognize his mistakes and in helping him to change his behavior. The nurse leader had the skills of open communication and active listening which inspired and motivated the nurse hence promoting behavior change (Broome & Marshall, 2021). Therefore, by listening to the concerns and needs of the nurse without criticism, the leader built a trusting relationship with the nurse. The relationship helped the nurse to be, to be honest, and fair which enabled him to decide on the behavior change. Leadership skills generate a positive workplace environment that motivates the employees to be part of the organization’s vision. Additionally, the skill makes nurses feel appreciated and improves their satisfaction.
References
Broome, M., & Marshall, E. S. (2021). Transformational leadership in nursing: From expert clinician to influential leader (3rd ed.). New York, NY: Springerhttps://dl.uswr.ac.ir/bitstream/Hannan/138756/1/9780826105288.pdf
Nilsson, K., & Nilsson, E. (2021). Organizational Measures and Strategies for a Healthy and Sustainable Extended Working Life and Employability-A Deductive Content Analysis with Data Including Employees, First Line Managers, Trade Union Representatives, and HR-Practitioners. International journal of environmental research and public health, 18(11), 5626. https://doi.org/10.3390/ijerph18115626
Suratno, K., Kusrini, K., & Ariyanti, S. (2018). The Relationship between Transformational Leadership and Quality of Nursing Work Life in Hospital. International Journal of Caring Sciences, 11(3), 1416-1420
Vidman, Å., & Strömberg, A. (2020). Leadership for a healthy work environment – a question about who, what, and how. Leadership in health services (Bradford, England), 34(1), 1–15. https://doi.org/10.1108/LHS-06-2020-0041
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Collapse SubdiscussionAshtyn Mcquaid Ashtyn Mcquaid
Dec 22, 2022Dec 22, 2022 at 9:15amPauline,
I agree the environment on the unit is influenced by relationships with leadership. I am a float nurse and have been on many units. An initiative in our hospital right now is barcode scanning percentages. On one unit, the manager hands out gift cards each month to the highest scanner and reminds her staff to keep scanning. On another unit we get emails showing everyone’s percentage and reminding us of the rules. Another unit emailed us warning this could lead to disciplinary action. “Transformational leadership is an approach that focuses on the attributes and behaviors of the leader required to empower and motivate team members” (Collins et al., 2020). Three different approaches by three different managers. Having a good manager is so important for job satisfaction. Elaine Marshall, RN, PhD (2021) states in her book, Transformational Leadership in Nursing, “Evidence is mounting that links the influence of transformational leaders to both improved nursing practice at the bedside, and positive patient outcomes in the aggregate” (p. 9).
References
Collins, E., Owen, P., Digan, J., & Dunn, F. (2020). Applying transformational leadership in nursing practice. Nursing standard (Royal College of Nursing (Great Britain) : 1987), 35(5), 59–66. https://doi.org/10.7748/ns.2019.e11408
Marshall, E. S., RN, PhD (2021). Transformational Leadership in Nursing, (p. 9). Springer Publishing Company. https://dl.uswr.ac.ir/bitstream/Hannan/138756/1/9780826105288.pdfLinks to an external site.
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Collapse SubdiscussionTyesha L Sullivan Tyesha L Sullivan
Dec 23, 2022Dec 23, 2022 at 10:45amPauline,
In order to become a great leader, one must master a demanding and complex role in order to navigate ensuring success for the company and delivering results that count. This is accomplished by leading in a way that creates a positive and encouraging atmosphere for all staff. As you stated, with transformational leadership staff’s satisfaction is met and burnout is minimized to create a safe and effective work environment. Transformational leaders develop the patient’s care quality and citizenship behaviors by providing an appropriate practicing atmosphere. These studies show the significance of TL to make a work atmosphere that helps and promotes a better practicing environment for nurses to be professional and enhance the desired outcomes for both the nurses and the patients (Asif et al., 2019).
