Transformational Leadership In Nursing Assignment

Transformational Leadership In Nursing Assignment

 

CHAPTER 6

Shaping Your Own Leadership Journey.

Marion E. Broome and Elaine Sorensen Marshall

While many people believe that transforming organizations… is the most difficult, the truth is that transforming ourselves is the hardest job. And if we transform ourselves, we transform our world.

—Dag Hammarskjold

LEADERSHIP AS A CAREER JOURNEY

Consequential leadership requires the cultivation of a lifetime of habits that build others and strengthen oneself. Hamric, Spross, and Hanson (2009, p. 254) reviewed leadership models and concluded that only three habits are most important to the transformational leader in clinical practice: (a) empowerment of colleagues and followers, (b) engagement of stakeholders within and outside nursing in the change process, and (c) provision of individual and system support during change initiatives. Although these are critically important skills for any leader, there are many more essential habits for the effective transformational leader. In Chapter 1, Frameworks for Becoming a Transformational Leader, we reviewed various dimensions of transformational leadership—the focus of this book. At the beginning of this chapter, we introduce two complementary leadership frameworks that you may find useful in thinking about your own personal leadership philosophy, style, and behaviors: authentic leadership (Avolio & Gardner, 2005) and leadership challenge (Kouzes & Posner, 2010). Consideration of these models provides a foundation for examining and developing personal leadership styles. A discussion of how competencies of leadership have evolved over time expands the conversation. We then show how leaders can take these frameworks to build their own leadership skills and competencies. Transformational Leadership In Nursing Assignment

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TWO MODELS TO USE IN BUILDING A FOUNDATION TO BECOME A TRANSFORMATIONAL LEADER

Authentic Leadership Model

Authentic leadership is one of the frameworks that emphasizes relationships between leaders and followers and focuses on the self-development potential of the leader. At the same time, the model reflects a recognition that this potential and subsequent interactions are in service of the larger organization and context, as well as the individuals within the organization. Authentic leaders are perceived as hopeful and optimistic, exhibiting behaviors reflective of a moral compass they can articulate. Such individuals speak with a clear voice for the needs of those in their organization (Avolio & Gardner, 2005). Key characteristics of these leaders include self-awareness, relational transparency, internalized moral perspective, and balanced information processing (Bamford, Wong, & Laschinger, 2013).

Nurse leaders who are authentic are able to be honest and open in their relationships with individuals to whom they report, as well as those who work for them. Their sense of integrity also facilitates, actually mandates, their need to seek diverse perspectives from others and use multiple sources of evidence when making an important decision. Bamford et al. (2013) conducted a secondary analysis of data from 280 nurses who worked with nurse managers. Those nurses who worked for nurse leaders who exhibited higher levels of authentic leadership were more fully engaged in the workplace and reported a greater sense of alignment in multiple areas of their work life. In another study of 273 nurses and 342 new graduates, authentic leadership was associated with lower levels of emotional exhaustion and cynicism for both groups (Laschinger, Wong, & Grau, 2013). Authentic leaders clearly empower others. Transformational Leadership In Nursing Assignment

Leadership Challenge Model

Kouzes and Posner (2010) developed a model of leadership by analyzing practices of leaders to provide emerging leaders with a description of behaviors and practices that develop strengths. The model consists of five practices: (a) model the way, (b) inspire a vision, (c) challenge the process, (d) enable others to act, and (e) encourage the heart.

The nurse leader who models the way understands his or her own beliefs and can articulate how the mission of the organization is an important responsibility of all. Such leaders are visible and committed to the organization and those who work with them. They are experts in their field. It is through their efforts to connect with others and set an example of how to maximize their own and others’ strengths that they can inspire a vision for the organization. Their assessment of the group’s potential based on listening to the hopes and aspirations of others and enthusiasm about where the organization is capable of going enlists others in working toward a common goal.

However, as the leader begins to set the stage, it becomes clear that traditional ways of being and doing will need to be challenged to develop new thinking and ways of behavior to achieve the goals. The leader will then engage in questioning and challenging existing processes. Experimenting with new ways of doing things and challenging others to develop their skills and take risks will enable them to act.

Enabling others to act will require the leader to set a challenge and provide resources for them to draw on to meet the challenge. As they achieve success, others will grow and develop leadership skills themselves. From the collaborations they form while working to solve the challenge, they will learn the value of working with others with complementary knowledge and skills.

