nursing leadership STYLES AND THEIR IMPACT ON LEADERSHIP
OUTCOMES
By
M. Joan Libsekal
A Research Study Presented in Partial Fulfillment
Of the Requirements for the Degree
Doctor of Philosophy
Capella University
June 2006
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UMI Number: 3232065
3232065
2006
Copyright 2006 by
Libsekal, M. Joan
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© M. Joan Libsekal, 2006
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Abstract
Nursing leadership styles impact leadership outcomes. Using the transformational
leadership model as the conceptual framework, the study sought to determine what
nursing leadership styles positively correlated with leadership outcomes of extra effort,
effectiveness, and satisfaction as perceived by staff nurses. Quantitatively data was
collected using a Multifactor Leadership Questionnaire 5X Short Rater form from a
The Term Paper on Scholarship, Practice, And Leadership In Nursing
Information literacy is foundational to scholarship, practice, and leadership. The three areas are dependent on information for their basic functions. Scholarship, practice, and leadership require information literacy: the ability to find, evaluate, and organize information for efficient operation. Nursing requires a high level of scholarship, practice, and leadership from initial entry to the ...
sample population of 144 staff nurses in Western Canada. Findings revealed significant
positive relationships existed between extra effort and transformational leadership style, r
(111) = .94, p
positive relationships were found between effectiveness and transformational leadership
style, r (111) = .90, p
Significant positive relationships were also found between satisfaction and
transformational leadership style, r (111) = .96, p
styles, r (111) = .47, p
transformational leadership styles and outcomes. Future recommendations include further
research in other geographical locations, comparative studies of raters and self rater
ratings of leadership styles, focused study on one leadership style, broaden the study to
include other health professionals and implementation of transformational leadership
training for front line nurse managers.
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Dedication
This dissertation is dedicated to the three most important and special people whom I have
been blessed with in my life, Kebreab, Efrem and Saba.
Kebreab, my loving husband has provided me with the unconditional love, courage and
support necessary for my dissertation and degree to become a reality.
Efrem and Saba, my two beautiful children, have demonstrated maturity and
understanding well beyond their years in allowing me to achieve my PhD.
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Acknowledgments
This dissertation would not have been possible without the many individuals who
contributed in a variety of ways. Thank you for your contributions. To each of you, I will
be forever grateful. I wish to formally acknowledge the following people.
The registered nurses who participated in my research study–thank you for your
participation and time in completing the surveys. I value your input. Without you, there
The Research paper on Communication Style Case Study 4
Communication style can vary among individuals. Common communication types include assertive, passive, and aggressive. Assertive individuals communicate confidently and speak up for themselves. Aggressive individuals communicate with verbal attacks; they speak their feelings without regard to others, often in a condescending manner riddled with superiority tones. Passive individuals communicate ...
would not be a research study.
Dr. Suzanne Holmes, my dissertation committee chair, valued mentor and exceptional
role model–thank you for your sound guidance, knowledge, expertise and common sense
approach that assisted me in strengthening my abilities and knowledge to bring them to a
new level. I can only hope to begin to measure up to your standards.
Jim Sanderson, my Vice President and executive supporter of my dissertation–thank you
for making the time to listen, for your words of encouragement and most importantly for
your support in allowing me to complete my research study and PhD. For this, I am
grateful.
Arlene MacLellan, my dear friend and colleague who knows only too well that timing is
everything-your magnificent sense of humor, honesty and trustworthiness are greatly
appreciated. Thank you for being the wonderful person that you are. I am honored and
privileged to have your friendship. I will not forget you.
Finally, to my family who deserve nothing but the best and need to know the vital role
they played in helping me achieve my goal. Each of you in your own special way has
been instrumental in making sure I reached the finish line. My success is because of you.
Saba, my beautiful daughter–I thank you for your honesty and feedback when Mom’s
study time was taking precedence over more important things. Now we can do “normal”
things.
Efrem, my wonderful son–I thank you for your humor and understanding during these
past two years when doing other things would have been more fun. Now we can do
“normal” things.
Kebreab, my beloved husband and best friend–I thank you for your strength, your
commitment to us and your support of me in achieving this goal. More importantly, I
thank you for your love and understanding that has sustained me throughout this
marathon. Now it is our time.
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Table of Contents
Page
Acknowledgements vi
List of Tables x
List of Figures xii
CHAPTER 1. INTRODUCTION 1
Introduction to the Problem 1
Conceptual Theoretical Framework 3
Background of the Study 12
The Research paper on Research Study on Gender Bias in Education
These instructions were used as a form of deception to prove my hypothesis. My hypothesis was that women would be more affected by this deception than would the men. My results proved otherwise. Results showed there was little difference in the way the women and men performed on these tests on either version. The ANOVA testing showed these clear results. Does Performance Reflect Success? Gender ...