Reference
Asif, M., Jameel, A., Hussain, A., Hwang, J., & Sahito, N. (2019). Linking Transformational Leadership with Nurse-Assessed Adverse Patient Outcomes and the Quality of Care: Assessing the Role of Job Satisfaction and Structural Empowerment. International journal of environmental research and public health, 16(13), 2381. https://doi.org/10.3390/ijerph16132381Links to an external site.
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Collapse SubdiscussionAudrey Okofo-Mensah Audrey Okofo-Mensah (She/Her)
Dec 23, 2022Dec 23, 2022 at 11:33pmPeer Response #2
Hello Pauline,
Thank you for giving a different perspective to leadership styles. I truly believe that a positive leader makes a lot of difference. You are right in saying leadership behaviors on nurses should be that of empowerment to acquire skills, increase job satisfaction and commitment towards high quality care. It will take a transformational and an authentic leader to inspire others and encourage them. Transformational leaders focus on building relationships with people and creating change by emphasizing values (Giddens, 2018) which is exactly what the manager did in your discussion post.
In a systemic review by Speechia and associates (2021), there was a positive correlation between transformational leadership style and nurse’s job satisfaction. The group advocated for leaders to promote technical and professional competencies while improving staff satisfaction and morale.
References
Giddens J. (2018). Transformational leadership: What every nursing dean should know. Journal of professional nursing : official journal of the American Association of Colleges of Nursing, 34(2), 117–121. https://doi.org/10.1016/j.profnurs.2017.10.004Links to an external site.
Specchia, M. L., Cozzolino, M. R., Carini, E., Di Pilla, A., Galletti, C., Ricciardi, W., & Damiani, G. (2021). Leadership Styles and Nurses’ Job Satisfaction. Results of a Systematic Review. International journal of environmental research and public health, 18(4), 1552. https://doi.org/10.3390/ijerph18041552Links to an external site.
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Collapse SubdiscussionCarolyn Hart Carolyn Hart
Dec 24, 2022Dec 24, 2022 at 11:33amPauline,
Excellent post with many wonderful points – thank you! It is so true that leaders are responsible for creating a healthy work environment.
Pauline and Class, take a look at Page’s (2020) article Links to an external site.on how to create a healthy work environment. Scroll down and look at the signs of a healthy work environment as well as the tips and ideas for promoting a healthy work environment. What do you think? Are these sound ideas and would you see yourself using them?
Dr. Hart
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Collapse SubdiscussionJulia Said Julia Said
Dec 21, 2022Dec 21, 2022 at 6:56pmThe U.S. healthcare system is facing significant challenges today, such as staff shortages, aging populations, increased chronic illnesses and comorbidities, the Covid-19 pandemic, an opioid crisis, and financial instability (Broome & Marshall, 2021). In these pressing times, healthcare leaders can prove to be invaluable or superfluous, depending on the leadership qualities they possess. Broome & Marshall (2021) mention the following qualities of a transformational leader: respect for others, beneficence, truthfulness, assertiveness, (emotional) intelligence, compassion, communication skills, reliability, and adaptability. In this discussion post, I will be identifying two key insights about leadership behaviors from the scholarly articles I reviewed, as well as discussing leadership behaviors and skills I have witnessed in my practice.
Nurse leaders play a powerful role in patient safety culture. Patient safety is defined as, “the freedom from accidental injury and error” (Chegini et al., 2020). Errors happen in healthcare. Human error is inevitable, that is why we have something called “just culture.” Just culture is the idea that errors stem from a faulty process in the organization, and that when an error is made, staff should not be blamed or punished for the mistake. Rather, the team is responsible for determining what went wrong and how the process can be improved to prevent this mistake in the future. It holds the person and the organization accountable (Boysen, 2013). How a leader reacts and responds to these errors says a lot about his/her leadership style and ethics. Good leaders are expected to promote honesty and patient-centered care with error reporting. They should provide a safe, coaching environment for staff to report their error and receive education (Chegini et al., 2020).
