From Novice to Leader * An Unexpected Journey

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Julie A. Coon, Ed.D, MSN,RN
RN-AIM 8th Annual Conference
September 27, 2013
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To explore the reasons that leadership tends to be
“unexpected” rather than an intentional component of role
development in nursing.
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To examine a personal leadership journey as an academic
nurse leader in terms of insights gained along the way.
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To identify evidence-based strategies to increase leadership
capacity, competency & intent among novice nurses.
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What do today’s nursing students tell us?
Poll of 120 FSU Nursing students asked:
▪ What would your dream job be upon
graduation?
▪ What is your long term goal for your nursing
career?
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Critical Care: ICU / ED (32)
Pediatrics / NICU (30)
OB / L&D (21)
Med Surg (17)
Travel Nurse (9)
Public Health/Home Health (5)
Ambulatory Care (2)
Psych (1)
Military (1)
Unsure /Just get a job! (9)
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Nurse Practitioner / Midwife (41)
CRNA (21)
Charge Nurse in desired specialty (9)
Nursing Administration (6)
Nurse Educator / Researcher (8)
Community based (5)
Earn a MS in Nursing (9)
Earn a Doctorate in Nursing (8)
Other: Unsure or Misc. answers with only 1-2
responses (26)
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No stated aspirations to become…
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A Nurse Executive
A Nursing Faculty Coordinator or Chair
A Nursing Dean or Director
An expert in public policy
A leader in their professional organization
An elected or appointed member of a
governmental entity
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Let’s explore that “unintended” journey to
better understand how it has happened
historically.
 A personal journey of a once reluctant
leader…from nursing school to academic
leadership and so much more.
▪ Is it Serendipity, Divine Intervention or an Accident?
Nursing as a career choice (1970-72)
Undergraduate nursing education (1972-75)
Graduate Nurse to Nurse Manager (1975-80)
Graduate nursing education – MSN (1980-82)
 Trial in ambulatory care as a CNS (1981-82)
 Entry to academia & the faculty role (1982-2001)
 Administration – where the action is (2001-now)
 Director to Interim Dean and back again (2010-12)
 The last challenge (2013 - ?)
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Informal recognition from people I respected
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Opportunities to be innovative in practice
settings – clinical & academic
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Formal recognitions & awards
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Opportunities to participate in nursing reform
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“I thought they would chew you up and spit you out…”
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“I noticed that you seem to see things differently than other
nurses around here.”
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“We need someone to do ______, and I think you would be
good at this, would you consider it?”
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“You, my dear, are one of the great thinkers and we need
more of you in leadership positions.”
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“Oh, they told me I should talk to Julie Coon about that…”
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Family-Centered Care Model
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Reducing C-Section incidence (quality)
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Problem-Based Learning Model
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Critical Thinking in academia (instruction) and practice
(consultation
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New models of clinical instruction
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Development of new degrees and tracks
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Innovative Ideas in a Rural Health Care Setting
Award (Michigan Association of Rural Health Care)
Co-recipient.
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Michigan Professor of the Year 1994 (Carnegie &
Council for the Advancement of Secondary
Education)
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Strategic Plan for Nursing: Actions to Avert a Crisis (2005,
Michigan Chief Nurse Executive)
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3M Task Force to Increase BSN prepared nurses in Michigan
(2005-08, MCNEA, MACN, MONE)
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Task Force on Nursing Education in Michigan (2008-09)
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Michigan Nursing Education Council (MNEC) (2010-11)
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Inter-professional Education and Practice (IPEP) Initiative
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Leadership is often thrust upon the “Last
Woman Standing” which only reinforces our
reluctance and sense of not being worthy.
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All new leaders are scared to death and suffer
from the “imposter” syndrome.
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Your nursing education experiences really do
matter.
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An administrator has to “manage” as well as
lead, i.e., The “Red Ball” phenomenon.
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Without formal training for leadership,
finding the right mentor is critical.
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Leadership succession is a challenge.
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Leadership is where the real fun is...but like
nursing, it is never if finished product.
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Leadership is a journey…not a light switch.
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This is not a new question – the literature is prolific
in this topic from a generic context. (Burns, Bennis
& Nannis, Starratt, Covey, Sergiovanni, Cleary,
Kouzes & Posner, etc.)
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If you Google “Leadership Lessons”….
 Colin Powell and FDR to Spiderman and the
Janitor!
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Keep your ends certain, but your means flexible.