The final exemplary practice, to encourage the heart, is one threaded throughout the leadership journey although clearly more important at times when the challenges are more difficult. Individuals working with the leader rely on coaching, celebrating small victories, and the presence of the leader when stress runs high in the organization. Kouzes and Posner developed the Leadership Practices Inventory series (2016), which allows individuals to assess their own leadership strengths in each of the five exemplary practices and provides tools and activities to use to grow their leadership skills. Transformational Leadership In Nursing Assignment

These two leadership frameworks reflect a clear emphasis on authentic and meaningful relationships between the leader and others. Leaders in each framework articulate their beliefs that serve as a foundation for their vision for the organization and for how the potential of others can be developed and leveraged for success of all. Leaders who are relationship based have a clear moral compass, are secure in their belief system, and are open to and seek out diverse perspectives to shape how they think about challenges and solutions. These models are broader and more philosophical, and frankly more inspiring from our perspective, than some other approaches that include lists of competencies for leadership performance.

MOTIVATION: LEADING BY INSPIRATION AND MODELING

Motivation is so much more than providing incentive for productivity. It is about inspiring and giving hope to colleagues and followers within the organization. And marketing is so much more than selling. It is also about inspiring and giving hope to colleagues and the public outside the organization. To motivate others is to listen to their aspirations for themselves and their careers, as well their aspirations for their organization. It is also the responsibility of the leader to listen for the signs of others’ fears and to show the way to hope.

For years, motivation experts have argued over whether intrinsic or extrinsic motivators are most effective. But motivation is larger than a polarized paradigm between external and internal rewards. The truth is that everyone responds to both extrinsic and intrinsic sources of motivation. Extrinsic factors include such things as power, money, and status; and intrinsic factors include finding meaning, growing, and learning. We all respond to both. Of course, many workers whose basic needs have been satisfied are best motivated by higher needs of achievement, emotional fulfillment through relationships, flexibility, and personal growth (Bal, De Jong, Jansen, & Bakker, 2012). Transformational Leadership In Nursing Assignment

Intrinsic or internal motivation is personal passion. Behind it is the energy to engage in the work, to set and pursue personal and organizational goals, to overcome obstacles, and to press forward. External incentives, such as money or status, are secondary to the satisfaction of engagement and achievement (Porter-O’Grady & Malloch, 2017). The transformational leader in a healthy organization believes that others respond to both internal and external motivators (Broome, 2013). Thus, the assumption is that people who are valued, encouraged, supported, and provided with the environment and resources to succeed will take initiative and perform creatively and effectively. From such groups will emerge collective wisdom, creativity, and some degree of self-governance.

Wise leaders stay in touch with the people with whom they work. The leader can do this in a variety of ways such as the following:

• Making rounds throughout the organization to be visible
• Talking with employees and other leaders in informal settings such as dining area, elevators, and hallways
• Sending personal congratulatory notes when an individual does something of note
• Calling and/or sending a personal note when something (e.g., a death, an illness) occurs to share condolences or concern

As a leader, you will find what habits and strategies are best for your style and comfort. But it is important to constantly keep in touch personally with colleagues and staff. There is no magic theory, strategy, or practice for motivation that works universally every time. Motivation requires authentic passion about the work, genuine interest in the workers, and vigilance to human needs for encouragement, support, autonomy, and meaning. But workers in any organization, especially those who are professionally young, need the leader to inspire and motivate them. Just sharing a vision is not enough, the leader must reach out and relate to others to effect change, improve the organization, and sustain improvement.

LEADERSHIP COMPETENCIES

There is growing agreement on the need for better leadership in healthcare, but little consensus or evidence regarding which specific areas of knowledge, skills, attitudes, habits, or competencies are best suited to the leaders of the next century (Northouse, 2018) or how they are best acquired. Thus, it seems that every leadership guru creates a list. We have lists of competencies from experts and expert panels, from authorities in business and healthcare, from government agencies, from the Institute of Medicine, and from every practice discipline. Transformational Leadership In Nursing Assignment

Much of the literature on leadership in healthcare refers to specific management skills with a focus on performance. Competency models originate from private and public sector business and industry as well as academe, each one with its own list of dimensions. The dimensions usually include items related to productivity, personal characteristics, and personnel relationships (Simonet & Tett, 2013). Such models have now found their way into healthcare organizations.