Statement of the Problem 15
Purpose Statement 16
Research Questions and Hypotheses 18
Nature of the Study 20
Significance of the Study 21
Definition of Terms 22
Assumptions and Limitations 24
Organization of the Remainder of the Study 25
CHAPTER 2. LITERATURE REVIEW 27
Transformational Leadership Theory 27
Empirical Research Review 40
Nursing Research Review 47
Summary 56
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CHAPTER 3. METHODOLOGY 58
Research Philosophy 60
Theoretical Framework 61
Research Design 68
Sampling Design 70
Measures 72
Data Collection Procedures 76
Data Analysis Procedures 77
Limitations of Methodology 78
Ethical Issues 80
Timelines for Research Activities 82
Summary 82
CHAPTER 4. PRESENTATION AND ANALYSIS OF DATA 84
Preliminary Analyses 84
Nursing Leadership Styles and Outcomes Findings 86
Hypotheses Testing 95
Summary 107
CHAPTER 5. SUMMARY, RECOMMENDATIONS AND CONCLUSIONS 111
Summary of Findings 114
Discussion 120
Recommendations for Future Research 126
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Conclusions 127
REFERENCES 130
APPENDIX A. LETTER OF PERMISSION 140
ix
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List of Tables
Page
Table 1. Variable Linked to Multifactor Leadership Questionnaire 5X Short Rater 74
Form
Table 2. Leadership Factor and Outcome Measure Ratings MLQ 5X Short Rater Form 75
Table 3. Research Study Timeline 82
Table 4. Mean and Standard Deviations of Transformational Leadership Style and 90
Behaviors
Table 5. Mean and Standard Deviations of transactional leadership Style and 92
Behaviors
Table 6. Mean and Standard Deviations of Laissez-Faire Leadership Style and 93
Behavior
Table 7. Mean and Standard Deviations of Leadership Outcomes 95
Table 8. Pearson r Correlations between Extra Effort and MLQ Leadership Behaviors 97
The Essay on Leadership Leader Style Group
First off every manager should know that being a manager does not automatically make you a leader. "Managers are people who do things right, and leaders are people who do the right thing." (Handy 1993) The position of a leader can be developed in four main theories. The first being the traits that an individual has this theory is based on the belief that people are born with essentially a ...
Table 9. Multiple Regression on Extra Effort and Three MLQ Leadership Styles of 99
Transformational, Transactional and Laissez-Faire
Table 10. Pearson r Correlations between Effectiveness and MLQ Leadership 101
Behaviors
Table 11. Multiple Regression on Effectiveness and Three MLQ Leadership Styles 103
of Transformational, Transactional and Laissez-Faire
Table 12. Pearson r Correlations between Satisfaction and MLQ Leadership 104
Behaviors
x
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Table 13. Multiple Regression on Satisfaction and Three MLQ Leadership Styles 106
of Transformational, Transactional and Laissez-Faire
xi
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List of Figures
Page
Figure 1. Full Range of Individual Leadership 9
xii
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CHAPTER 1. INTRODUCTION
Introduction to the Problem
What is leadership? What is an effective leadership style? What is a leader? What
is an effective leader? The quest for answers to such questions continues, despite more
than 100 years of study (Fairholm, 1998).
Leadership is a relation-based activity in which
a common vision and shared values are endorsed by a leader and their followers
(Fairholm & Fairholm, 2000).
Leadership is future oriented (Sarros & Santora, 2001).
To
be successful, leaders need to fully understand their roles, their own visions and values as
well as those of their followers regardless of the type of business or organizations they
are leading (Fairholm, 1998).
This applies to health care organizations such as hospitals
and their nursing leaders. The purpose of this research is to determine what nursing
leadership styles positively correlate with leadership outcomes. The leadership styles
include transformational, transactional and laissez-faire while leadership outcomes
consist of satisfaction, extra effort and effectiveness. This chapter introduces the research
problem and provides background on the study, identifies the problem and purpose
The Dissertation on Charismatic Leadership Leaders Leader Transformational
... followers must share the same visions and goals for the charismatic leader to survive.Charismatic leadership qualities are mutually shared by other leadership styles such as transformational ... organizational effectiveness.pp. 276-308. San Francisco: Jossey-Bass. Bass, Bernard M. , Bass & Stogdill's Handbook of Leadership, Theory, Research, and Managerial Applications. 3 rd ...
statements, research questions and hypotheses, nature and significance of the study,
defines terms used in the study, identifies assumptions and limitations followed by an
overview of the remainder of the study.
