Stephen Forte Sarah Parker Melinda Winans

1. Leading The Way Stephen Forte Sarah Parker Melinda Winans

2. Leadership Styles and History • There are many • Most mentioned: transactional, transformational, laissez-faire • James MacGregor Burns (1978) transactional and transformational mutually exclusive • Bernard Bass (1985) stated two styles are separate but can possess both-4 components transformational: -idealized influence -inspirational motivation -intellectual stimulation -individualized consideration • Kouzes & Posner (2007-2009) expanded transformational further Exemplary Leadership Model: -encouraging the heart (individual’s values recognized) -enabling others to act (trust, collaboration) -modeling the way (inspirational role model) -inspiring shared vision (shared goal) -challenging the process (creativity, ideas)

3. Current Vs. Future Leadership Styles • Transactional focus on day-to-day operation • Transformational focus on empowering staff power to staff=more power to leader • Currently transactional most common in health care • Changing to transformational-more applicable in today’s dynamic health care system • Both types of leadership styles • may be used

4. Why this move toward transformational leadership? • Literature states best leadership model for changing health care environment • Other styles shown not to working in chaotic changing environment • Need skills and knowledge of larger number of staff (involvement of everyone) • Leader needs to be ahead of change (proactive) requiring vision, creativity, and style empowering staff • Focus on Upward, lateral, diagonal communication • Studies show positive correlation with perceived group effectiveness, job satisfaction, patient outcomes

5. Transformational Communication • Effective communication lessens frequency of clinical errors • Most leadership focus on downward communication-only commands and directions (from superior to subordinate) no active receiver of message • Transformational encourages lateral, diagonal, and upward communication-staff interacts in a participatory environment: shared governance decision-making, suggestions, “open door” policy.

6. Transformational Leadership Success & Satisfaction Supported by Research • Early AAN study (1980’s): no shortage where nurses were respected, valued and had “voice.” • International Journal of Nursing Studies (2009)systematic review of 53 studies -link characteristics of nursing work environments (ex: nurse/physician relationship) to patient adverse events and mortality -Negative or positive leadership has indirect impact on patient outcome -Studies support relationship/people focused leadership to improved outcomes in nursing workforce, work environment, productivity, effectiveness of health care organization -Transformational leadership focus on people/relationships to achieve common goal, motivates to do more than originally intended or thought possible -Transformational leaders use: idealized influence, inspirational motivation, intellectual stimulation, individualized consideration -Transformational leadership had decrease in workforce turnover, anxiety, emotional exhaustion, stress and increased organizational commitment , role clarity

7. Transformational leadership and Organizational Success • No more traditional command-and control style of staff supervision • Movement towards leadership enhancing motivation, morale, and performance=culture of engagement • Nurse’s quality of work life positively predicts work engagement (vigor, absorption, dedication) increasing work performance and client satisfaction important to organizational success • QWL positively correlated to distributive and interactional justice-positively correlated to transformational leadership (Gillett et al., 2012)

8. Remember… • Studies are correlational not causal • Common method bias • Interpretations often are dichromatic • Success based on individual integrity • Culture may affect leadership style effect • Important to always be open to new methodology and perspectives

9. Goals of Successful Transformational Leadership • Begins with VISION • Empowers staff-self-confidence leads to action, encourage enthusiasm • Collective purpose-all team members work together toward shared goal, sense of commitment • All team members (nurses, staff) take active role in evaluating and establishing changing policies, give feedback, active in CHANGE • Find meaning, purpose, growth, maturity in work

10. Qualities of Transformational leaders Overall collaborate more, support new leaders, adapt to & implement change in environment by: • Embracing change • Rewarding staff • Developing self-aware staff motivated to improve • Guiding staff in understanding roles in organization • Guiding staff in understanding importance of organization • Possessing: Self-confidence, self-direction, honesty, energy, charisma, optimism, respect, trustworthiness, inspiration, loyalty, commitment, motivation, empathy, reliability, determination, ability to develop/implement vision