Many of the competency models rely on some sort of 360-degree evaluation model, which refers to regular, formal, and direct leader feedback related to performance on specific goals based on stated organizational values. This model begins with self-evaluation and then integrates formal evaluation from superiors, peers, and subordinates. The critiques are reviewed with an immediate supervisor, and a plan for improvement is developed. This evaluation model is commonly used in business and increasingly incorporated into healthcare environments (Day, Fleenor, Atwater, Sturm, & McKee, 2014).

In healthcare organizations, one of the frequently referenced models of competencies is that produced by the American Organization of Nurse Executives (AONE; 2016), an assessment tool that emerging leaders can use to examine their own competencies and where they are in their leadership journey. Nurse educators can also use the tool to help guide curricular development. The AONE noted the need to delineate differences in leadership competencies among leaders of healthcare systems, leaders working outside of traditional hospital or inpatient settings, and those who are nurse managers. The organization developed this list of competencies using expert nurse leaders at all levels from nurse managers to health system executives, and their publications are available from the organization. Transformational Leadership In Nursing Assignment

There is increasing interest in the empirical discovery and measurement of competencies for successful leaders (Day et al., 2014). Guo (2009) promoted a paradigm that identified four essential dimensions: conceptual, participation, interpersonal, and leadership. Guo identified the following core competencies: healthcare system and environment, organization, and interpersonal competencies.

One group of competencies that has been extensively researched originates from the National Center for Healthcare Leadership in Chicago, Illinois. Its Health Leadership Competency Model (National Center for Healthcare Leadership, 2015) was developed from extensive academic and clinical study. The model comprises three domains of transformation, execution, and people. Under each domain is a list of the following competencies:

1.Transformation competencies: Achievement orientation, analytical thinking, community orientation, financial skills, information seeking, innovative thinking, and strategic orientation

 

2.Execution competencies: Accountability, change leadership, collaboration, communication skills, impact and influence, information technology management, initiative, organizational awareness, performance measurement, process management/organizational design, and project management

3.People competencies: Human resources management, interpersonal understanding, professionalism, relationship building, self-confidence, self-development, talent development, and team leadership (Calhoun et al., 2004; National Center for Healthcare Leadership, 2015).

The Healthcare Leadership Alliance Competency Directory (2013; Stefl, 2008) lists 300 competences under the five domains of leadership, communications and relationship management, professionalism, business knowledge and skills, and knowledge of the healthcare environment. If leadership performance could be learned from a dictionary, this would be the one of choice. It is a large classification system of knowledge and skill areas searchable by an elaborate system of key words. Sponsored by the American College of Healthcare Executives, the American College of Physician Executives, the AONE, the Healthcare Financial Management Association, the Healthcare Information and Management Systems Society, and the Medical Group Management Association, it provides an impressive inventory of leadership concepts that can enable managers and leaders to meet the challenges of navigating and leading through the complexities of current healthcare environment (Healthcare Leadership Alliance, 2013). Unfortunately, it does not provide mentorship, role models, personal experience, or inspiration for the soul of the aspiring leader. For nurse leaders, these supports must be found through the many available leadership academies, conferences, short intensive courses, and other similar options. Transformational Leadership In Nursing Assignment

Huston (2008, p. 906) outlined eight “essential” leadership competencies for the nurse leader of 2020:

1.A global perspective of healthcare and professional nursing issues

2.Technology skills that facilitate mobility and portability of relationships, interactions, and operational processes

3.Expert decision-making skills rooted in empirical science

4.The ability to create organization cultures that permeate quality healthcare and patient/worker safety

5.Understanding and appropriately intervening in political processes

6.Collaborative and team-building skills

7.Ability to balance authenticity and performance expectations

8.Ability to envision and proactively adapt to a healthcare system characterized by rapid change and chaos

A recent study by Shillam et al. (2018) can be used to self-assess one’s ability to influence others—one of the most important competencies of overall leadership. This tool was designed to help nurse leaders assess and enhance their ability to influence others by measuring traits and practices and point out the individual areas of strength and need for improvement. The Adams Influence Model was used as the conceptual model that serves as a basis for the tool. This model (Adams & Natarajan, 2018) contains five areas of competence:

• Knowledge-based competence: Reflects individuals’ intellectual expertise as measured by empirical knowledge of their field, personal and aesthetic knowledge of their culture, and sociological and ethical understanding of the worlds they work within
• Authority: The right to take action
• Status: Holding a high-standing position or prestige
• Communication traits: The proficiency with which one relates and interacts with others
• Use of time and training: The balance between knowing when to act and what time frame is available to act for maximum effectiveness Transformational Leadership In Nursing Assignment

The tool was developed based on interviews with 15 nurse leaders across academe, clinical practice, policy, and philanthropy. Common themes across all leaders included: authentic leadership, risk-taking, and emotional intelligence. Additional skills included negotiation, sense of micro and macro focus, and integrity. This tool will be very useful for middle- to senior-level leaders as they plan their next phase of development and will help identify areas on which they could work to strengthen.