If a leader does not promote just culture, staff are less likely to report their errors, putting patients at a higher risk of injury or mortality (Chegini et al., 2020). When I was a new grad, I was working on the inpatient adolescent psychiatric unit. It was flu season, and charge nurses were frequently reminding all staff members to offer and administer influenza vaccines to our patients before discharge. During my shift, I administered a vaccine to an adolescent patient without getting his guardian’s consent first. This was a policy I had forgotten about in the rush of my shift. Turns out, the guardian did not want him to receive the vaccine due to previous negative experiences. As a brand-new nurse, I sobbed and thought my career was over. My charge nurse was there and assisted me in informing the guardian of my mistake. She supported me and reminded me that mistakes will happen in nursing. She also educated me on the importance of slowing down and thinking about each step of a process. My charge nurse exhibited just culture and good leadership skills that day when she supported me through my mistake and educated me on it.
Nurse leaders must also motivate and empower their staff members, while promoting autonomy. By fostering this positivity, leaders will improve employee attitudes, mental health, and overall performance (Fernet et al., 2015). I have personally worked with two types of leaders: the burnt-out, negative ones, and the positive, motivating ones. Speaking from personal experience, I enjoy my work so much more when my leader exhibits these positive characteristics. Leaders influence the culture of the entire department, and attitudes are contagious. When they set the example of being a positive employee who is willing to work hard, be a team player, and provide high quality care, other staff members are more likely to mimic this behavior (Fernet et al., 2015). Leaders are responsible for modeling the mission, vision, and values of the organization.
When I started my nursing career, I was working for a manager that was not passionate about mental health. She was managing two units due to a staffing shortage and funding, and the behavioral health unit was one of them. She even openly admitted to not loving psychiatric care. This set the tone for a very negative work environment. I believe it is crucial to be passionate about the care we provide in order to provide the highest quality of care. With her as the leader, the work environment was dull and unfavorable. There was a considerable shift in culture when the new manager started. Employees started to pick up more over time, work as a team, and show compassion for our patients again. In this experience, I learned that the attitude of a leader can make or break the unit.
References:
Broome, M., & Marshall, E. S. (2021). Transformational leadership in nursing: From expert clinician to influential leader (3rd ed.). New York, NY: Springer.
Boysen, P. G. (2013). Just culture: a foundation for balanced accountability and patient safety. National Library of Medicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3776518/
Chegini, Z., Kakemam, E., Jafarabadi, M.A., & Janati, A. (2020). The impact of patient safety culture and the leader coaching behaviour of nurses on the intention to report errors: a cross-sectional survey. BMC Nursing, 19(1), 1–9. https://doi.org/10.1186/s12912-020-00472-4Links to an external site.
Fernet, C., Trépanier, S. G., Austin, S., Gagné, M., & Forest, J. (2015). Transformational leadership and optimal functioning at work: On the mediating role of employees’ perceived job characteristics and motivation. Work &Amp; Stress, 29(1), 11–31. https://doi.org/10.1080/02678373.2014.1003998
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Collapse SubdiscussionMorgan Alicia Smith Morgan Alicia Smith
Dec 23, 2022Dec 23, 2022 at 6:40pmSecond Response
Julia, I really enjoyed reading your post this week. I thought you did a fantastic job of relaying your personal experiences with different types of leaders in your nursing practice. Familiarity with the fundamental leadership theories is essential to understanding the importance of leadership within one’s practice (Broome & Marshall, 2021). It sounds as though you have had personal experience with both great and poor leaders. I believe these experiences teach us how important leadership is within healthcare, as we see the impact both poor leadership and transformational leadership can have on a team. As you said, a great leader can change a unit’s culture entirely for the better. Transformational leaders lead by example and encourage and inspire others to perform to the best of their abilities (Ferreira et al., 2022). It sounds like this leader did just this, allowing the team to find a passion for nursing again. It is incredible just how much of a difference a transformational leader can make within an organization. It truly inspires me to ensure that I embody the characteristics of a transformational leader within my own organization so that I can have the impact that other transformational leaders have had on me. Great job!
