Question

In chapter 21 (Leadership for APNs: If Not Now, Then When?) the author outlines serval leadership theories or styles including:

• Situational or Contingency Leadership
• Servant Leadership
• Transformational or Transactional Leardershp
• Rational Leadership
• Clinical Leadership and Congruent Leadership

Select one of the above leadership theories or style.

1. Using your own words define the theory.
2. Considering the various APN roles (Clinician, Educator, Researcher, Administrator, Entrepreneur, Consultant, and Leader) describe how you might use the leadership theory in your future APN role.
3. From your experience as a professional nurse, give one example of the selected leadership theory or style as seen in action or provide an exemplary example.

Answer 1

Demonstrate leadership in nursing :

Keeping your staff motivated to perform at top quality takes clever nursing leadership.

1. Making the Numbers. ...
2. Become more self-aware. ...
3. Understand your organizational culture. ...
4. Show empathy. ...
5. Learn to listen. ...
6. Support your staff. ...
7. Act as a mentor. ...
8. Inspire and encourage

The 5 Most Important Qualities a Nurse Needs to Lead

1. Strong communication. Effective communication skills serve you well in every rung of the nurse ladder, but it's particularly important in leadership roles. ...
2. Delegation. ...
3. Business-mindedness. ...
4. Empathy. ...
5. Conflict resolution

Help reach the pinnacle of your profession with these five ways to improve your nurse leadership skills.

• Pursue lifelong learning. ...
• Mentoring goes both ways. ...
• Confidence is a vital nurse leadership skill. ...
• Enhance communication skills. ...
• Get involved

Here are three ways you can prepare nurses for leadership roles:

1. Offer employee training and educational opportunities approved and endorsed by national associations. ...
2. Create an internal support system to support relationship building opportunities. ...
3. Offer healthcare specific educational content and assess your leaders.

Leadership skills

Nursing leadership has been defined as influencing others to improve the quality of care along with the direct participation in clinical care . Leadership in nursing involves an environment that has a clear vision, and where staff are motivated and empowered.

Shared decision-making, relationship management, and social awareness are all important to nursing leadership success. ... As a successful nurse leader, you inspire others every day to do their best and help them develop effective leadership skills.

Effective clinical leadership has been linked to a wide range of functions. It is a requirement of hospital care, including system performance, achievement of health reform objectives, timely care delivery, system integrity and efficiency, and is an integral component of the health care system.

Nurturing Teamwork. Strong nursing leadership helps encourage other nurses to function as team units. Nurses -leaders or otherwise must have strong interpersonal skills to be successful. They must be adept at communicating with each other, with doctors and other staff, with patients and with patients' families.

Essential nurse leader competencies for 2020 include: A global perspective or mindset regarding healthcare and professional nursing issues. Technology skills which facilitate mobility and portability of relationships, interactions, and operational processes.

Upper level nurse leaders, in most instances, are less task-oriented than nurse managers. They are less hands-on and more focused on setting standards, spearheading transformation and inspiring and influencing their teams. ... Both staff and management look to them for their knowledge, experience and vision.

Empathy. I believe that empathy is the most important skill to build, whether you're a leader or not. If there was more empathy in leadership, the employee engagement problem would go away. At the end of the day, employee engagement comes down to treating your team with respect.

Some examples of skills that make a strong leader include:

• Patience.
• Empathy.
• Active listening.
• Reliability.
• Dependability.
• Creativity.
• Positivity.
• Effective feedback.

Nurse leaders who can role-model excellence, clear communication, collaboration, and courage help bring teams into alignment and ensure the best possible outcomes for the organization, the teams, and most of all, our patients.

The impact of nursing clinical leadership

Effective clinical leadership skills empower nurses while providing care with the abilities to direct and support patients and healthcare teams . It also improves the care delivered to patients, which in turn improves patient outcomes.

Let's take a look at 10 must-have characteristics of a good leader.

• Trustworthy. ...
• Articulates purpose and goals. ...
• Exemplifies the culture. ...
• Recognizes accomplishments. ...
• Empathetic. ...
• Admits when they don't have all the answers. ...
• Knowledgeable. ...
• Trusts their people's expertise.

The four main leadership styles — transactional, charismatic, transformational and servant — may vary, but they each have the ability to improve poorly-structured organizations.

Strong leadership is critical if the vision of a transformed health care system is to be realized. Yet not all nurses begin their career with thoughts of becoming a leader. The nursing profession must produce leaders throughout the health care system, from the bedside to the boardroom, who can serve as full partners with other health professionals and be accountable for their own contributions to delivering high-quality care while working collaboratively with leaders from other health professions.

APN (Advanced Practice Nurses) Leadership Role :

Identified APN leadership as clinical or professional leadership activities, in the APN Leadership Capabilities Model leadership is defined through a set of capabilities that have an impact on the patient and the system or organization. Leadership is a shared responsibility of all nursing roles.