As you consider new roles or simply a new perspective for an existing clinical leadership role with advanced preparation at the highest level of clinical practice, it would be most unfortunate if you were to attempt to reinvent the entire concept of competency. This review confirms the abundance of work on healthcare leadership competencies. It is the responsibility of the next generation of leaders to sort, identify, test, and apply most effective competencies that will support the vision of the transformational leader.

VISION: PERSPECTIVE AND CRITICAL ANALYSIS

Vision is probably one of the most discussed and commonly accepted attributes of leaders. Visionary leaders do not stop at simply holding workers accountable to competencies. They make it their habit to look up and beyond, foreseeing next steps and future challenges, opportunities, and accountabilities. Their own personal vision enlivens formal vision statements and integrates the meaning of the statements into their very beings. Vision releases forces that attract commitment and energize people to create meaning in the lives of others, to establish standards of excellence, and to bridge the present and the future (Kouzes & Posner, 2010).

If you have no vision of where you are going, why should anyone follow you? Followers expect leaders to know where they are going and to strike the path toward a vision. Kouzes and Posner (2007, 2010) are credited with the well-known statement, “There’s nothing more demoralizing than a leader who can’t clearly articulate why we’re doing what we’re doing.” By the same token, to spare themselves their own personal demoralizing sense of daily drudgery and 191burden, visionary leaders take the larger perspective, beyond day-to-day tasks and operations. Transformational Leadership In Nursing Assignment

What is vision and how do you cultivate the habit of sustaining your own vision? Vision is the image of the future you want to create. It is your picture of what is possible. Vision requires a dream and a perspective that set a direction that others want to follow. Heathfield (2015) proposed the following fundamental requirements for vision to actually make a difference: The vision must clearly set a direction and purpose for the entire organization. It must inspire a commitment, loyalty, caring, and genuine interest in personal involvement in the enterprise. The vision should reflect the unique culture, values, beliefs, strengths, and the direction of the organization. It must “fit” within the culture of the organization and its teams. The vision always promotes the feeling among followers that they are part of something greater than themselves, that their daily work is more than operational, but rather part of some greater future. Such a vision challenges others to stretch, to reach, and to produce beyond their own expectations.

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The leader who sets such a vision will have the larger perspective not only of the official vision statement or strategic plan, but also beyond. Nevertheless, the effective visionary leader does not only see the big picture of the vision, but also is able to sensitively support others in the daily work of all members of the organization. To the perceptive leader, the vision is more than a rallying cheer. It represents a substantive direction for action and achievement. The vision is only one aspect of a strategic plan for action, but it is the vital life force of that plan. Inspiring leaders have the courage and the drive to dream. In times of near despair, confusion, chaos, or even routine and boredom, we need dreams. As a leader, you must believe in your dream; you must believe that it can happen. Kouzes and Posner (2007, p. 17) observed: Every organization, every social movement, begins with a dream. The dream of vision is the force that invents the future…. Leaders gaze across the horizon of time, imagining the attractive opportunities that are in store…. They envision exciting and ennobling possibilities. Leaders have a desire to make something happen, to change the way things are, to create something that no one else has ever created before.

Dreams that become fulfilled are shared among members of a critical mass. A leader must have followers. Solitary vision that is not shared is only daydreaming. Transformational leaders must be vigilant that they do not follow their own light so far into the distance that followers are left in the dark. Shared dreams “fit,” and they grow in the hearts of those committed to the organization. Stichler (2006, pp. 255–256) stated:

The nurse leader is responsible for creating a vision for the organization and clearly articulating that vision to others. The vision must be so compelling that others can feel passionately enough about it to direct their efforts toward achieving the vision. The vision must be viewed as being for the “common good,” and the [leader] must foster that sense of common commitment so that others are willing to follow on the quest toward the vision.