Today’s nursing leaders function in environments where change is the only
constant (Clancy, 2003).
They face critical leadership challenges in a world of fast paced
turbulent change from both the organization and the environment (Kerfoot, 2000).
Such
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challenges include health care delivery systems, multiple demands for quality services,
and shortages within the nursing profession (Newman, 2002; Peterson, 2001).
Organizational change and how health care delivery systems are managed have led to
role changes of nurse leaders (Ribelin, 2003).
Additionally, how effective leaders are
impacts their employees along with organizational success (Manion, 2000; Sarros &
Santora, 2001; Scoble & Russell, 2003; Shader, Broome, Broome, West & Nash, 2001;
Song, Daly, Rudy, Douglas & Dyer, 1997; Steinbrook, 2002).
Review of the literature
reveals that leadership outcomes such as extra effort; effectiveness and satisfaction are
impacted by leadership styles (Avolio & Bass, 2004; Kelloway & Barling, 2000).
Based
on these findings, there is a need for effective leadership.
Effective leaders at all organizational levels including middle and front line
managers are needed (Manion, 2004).
Health care impacts individuals across the entire
spectrum (Friedrich, 2001).
Health care users expect and demand quality services
(George, 2002).
Given the magnitude of the health care industry and its impact on people
of all ages everywhere, the need for effective leaders is evident (Kerfoot, 2000).
Health
care professionals in general and nurses specifically, are in high demand and short supply
(Cowin, 2002; Ribelin, 2003).
These vital, but precious resources need to be valued and
protected if health care services are to continue being provided (Sherman, 2002).
The Essay on Democratic Leadership People Leader Work
The policies of democracy in practice may not be all that they claim to be but they have done more good than any other organizational system that has been tried before. Democratic leadership certainly has more advantages than disadvantages. It is important to understand the term 'Democratic Leadership' before we can talk about its advantages and disadvantages. In simple terms democratic leadership ...
Health
care executives are demanding their leaders to deliver high quality services in cost
effective ways (Cullen, 1999).
Continuous attempts at doing more with less require
strong leaders (Kerfoot, 2000).
Given the demands of the public, employees and
executive leaders, coupled with the turbulent ever-changing health care environment, it is
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not easy to be a leader in health care in these demanding circumstances (Ribelin, 2003).
This information offers support for the important role nursing leaders’ play in this
complex setting. It further demonstrates the need to study the relationship between
nursing leadership styles and leadership outcomes so as to better understand effective
leadership and develop effective leaders.
Although there have been decades spent on leadership research, a void still exists
between leadership research findings and their application in practice (Fairholm, 1998;
Sarros & Santora, 2001; Tjosvold & Wong, 2000).
In turn, this creates a further void
between leaders and followers (Sarros & Santora, 2001).
This gap needs to be addressed
so effective nurse leaders are able to achieve goals on a consistent basis through the trust
and commitment gained from their followers (Manion, 2004).
In this type of environment
the leader and followers are able to entrust the intent, actions and purposes of others and
thus commit to organizational goals (Fairholm & Fairholm, 2000).
Benefits to
implementing such leadership are directed towards organizations, leaders, followers and
the clients being served (Landrum, Howell, & Paris, 2000).
This leads one to question
what leadership model is to be followed.
Conceptual Theoretical Framework
An abundance of literature has been published on leadership over the past several
decades (Fairholm, 1998; Sarros & Santora, 2001; Tjosvold & Wong, 2000).
Leadership
models that worked in the past may no longer be viable in the constantly changing
environment of today. Early leadership theories and models emphasized the need for
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order and control, while the past 30 years have experienced a new group of leadership
theories known as transformational leadership theory (Bryman, 1992).
This leadership
theory began with Burns and was further expanded by Bass (Fairholm, 1998).
It is the
guiding framework for this research study.
Transformational leadership is referred to as a process in which followers are
motivated by appealing to their moral values and higher ideals (Burns, 1978).
Bass
(1990) defines transformational leadership as an exemplary leadership style in which
followers’ interests are elevated and broadened. These leaders are aware of and accept the
mission and goals of the larger group and they willingly look past self-interests to those
of the group (Bass, 1990; 1998).
The leaders and their followers form a relationship that
accounts for exceptional performances and accomplishments (Bass, 1998).