11. This Lead Us Into Magnet Designated Hospitals • A voluntary credentialing process set by the ANCC to recognize nursing excellence • Acknowledges successful nursing practice and strategies • Recognizes quality patient care, nursing excellence and innovations in the professional practice, provides benchmarking to measure quality of care • Based on the ANA Nursing Administration: Scope and Standards of Practice (2009) • 14 Forces of Magnetism • 5 overarching Global Issues

12. The 5 main components • Transformational Leadership • Structural Empowerment • Professional Practice • Knowledge, Innovation, & Improvements • Empirical Quality Results • Creates a vision for the future, necessary for change • Gives staff the strength to grow and accomplish desired outcomes • Exemplary professional practice of nurses in the application of knowledge and evidence • Quality Improvement for the future • Benchmark data to show desired outcomes

13. Transformational Leadership “In Magnet Terms” • These leaders have the vision and atypical approaches to influence change • Strong clinical knowledge and expertise in professional practices • Futuristic thinking and emergent changes with the fast changing health care system • Encourage staff to contribute and add to the culture of the change • Hold nurses accountable for decision making and teamwork • Provide supportive creative opportunities for nurses to increase competencies

14. Statistics for Magnet Organizations • 6.78% of hospitals in the US have ANCC Magnet Recognition status • Low RN turnover rates (approx 10%) • Average length of employment (10 years) • Decrease tendency to hire traveling nurses • 48.8% with BSN • Tendency to hire BSN over ADN • 37.8% with ADN

15. Statistics for Magnet Organizations • In 2010, 8/10 (80%) of the top rated medical centers were ANCC Magnet recognized, 6/8 (75%) of the top Children’s Hospitals were ANCC Magnet recognized • As of November 2010 there are 378 Magnet designated hospitals

16. Institute of Medicine's Future of Nursing • Created to address needed changes in health care system • Increase quality, accessibility and affordability • Promote wellness, disease prevention • Make primary, preventative care main focus • Payments based on value

17. Institute of Medicine's Future of Nursing • Key messages • Practice to full extent of education/training • Achieve higher levels of education • Become full partners with others • Implement effective workforce planning

18. Institute of Medicine's Future of Nursing • Practicing to full extent of education and training • Barriers: scope of practice variation from state to state; transition from school to practice • Solutions: Feds can promote reforms, incentivize adoption; nurse residency programs • In both acute and ambulatory care settings • Turnover rates reduced from 35% to 6% over 12 months

19. Institute of Medicine's Future of Nursing • Achieving higher levels of education • Patients are sicker, more chronic disease management, prevent acute care • Fill more primary care roles • Coordinate care with other team members (who often have advanced degrees in their fields of practice) • Calls for BSN for entry level nurses • Plan for graduate work

20. Institute of Medicine's Future of Nursing • Full partners with other team members in redesigning health care system • Identifying problems, areas of waste • Devising and implementing plans for improvement • Tracking improvements over time • Making necessary adjustments for established goals • Taking part in policy changes • Shaping policy instead of “letting it happen” • Serve on committees, commissions, policy boards

21. Institute of Medicine's Future of Nursing • Full partners (continued) • Leadership competencies fostered through education • Mentoring • Professional organizations • Attaining professional degrees in other fields

22. Institute of Medicine's Future of Nursing • Effective workforce planning • Lack sufficient data on numbers, types of nurses available; projected needs • Impacts from bundled payments, medical homes, accountable care organizations, • Shifts to team based care

23. Institute of Medicine's Future of Nursing • Recommendations • Remove scope of practice barriers • Expand opportunities to collaborate on improvements • Greater implementation on residency programs • Increase BSNs and advanced degrees • Promote lifelong learning

24. What type of leader are you? • Do you prefer idealized influence, inspirational motivation, intellectual stimulation and individual consideration? • Do you prefer to reward performance and effort? • Do you prefer to let well enough alone just as long as performance goals are met (only to intervene before trouble happens)? • Do prefer to cede control to a team (only to intervene after trouble happens)?