Morgan Smith
References
Broome, M., & Marshall, E. S. (2021). Transformational leadership in nursing: From expert
clinician to influential leader (3rd ed.). New York, NY: Springer.Ferreira, T. D. M., de Mesquita, G. R., de Melo, G. C., de Oliveira, M. S., Bucci, A. F., Porcari,
T. A., Teles, M. G., Altafini, J., Dias, F. C. P., & Gasparino, R. C. (2022). The influence
of nursing leadership styles on the outcomes of patients, professionals and institutions:
An integrative review. Journal of Nursing Management, 30( 4), 936– 953.
https://doi.org/10.1111/jonm.13592 Links to an external site. -
Collapse SubdiscussionHeather Fechko Heather Fechko
Dec 23, 2022Dec 23, 2022 at 8:09pmREPLY #2
Hey Julia,
Thank you for your post. I enjoyed reading about the many important roles that nurse leaders play. I love the insight that you shared about the negative leadership example that you discussed. When I was asked to share an example of leadership skills and behaviors that I’ve witnessed in practice, I instantly tried to think of good examples. It is important to also remember the poor examples, which can push us to be better leaders.
Transformational leadership is a process in which leaders influence others by changing the understanding of others of what is important (Broome & Marshall, 2021, pg. 4). The poor leadership skills that you identified will impact my personal leadership by reminding me of the importance of maintaining a positive attitude and being a role model that staff may look up to. Empowering employees is a characteristic that transformational leaders must possess. Through psychological empowerment, employees will be motivated to increase their performance and have increased job satisfaction. (Adri, et. al., 2022). Leading by inspiration and motivation shows personal passion and provides the environment that is necessary for success (Broome & Marshall, 2021, pg. 186).
References
Broome, M., & Marshall, E. S. (2021). Transformational Leadership in Nursing: From Expert Clinician to Influential Leader (3rd ed.). New York, NY: Springer.
Adri, E., Setiawan, D., & Hia, C. (2022). The Role of Transformational Leadership Style in Psychological Empowerment of Employees: Literature Review. Indonesian Journal of Multidisciplinary Science, 1195–1201. https://doi.org/10.55324/ijoms.v1i10.187
Broome, M., & Marshall, E. S. (2021). Transformational Leadership in Nursing: From Expert Clinician to Influential Leader (3rd ed.). New York, NY: Springer.
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Collapse SubdiscussionLeslie Sandoval Leslie Sandoval
Dec 23, 2022Dec 23, 2022 at 11:05pmJulia,
The topic in the discussion post was interesting and well-written, and I enjoyed reading it. The “just culture” section was a new term I had never heard before. In a just culture environment, safety incidents are seen as opportunities to share observations about system risks and organizational behaviors. Establishing a just culture is key to creating better patient safety outcomes. (Stafford, n.d.). Paradiso & Sweeney (2019) report that healthcare institutions have adopted nonpunitive incident management structures to improve patient safety outcomes. This leadership structure creates an atmosphere of trust between the employee and the employer. It positively impacts staff members’ willingness to report outcomes when results are not as expected. The discussion post helped introduce this concept.
There is no right or wrong answer as to what makes a good nursing leader or, for that matter, the best leadership style. A recent article lists seven types of leadership styles in nursing:
- Autocratic leaders make decisions with little or no input from their employees.
- Laissez-faire leaders provide little or no supervision to employees. They take a “hands-off” approach.
- Democratic leaders encourage participation and communication from employees. They promote personal and professional growth.
- Servant leaders focus on individual needs and are relationship oriented. They ensure that employees have the tools, resources, and skills to achieve goals.
- Situational leaders analyze a situation and then determine the best approach. They work well in healthcare because they are flexible and adapt to each situation.
- Transactional leaders focus on supervision, organization, and performance and use a reward and punishment system.
- Transformational nurse leaders are visionary, build engaged teams, and are beneficial in facilities where significant changes are needed, such as improving overall patient care.
(Wofford, 2022).