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You are usually stronger when you work through
others.
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Reach out to your opponents.
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Curiosity is a good thing.
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The most important leadership quality is courage.
What is the value of exemplary leadership?
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Study by Salanova, Lorente, Chambel & Martinez
(2011) linking TFL to nurses’ extra role
performance, self-efficacy and work engagement.
 NM with a TFL style enhanced ‘extra-role’ performance in
nurses, increasing hospital efficacy.
 A direct relationship between transformational leadership
and work engagement was also found.
 Study by Casida, Crane, Walker & Wargo (2012):
Elaboration of Leadership and Culture in High
Performing Nursing Units of Hospitals as perceived
by Staff Nurses (SN)
▪ SN at BSN or higher level had more favorable / different
perceptions of their NM leadership than diploma or ADN
SN
▪ The frequent portrayals of TFL behaviors (i.e.,
visionary) by NM were paramount in shaping culture
traits that exemplify high performance, are flexible
and adaptive.
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Downey, Parslow & Smart (2011) described
informal leaders as the “hidden treasure” in
nursing leadership.
 Informal Leaders are the most underutilized asset in
health care (approximately 80-90% of a typical HC
organization).
 If identified early, they can be developed and empowered
to impact environmental culture in a positive manner
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Traits to watch for:
 Ubiquitous – everywhere at the same time
 Expert nurses who share their knowledge
 Those names that always come up to lead teams or volunteer
 Recognized amongst their peers
 Elevate the whole team – pull us together
 Credibility with both staff and administration
 High performers / strong work ethic
 Sense of the heartbeat of their unit and want to make it better – they
want to be part of the discussion in shaping the organization
 They do not usually view themselves as special or even as leaders
 They may accept acknowledgement or rewards for their
accomplishments, but may oppose any formal title or visible recognition.
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Give them opportunities to show they can solve problems –
chair a task force, etc.
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Be mindful to not overuse them to prevent burnout; select
projects carefully
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Informal Leaders need to know that their positive attitude
and creative contributions are of great value to the NA
and the unit/org.
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Simple day to day recognitions are often most highly valued.
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Eddy, Doutrich, Higgs, Spuck, Olson & Weinberg
(2009) conducted a qualitative study to elicit
narratives about essential nursing leadership
competencies to inform the revision of a graduate
nursing program:
 Communication Skills: listening & conflict resolution
 The ability to communicate a vision, motivate and inspire
 Technological adroitness & Fiscal dexterity
 The courage to be proactive during rapid change
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Stiles, Pardue, Young & Morales (2011) examined
the process of becoming a nurse faculty leader
and found that advancing reform was a
significant experience:
 Being able to envision oneself in the leadership role
 Being involved with others in a common cause or goal
 Serving as a symbol and preserving authenticity
 Creating an environment for change
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Crosby & Shields (2010) convened a task force of leaders
from academia and practice to address succession
planning.
 Noted that as HC has become less hierarchal, leadership is less
about position and more about influence.
 Also noted the correlation between how staff perceive the NM and
job satisfaction / work effectiveness.
 Current environmental pressures are influencing the pool of future
nurses & highlight the need for strong leadership.
 Led to the development of leadership academy workshops in the
clinical setting to address these needs.
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Anazor (2012) reported on a program developed by
the International Council of Nurses (ICN) to develop
the Leadership for Change (LFC) program to
complement leadership education programs from
different countries to enhance nurse’s skills to
prepare them to meet the challenges posed by
ongoing health reforms and empower them to
contribute to decision-making.
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Participate effectively in health policy development and
decision-making.
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Be effective leaders and managers in nursing health services.
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Prepare future nurse managers and leaders for key positions.
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Influence change in nursing curricula so future nurse
leaders are prepared appropriately.
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Scott & Miles (2013) provide a framework for
viewing the current strategies in both education
and practice to address the potential shortage of
nurse leaders.
 This call to advance leadership capacity and competence
in nursing has never been louder or more urgent than it is
today.
Although the public is not used to viewing nurses as
leaders and not all nurses begin their career with
thoughts of becoming a leader, all nurses must be
leaders in the design, implementation and evaluation of,
as well as advocacy for, the ongoing reforms to the
system that will be needed. Additionally, nurses will need
leadership skills and competencies to act as full partners
with physicians and other health professionals in redesign
and reform efforts across the health care system.