Nurse leaders are responsible for how the professional nursing models exemplify the visions of the chief nursing officer and the organization (Pelletier & Stichler, 2014). The leader sets the tone and communicates expectations for patient-centered care that results in positive outcomes. Transformational Leadership In Nursing Assignment

A shared vision for any project or organization gives perspective. It allows everyone to look up from many lists of competencies and the daily grind that hovers over nearly every team or organization at one time or another. As a leader with a vision in your heart, you are the guardian of perspective. You can critically appraise what is important and what simply appears to be urgent at the time. You help people cut through the daily lists of “stuff” that must be done to see what really might be done for a better future. Sometimes, it involves just a moment of reflection or a reminder; sometimes, a change of schedule or procedure; and sometimes, a different use of language. Language is important, particularly in the vision statement. It must be beautiful so that it clearly reflects the image of where you are going, the picture of the desired future. The leader who believes and constantly carries the vision is able to critically analyze decisions, solve problems, and effectively predict next steps. The vision is not about you, your career goals, or your personal desires. It is about the organization as a living organism, as a community, perhaps even as a family. You are the steward of the vision of the organization. For your vision to be authentic, you must love the place, the people, and the work you are doing.

Because the vision is integrated into your being as the leader, many plans and decisions will seem to automatically flow in the direction of the vision. Opportunities will appear, or you will suddenly see opportunities in a new way to allow you to move toward the vision. The vision becomes your habit. It will not be easy, but a clear vision allows purposeful critical analysis and helps to winnow away issues that cloud direction. It allows you to better trust your decisions because you know where you are going, and your actions are more likely to be trusted because you have the credibility of a clear direction. Critical analysis becomes easier, almost second nature, because you have set your own benchmark. You know where you are going. Transformational Leadership In Nursing Assignment

USING EVIDENCE AND LEADERSHIP TO MAKE A POSITIVE DIFFERENCE

Vision is only dreaming without the use of evidence to make decisions that make it happen. The use of evidence in healthcare is no longer an option (Malloch & Melnyk, 2013). It must become the intellectual and practice habit of all leaders and clinicians. If use of evidence, or empirical research data, is truly to make a difference, it must be embraced at all levels, from the point of contact to the broadest systems perspective. Furthermore, evidence must be implemented and evaluated from the perspective of all aspects of leader, clinician, and patient experiences. The effects or outcomes of evidence cannot be evaluated from any sole viewpoint. Evidence must be integrated and synthesized into the practice experience, the patient response, and the entire caregiving or healing event.

The recent sweeping movement toward evidence-based practice (EBP) has been largely promoted by academics and targeted to clinicians in direct patient care. Nurse leaders have long been accustomed to the challenges of promoting research utilization within healthcare organizations. Current care settings are often laden with practices of habit, tradition, and routine. Nevertheless, Porter-O’Grady and Malloch (2010) warned against joining “the evidence-based practice fad,” that the current surge toward use of evidence should “not exclude other non-quantitative sources of evidence,” and cautioned not to oversimplify clinical nursing knowledge. It is important as we embrace EBP that we do not lose, but rather empirically document, other significant ways of knowing and practice such as clinical intuition, attention to individual differences, the art of practice based on clinical expertise, and professional autonomy. Indeed, Råholm (2009, p. 168) “challenged the wisdom of basing the practice of leadership on a narrow, reductionist understanding” of evidence and defended the meaning of context in the definition of evidence. With the emerging focus on implications of genetic testing and genomics, healthcare practice is poised to move from the application of evidence-based protocols to a focus on individualized or customized care.

Although the development, discovery, and use of evidence for clinical practice continue to mount, there is a continuing need to close the gap between evidence and practice (Meljak, Gallagher-Ford, Thomas, Troseth, & Szalacha, 2016). In most clinical settings, truly integrated EBP is still not second nature. In the past several years, much emphasis has been placed on the role of leadership for implementation of EBP. Aarons, Farahnak, Ehrhart, and Sklar (2014) discussed the critical importance of the leader in shaping a culture in which all clinicians value evidence versus tradition-based practices in their work. The leader’s mandate is to expect, support, and reward those who demonstrate that value through their work. Examples of clinicians who demonstrate these behaviors include the following: Transformational Leadership In Nursing Assignment

• The nurse who consults the pharmacist on the unit after a patient mentions that his wife brought his anti-nausea drug from home, and a check of the medication triggers an alert when entered into the electronic health record (EHR)
• The new graduate who questions the use of 48-hour dressing changes in the manager’s staff meeting after reading a related research study in a journal on the unit
• An experienced nurse who suggests a new procedure for communicating physician messages to nurses who are administering medications after reading new evidence on the relationship between information overload and medication errors.