No matter what style is used, nurse leaders play an essential part in the health care system. Nurse leaders must serve as role models to nursing staff and team members. Leaders and followers engage with each other, raise, and inspire each other. (Marshall & Broome, 2021). Successful leaders are effective in communicating goals and expectations between team members. (Marshall & Broome, 2021) state that effective communication begins with an awareness of your style and of how other individuals respond to you and that tone of voice, volume, word choice, ethnic or regional styles, facial expression, and body language all impact the effectiveness of communication.
References
Stafford, T. (n.d.). 10 Elements of a Just Patient Safety Culture by Performance Health Partners. www.performancehealthus.com Links to an external site.. https://www.performancehealthus.com/blog/10-elements-of-a-patient-safety-culture Links to an external site..
Paradiso, L., & Sweeney, N. (2019). Just culture: It’s more than policy. Nursing Management, 50(6), 38-45. https://doi.org/10.1097/01.numa.0000558482.07815.ae Links to an external site..
Wofford, P. (2022, December 7). 7 Leadership Styles In Nursing: How Do They Impact You? Aspen University. https://www.aspen.edu/altitude/leadership-styles-in-nursing/
Marshall, E.S., & Broome, M. (2021). Transformational leadership in nursing: from expert clinician to influential leader (3rd ed.). Springer Publishing Company.
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Collapse SubdiscussionCarolyn Hart Carolyn Hart
Dec 24, 2022Dec 24, 2022 at 11:26amJulia,
You made quite a few good points in your post, but I was really struck by your final sentence: I learned that the attitude of a leader can make or break the unit. This is an incredibly true – and incredibly powerful – statement! As a nurse, we directly influence the patient experience. As a nurse leader, you influence every single nurse and every single patient on a unit that you oversee. it is so important to get leadership right!
Julia and class, I encourage you to always complete readings and assignments with the thought of “How could and how should this affect my practice”; I am convinced that unless you do this, you will not get as much benefit out of this class!
Dr. Hart
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Collapse SubdiscussionJulie Baker Julie Baker
Dec 21, 2022Dec 21, 2022 at 8:48pmProfessor and class,
This week as we review leadership skills and behaviors, I am reminded of multiple instances in which effective leaders created positive impacts in the workplace. Broome and Marshall have created a roadmap of theories related to transformational leadership including emotional intelligence (Broome & Marshall, 2021). Emotional intelligence can be broken down into 4 compartments: self-awareness, self-management, social awareness and relationship management (Landry, 2019). With emotional leadership comes the ability to control your own emotions as well as recognize emotions of others. This is helpful in a stressful nursing environment to see potential issues and have the capacity to diffuse those situations. Those fortunate enough to excel in these areas can become very influential leaders. I think of an old manager Charley. Charley was known throughout the unit at the time as the calm in the storm. She was able to calm down the most agitated patients, diffuse conflict between employees and could effectively tread between upper management and staff working for her creating a very positive workflow.
The second article relates to supporting trust building through the creative process (Campos et al., 2020). In my opinion, fostering and supporting the creative talents of a team is one of the most important parts of being an effective leader. We all like to have a voice in the things that affect us. Having a manager that allows the expression of creative freedom is a part of that and can be allowed in several different ways. For example, a previous manager Angie, allowed us to create and decorate baby cards for the nursery that had the footprint, baby name, moms name and details of birth. This allowed us to disperse with generic versions and gave mom and dad something very special to take home. We also used holidays as reasons to decorate visiting areas and cribs in nursery themes related to that particular holiday. It was a small thing but allowed us to express our creativity while making a hospital stay a special experience.
Broome, M., & Marshall, E. S. (2021). Transformational leadership in nursing: From expert clinician to influential leader (3rd ed.). New York, NY: Springer.
Campos, J. A., Aubert, A., Guo, M., & Joanpere, M. (2020, January 31). Improved leadership skills and aptitudes in an excellence Emba program: Creating synergies with dialogic leadership to achieve Social Impact. Frontiers in psychology. Retrieved December 21, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7005995/
Landry, L. (2019, April 3). Emotional intelligence in leadership: Why it’s important. Business Insights. Retrieved December 21, 2022, from https://online.hbs.edu/post/emotional-intelligence-in-leadership#:~:text=Emotional%20intelligence%20is%20defined%20as,popularized%20by%20psychologist%20Daniel%20Goleman.
