Transformational Leadership
Carrie Nowatzke, BSN, RN
Michelle Leinen, BSN, RN
Rick Perez, BSN, RN
Many times
in the nursing world, there are leaders who are satisfied with the same results
day after day. In transformational
leadership, leaders want change and they aren’t afraid to make it happen. They can be the most radical type of leaders.
The
population affected by this issue is the staff and also the leaders
themselves. Leaders are not born, they
are made therefore, and they must be on board with this type of change as
well. However, the staff is affected
most. They are the ones who will benefit
from this type of leader. Desired
outcomes for this issue are as follows: staffing changes that will benefit the
nurses, higher employee engagement, and increased self-efficacy for the nurse
and increased job satisfaction. It is
amazing that one manager can do all of these things! When the staff is motivated by their leader,
they in turn will make a positive change for their patients. Therefore, the patients will also benefit from
this type of leadership. It is safe to
say that transformational leadership will cause positive outcomes for the
patient as well as the staff.
“Nurse
Managers will feel more comfortable and confident by adopting the qualities of
a transformational leader when engaging in the development of healthcare
policies and the ever-changing components of healthcare technology” (Smith,
2011, p.44). Transformational leaders
feel they are able to make changes and see the benefit of these changes. They also are able to motivate their staff to
see the good in these changes and assist them in smooth transition. They are able to overcome resistance.
Variables
that affect transformational leadership are broad and complex themselves! Variables such as demographics and culture
can be difficult to change. However, it
was a belief of Burns that transformational leaders will be able to effectively
create change in different cultures because they are essentially working for
the good of the people. There will
always be staff that will not accept change either. However, the transformational leader, if
effective, should be able to motivate a high percentage of those. Institutional policies may also be a
variable that the transformational leader will have to tackle. Motivation and inspiration are key elements
in this type of leadership.
Access to
health care does not necessarily apply to this topic. If anything, transformational leaders will
change the way healthcare is administered to everyone. There is no prejudice in this type of
healthcare. These leaders want change
for the better that will benefit everyone.
Transformational leaders may be able to change policies and budget,
therefore making healthcare more accessible to everyone.
Today’s
health care environment is experiencing unprecedented, intense reform and it is
becoming increasingly more complex. Hospital and healthcare systems have become
much more complex than in years past. Trends for transformational leadership
include the need to focus on the promotion of innovation and change (Carroll,
2006). The American Nurses Credentialing Center (2008) stated, Nurses are faced
with increasing demands and today’s leaders are required to transform their
organization’s values, beliefs, and behaviors. It is somewhat easy to lead
people where they want to go, but the transformational leader must lead people
to where they need to be in order to meet the demands of the future. This
requires vision, influence, clinical knowledge, and a strong expertise relating
to professional nursing practice.
Transformational
leadership encompasses skills, behaviors and characteristics that are critical
for transformational leaders to have a positive impact on followers (Rosebach,
Sashkin and Harburg, 1996). Specifically, transformational leaders convey the
connection between the organization’s philosophy and shared values, and
embedded in those values in organizational rules and actions in order to
communicate meaning and inspire (Bennis & Nanus, 1985).
For the
organization that is able to successfully implement and sustain
transformational leadership, there will be immediate return on their investment
simply with the ability to retain employees. There is such focus on first year
turn-over in hospitals and new employees want to feel empowered, they want to
be paid for their expertise, but what will initially attract people to the
nursing profession is the chance to make a difference in people’s lives. Effective leadership on individual nursing
units directly affects nursing staff satisfaction. Employees are interested in
managers who can lead in a positive and encouraging manner. Nurses who are
content in their positions correlate to a reduction in staff turnover and
improve retention. When the nursing staff is satisfied with their employment,
patient satisfaction rises.
Health
care organizations can see this trickle-down effect through increases in
patient satisfaction scores over time. The promotion of effective communication
and positive attitudes enhances a healthy environment for all employees and
staff. Health care organizations should evaluate individual nurse managers on
units to promote transformational leadership qualities; this will directly
result in staff satisfaction, staff retention, and patient satisfaction
(Robbins & Davidhizar, 2007). This will directly affect the bottom line of
any organization.