Nurse managers are critical to the sustainment of an evidence-based nursing culture. Cheng, Feng, Hu, and Broome (2018) found that nurse leaders who helped staff nurses by challenging processes, modeling the way, and encouraging nurses were most effective. Nurses looked to the leader to support their efforts to improve patient care through evidence and to praise their “over and above” efforts. Leaders who focus on influencing others to achieve positive patient outcomes use their relationship with others to communicate clear expectations, include them in decision-making, and help them see their own strengths (Cheng et al., 2018).

 

It is the role of the leader to remove barriers and provide resources for clinicians to access the best research evidence. Such practice often represents a change of culture and total integration of use of evidence in clinical communications (Aarons et al., 2014; Cheng et al., 2018). All nursing leaders, from managers to executives, must be aligned in their expectations about implementation of innovative approaches (O’Reilly, Caldwell, Chatman, Lapiz, & Self, 2010). If they are not engaged and aligned, nurses at the bedside may revert to become traditional and trial-and-error bound in their practices caring for patients.

It continues to be largely the responsibility of the leader to break the path, to facilitate the culture for EBP to be comprehensive throughout all systems. Use of evidence must simply become a way of doing and being in clinical practice. The entire organizational culture, especially its leadership, must support the ongoing practice of evidence-based decision-making, actions, and evaluation of outcomes.

Leaders must incorporate the language and concepts of EBP into the organizational mission and strategic plans, establish clear performance expectations related to the use of evidence, integrate the work of EBP into the governance structures of the system, and recognize and reward performance and outcomes based on the use of evidence. The transformational leader coaches and promotes collaboration among clinicians, patients, and researchers to create a “professional culture and transformed environment of care in which decisions are made on the basis of best evidence, patient preferences and needs, and expert clinical judgment” (Worral, 2006, p. 339). Thus, it is well established that EBP will not thrive without leadership support (Aarons et al., 2014; Berwick, 2003; Everett & Titler, 2006). Leaders must provide access to evidence, authority to change practice, an environment of collaboration, and policies that support EBP (Malloch & Melnyk, 2013). Transformational Leadership In Nursing Assignment

Although we have become more careful to seek and use research for aspects of patient care, with all our attention on the trend of the past decade toward EBP we have largely neglected the need to generate and use evidence specifically related to leadership practices. A growing body of clinical guidelines are in use internationally, but we are just beginning to assemble an empirically tested knowledge base for best practices in leadership. Day et al. (2014) recently reviewed 25 years of research on leadership development and called for a continuing focus on gathering data that support the effectiveness of certain leadership strategies and education/training programs. In healthcare, we are just beginning to document and promote models for evidence-based decision-making in leadership (Aarons et al., 2014; Uzarski & Broome, 2019). Effective leaders pay attention to the need to recruit nurses who enjoy innovative approaches to old challenges, support those nurses who can influence others using positive evidence-based strategies for change in policies and procedures, and provide vision and time to teams who invest in the work culture (Broome, Everett, & Wocial, 2014). The next generation of transformational leaders must continue the task of discovering and utilizing best evidence for successful leadership. Valid use of evidence for leadership will define and strengthen the entire concept of power to leaders of the future.

USING YOUR POWER AND INFLUENCE EFFECTIVELY

Leadership, authority, power, and influence are often confused. Leadership may be formal or informal and is always characterized by the ability to influence others toward the attainment of some task or goal. We have already described transformational leadership as value driven and grounded from an ethical foundation. It includes the personal qualities and behaviors of the leader. Authority is a formally designated or organizationally endowed ability, accountability, or right to act and make decisions. Power is the ability to exert influence, but it may or may not be rooted in an ethical value system. It may also be formal or informal. Gardner is said to have defined power as “the basic energy needed to initiate and sustain action or … the capacity to translate intention into reality and sustain it” (National Defense University, n.d., p. 2). Positional power “confers the ability to influence decisions about who gets what resources, what goals are pursued, what philosophy the organization adopts, what actions are taken, who succeeds and who fails” (National Defense University, n.d., p. 4). The source and use of power by world leaders have been a fascination throughout the centuries. Transformational Leadership In Nursing Assignment

Power is key to leadership. It is its underlying energy. To become an effective leader, you must become comfortable with power. It takes many forms. There is power of position, power of personality, power in presence or of charisma, power of informal authority, and power by relationships with others of greater power. Power is the ability to move others, to move causes forward, and to extend both energy and assurance or confidence. No matter what the external source of authority, power is eventually ineffective if some sense of personal power does not burn from within. It emanates from conviction, 198drive, and confidence in self, from a greater self, and from the direction of the organization.