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Collapse SubdiscussionAshtyn Mcquaid Ashtyn Mcquaid
Dec 23, 2022Dec 23, 2022 at 6:04amJulie,
Great post. Creating a positive practice environment is so important, as this helps to “foster a culture of excellence that safeguards staff members’ health, safety, and well-being, translating to high-quality care and improved staff morale, productivity, and efficiency” (Dans & Landmark, 2019). I try to be one of those leaders to “calm the storm”. When I come in and everyone is buzzing about their “terrible shift”, I try to state something like, “Well, I’m here now, so how can I help?” Sometimes the nurses will give me something, sometimes they’ll say they did it all – to which I say “Because you’re a super nurse. Nice job.” Even the patients benefit from our positive work environment. One article I found states “it reduces hospital-acquired infection rates, hospital mortality, re-admissions, and adverse events” (Masson et al., 2021). Our assistant manager also burns incense and plays light music at the nursing station. I think it adds to the positive work environment for sure. Also, to note, I have all five of my crib cards, made by the lovely nurses like yourself. They are a little something to remember parents’ most important day.
References
Dans, Maricon MSN, RN; Landmark, Vicki, PhD. (2019). The effects of positive practice environments leadership must-knows. Nursing Management (Springhouse) 50(10): p 7-10. DOI: 10.1097/01.NUMA.0000580624.53251.29
Maassen, Susanne; van Oostveen, Catharina; Vermeulen Hester; Weggelaar, Anne Marie. (20201). Defining a positive work environment for hospital healthcare professionals: A Delphi study. https://doi.org/10.1371/journal.pone.0247530a
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Collapse SubdiscussionCarolyn Hart Carolyn Hart
Dec 24, 2022Dec 24, 2022 at 11:20amJulie,
You really do remind us of how important the ‘little things’ can be – not just for us, but also for our patients. As we all think about positive leaders and read about leadership styles, what do you (Julie and class) think one thing that you read in the text or a discussion post do you think you can incorporate into your practice?
Dr. Hart
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Collapse SubdiscussionJulia Said Julia Said
Dec 24, 2022Dec 24, 2022 at 11:52amJulie,
I really enjoyed your post! Your comment about Charly being able to “effectively tread between upper management and staff working for her” made me think of a really good point about nurse leadership. We are often very focused on what makes a good leader vs a bad leader, and how the leaders we have encountered impacted our nursing careers. It is important to turn the perspective to what our managers and leaders also go through. My mom used to manage the orthopedic unit at our local hospital. I watched her struggle with trying to be the “good guy” to her staff members, while also attempting to please upper management like the CEO and CFO. She often reported feeling torn between doing what is best for her staff, and meeting the bottom line instituted by upper management. Sometimes these two things do not work together- aka they create competing needs. Nurse managers frequently report not feeling supported by their superiors, and like they do not have the resources to handle the responsibilities they are given (Paliadelis et al, 2007). If our leaders do not feel supported or encouraged, it is foolish to believe they can do so for us. As bedside nurses, our responsibilities mainly consist of providing high quality patient care. We do not stop during our shift to think about budgets or major meetings. Nurse managers are tasked with ensuring high quality care is being provided, while also taking on the administrative role, considering budget, staffing, supply chain, etc. (Paliadelis et al., 2007). A study found that one in five nurse managers report increased stress, intentions to leave the organization, and dissatisfaction with professional and personal life (Jappinen et al., 2021). In this discussion, I have read many of us mention that the behaviors and attitudes of our leaders affect our behaviors and attitudes, and that their leadership qualities are contagious throughout the unit. This begs the question: Who are they learning from? Are their leaders positive and compassionate? Really, workplace culture starts from the top and trickles down.
