Running head: Nursing Leadership
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The Path to Nursing Leadership:
A Continuous Journey of
Aspirations, Competencies, and Achievements
Sarah Parker, RN, BSNс
San Francisco State University
Nursing 558
Mercy Popoola, RN, PhD, CNS, CFCN, FWACN
April 25, 2013
Nursing Leadership
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Abstract
Developing nursing leadership skills and style is a continuous evolving process. It changes with
each situation and with the experience of the leader. Transformational leadership is one style that
seems to work well in the dynamic fast-paced health care environment. Studies have shown that
transformational leadership has positively affected the nursing workforce. The development of
personal leadership styles such as transformational requires achievement of certain competencies
and skills. The Institute of Medicine and the Quality and Safety Education for Nurses Institute
provide a framework of competencies that nurses may follow for leadership development.
Experienced nurse leaders such as Sheila Burke also offer insights that nurses of all backgrounds
can embrace to better their leadership skills. Joining nursing organizations, finding a nursing
mentor, becoming a good public speaker, and following healthcare trends are some of Burke’s
suggestions on leadership development. Furthermore, national and community involvement is an
integral part of becoming a nurse leader. Building strong relationships and connections are
another aspect of leadership development. Finally, a successful nurse leader must be on a
continuous journey of lifelong learning.
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Nursing Leadership
What makes a great nursing leader? There is no one simple answer. Still, there are
qualities of a leader that are associated with success and productivity including qualities such as
trustworthiness, assertiveness, and innovativeness. However, it may be easily argued that actual
leadership styles vary as much as the individual nurse does. Despite the uniqueness each
individual brings to leadership, some consistent styles have been categorized. Some of the styles
mentioned in class were autocratic, democratic, transformational, transactional, laissez-faire, and
situational. These styles may overlap or change overtime for a leader. Being aware that personal
leadership style is not a stagnant state but an ever-changing, evolutionary development is
probably just as significant as the style itself. Indeed, it was a personal revelation to realize that
leadership styles change with who interaction occurs, the situation and environment where it is
required, and the continuous personal growth and development of the leader themself.
Aspirations of Transformational Leadership
A Current Focus on Transformational Leadership
Recognizing that leadership styles change over time and different styles are
appropriate for different situations, this novice nurse and writer finds transformational leadership
appealing in this rapidly changing health care system. It provides a promise of new ideas,
change, innovation, empowerment, and teamwork. Clinical experiences while in nursing school
supported this perception of a need for transformational nursing leadership. This writer observed
that many long-time nurses in various clinical settings without this form of leadership had a dire
loss of enthusiasm and a loss of the genuine passion towards the practice of nursing. Without the
transformational mindset, these nurses fostered old beliefs, old ways of doing things (rather than
current evidence-based practice), focused on repetitive tasks, had a lack of individual creative
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input in the health care organization, and suffered from burnout. Even research supports that
these same nurses and the work environment would have improved with people-focused,
transformational nursing leadership (Cummings, MacGregor, Davey, Lee, Wong, Lo, Muise, &
Stafford, 2009). One systematic review of 53 studies on various nursing leadership styles
concluded that transformational and people-focused leadership “increased organizational
commitment, […] that culture and climate were better, and […] that staff health was better while
emotional exhaustion and stress were lower” (Cummings, et al., 2009). Overall, it is the many
components of transformational leadership that cultivate continuous improvement and change.
Concepts of Transformational Leadership
Based on personal experiences and review of the research, this writer’s curiosity
and pursuit of the transformational style continues to increase. The transformational concepts of
“idealized influence, inspirational motivation, intellectual stimulation, and individualized
consideration” (Doody & Doody, 2012) speak of “adaptive flexibility” and “shared
responsibility” (Doody et al., 2012) which this writer believes is essential to successful
leadership in a complex health care field of new technologies, more specialties, and sicker
patients (Institute of Medicine [IOM], 2011). Idealized influence, the first concept of
transformational leadership, requires a charismatic leader to be a mentor (Doody et al., 2012),
focusing on “individual beliefs and values” and providing the staff “a sense of purpose”
(Bamford-Wade & Moss, 2010). Furthermore, the idea of inspirational motivation expects a
motivational leader to foster the staff’s dedication to work contribution and to establish a vision
that meets organizational needs (Bamford-Wade et al., 2010; Doody et al., 2012). The concept of
intellectual stimulation focuses on “encouraging critical thinking, creativity, and analysis of new
perspectives” (Bamford-Wade et al., 2010). Finally, the fourth component of transformational
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leadership, individual consideration, is based on a leader that encourages the staff to grow and
“to reach higher levels of achievement” (Doody et al., 2012). The overall goal is for continuous
growth in the health care environment and its staff empowering all to become future leaders.