Management and Leadership within Advanced Practice

With healthcare services constantly adapting to trends and policies, healthcare professionals especially nurses, are having to lead, organise and deliver care in an increasingly challenging and changing environment

The role of the advanced nurse practitioner was developed in 2004 following the reduction in the number of hours junior doctors could work under the European Working Time Directive . This resulted in a need for other clinicians, including nurses to undertake advanced practice roles .

The Framework for Advanced Practice in Wales sets out four pillars of advanced practice – Education, Advanced Clinical Practice, Research and Management and Leadership. These pillars articulate the core principles that advanced practice is a level of practice rather than just a role or title.

These four pillars work in combination with many other management and leadership frameworks such as NHS Wales Leadership Qualities Framework and the Healthcare Leadership Model .

Advanced nurse practitioners have a responsibility to understand the increasing complex demands on the NHS, including the ageing population and innovations in clinical treatments highlights that advanced nurse practitioners are required to have an understanding of the necessity of responding to and influencing changes in healthcare policy and practice. As such, strategic and clinical leadership are integral to the advanced nurse practitioner’s role. Cook believes that leadership is as much about having the correct attitude and behavior as it is about skills and knowledge.

Leadership Theories

There are several leadership styles identified in nursing literature. Cummings stated that most styles can characterized as relational leadership or task- focused leadership. Relational leadership relate to relationships and people while task- focused leadership focuses on job completion, deadlines and directives.

Authentic leadership (a relational leadership style) is an emerging theory which suggests that in order to lead, leaders must be true to themselves and their values and act accordingly. Authenticity can however, like many usually positive leadership characteristics have an adverse consequence when it occurs accidentally, it may positively destroy or at least severely damage a leader’s credibility and reputation.

Another relational leadership styles which is gaining prominence in the 21st century is Emotional intelligence . EI refers to the ability to perceive, understand and control own emotions as well as those of others. Goleman identified five components of EI: self-awareness, self-regulations, motivation, empathy and social skills. Mansel suggests that it is important to recognize how your own emotions effect your performance. Many of the five components of EI are advocated within the leadership and advanced practice frameworks therefore are advantageous and often promoted within advanced practice and healthcare in general. Emotionally intelligent leaders reflect on their emotions and make rational decisions.

The most documented leadership style in healthcare is Transformational leadership. Transformational leadership is considered to be the gold standard of leadership .

The work of Burns which was further developed by Bass and Avolio demonstrated that transformational leadership is central in nursing, this has been validated by its proven influence on staff satisfaction, patient outcomes and safety culture Transformational leaders are believed to put nurses and nursing first; are positive under pressure and form connections with their followers. They also act as a role model and effective mentor while adhering to a core set of values . These attributes enable the transformational leader to motivate, empower and inspire others to achieve a long-term vision with organizational goals as well as career goals. Bawafaa et el also suggests that outcomes associated with transformational leadership include reduced stress, increased collaboration and teamwork and increased intention to remain in the nursing profession. However, Mannix et el and Marquis and Huston suggest that transformational leaders may require ‘Transactional’ leadership skills for the day-to-day management of the organization and the people in it. Transactional leadership is a task-focused style, it is suggested that in crisis situations when clear direction is required, this approach is an effective style .

Laissez-faire leadership is a task-focused style of leadership. It involves reactive leadership such as setting tasks in times of crisis. This style of leadership is considered a ‘hands off’ approach, leaving decisions to others. Often a style seen used by inexperienced leaders or leaders who are due to leave their position. Laissez-faire leadership and/or lack of leadership can be known to have a significant negative effect on employee effectiveness and satisfaction, thus in turn may ultimately affect quality of patient care.

Servant leadership

Servant leadership focuses on supporting and developing the individuals within an institution, while transformational leadership focuses on inspiring followers to work towards a common goal.

Servant leadership has been embraced by many nurse leaders as the philosophy that guides their practice. Servant leadership is caring leadership and helps to build trust because followers believe that their leader genuinely cares about their welfare.

One of my neighbors is fighting an aggressive cancer, and recently spent three weeks in the hospital receiving chemotherapy. Happily, she has been discharged and appears to being doing well. In my conversations with her about her hospitalization, she was very complimentary of the nursing care that she had received. What she found even more remarkable was the incredible leadership provided by the nurse manager on the unit. This neighbor had been in leadership positions outside of health-care almost her entire working life. She told me that she was amazed watching this nurse leader interacting with staff. She exemplified servant leadership. Her comments were not surprising to me. I have known this beloved nurse manager for years. What was surprising is that her leadership was clearly visible to a very sick patient.

What is Servant Leadership?

Servant leadership as a leadership philosophy was first defined by Robert K. Greenleaf. He described servant leaders as those who achieve results for their organizations by attending to the needs of those they serve. A nurse servant leader looks to the needs of his/her staff and continually asks how they can help them solve problems and promote their personal development. The manager described by my neighbor as a servant leader worked with her staff to help them meet the needs of patients, while coaching them in their professional practice. The ability to provide service is their primary motivator for seeking a leadership role. Larry Spears describes 10 characteristics that are key to the development of a servant leader:

1. Listening – the servant leader actively listens to the needs of staff and helps to support them in their decision making.