To lead with power, you must understand yourself and build a power base. Genuine leaders use any formal power; they must understand each aspect of a challenge. They can only do this through the knowledge and understanding about a challenge if they think you will not give them credit and use it to make good things happen.

Some leaders may struggle with seeing themselves as powerful and may interpret “power” as being above others. This could not be further from the truth, that power is best when used for good. Powerful leaders work with others to accomplish goals, relying on their followers in any organization for their knowledge, commitment, and creativity as well as their own (Speedy & Jackson, 2015). Speedy and Jackson (2015) described 13 strategic influences you as a leader can use to enhance your power.

Individuals who acquire managerial power seek to maintain or enhance their power by using several strategies. These may include the following:

• Increasing their centrality and criticality to the organization
• Augmenting their personal discretion and flexibility in their job
• Building into their job tasks that are difficult to evaluate
• Expanding the visibility of their job performance, resulting in increased contact with the senior people they seek to impress (from Wood et al., 2012).

There are several other common strategies used to enhance one’s power and influence. These include the following:

• Building and developing personal resources
• Using of reason (using evidence to support a logical argument)
• Being friendly
• Developing coalitions or relationships with other people
• Bargaining with others, which involves using the exchange of benefits as a basis for negotiation
• Being assertive, which requires a direct personal approach
• Appealing to a higher authority, which results in high-level support
• Continually increasing one’s own skills and knowledge
• Using of sanctions as appropriate, which are organizationally derived rewards and punishments (Wood et al., 2012)

 

The network and power base you build is both a process and a structure of connecting to personal attributes, skills, organizations, and people to contribute to the creation and control of strategic goals, direction, and resources (Broome, Bowersox, & Relf, 2018; Uzarski & Broome, 2019). A power base is built by engaging in communication, information, and personal networks; reaching out to influential others for mentorship; acquiring your own reputation as powerful; and reflecting the influence and reputation of your own organization (National Defense University, n.d.). Transformational Leadership In Nursing Assignment

Pfeffer (1992, 2015) outlined the following attributes of a leader to acquire and sustain a strategic power base:

• Having high energy and physical endurance, including the ability and motivation to personally contribute long and sometimes grueling hours to the work of the organization
• Directing energy to focus on clear strategic objectives, with attention to logistical details embedded with the objectives
• Successfully reading the behavior of others to understand key players, including the ability to assess willingness and resistance to following the leader’s direction
• Employing adaptability and flexibility to redirect energy, abandon a course of action that is not working, and manage emotional responses to such situations
• Motivating to confront conflict, willing to face difficult issues, and the ability to challenge difficult people to execute a successful strategic decision
• Subordinating the personal ego to the collective good of the organization, by exercising discipline, restraint, and humility.

Authentic, transforming power emanates from values and principles. Such principles carry their own form of power to be expanded by the person who carries them forward. Principle-based power is not self-aggrandizement or self-advancement. Rather, the more one empowers others, the more power is generated.

In new paradigms of self-organization and transformational leadership, power is generated from sharing, enhanced by a shared vision, and becomes the amplified energy for change when understood and used as the secret treasure of the leader who shares it strategically within the organization. In fact, the judicious and other-centered use of power and influence are often defined as empowerment of others (Broome, 2012; MacPhee, Skelton-Green, Bouthillette, & Suryaprakash, 2012). Giving the gift of power actually expands the power of the giver. When people feel that power is being taken from them, they engage in actions to “hoard” power: sabotage, passive resistance, withdrawal, or outright rebellion. But a sense of having power frees energy and promotes a sense of self-efficacy, positive influence, commitment, and greater willingness to give. Conflict is reduced as influence becomes more positive and shared. This discussion makes the process sound reasonable and easy. It is not easy. However, it is worth the effort to cultivate skills in sharing power and influence, and empowering others.  Transformative leaders use their power in helpful ways to grow others and their organization. Transformational Leadership In Nursing Assignment

THINKING AS AN ENTREPRENEUR AND INNOVATOR

Appropriate use of power releases freedom to innovate and tap into your entrepreneurial learnings. Yet, preparation as a healthcare professional is not rooted in entrepreneurial thinking. Entrepreneurship is largely absent in American professional clinical curricula. Marshall remembers when a creative, nonconformist nurse asked, while they were at work years ago, “Do you ever think of your entrepreneurial self?”