IOM and QSEN Learned Leadership Competencies and Achievements
IOM offers a Framework of Nurses Leading Healthcare Change
This proactive approach for all staff nurses to be involved in changing and
improving healthcare mirrors the Institute of Medicine’s message in the Future of Nursing
report. One of the four key messages of The Institute of Medicine’s Future of Nursing (2011)
report is that “Nurses should be full partners, with physicians and other health professionals, in
redesigning health care in the United States.” The IOM (2011) states, “The nursing profession
must produce leaders throughout the system, from the bedside to the boardroom.” In order to
lead changes in health care nurses need to be prepared. An important aspect in leadership
development is the achievement of certain competencies. Both the Institute of Medicine and the
Quality and Safety Education for Nurses Institute provide a framework to gain necessary
competencies. Some of the ways to gain these competencies are mentioned in two other key
messages from the IOM. One is for nurses to receive higher levels of education and training and
the other is to practice to the full extent of their training and education (IOM, 2011). The IOM
(2011) states “Nurses should take responsibility for their personal and professional growth by
continuing their education and seeking opportunities to develop and exercise their leadership
skills.” To gain these competencies nurses need to gain experience in academic settings, in the
hospital, community, etc. Furthermore, nurses need to seek out mentors and build partnerships to
cultivate these skills (IOM, 2011). The IOM (2011) encourages nurses to lead the way in
improving the “quality, access, and value” of health care. The IOM’s (2003) Health Profession
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Education: A Bridge to Quality elaborates on essential competencies to be learned by nurses and
any health care staff including “Provide patient-centered care, work in interdisciplinary teams,
employ evidence-based practice, apply quality improvement, and utilize informatics” (IOM,
2003). These competencies were used to develop the Quality and Safety Education for Nurses
Institute’s six competencies.
QSEN Competencies in Leadership Development
San Francisco State University’s curriculum focuses on the Quality and Safety
Education for Nurses (QSEN) framework, also based on the IOM’s competencies. The focus on
knowledge, skills, and attitudes in six areas including patient-centered care, teamwork and
collaboration, evidence-based practice (EBP), Quality Improvement (QI), safety, and informatics
(Quality and Safety Education for Nurses Institute, 2013) have been continuously used through
various projects in the academic setting. This writer has used them in presentations, clinical
electronic health record documentation analyses, preceptor’s guidance and knowledge sharing,
class discussions, and research assignments. The latest achievement was a presentation for the
Stanford Quality Department team and manager focusing on improved core measure compliance
in the clinical setting. This presentation in itself utilized all six QSEN areas of competency
broadening this writer’s scope in each. The knowledge accumulated from these sources and a
knowledgeable nurse leader, Sheila Burke, RN, MPA, FAAP, has advanced many nurses
including this writer’s leadership development.
Insights from a Well-Established and Experienced Nursing Leader
The Experienced Leader
Much can be learned from a knowledgeable leader with years of experience and
professional advice. This writer attended the Leading the Way in Nursing conference, which was
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a discussion with Sheila P. Burke, RN, MPA, FAAN who “is a Faculty Research Fellow at the
Malcolm Wiener Center for Social Policy and a member of the faculty at the John F. Kennedy
School of Government at Harvard University.” She was the “Executive Dean and lecturer in
public policy at the John F. Kennedy School of Government at Harvard University […] and the
Chief of Staff to Senator Bob Dole” along with other accomplishments (The Henry J. Kaiser
Family Foundation, n.d.).
Leadership Insight and Advice
Leadership training. Ms. Burke enlightened the new and seasoned nurses with the sharing of
her leadership experiences and wisdom. Among important points covered, was that as leaders
there is a consistent need to make new partners building new relationships, translate complicated
information from one person to the next, and manage disagreements. New nurses need training
through experiences which Burke received through multiple organizations beginning with active
memberships in the California Nurses Association (CNA) and the National Student Nurse’s
Association (NSNA). Furthermore, an ideal mentor for guidance in personal development is
required. It is necessary to find a mentor with a background in the area of interest, someone who
believes in the mentee but still will hold them to the highest expectations. This person needs to
be someone that gives permission for the mentee to say, “I don’t know” but who gives feedback
in areas that are not the mentee’s strengths. It is a person who is honest, direct, and can tell the
mentee if they have messed up. For her this was a nun and instructor at the University of San
Francisco, USF (S. P. Burke, personal communication, March 5, 2013).
Start a conversation and have voice. In addition, Burke stated, as nurses and
future leaders, it is our responsibility to be part of conversations in health care. Numerous times
as Bob Dole’s Chief of Staff, did Ms. Burke attend Town Hall meetings where numerous doctors
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spoke up but no nurses attended or gave voice to the profession despite the expertise nurses have.
It is important to organize and to be involved in the community as a future leader. In order to do
this successfully, training in public speaking is a must. She stated, as a leader one must always be
the “best prepared person” in a room and to “start and advance” conversations (S. P. Burke,
personal communication, March 5, 2013). Furthermore, keeping up with trends in nursing is
important. The current trend is for an influx of insured individuals, movement outside of the
acute-care setting into ambulatory care, a focus on preventative care, with a greater need for
graduate level nurses.