25. IOM's Vision for Nurse Leaders • “Leaders who merely give directions and expect them to be followed will not succeed in this environment” • –Future of Nursing

27. IOM's Vision for Nurse Leaders • Two sets of leadership competencies • Common set: • Knowledge of care delivery systems • Collaboration within and across disciplines • Knowledge of medical ethics • Patient advocacy • Advocating for safety improvements

28. IOM's Vision for Nurse Leaders • Two sets of leadership competencies • Nursing focused set: • Becoming a “full partner” • Collaboration • Holding other team members accountable regardless of discipline, training, rank • Reduces preventable adverse events • Medication errors

29. IOM's Vision for Nurse Leaders • Leadership at every level • Student nurses • Faculty obligation to career placement/degree • Health Students Taking Action Together (HealthSTAT) • Promotes being active in the health community a professional habit • Workshops in political advocacy • Media training • Networking • Fundraising • http://www.healthstatgeorgia.org/

30. IOM's Vision for Nurse Leaders • Leadership at every level • Student nurses (continued) • Understand and anticipate population trends • Other degree considerations: public health, law • Consider dual majors in business/engineering

31. References • American Nurses Credentialing Center (2013). Retrieved from http://www.nursecredentialing.org/ • Cummings, G. G., Macgregor, T., Davey, M., Lee, C., Wong, C. A., Lo, E., Muise, M., & Stafford, E. (2009). Leadership styles and outcome patterns for the nursing workforce and work environment: A systematic review. International Journal of Nursing Studies, 47(3), 363-385. • Dawes, D. (2011, April 11). The foundations of nursing leadership. Retrieved from http://www.nursingleadership.org.uk/test1.php • Den Hartog, D. N., Van Muijen, J. J., & Koopman, P. L. (1997). Transactional versus transformational leadership: An analysis of the MLQ. Journal of Occupational and Organizational Psychology, 70, 19-34. • Finkelman, A. (2012). Leadership and management for nurses: Core competencies for quality care. Upper Saddle River, NJ: Pearson Health Science. • Gillett, N., Fouquereu, E., Bonnaud-Antignac, A., Mokounkolo, R., & Colomat, P. (2012). The mediating role of organizational justice in the relationship between transformational leadership and nurses’ quality of work life: A cross-sectional questionnaire survey. International Journal of Nursing Studies doi: 10.1016/j.ijnurstu.2012.12.012. • Hutchison, M. & Jackson, D. (2012). Transformational leadership in nursing: Towards a more critical interpretation. Nursing inquiry, 20(1), 11-22. • Institute of Medicine (2011). Summary. In The Future of Nursing: Leading Change, Advancing Health (pp. 1-16). Retrieved from http://www.nap.edu/catalog.php? • Institute of Medicine (2011). Transforming leadership. In The Future of Nursing: Leading Change, Advancing Health (pp. 221-251). Retrieved from http://www.nap.edu/catalog.php? • Messmer, P., & Turkel, M. (2010). Magnetism and the nursing workforce. Annual Review Of Nursing Research,28233-252. doi:http://0-dx.doi.org.opac.sfsu.edu/10.1891/0739-6686.28.233

32. References • Selanders, L., Crane, P. (2012). The voice of Florence Nightingale on advocacy. OJIN: The Online Journal of Issues in Nursing, 17(1). • Sherman, R., Pross, E. (2010). Growing future nurse leaders to build and sustain healthy work environments at unit level. OJIN: The Online Journal of Issues in Nursing, (15)1. • Smith, M. A. (2011). Are you a transformational leader? Nursing Management, 42(9). • Thomspon, J. (2012). Transformational leadership can improve workforce competencies. Nursing management, 18(10), 21-24.