Stephen Forte
Sarah Parker
Melinda Winans
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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)
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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

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Both types of leadership styles
may be used
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
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
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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.
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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
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
No more traditional command-and control style of staff
supervision

Movement towards leadership enhancing motivation,
morale, and performance=culture of engagement

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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)
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
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
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
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
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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
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
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
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
Transformational
Leadership

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Creates a vision for the future,
necessary for change
Gives staff the strength to grow
and accomplish desired
outcomes

Structural Empowerment

Professional Practice

Knowledge, Innovation, &
Improvements

Quality Improvement for the
future

Benchmark data to show desired
outcomes


Empirical Quality Results
Exemplary professional practice
of nurses in the application of
knowledge and evidence
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“In Magnet Terms”
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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
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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
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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
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
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
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Key messages
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Practice to full extent of education/training
Achieve higher levels of education
Become full partners with others
Implement effective workforce planning
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Practicing to full extent of education and
training
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Barriers: scope of practice variation from state to
state; transition from school to practice
Solutions: Feds can promote reforms, incentivize
adoption; nurse residency programs

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In both acute and ambulatory care settings
Turnover rates reduced from 35% to 6% over 12
months
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Achieving higher levels of education
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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
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Full partners with other team members in
redesigning health care system

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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
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Shaping policy instead of “letting it happen”
Serve on committees, commissions, policy boards
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Full partners (continued)

Leadership competencies fostered through
education
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Mentoring
Professional organizations
Attaining professional degrees in other fields
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Effective workforce planning
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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
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Recommendations
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Remove scope of practice barriers
Expand opportunities to collaborate on
improvements
Greater implementation on residency programs
Increase BSNs and advanced degrees
Promote lifelong learning
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•
•
•
•
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)?
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“Leaders who merely give directions and
expect them to be followed will not succeed
in this environment”
 –Future of Nursing
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Two sets of leadership competencies
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Common set:
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Knowledge of care delivery systems
Collaboration within and across disciplines
Knowledge of medical ethics
Patient advocacy
Advocating for safety improvements
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Two sets of leadership competencies

Nursing focused set:
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Becoming a “full partner”
Collaboration
Holding other team members accountable
regardless of discipline, training, rank
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Reduces preventable adverse events
Medication errors
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Leadership at every level
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Student nurses
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Faculty obligation to career placement/degree
Health Students Taking Action Together
(HealthSTAT)
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Promotes being active in the health community a
professional habit
Workshops in political advocacy
Media training
Networking
Fundraising
http://www.healthstatgeorgia.org/
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Leadership at every level
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Student nurses (continued)
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Understand and anticipate population trends
Other degree considerations: public health, law
Consider dual majors in business/engineering
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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
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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.
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Gillett, N., Fouquereu, E., Bonnaud-Antignac, A., Mokounkolo, R., & Colomat, P. (2012). The mediating
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Messmer, P., & Turkel, M. (2010). Magnetism and the nursing workforce. Annual Review Of Nursing
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Selanders, L., Crane, P. (2012). The voice of Florence Nightingale on advocacy. OJIN: The Online
Journal of Issues in Nursing, 17(1).
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