References:
Jappinen, K., Roos, M., Slater, P., & Suominen, T. (2021). Connection between nurse managers’ stress from workload and overall job stress, job satisfaction and practice environment in central hospitals: A cross-sectional study. Nordic Journal of Nursing Research, 42(2), 109–116. https://doi.org/10.1177/20571585211018607
Paliadelis, P., Cruickshank, M., & Sheridan, A. (2007). Caring for each other: how do nurse managers ‘manage’ their role? Journal of Nursing Management, 15(8), 830–837. https://doi.org/10.1111/j.1365-2934.2007.00754.x
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Collapse SubdiscussionJessica Velez Jessica Velez
Dec 21, 2022Dec 21, 2022 at 9:01pmOverall Impact of Leadership Behaviours on Creation of Healthy Working Environments
For the best possible patient care, nurses must work in a safe atmosphere that is also healthful, often gratifying, and empowering. The establishment of a healthy workplace for healthcare workers frequently depends on the leadership behaviors. One of the two main takeaways from the articles is the importance of leaders in helping to create work environments that have a tendency to affect how employees feel about their jobs and the outcomes that follow. According to research, a good or authentic leader can foster a supportive work environment with the goal of empowering people. This kind of leader is characterized by self-awareness, trustworthiness, honesty, and clarity (Scott & Klein, 2022).
Positive leadership techniques also reduce the likelihood of staff turnover, unhappiness, and burnout. The general leadership behavior that encourages healthcare personnel to use their abilities, knowledge, and behaviors seems to boost engagement, job happiness, and healthcare quality. It is crucial to remember that these empowering behaviors educate, demonstrate concern, and show care in a way that lessens the emotions of depersonalization and heightened psychological tiredness experienced by healthcare professionals. To do this, make sure that the organization’s leadership process has the nurses’ trust (McLaughlin & Kunk-Czaplicki, 2020). Nurses tend to feel empowered and more committed to their profession in an environment that is characterized by transformational leadership behaviors.
Additionally, leadership behaviors have the power to encourage people to make or adapt to changes as necessary, as well as to support workers in realizing their full potential. One may claim that CEOs who encourage cooperation tend to include their employees in decision-making, reward exceptional performance, increase enthusiasm, and generally have a positive impact on the harmony between work and life. As an illustration, a manager that possesses transformational leadership skills will frequently give guidance and effectively use the delegates to help staff members go over both professional and personal obstacles.
Situation where Leadership Behaviours and Skills have been Witnessed in Practice
When a nurse manager in the medical-surgical unit dealt with a situation where a nurse from the same unit was found napping on duty, I saw how leadership and the use of leadership abilities include creating a healthy work environment, which is mostly employed in practice. Initially incensed, the nurse manager eventually came to understand the nurse’s predicament. He persuaded him to take his work more seriously and with greater zeal. The management made no negative comments to the nurse during the discussions. The nurse has earned the manager’s growing respect and trust. However, the manager warned the nurse that his failure to do his obligations could have an adverse effect on patient outcomes. He offered a plan on how the nurse could enhance the services provided by the unit and was willing to hear the nurse’s justifications for her actions. The nurse improved performance, became more committed to his work, stopped procrastinating, and was also in a position to meet the organization’s goals.
Extent of the Effectiveness of the Skills and Overall Impact in the Workplace
The nurse manager’s primary leadership techniques in this situation were successful, particularly in helping the nurse come to terms with his mistakes and support behavior change. The nurse was inspired and encouraged by the nurse’s open communication and active listening abilities, which had a big impact on how she behaved. The leader also developed a relationship of trust with the nurse by paying attention to his wants and worries without condemning him. The leader also built a relationship of trust with the nurse by being truthful, forthright, and fair with the worker, further encouraging him to make an individual decision to change his behavior (Ruben & Gigliotti, 2021). A high level of trust was developed between the nurse and the manager by active listening to the nurse’s wants and concerns. Honesty and general participation in transparent and equitable communication between the two parties helped to promote this. The nurse was motivated to alter his behavior on his own by these factors. The nurse was further inspired to contribute to the organization’s vision by the nurse’s leadership abilities rather than being punished for his error. The abilities encouraged a work environment where the nurse felt valued and significant as well, enhancing his commitment to his job and the organization.