The Continuous Process of Personal Leadership Development
The Next Step to Leadership Development
Guidelines and plan for a future leader. This writer has gathered information
learned from theory class, clinical experiences, articles, books, organizations, and nursing leader
conferences, to guide the leadership development process. However, just as the nursing process
dictates, next is the drafting and implementation of a plan for future goals.
Professional organizations and mentors. The first step in fulfilling leadership
competencies is to be part of an organization such as the NSNA or CNA thereby being exposed
“to broader conversations” (S. P. Burke, personal communication, March 5, 2013). Also, it is
imperative to find a mentor, looking for someone admire for how they “deal with people.” This
writer will find a mentor that has something to be acquired, a strength that is this writer’s
weakness (S. P. Burke, personal communication, March 5, 2013).
National engagement and current policies. It is also important to engage at the
policy level and the national platform. Giving up the decision-making-process to others thereby
letting others solely decide the nursing agenda for the future, is not an option. Furthermore,
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awareness of current changing policies is necessary, such as the proceedings of the Exchanges
taking place, the focus on continuum of care, and medical homes. In addition, despite the recent
passing of the Patient Protection and Affordable Care Act (PPACA) millions will still not be
insured and will not have access to health care therefore many more changes are necessary for
the future in health care and nursing. This writer, as a future leader, needs to be part of that
change. As Ms. Burke stated, all of this is possible when this author and other leaders actively
participate in organizations and through governance have raised the volume of the individual
voice.
Community involvement and volunteering. Another area of development for the
nursing leader is to be involved at the community level. Therefore, the plan must include
volunteering when able, looking for opportunities of interest, even participating in the decisionmaking process in arenas such as school boards, neighborhood planning, grocery store
distribution, and walkability of a neighborhood. Ms. Burke wisely stated, “Nurses need to be
involved in all of that” (S. P. Burke, personal communication, March 5, 2013).
Relationships and ownership of decisions. Being able to face and handle changes
is a vital role of a leader. Ms. Burke stated to “Never burn bridges” (S. P. Burke, personal
communication, March 5, 2013) and to always make new relationships. It is important to be
honest about disagreements and to not mislead others. She has personally kept up good working
relationships with many individuals who had very different political views than herself. Part of
the challenge as a leader, is to stand up and “take ownership” of the decisions made (S. P. Burke,
personal communication, March 5, 2013). Physicians, patients, families and others will challenge
the leader and mistakes must be admitted to and a trustful reputation maintained.
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Continuing education and new opportunities. Part of the development as a nurse
and future leader will require graduate level training and the acceptance of new working
opportunities. This writer will continue onto graduate school to receive her nurse practitioner
license. Also, she will pursue non-traditional and non-acute care settings such as surgical,
hospice, home care and other ambulatory settings to work in since they are the future in nursing.
Leadership Tips to Remember
Some final reflections and tips on leadership given by Ms. Burke and the
interviewer David Vlahov, PhD, RN, FAAN is to: “work with people you respect, prioritize
family, never burn bridges, talk less and listen more, find a mentor, be the best prepared person
in the room, start and advance conversations, never lose your sense of humor and be
enthusiastic” (S.P. Burke, personal communication, March 5, 2013). These tips are imperative to
this writer’s development as a leader and continuous reflection, internalization, and application
of them is the goal.
Conclusion
Finding and developing ones leadership style is a continuous process. Currently, this writer is
drawn to the concepts of transformational leadership but this too may change depending on
situations and continuing individual growth. Certain competencies are necessary to build and
improve leadership skills in a nurse. The IOM and QSEN Institute offer a framework on
competencies to master. Through lectures, projects, research, and conferences, this writer has
obtained an in-depth view of the leadership process and has reached personal achievements in
gaining leadership skills. However, the path to leadership is a continuous journey of growth and
development and requires a lifelong commitment to self-improvement and to contribute a voice
to the nursing field.
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References
Bamford-Wade, A., & Moss, C. (2010). Transformational leadership and shared governance: an
action study. Journal of Nursing Management, 18(7), 815-821.
doi:10.1111/j.1365-2834.2010.01124.x
Burke, S. P. (2013). Leading the way in nursing. (Personal communication).
Cummings, G. G., MacGregor, T., Davey, M., Lee, H., 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. doi:10.1016/j.ijnurstu.2009.08.006
Doody, O., & Doody, C. M. (2012). Transformational leadership in nursing practice. British
Journal of Nursing, 21(20), 1212-1218.
Institute of Medicine. (2003). Health Professions Education: A Bridge to Quality. Washington,
DC: The National Academies Press.
Institute of Medicine. (2011) The Future of Nursing: Leading Change, Advancing Health.
Washington, DC: The National Academies Press.
Quality and Safety Education for Nurses Institute. (2007). Competencies. Retrieved from
http://qsen.org/competencies/pre-licensure-ksas/
The Henry J. Kaiser Family Foundation. (n.d.) Biography Sheila P. Burke, RN, MPA, FAAN.
Retrieved from http://www.kaiseredu.org/en/tutorials-andpresentations/bios/sheila-burke.aspx