The
transformational leadership theory is a means of explaining this leader follower
relationship.
Leadership, as posited by Bass (1985) consists of three second order domains that
include transformational, transactional and laissez-faire. This is referred to as the full
range of individual leadership (Bass, 1990).
Bass views transformational and
transactional leadership as separate conceptually (Tejeda, 2001).
Both styles are however
seen as positive with effective leaders displaying both behavioral types (Avolio & Bass,
2000).
Bass and Avolio (1994) theorized that transformational leadership consists of four
dimensions including idealized influence, individualized consideration, inspirational
motivation and intellectual stimulation. It is these dimensions or behaviors that foster the
leader follower relationship amongst transformational leaders and their followers (Bass &
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Avolio, 1997).
The following pages outline the conceptual and operational definitions of
transformational leadership.
Conceptual Definition of Transformational Leadership
Transformational leadership. Transformational leadership is a visionary
leadership style characterized by behaviors intended to empower, inspire and motivate
followers to exceed expectations as measured by the Multifactor Leadership
Questionnaire 5X Short Rater form (Avolio & Bass, 2000).
The behaviors include
idealized influence–attributed, idealized influence–behavioral, inspirational motivation,
intellectual stimulation and individualized consideration (Bass, 1999).
Operational Definitions of Transformational Leadership
Idealized influence–attributed. Idealized influence–attributed is a transformational
leadership behavior that refers to the transformational leader’s charismatic quality which
results in followers having confidence, respect and trust in their leader as measured by
the Multifactor Leadership Questionnaire 5X Short Rater form (Avolio & Bass, 2000).
Table 1 identifies the Multifactor Leadership Questionnaire items that measure this
factor.
Idealized influence–behavioral. Idealized influence–behavioral is a
transformational leadership behavior that alludes to the charismatic quality of the
transformational leader which results in followers identifying with their leader, the vision
and the sense of purpose as measured by the Multifactor Leadership Questionnaire 5X
Short Rater form (Avolio & Bass, 2000).
Table 1 identifies the Multifactor Leadership
Questionnaire items that measure this factor.
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Inspirational motivation. Inspirational motivation is a transformational leadership
behavior that deals with the role model capabilities of the leader that results in building
confidence and inspiring followers to believe as measured by the Multifactor Leadership
Questionnaire 5X Short Rater form (Avolio & Bass, 2000).
Table 1 identifies the
Multifactor Leadership Questionnaire items that measure this factor.
Individualized consideration. Individualized consideration is a transformational
leadership behavior that focuses on the leader’s ability to support, coach and provide
learning opportunities for followers so they may achieve to their greatest potential as
measured by the Multifactor Leadership Questionnaire 5X Short Rater form (Avolio &
Bass, 2000).
Table 1 identifies the Multifactor Leadership Questionnaire items that
measure this factor.
Intellectual stimulation. Intellectual stimulation is a transformational leadership
behavior that refers to the leader’s ability to understand and solve problems using
innovative approaches, which in turn encourages followers to use creativity and intellect
to solve their own problems as measured by the Multifactor Leadership Questionnaire 5X
Short Rater form (Avolio & Bass, 2000).
Table 1 identifies the Multifactor Leadership
Questionnaire items that measure this factor.
Transactional leadership, on the other hand is an exchange process in which
followers receive rewards when performance requirements are completed (Bass, 1990).
Transactional leadership behaviors include contingent rewards, management by
exception-active and management by exception-passive. Bass and Avolio (1997) view
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the two former behaviors as positive, while the latter one is not. The conceptual and
operational definitions of transactional leadership are explained below.
Conceptual Definition of Transactional Leadership
Transactional leadership. Transactional leadership is a leadership style
characterized by behaviors of risk avoidance, operating within existing systems; close
attention paid to efficiency and time constraints and maintains control through processes
(Bass, 1997).
Behaviors included in this style of leadership are contingent reward,
management by exception–active and management by exception–passive.
Operational Definitions of Transactional Leadership
Contingent reward. Contingent reward is a transactional leadership behavior that
places emphasis on clarifying goals and recognizing when they are achieved as measured
by the Multifactor Leadership Questionnaire 5X Short Rater form (Avolio & Bass, 2000).
Table 1 identifies the Multifactor Leadership Questionnaire items that measure this
factor.
Management by exception–active. Management by exception–active is a
transactional leadership behavior that encompasses the leader stating the standards to be
complied with as well as those that are ineffective performance as measured by the
Multifactor Leadership Questionnaire 5X Short Rater form (Avolio & Bass, 2000).