In comparison
to other aspects of leaders or leadership, relatively little discussion is
devoted to the ethical responsibilities of those who lead or to the ethical
aspects of the process of leadership, which makes it important to discuss
possible ethical issues of leadership. First, professions have a duty to
maintain and protect public trust. Society empowers professions such as nursing
to meet its specialized needs. Such empowerment creates a moral bond between
the professions and the members of society it serves. Health care institutions are powerful
organizations that influence the quantity and quality of available health care
services. Leaders who understand the ethical dimensions of making such
decisions are important in shaping the structure of health care organizations.
Nurses are
continuously faced with constant ethical issues and dilemmas in their practice
and leaders will need to assist them in addressing the ethical dimensions of
their practice (Cassidy & Koroll, 1994). An example of these ethical issues
would be caring for the chronically ill, older adult populations, health care
rationing and resource allocation. Because transformational leaders are in a
unique situation to motivate, and empower staff, they must function as moral
agents for the staff fulfilling their role as leader being responsible for and
assisting staff when ethical issues arise.
Transformational leaders can be instrumental in helping define he
ethical standards of the profession in a changing healthcare environment
(Cassidy & Koroll, 1994).
Effective
leadership styles among nurse managers have been associated with staff job
satisfaction and retention. There is evidence that transformation leadership
style is linked to employee psychological well-being. Despite transformational leadership styles
have been described as effective, it is still unclear which nurse leadership
behaviors contribute most to nurse retention or well-being. Transformational
leadership could provide a new optimism in a changing health care environment. Through
partnering efforts, sharing information and sharing power, the transformational
leadership can increase staff satisfaction, alleviate the burden of staff
shortages and resource constraints while creating work environments that
benefit nurses and ultimately patients.
Bass’s Transformational Leadership Theory
Bass (1985), defined transformational
leadership in terms of how the leader affects followers,
who are intended to trust, admire and respect the transformational leader.
He identified three ways in which leaders transform followers:
·
Increasing their awareness of task importance
and value.
·
Getting them to focus first on team or
organizational goals, rather than their own interests.
Bass noted that authentic transformational leadership is grounded
in moral foundations that are based on four components:
·
Idealized influence
·
Inspirational motivation
·
Intellectual stimulation
·
Individualized consideration
...and three moral aspects:
·
The moral character of the leader.
·
The ethical values embedded in the leader’s
vision, articulation, and program (which followers either embrace or reject).
·
The morality of the processes of social
ethical choice and action that leaders and followers engage in and collectively
pursue.
Model of
Transformational Leadership
(“Transformational”, 2008)
Bass saw these aspects of transformational leadership:
- Individual
consideration, where there is an emphasis on what a group
member needs. The leader acts as a role model, mentor, facilitator, or
teacher to bring a follower into the group and be motivated to do tasks.
- Intellectual
stimulation is provided by a leader in terms of
challenge to the prevailing order, task, and individual. S/he seeks ideas
from the group and encourages them to contribute. Learn, and be
independent. The leader often becomes a teacher.
- Inspirational
motivation by a leader means giving meaning to the follows of a task.
This usually involves providing a vision or goal. The group is given a
reason or purpose to do a task or even be in the organization. The leader
will resort to charismatic approaches in exhorting the group to go
forward.
- Idealized
influenced refers to the leader becoming a full-fledged role model,
acting out and displaying ideal traits of honesty, trust, enthusiasm,
pride, and so forth.
Transformation is synonymous with
change and we are concerned with how people participate in change. A Transformational Leader can have a great
effect on people’s casual effort to change but how can we encourage people to
change from within?
Barrett
Power as Knowing Participation in Change Theory
© 2009 Dr.
Elizabeth Ann Manhart Barrett. All rights reserved.
To make
change a reality, Barrett suggests people must knowingly participate in
creating their experience by being aware of what one is choosing to do, making
choices based on that awareness, feeling free to act, and acting intentionally
to create change.
Barrett
describes power-as-freedom not power-as-control. She describes power-as-freedom where change
is innovative, creative, and unpredictable.
By
applying Barrett’s theory, a transformational leader can promote change and
encourage adoption of evidence-based practice in individual staff, units, and
hospital systems.
Analysis of Barrett’s Theory
Clarity/ Simplicity
Concepts
in Barrett’s theory are given simple operational and theoretical definitions to
describe how they are being used. Concepts in the theory are related to each
other, are clearly stated, and a simple diagram is used to illustrate
relationships between the concepts. Since there are only four dimensions, there
are not too many interacting factors to confuse the concept.