(Institute of Medicine. The Future of Nursing; Leading
Change, Advancing Health. Washington, DC, National
academies Press; 2010)
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Education:
 Note that most nursing literature on leadership is devoted
to “leader” development rather than “leadership”
development.
 Efforts must be made to augment faculty and students’
conceptualization of nursing such that leadership is
seen as a dimension of practice for all nurses, not just
those in formal leadership roles.
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Education to Practice:
 A comprehensive conceptual framework for lifelong
leadership development of nurses needs to be designed.
 A baseline leadership capacity (novice) to build upon in all
nurses regardless of their nursing role.
 Example: We have done this for quality & safety education
for nurses…but not for leadership.
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We lack the evidence base for teaching leadership.
 Leadership vs. Management
 Leader vs. Leadership
 AACN Essentials – no consistent framework
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Collective wisdom would suggest that leadership
should be shared, participative and relational.
 Shared leadership vs. leadership as a role
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Moving to adopt leadership in nursing as both a
process AND a role promotes the potential for all
nurses to develop leadership competency and
capacity.
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As more nurses perceive themselves as being able
to lead; more will be inspired to become leaders
in formal roles, i.e., SUCCESSION!
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Hannah (2006) as cited in Scott & Miles (2013)
conceptualized a model the highlights the
components that influence whether or not a
person identifies him- or herself as able to lead –
from developmental readiness to Leader selfefficacy.
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Leadership self-efficacy: The level of confidence in the
knowledge, skills and abilities associated with leading
others. Self-confidence is the most prevalent
characteristic used in defining a leader.
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Include opportunities for students to develop desire for and
participate in successful leadership experiences.
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One path to an administrative position in nursing began
when managers told nurses they think they would be good in
leadership. Therefore…we need to TELL them!!!
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Students need to be exposed to nurses who are passionately
addressing issues in health care in both formal and informal
roles of leadership so they are aroused to consider
leadership as a course of action for resolving challenges in
health care.
10. Acknowledge that nursing equals leadership.
9. Admit that leadership takes time to develop.
8. Don’t hesitate to “pretend” to be a leader.
7. Leadership doesn’t mean just one thing.
6. Leadership development must be a feature of
every work setting and professional association.
5. Nurses need to be transformational leaders.
4. Nurses need to be capable of strategic vision
3. If you’re going to have a vision, it might as well be
for excellence
2. Transformative leadership requires that nurses
shape more than the purview of nursing
1. Nurses need to seize the opportunities handed to
them.
McBride, A. (2011) Taking leadership seriously. American Journal
of Nursing, 111 (3), 11.
Julie A. Coon, Ed.D, MSN
Associate Dean
College of Health Professions
Ferris State University
[email protected]
Anazor C. (2012) Preparing nurse leaders for global health reforms.
Nursing Management, 19 (4), 26-28.
Casida J., Crane P., Walker T. & Wargo, L. (2012) Elaboration of
leadership and Culture in high-performing nursing units of
hospitals as perceived by staff nurses. Research and Theory for
Nursing Practice: An International Journal, 26 (4), 241-261.
Crosby F. & Shields C. (2010) Preparing the next generation of nurse
leaders: An educational needs assessment. The Journal of
Continuing Education in Nursing, 41 (8), 363-368.
Downey M., Parslow S., & Smart, M. (2011) The hidden treasure in
nursing leadership: Informal leaders. Journal of Nursing
Management, 19, 517-521.
Eddy,L., Doutrich, D., Higgs, Z, Spuck, J, Olson, M. & Weinberg, S. (2009)
Relevant nursing leadership: An evidence-based programmatic response.
International Journal of Nursing Education Scholarship, 6 (1), 1-17.
Institute of Medicine (2010) The Future of Nursing; Leading Change, Advancing
Health. Washington, DC, National academies Press.
McBride, A. (2011) Taking leadership seriously. American Journal of Nursing,
111 (3), 11.
Salanova M., Lorente L., Chambel M. & Martinez I. (2011) Linking
Transformational leadership to nurses’ extra-role performance: The
mediating role of self-efficacy and work engagement. Journal of Advanced
Nursing, 67 (10), 2256-2266.
Scott E. & Miles J. (2013) Advancing leadership capacity in nursing. Nursing
Administration Quarterly 37 (1), 77-82.
Stiles K., Pardue K., Young P. & Morales M. (2011) Becoming a nurse faculty
leader: Practices of leading illuminated through advancing reform in nursing
education. Nursing Forum 46 (2), 9-101.
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