Table
1 identifies the Multifactor Leadership Questionnaire items that measure this factor.
Management by exception–passive. Management by exception–passive is a
transactional leadership behavior that includes a more passive and reactive approach to
concerns as the leader fails to act until one is made aware of the mistakes as measured by
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the Multifactor Leadership Questionnaire 5X Short Rater form (Avolio & Bass, 2000).
Table 1 identifies the Multifactor Leadership Questionnaire items that measure this
factor.
Laissez-faire leadership is the third leadership style and is referred to as a
leadership condition in which there is no leadership or intervention when needed is
avoided (Bass & Avolio, 1997).
This leadership style is viewed as ineffective (Fairholm
& Fairholm, 2000; Sarros & Santora, 2001).
Below are the conceptual and operational
definitions of this leadership style.
Conceptual Definition of Laissez-Faire Leadership
Laissez-faire leadership. Laissez-faire leadership is a leadership style that is
viewed as leaders failing to accept responsibilities, refrain from expressing views on
important issues and failing to follow up on requests for assistance (Avolio & Bass,
1999).
Operational Definition of Laissez-Faire Leadership
Laissez-faire leadership. Laissez-faire leadership is leadership behavior that is
viewed as passive and ineffective as measured by the Multifactor Leadership
Questionnaire 5X Short Rater form (Avolio & Bass, 2004).
Table 1 identifies the
Multifactor Leadership Questionnaire items that measure this factor.
This full range of individual leadership as conceptualized by Bass (1990) from the
laissez-faire to the transactional and the transformational is depicted in Figure 1.
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Figure 1. Full Range of Individual Leadership
Adapted from Bass and Avolio, (1997), Improving Organizational Effectiveness
Through Transformational Leadership, p. 5.
Beginning in the bottom left hand corner, the laissez-faire leadership style is
shown as the most passive and ineffective followed by the transactional behavior of
management by exception–passive (Bass & Avolio, 1990).
Management by exception-
Laissez-
Faire
Management
by
Exception-
Passive
Management
by Exception-
Active
Contingent
Reward
Four I’s
Individualized
Consideration
Intellectual
Stimulation
Inspirational
Motivation
Idealized
Influence
INEFFECTIVE
PASSIVE ACTIVE
EFFECTIVE
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active is viewed as more effective and less passive than the former two, but not as
effective as the transactional behavior of contingent rewards (Bass & Avolio, 1997).
On
the right hand side, the four transformational behaviors are identified including
individualized consideration, intellectual stimulation, inspirational motivation and
idealized influence which are viewed by Bass and Avolio, (1997) as the most active and
effective.
Transactional and transformational leadership styles are effective in different
circumstances (Avolio & Bass, 2000; Fairholm & Fairholm, 2000; Sarros & Santora,
2001), while laissez-faire leadership is viewed as ineffective (Bass & Avolio, 1997).
Transactional leaders place emphasis on clarifying expectations and creating confidence
in their followers to successfully achieve desired outcomes (Avolio & Bass, 2000).
Transformational leaders move beyond the transactional approach to transforming
individuals and organizations to achieve higher-level goals (Bass, 1998).
Depending on
the situation, to be effective the appropriate leadership style may vary (Fairholm &
Fairholm, 2000).
Differences exist amongst the three leadership styles. The primary difference
between the three leadership styles lies in the relationship that is present between the
leader and followers (Bass & Avolio, 1997).
Transformational leaders successfully
establish and maintain an effective leader-follower relationship that results in followers
consistently exceeding expectations (Avolio & Bass, 2000).
The other two leadership
styles do not result in establishing this unique relationship (Bass & Avolio, 1997).
The
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Nursing Leadership Styles and Outcomes
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latter styles are more reactive to situations as opposed to the transformational leaders’
proactive approach (Avolio & Bass, 2000).
Regardless of the leadership styles being practiced, they result in leadership
outcomes, which impact followers. Three leadership outcomes cited by Bass (1990) are
satisfaction, extra effort and effectiveness. Satisfaction refers to how satisfied followers
are with their leaders and their jobs (Avolio, 1999).
According to Bass (1997), extra
effort refers to the leader’s ability to increase followers’ desires to succeed and
willingness to try harder. Effectiveness is the third leadership outcome identified that
alludes to the leader’s abilities to lead an effective group and meet the followers’ job
related needs (Bass, 1998).
Bass and Avolio (1997) contend that enhanced performance and effectiveness in
various cultures and organizations is correlated with effective leadership. Research
studies show that the performance of followers is positively affected to a greater extent
and in different ways by transformational leadership than any other style of leadership
(Avolio, 1999; Bass, 1998; Fairholm, 1998; House & Aditya, 1997).