Generality
Barrett’s
power theory and/or the Power as Knowing Participation in Change Tool (PKPCT)
has been validated cross culturally via its use in the United States, Germany,
Korea and Brazil. It has been used in the homeless, cardiac rehab, breast
cancer survivors, and critical care nurses. The theory is not limiting, it can
be applied to numerous aspects of nursing and to diverse patient populations.
Empirical
Precision
Barrett’s
power theory and/or the PKPCT have been used as conceptual, theoretical, and
empirical structure for research in more than 50 (qualitative and quantitative)
studies (Kim, 2009). Concepts are
operationally defined and the use of the PKPCT helps measure the four
dimensions of power. It generates
theoretical hypotheses and adds to the body of nursing knowledge.
Barbara W.
Wright RN PhD FAAN (2010) cites,
“In over 20 years of serving in elected office … and member of the legislature,
I expressed my power as I participated knowingly in the process of change. The
lens through which I participated was influenced by the science of unitary
human beings, and more specifically by my research on trust and power.” Barrett’s influence on Wright’s practice
demonstrates and supports the theory’s empirical precision and its ability to
affect change even in the political arena.
Derivable
Consequences
The theory has implications for
education, practice, and administration. Barrett’s theory can be readily adopted by
transformational leaders. It has been shown in practice among critical care
nurses to help create a nurse-to-nurse caring environment. France, Byers, Kearney, & Myatt, (2011)
indicate that to create environments for healing, administrators must be open
to empowering the registered nurse (RN) and encourage RNs to be accountable and
responsible to design quality nursing care.
Findings in this study include, trust,
respect and empowerment/power are essential structures to create a healing
environment for nurses, patients, families, and healthcare team members. The
RNs who participated in this study made choices, which influenced and
transformed their environment.
Implications from this study address the need for nurse educators to
create positive nurse-to-nurse relationships. The study indicates that
education on empowerment and nurse-to-nurse caring is imperative to break the
cycle of nurses eating their young (France, Byers, Kearney, & Myatt, 2011).
Transformational
leaders can make staff aware of issues, ask for input and allow staff to make
choices regarding solutions for managing issues, allow staff freedom to act,
and encourage staff to be actively involved in creating change. Just by applying, the simple principles of
transformational leadership and Barrett’s Power theory leaders may see
increased employee engagement, increased nurse self-efficacy, increased job
satisfaction, and quality patient outcomes.
In a sense, a leader can empower and transform an individual, a unit, or
whole hospital system to meet the complex needs of staff and patients in
today’s ever changing healthcare system.
References
Barrett,
E.M. (2009). Summary of the Barrett Power as Knowing Participation in Change
Theory. Retrieved from http://www.drelizabethbarrett.com/background/power-knowing-participation-change-theory
Bennis, W., & Nanus, B. (1985). Leaders: The strategies for taking charge.
New York: Harper & Row.
Carroll,
P. L. (2006). Nursing Leadership and
management: A practical guide. New York, NY: Thomson Delmar Learning.
Cassidy,
V. R., & Koroll, C. J. (1994). Ethical aspects of transformational
leadership. Nurse Management, 9(1), 41-47.
Farren, A. T. (2010). Power in breast
cancer survivors: A secondary analysis. Visions:
The Journal of Rogerian Nursing Science, 17(1), 29-43.
doi:10.1177/0894318404263303
France, N., Byers, D., Kearney, B., &
Myatt, S. (2011). Creating a healing environment: nurse-to-nurse caring in the
critical care unit. International Journal
for Human Caring, 15(1), 44-48.
Robbins,
B., & Davidhizar, R. (2007). Transformational Leadership in Healthcare
Today. Health Care Manager, 26(3), 234-239. doi:
10.1097/01.HCM.0000285014.e7
Rosenbach,
W., Sashkin, M., & Harburg, F. (1996). The
leadership profile. Seabrook, MD: Ducochon Press.
Smith, M.K. (2011). Are you a transformational leader? Nursing
Management, 42(9), 44-50.
Thompson, J. (2012). Transformational leadership can improve
workflow competencies. Nursing Management-UK, 18(10), 21-24.
Trofino,
J. (1995). Transformational Leadership in Healthcare. Nurse Management, 26(8),
42-47.
Wright, B. W. (2010). Power, Trust, and Science
of Unitary Human Beings Influence Political Leadership: A Celebration of
Barrett's Power Theory. Nursing Science
Quarterly, 23(1), 60-62. doi: 10.1177/0894318409353794
Leaders develop tight systems to monitor and evaluate all parts of the system to ensure that they are efficient and effective.
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