References
McLaughlin, C. P., & Kunk-Czaplicki, J. (2020). Leadership: Theory and Practice by Peter G. Northouse (review). Journal of College Student Development, 61(2), 260-261. https://doi.org/10.1353/csd.2020.0023
Ruben, B. D., & Gigliotti, R. A. (2021). Explaining incongruities between leadership theory and practice: integrating theories of resonance, communication and systems. [Leadership theory and practice incongruities] Leadership & Organization Development Journal, 42(6), 942-957. https://doi.org/10.1108/LODJ-02-2021-0072
Scott, C. L., & Klein, L. B. (2022). Advancing Traditional Leadership Theories by Incorporating Multicultural and Workforce Diversity Leadership Traits, Behaviors, and Supporting Practices: Implications for Organizational Leaders. Journal of Leadership, Accountability and Ethics, 19(3), 1-11. https://www.proquest.com/scholarly-journals/advancing-traditional-leadership-theories/docview/2702534773/se-2
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Collapse SubdiscussionLeslie Sandoval Leslie Sandoval
Dec 24, 2022Dec 24, 2022 at 11:46amHello Jessica:
Your article touches on the importance of a healthy workplace for employees. Authentic leaders play an essential part in creating a healthy work environment. Authentic leadership is one of the frameworks that emphasize relationships between leaders and followers and focuses on the self-development potential of the leader. (Marshall & Broome, 2021). A recent article by Jaworski et al. (2022) states that there are four dimensions to an authentic leader:
- Self-Awareness- The leader’s knowledge of his strengths and weaknesses.
- Transparency – Sharing information, feelings, and attitudes.
- Morals and Ethics- Reflects on the leaders’ behavior in line with standards of internal moral conduct, and
- Balanced Processing – Concerns proper decision-making after listening to the opinions of their followers.
(Jaworski et al., 2022)
Our text points out that authentic nurse leaders can be honest and open in their relationships with individuals to whom they report, as well as to those who work for them. Moreover, they seek diverse perspectives from others, leading to lower exhaustion levels. (Marshall & Broome, 2021). In contrast, an unhealthy, hostile work environment can lead to burnout, harming patient care. Marshal and Broome (2021) recommend that wise leaders make rounds throughout the organization to remain visible, talking with employees and other leaders in informal settings such as dining areas, elevators, and hallways, sending personal congratulatory notes when an individual accomplishes something of note, and calling an employee when something occurs (such as a death or illness) to share condolences or concern.
I appreciate the portion of your discussion post in which the nurse manager found the nurse sleeping during the shift. The nursing leader you mentioned used the opportunity as a learning experience, turned a negative instance into a positive lesson for the nurse, and illustrated a positive work environment. The concept of a positive work environment can be found in the Quadruple Aim theory, which has four components: improvement of patient care and experience, promoting the health of populations, lowering health costs, and improving the lives of healthcare workers, including clinicians and staff. (Bodenheimer & Sinsky, 2014). If we keep this fourth component in mind, we will always be able to turn a negative work situation into a positive learning experience.
References
Marshall, E.S., & Broome, M. (2021). Transformational leadership in nursing: from expert clinician to influential leader (3rd ed.). Springer Publishing Company.
Jaworski, M., Panczyk, M., Lenczuk-Gruba, A., Nowacka, A., & Gotlib, J. (2022). The Trend of Authentic Leadership Skills in Nursing Education: The Key Role of Perfectionism and Self-Efficacy. International Journal of Environmental Research and Public Health, 19(4), 1989. https://doi.org/10.3390/ijerph19041989 Links to an external site..
Bodenheimer, T., & Sinsky, C. (2014). From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider. The Annals of Family Medicine, 12(6), 573-576. https://doi.org/10.1370/afm.1713 Links to an external site..
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