Bratt, Broomer,
Kelber and Lostocco, (2000) found a positive correlation between job satisfaction and
nursing leadership. Loke (2001) explored nursing leadership and their effects on
employee outcomes and reported a strong correlation between job satisfaction and
leadership behaviors. These findings are based on perceptions of the leader which
according to Avolio and Bass (2000) is a useful way to measure leadership behaviors.
Understanding the leader-follower relationship is vital to the transformational
leadership theory. The aforementioned studies support the need for and value in effective
*Senior nurses are likely to engage in a range of leadership activities in their daily routine. Some will naturally adopt an effective leadership style, while others may find the concept of leadership or seeing themselves as leaders difficult to understand. Effective leadership is critical in delivering high-quality care, ensuring patient safety and facilitating positive staff development.
Frankel, A. (2008) What leadership styles should senior nurses develop? This is an extended version of the article published in Nursing Times; 104: 35, 23-24.
Author
Andrew Frankel, MSc, BA, PGCMS, RNM, DipN, is hospital director, Churchill Gisburn Clinic, Lancashire.
Introduction
This article outlines the characteristics of an effective leader, the political context and various leadership activities for senior nurses. It also discusses mentorship, different leadership models and the process of professional socialisation.
For the purposes of this article, senior nurses are defined as practitioners with additional post-qualification education, skills and experience who work within the nursing team providing a day-to-day, hands-on, visible presence.
Leadership can be defined as a multifaceted process of identifying a goal or target, motivating other people to act, and providing support and motivation to achieve mutually negotiated goals (Porter-O’Grady, 2003).
In the daily life of a senior nurse, this could refer to coordinating the day/night shift and the team of nurses and support staff on duty under the direction of that nurse. The successful operation of the shift, staff morale and managing difficult or challenging situations depends largely on the senior nurse’s leadership skills.
It is important to appreciate that leadership roles are different from management functions. In Stephen Covey’s (1999) book The Seven Habits of Highly Effective People, he quoted Peter Drucker as saying: ‘Management is doing things right; leadership is doing the right things. Management is efficiency in climbing the ladder of success; leadership is about determining whether the ladder is leaning against the right wall.’ This suggests that management is about tasks, whereas leadership is about perception, judgement, skill and philosophy. We could infer from this that it is much more difficult to be an effective leader than an effective manager.
Characteristics of an effective leader
Leaders are often described as being visionary, equipped with strategies, a plan and desire to direct their teams and services to a future goal (Mahoney, 2001).
Effective leaders are required to use problem-solving processes, maintain group effectiveness and develop group identification. They should also be dynamic, passionate, have a motivational influence on other people, be solution-focused and seek to inspire others.
Senior nurses must apply these characteristics to their work in order to win the respect and trust of team members and lead the development of clinical practice. By demonstrating an effective leadership style, these nurses will be in a powerful position to influence the successful development of other staff, ensuring that professional standards are maintained and enabling the growth of competent practitioners. In a study by Bondas (2006), leaders who were described as driving forces were admired. They were regarded as a source for inspiration and role models for future nurse leaders.
Leadership for senior nurses is primarily about the following: making decisions; delegating appropriately; resolving conflict; and acting with integrity. The role also involves nurturing others and being aware of how people in the team are feeling by being emotionally in tune with staff.
The above functions are the core elements necessary to connect leadership with the effective development of other team members. This is largely achieved by working alongside them in a mentoring and coaching role. A good and successful leader will seek to develop other staff through their leadership. Saarikoski and Leino-Kilpi (2002) found the one-to-one supervisory relationship was the most important element in clinical instruction. Research also suggests that mentorship facilitates learning opportunities, helping to supervise and assess staff in the practice setting. Terminology frequently used to describe a mentor includes: teacher; supporter; coach; facilitator; assessor; role model; and supervisor (Hughes, 2004; Chow and Suen, 2001).
Within my own organisation we often refer to the phrase ‘don’t just tell me – show me’, which illustrates the need for management instructions to be supported by clear leadership and supervision. It is recommended that staff are first shown how to perform a task and then supported to complete it.
A culture based on continual learning through support and best-practice methods will empower and motivate staff. Dynamic clinical leaders and supportive clinical environments are essential in the development and achievement of best practice models.
Key factors described as effective in nurturing transformational clinical leaders are: provision and access to effective role models; mechanisms for mentoring and clinical supervision; provision of career pathways; intentional succession planning; organisations that value clinical competence; and promotion of centres of excellence (Borbasi and Gaston, 2002).
