Transformational Leadership in Nursing

Ashley Freeman

Introduction

Transformational leadership theory is the process whereby the leaders attends to the needs and motives of their followers so that the interaction advance each to higher levels of morality and motivation (Yoder-Wise, P., 2014, pg. 10). In its most optimal form, it produces positive and valuable change within the followers with the purpose of developing the followers into leaders. When a leader embodies transformational leadership, they enhance the morale, motivation and performance of followers with various techniques. These techniques include helping the followers to connect their sense of self and identity to the mission and the collective identity of the organization; inspire followers by being their role model; challenge followers to go above and beyond what is expected of them, and understand their strengths and weakness, so the leader can assign tasks to its followers that can optimize their performance.

Background

In 1978 leadership expert, James McGregor Burns developed the first concept of the transforming leadership theory. He created this theory to address the aspects of an organization in which leaders focus on the beliefs, success, needs and values of their employees. According to Burns (1978), “the transforming approach creates significant change in the life of people and organizations. It redesigns perceptions and values, and changes expectations and aspirations of employees.” In 1985 Bernard M. Bass extended the work of Burns by explaining transforming leadership, but using the term transformational instead, that the followers of such leaders feel, trust, appreciation, constancy and respect for the leader because of the attributes of the transformational leader willingness to work harder than anticipated.

Transformational Leadership in Nursing

Transformational leaders have the following characteristics: model of integrity and fairness, effective communication skills, provides support and recognition, sets clear goals, visionary, encourage others and has high expectations (Yoder-Wise, P., 2015). My current nurse manager, Cathy, is a transformational leader. She allows the Patient Care Coordinators (PCCs) or charge nurses and sometimes the staff to participant in the decision making. As one of the PCCs, Cathy lets me make decisions about staffing and I am responsible for scheduling the staff. “She provides constructive criticism, offers information, makes suggestions, and ask questions (Blais & Hayes 2011, p. 167).” Cathy lets me know when I am doing a good job and gives me recommendations on how I can make improvements. She gives us complements and rewards for working an extra day, orienting new staff or mentoring student nurses. Cathy “is open and encourage openness, so that real issues are confronted (Blais & Hayes 2011, p. 168).” She respects each individual and “values and uses each staff members’ contribution” (Blais & Hayes 2011, p. 168). She encourages everyone to be a team player because when everyone is working together, there is a higher job satisfaction, less nurse turnover, better patient satisfaction and outcomes. She comes to work with a smile on her face, says good morning and how are you doing to everyone. She builds relationships with the staff and gets to know everyone on a personal level. She is straightforward and gives you her honest opinion. Cathy is a good leader and remodel.

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Since I am a member of the leadership team as a PCC of a critical care unit, we must be able to contain cost while ensuring staffing productivity and competency, along with improving patient outcomes. One major area of cost containment where I work is staffing productivity. My hospital uses a predictive model to determine the number of full-time staff each department can have based on the number of patient that were seen that month from the previous year.

I work in an eight beds intensive care unit and our staffing grid is the following: eight or seven patients – four nurses and one patient care tech. (PCT); six patients – three nurses and a PCT, five patients – three nurses and a PCT, unless we are tight on man-hours then we can only have two nurses and no PCT, however if there is a patient(s) that needs behavioral observation (sitter), then we can have that extra person; four patients – two nurses, unless patient(s) need a sitter, then we can have an extra person; three patients – two nurses and no PCT; two patients – two nurses and no PCT and one patient – one nurse and no PCT. When we have an odd number of patients, we tend to go over in man-hours, so we must follow our staffing grid to ensure that we don’t have to answer to administration.

As a nurse manager, you educate, encourage and support staff through the changes to come within health care. It’s the nurse manager role to ensure that all staff is maintaining the current acceptable level of care. Along with maintaining adequate staff for patient safety, while controlling the budget. One of my responsibilities is to help motivate the staff to buy into different policies and procedures changes. We recently had our blood culture collection policy changed and I had to educate all the staff about the new changes.

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One of my biggest attributes is that I am a visionary leader because I can envision the potential reality, think outside of the box and I have innovative ideas. I can come up with new ideas and new ways of looking at situations. I am a big thinker and I dream even bigger. The critical care unit that I work in has eight beds, so relatively small, and it is on the third floor. We will be expanding, which means more beds, however, I requested through my manager for the unit to move down to the first floor because it makes more sense for us to be down there, close to the ER, OR and radiology, but I was told that was not going to happen. That was just one of the many ideas that I had.

As health care continues to transform, hospitals should work to improve current practices for the future. “Whether you are a leader, a follower, or a manager, being able to visualize in your mind what the ideal future is becomes a critical strategy” (Yoder-Wise 569). The Wise Forecast Model would be useful because it allows us to be proactive in preparing for the future instead of being passive and reacting to the changes as they happen. There are three steps: 1. Learn widely, 2. Think wildly and 3. Act wisely. Learn widely means to extend your knowledge beyond your own clinical role and area. Think wildly means to think outside of the box, dream big, and know that we are only limited by our imagination. Act wisely is bringing thoughts and/or ideas back down to reality and doing what is possible with the resources that is available (pg. 570).

Conclusion

Transformational leaders provide their followers with an inspiring mission and vision to give them an identity, rather than just working for self-gain. The followers are motivated and transformed through their leaders’ charisma, encouragement and individual consideration. These leaders encourage their followers to think of new and unique ways to challenge the status quo and to adjust the environment to support them being successful.

References

Blais, K. K., & Hayes, J. S. (2011).Professional nursing practice: Concepts and perspectives (6th ed.) [Vital Source Bookshelf]. Retrieved from https://online.vitalsource.com

Burns, J.M. (1978) ‘Leadership,’ New York: Harper and Row.

Yoder-Wise, P. (2015). Leading and Managing in Nursing. (6th ed.). United States: Elsevier Health Sciences.