I did not have a clue what she was talking about. I have often wondered what happened to her. I always imagined that she started her own care business or consulting firm. I have always assumed that entrepreneurs either had patrons to support their inventive habits or put their family fortunes at risks on whimsical new business ideas. I was wrong. Entrepreneurial habits are ways of thinking, creating, and solving problems.

Never have there been more opportunities for innovative entrepreneurial thinking in healthcare. The U.S. system cries out for innovative answers to difficult, complex problems. It may be a new kind of independent practice; it may be a consultation service to solve unique problems; or it may be a new kind of business relationship between the practitioner and the agency (Broome et al., 2018). However, we need more independent, creative approaches to solve problems. Some outstanding examples of entrepreneurial nurses who developed businesses to improve health are highlighted by the American Academy of Nursing (2016). Transformational Leadership In Nursing Assignment

You can be a system employee and still be an entrepreneur. Synonyms for entrepreneur include adventurer, promoter, producer, explorer, hero, opportunist, voyager, risk taker, and innovator. Our healthcare systems need innovators and thinkers. We need those willing to risk a new idea, provide evidence for its value, take the responsibility for its implementation and evaluation, and nurture teams to risk innovative practices for positive outcomes. An innovative thinker resists habits of “stuck” thinking and forms new habits of looking at old problems in new ways. If such approaches are adopted within the system effectively, the entrepreneur may become even more valued by the system. When you see a problem, before lamenting its existence, reflect on the problem, let it simmer, then brainstorm at least three ways to solve it. Search for evidence on the problem. Think some more. Create a plan to address the problem, marshal the team to commit, implement the new idea, and then test the outcomes. The process is as old and familiar as practice, but it is the reframing of problems and search for ideas and solutions that call for some adventure.

Given the pioneering roots of professional nursing, in general, and of advanced practice nursing it is ironic that the entrepreneurial spirit seems so foreign to current daily practice. Lillian Wald dared to envision, champion, and create public health nursing. Following the loss of her own two children and the heartache of observing the lack of healthcare in rural America, Mary Breckinridge did not hesitate to nearly single-handedly bring the independent practice of nurse-midwifery to the United States. And Loretta Ford legitimized the primary care practice of public health nurses by establishing the first nurse practitioner program. Why, then, is entrepreneurial nursing not evident in the everyday practice of every nurse leader today? Several authors have pointed out that worldwide, although expertise among nurses is increasingly recognized, traditional organizational bureaucratic and hierarchical mechanisms, ingrained cultures, and ambivalence and ambiguity among practitioners in shaping “new” identities and practices continue to restrain entrepreneurial activities that might improve healthcare (Aranda & Jones, 2008; Austin, Luker, & Roland, 2006; Exton, 2008). Transformational Leadership In Nursing Assignment

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Innovative habits need to be fed. Ideas are not born of nothing. They come from watching, listening, and reading widely. Begin today with the habit of reading within and outside the healthcare literature. Read business magazines and newspapers.

When something innovative is happening in one part of your own organization, it is sometimes difficult to spread the word and even more challenging to spread the positive action. Make an appointment with your communications and marketing department and find out what media channels they use. Can you write a story for their annual magazine that goes to patients and donors to the system? Are you involved in a healthcare innovation project that needs to be shared as the results and impact on patient care, family satisfaction, and employee retention is impressive (Chaudoir, Dugan, & Barr, 2013; Ireland, 2016)? It sometimes requires an entire change of culture to accept innovation as a way of living, working, and serving. When you are frustrated with the slow rate of change, remember the following guidelines to promote diffusion of innovation: Transformational Leadership In Nursing Assignment

• Promote the idea: The innovation must be perceived as better than what people are already doing, so you have some selling to do.
• Provide a reliable source or channel of communication to spread the news that the new idea is better.
• Give people a little time to learn about the innovation, to participate in the decision, and to implement change.
• Make your institution a place of learning. (Newhouse & Melnyk, 2009)

To be able to encourage others to be innovative, you must provide a culture that encourages others to think big and take small risks. Innovators respond to transformative leaders who support their diverse (and sometimes divergent) perspectives on things (Broome, 2016). To facilitate the diffusion of innovations the leader must be visible in adoption and support of new innovations. Transformational Leadership In Nursing Assignment