Political context
Nurse leaders need to be able to respond to an ever-changing healthcare environment, including organisational expectations and changes to local and national policy. I do not know of any clinician or manager who would dispute that nursing roles are changing. These roles have become more specialist, autonomous, accountable and focused on outcome, with both positive and negative consequences for the profession. Consumers and purchasers of healthcare services have greater expectations of higher standards, particularly in relation to nursing care.
Nurse leaders must demonstrate resilience in responding to change and supporting others to embrace this in a positive way. Effective leaders should be capable of reframing the thinking of those whom they are leading, enabling them to see that changes are not only imperative but achievable.
Senior nurses need to find ways of becoming involved in organisational decision-making on issues impacting on clinical care such as: developing policy; workforce planning; departmental business planning; and clinical and corporate governance. Sorensen et al (2008) advocate that senior nurses must develop constructive processes through which they become accepted as equal team members. They also need to design workplace systems that underpin good patient outcomes, evaluate nursing expertise and represent nursing interests in corporate decision-making forums.
Leadership activities of senior nurses
Senior nurses should be able to develop other staff by enabling them to apply theory to practice and encouraging them to test new skills in a safe and supportive environment. This, again, is an example of where leadership activities combine with developmental ones to create competent practitioners through practice-based learning.
These nurses should adopt a supportive leadership style with mentorship, coaching and supervision as core values. Constable and Russell (1986) showed that high levels of support from supervisors reduced emotional exhaustion and buffered negative effects of the job environment. Consequently, it would be particularly beneficial for supervisors to provide emotional support to nurses and give them adequate feedback about performance to increase self-esteem (Bakker et al, 2000).
Senior nurses should also apply leadership skills in encouraging staff to use critical reflection to facilitate new understanding.
In the ward environment, there can be tensions between professional disciplines. Resolving these and building effective relationships between multidisciplinary team members is a test of senior nurses’ leadership abilities. With nurses becoming more autonomous decision-makers, this must inevitably lead to revising the relationship between professional roles.
Senior nurses also have a leadership role in facilitating their organisation’s staff support and development programme, which should aim to reduce stress, burnout, sickness and absenteeism among colleagues. Supervisors have a significant influence on employees’ personal and professional outcomes. Bakker et al (2000) reported that senior nurses can buffer the effects of a demanding work environment on staff nurses by thoughtfully maintaining a leadership style that supports staff needs.
A successful leader will see each person as an individual, recognising their unique set of needs, as not everyone will perform at the same level or respond in the same way to environmental stressors or workplace pressure. Leaders need to support staff in ways in which individuals recognise as being useful.
In the same way, staff will be motivated by different factors. Leaders must focus on the needs of individual staff and use motivational strategies appropriate to each person and situation. They must seek to inspire demotivated staff and maintain the motivation of those who are already motivated. Leadership seeks to produce necessary changes in demotivated staff by developing a vision of the future and inspiring staff to attain this. Leadership is the driving force of the work environment and directly affects staff motivation and morale. West-Burnham (1997) argued that leaders should seek to improve on current practice, and use their influence to achieve this. This includes working within the team to develop goals and a feeling of shared ownership to achieve excellence in clinical practice.
Mentorship
Different people are motivated in different ways. Therefore, leaders must use strategies that individuals find motivating to empower them and highlight the importance of the nursing role.
One method of achieving this is through the process of structured mentorship. I believe that mentorship should foster ongoing role development and be based on the acquisition and mastery of new skills.
Senior nurses should take time on every shift (between five and 30 minutes) to be involved in some form of mentoring activity, which should then be recorded in staff members’ ‘learning log’.
The learning log is a simple, task-specific recording method used as documented evidence that mentorship has been given on a particular area of work activity. The staff member participates in the completion of their log, which briefly records:
• The nature of the activity being coached;
• Strengths and weaknesses in performing the activity;
• Coaching intervention;
• Future goals.
It is important that staff members do not feel micromanaged. Learning logs must be viewed as a mentorship tool, rather than a management one. The log is merely used to remind and refresh the mentor and staff member about what has been achieved between the last formal clinical supervision session and the next. The learning log will be used for reflection purposes to form the basis of a more comprehensive supervision discussion.
Leaders, in their capacity as mentors, must ensure that more junior staff have the freedom to seek information, through an open exchange of opinions and ideas. Staff should also be given the opportunity to show initiative, thus promoting confidence in decision-making and underpinning knowledge and competence in their own skills. The goal of mentorship should be to create a stable and supportive environment which encourages professional growth through effective role modelling. Murray and Main (2005) argued that the notion of role modelling is seen as a traditional expectation of less experienced nurses learning from more experienced ones.