2.  Empathy – the servant leader seeks first to understand the needs of others and empathize with them.

3.  Healing – the servant leader helps staff to resolve their problems, negotiate their conflicts and encourage the formation of a healing environment.

4.  Awareness – the servant leader has a high degree of emotional intelligence and self-awareness. He or she views situations from a holistic, systems perspective.

5.  Persuasion – the servant leader does not use coercive power to influence or persuade but rather their personal powers of persuasion.

6. Conceptualization – the servant leader sees beyond the day to day operations of their unit or department. They are able to focus on the bigger picture and build a personal vision.

7.  Foresight – the servant leader is able to envision the likely outcome of a situation and is proactive in attempts to create the best consequences.

8.  Stewardship – the servant leader is a good steward of the resources and staff that they are given. They feel an obligation to help and serve others without focusing on their own rewards.

9. Commitment to the Growth of People – the servant leader is inclusive of all staff and sees value in everyone. They attempt to maximize the strengths of all who work with them.

10. Building Community – the servant leader recognizes the importance of building a sense of community among staff.

Servant leadership has been embraced by many nurse leaders as the philosophy that guides their practice.  Servant leadership is caring leadership and helps to build trust because followers believe that their leader genuinely cares about their welfare. This psychological safety leads to a higher level of employee engagement. Through their work, nurse servant leaders like the nurse manager described by my neighbor naturally build healthy work environments that attract and retain staff.

Servant Leadership in Daily Practice

The tenets of servant leadership strike a chord with many managers in the medical profession. The concepts are easy enough to understand and the principles make intuitive sense; but without putting them at the forefront of our daily routine, these tenets are likely to fade quickly. Hunter suggests budding servant leaders can begin with the three F’s: Foundation, Feedback, and Friction.12 Foundation involves setting the standard for both the leader and the team, and usually involves two questions: (a) how am I supposed to behave? (b) what happens if I don’t behave that way? Once the leader understands this vision of excellence and accountability, they are better able to relay it to the staff by modeling the behavior that is expected of them.

Feedback and self-assessment are important tools used to identify where we may be deviating from the high standards of servant leadership, or where there are gaps. Friction refers to the “healthy tension” that is needed for growth and behavior change, and it naturally follows feedback. It is, in fact, caused by that feedback.

Servant leadership does not mean being “soft” or “a pushover”. Sometimes it means holding others accountable to the extent that you may become very unpopular with them. Herein lies the crux of servant leadership: it is not about improving your own comfort or circumstances, but it is about improving those whom you serve and putting their needs ahead of your own — staff, institution, and beyond.

A common misconception about leadership training is that an intellectual push into any leadership endeavor is enough. How many new members of management teams are sent to classes, courses, seminars, or other information sessions on leadership, only to come back to the workplace with new information and insight on leadership, but no roadmap on what to do with what they have learned?

Though the tenets of servant leadership can be particularly powerful, these tenets will amount to nothing unless they are put into daily practice. These concepts do not only apply to those who are currently in or working toward management positions, but are available to everyone who serves anyone, from staff to physicians, to any other medical worker; even those who do not partake in direct patient contact.

One of the Cleveland Clinic’s mantras during their struggle to reengage their employees was “We are all caregivers”.13 This meant that everyone had a voice and everyone was a valued member of the team, whether they had an alphabet of letters after their name or none, whether they worked on patients, with patients, for patients, or simply around patients, everyone affected patient satisfaction, whether directly or indirectly.

So, how does one begin this journey? The best place to start is to make an effort to develop the ten characteristics of a servant leader. We have many opportunities to do this every day in the medical field, especially regarding listening, empathy, and healing. We can do this with patients, their families, our coworkers, and anyone we come across. Taking an extra few seconds to smile or look people in the eye while they are speaking, and to acknowledge that you are hearing their concerns, can go a long way to start building relationships rather than just coexisting in the same space for ten or twelve hours per day. A high degree of emotional intelligence is helpful in this realm. The good news, according to Goleman and others4, is that EQ is not fixed like IQ, so it can, indeed, be developed. Being mindful, rather than reactionary, in our dealings with others is a huge step in the right direction. Hunter’s “F”s of feedback and friction are useful in measuring success.

The journey into servant leadership is not an easy one and there is no “final destination”, as we are all human. We make mistakes in judgment, we sometimes lose our cool, we all have good and bad days. We take one step forward, we fall back two steps; we work hard to make progress over days, weeks, months, only to derail in one weak moment. This is the human condition and it is inextricably bound to our growth not only as leaders, but as human beings. However, the more self-aware we become, the more we are able to check ourselves when faced with crises. If we work on taking little steps daily to build our servant leadership skills and develop the ten characteristics of servant leadership, we become more and more apt to respond to the bigger issues more effectively as they arise. Remember, true lasting change does not come quickly or easily, but it is well worth the effort for everyone.