Leadership models
There are a number of useful models to help to guide senior nurses in leading other staff. The two most common are transformational and transactional models (Bass, 1985; Burns, 1978).
The effects of transactional leadership are short-lived, episodic and task based, with the transactional leader only intervening with negative feedback when something goes wrong. This form of leadership would have a place where there is a specific short-term directed project or piece of work to be completed.
In a ward, it is more desirable to identify a leadership model that offers longevity in the relationship between senior nurses and junior colleagues. The transformational model is more complex but has a more positive effect on communication and teambuilding than the transactional model (Thyer, 2003).
Transformational leadership shapes and alters the goals and values of other staff to achieve a collective purpose to benefit the nursing profession and the employing organisation. Bass (1985) found that transformational leadership factors were more highly correlated with perceived group effectiveness and job satisfaction, and contributed more to individual performance and motivation, than transactional leaders.
Adair (2002) proposed a different model. This is the three-circle model of strategic leadership, with the circles being the needs of the task, the individual and the team (Fig 1).
Adair believes that knowledge or expertise alone is not enough to lead; however, without it, leadership is impossible. Leaders should be aware of both group and individual needs, and should harmonise them to support common goals.
Each of the three needs in the model interacts with the others. One must always be seen in relation to the other two (Adair, 2003).
This is a democratic model of leadership, in which there is consideration for the opinions of those who have to carry out the task. Individuals and groups are involved in decision-making processes concerning their work. The valuing of people, their knowledge, experience and skills is central to this model.
Leadership models are a useful tool for senior nurses and help to put the function of leadership activity into perspective. These nurses should not be concerned about using concepts from various models and developing an eclectic strategy. The models should be used as a framework on which to build an effective leadership style which suits the individual leader and those whom they are leading.
Professional socialisation
Supervised learning in clinical practice fosters emotional intelligence, responsibility, motivation and a deeper understanding of patient relationships and nurses’ identity and role (Allan et al, 2008).
For care standards to improve, attention must be paid to improving post-registration education and practice development. This should include clarifying role expectation and developing a professional identity. Professional socialisation is a learning process that takes place in a work environment, of which junior nurses are an integral part. Effective leaders will generate opportunities which create potential for professional self-development for junior staff. It is during this socialisation period that junior nurses develop opinions, attitudes and beliefs about their role which form the basis of professional growth. The role-modelling behaviour of senior nurses during this process is critical in transmitting appropriate professional values from one generation of nurses to the next.
The role of senior nurses is dynamic and multifaceted. Nurse leaders in practice settings have unique opportunities to influence and even create the environment in which professional nursing practice can flourish. Marriner-Tomey (1993) suggested that, in this highly influential role, nurse leaders have a major responsibility to change behaviour to provide an environment that supports the preparation of competent and expert practitioners. It is part of nurse leaders’ role to serve as a model in providing effective socialisation experiences that impart the appropriate values, beliefs, behaviours and skills to staff.
Better outcomes for patient care
Ultimately, a goal of any healthcare organisation should be to influence the quality of patient care through good nursing leadership. Good leaders should encourage junior staff to gain a better understanding of patients and their needs and values. Overall, these strategies will lead to increased patient satisfaction, more effective nurse-patient relationships and quicker recovery times.
Empowered nurses are eager to implement evidence-based practice. They are highly motivated, well informed and committed to organisational goals, and thus deliver patient care with greater effectiveness (Kuokkanen and Leino-Kilpi, 2000).
Good leadership could produce better patient outcomes by promoting greater nursing expertise through increased staff ability and a new level of competence. Aiken et al (2001) argued the hospital practice environment has a significant effect on patient outcomes. Junior nurses should be encouraged to seek maximum rather than minimum standards, and be expected to achieve and maintain high-quality benchmarks.
Conclusion
This article has highlighted the essential leadership role that senior nurses have in developing skilled and competent staff. Leadership behaviour has a great impact on staff. Senior nurses must acknowledge the importance of their role, recognising that junior staff rely on their leadership in developing their own professional skills and capability.
These nurses must use their leadership behaviour to positively influence organisational outcomes and need to appreciate the inter-relationship between developing nursing practice, improving quality of care and optimising patient outcomes. Healthcare organisations need nurse leaders who can develop nursing care, are an advocate for the nursing profession and have a positive effect on healthcare through leadership.
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