The role of transformational leadership in nursing Show Earn 1 credit hour with this continuing education course  Move forward or backward between articles by clicking the arrows. Click or tap to bring up the Table of Contents. Share articles by clicking on one of the social media icons in the upper right corner of the page. Use your mouse wheel, keyboard arrow keys, or scroll bar to move up and down in an article. Transformational Leadership: A Growing Promise for NursingRose O. Sherman, EdD, RN, NEA-BC, CNL, FAAN, and Maureen Habel, MA, RN This course is 1 contact hour Course must be completed by September 4, 2022 Goals and objectives: The goal of this continuing education program is to inform nurses about transformational leadership in healthcare. After studying the information presented here, you will be able to:
Nurse.com educational activities are provided by OnCourse Learning. For further information and accreditation statements, please visit Nurse.com/Accreditation . The planners and authors have declared no relevant conflicts of interest that relate to this educational activity. OnCourse Learning guarantees this educational activity is free from bias. See “How to Earn Continuing Education” to learn how to earn CE credit for this module or visit http://ce.nurse.com/instructions.aspx . Allison has been an assistant nurse manager in a Magnet-designated hospital on the evening shift for the past year. Emily, her nurse manager, knows Allison is interested in a leadership role and has agreed to be her mentor. Before Emily goes on vacation, she asks Allison to move to the day shift for two weeks to be in charge of the unit. Emily suggests that Allison keep a notebook describing why and how she makes important decisions during her absence. Reviewing Allison’s notebook will allow Emily to reinforce effective decision-making skills and to identify areas for learning and mentoring. By developing a creative way to help Allison develop decision-making skills, Emily is demonstrating one of the characteristics of a transformational leader. In today’s healthcare environment, nurses seek leaders like Emily who help staff build self-esteem and empower them to realize their career aspirations. This module explains what transformational leadership is, why transformational leadership is a key part of Magnet nursing organizations, and how it can promote work satisfaction among nurses and improve care for patients. Transformational leadership is a key ingredient in establishing a nursing environment that achieves Magnet designation. More than two decades ago, the American Academy of Nursing began to look at hospitals that retained highly qualified nurses during serious nursing shortages.1 An analysis of these organizations revealed that they had several things in common; these commonalities became known as the forces of magnetism. Today, there are more than 545 Magnet hospitals in the United States and 14 in 11 other countries recognized by the American Nurses Credentialing Center for their excellence in nursing practice.2 Magnet designation is considered the hallmark of nursing practice excellence, and research has demonstrated that Magnet-level nursing care has a profoundly positive impact on nursing practice and patient care.3 The Magnet program was expanded to include long-term care facilities in 1998; in 2000, it was further expanded to include international healthcare organizations.1,2 In 2008, the American Nurses Credentialing Center published a Magnet model that emphasized the importance of using a leadership style known as transformational leadership.4 Transformational leadership has been shown to be particularly effective in turbulent and uncertain environments, such as those found in today’s healthcare organizations.3 Although not every organization will achieve Magnet status, nurses at all organizations can learn how to use the principles of transformational leadership to support a professional practice environment that results in outstanding patient care. In his book Leadership, published in 1978, James MacGregor Burns introduced a leadership theory that he called transformational leadership. Burns, a political scientist and historian, was interested in the leadership styles used by key figures in history, including Mahatma Gandhi, Franklin D. Roosevelt, and John F. Kennedy. Burns described transformational leadership as occurring when “two or more persons engage with others in such a way that the leader and followers raise one another to high levels of motivation and morality.” This theory differed significantly from older leadership theories because it proposed that meeting the needs of followers was vital to achieving high work performance.6 Burns’ work was influenced by Maslow’s hierarchy of needs, a model familiar to nurses who have taken growth and development courses. Psychologist Abraham Maslow described basic human needs as physiological stability, safety, belongingness and love, self-esteem, and self-actualization. These needs are arranged in a hierarchical order starting with the need for physiological stability and ending with self-actualization. In general, higher-level needs are not seen as important until basic needs are fulfilled. For example, most people do not strive for higher-level needs such as self-esteem or self-actualization until their basic physiological needs for food, water, and sleep are met. Historically, healthcare organizations have focused their energies on motivating employees by meeting the first three levels of Maslow’s hierarchy.5 For example, appropriate compensation allows employees to meet their basic physiological needs, workers’ safety is satisfied through a secure work environment, and strategies such as shared governance and participatory management promote a sense of belonging among employees.5 In Burns’ view, transformational leadership has the potential to motivate followers to satisfy higher-level needs, such as self-esteem and self-actualization. Those influenced by transformational leaders find meaning and value in their work, make significant contributions to the success of their employing organization, and become leaders themselves.5 Burns’ view is that transformational leadership makes a profound difference in the life of employees and organizations.5 In the past several decades, there has been a paradigm shift concerning what leadership is and what it can do. From a model that emphasizes tasks and controls, leadership is now seen as vital in developing a work culture in which employees are successful. Essential to this effort are leaders who have a positive and compelling vision and followers whose needs are met.3 Transformational leadership depends on a high level of engagement between leader and followers. Traditionally, nursing leaders have used management styles ranging from an autocratic style, in which engagement goes in only one direction, to a “hands-off” or laissez-faire style, in which the manager is nearly disengaged.6 A laissez-faire management style is basically an abdication of leadership; there are no followers in a work setting where a manager uses this style because there is no leader.6 Having a manager who is visible and collaborative is important for staff to perceive active and appropriate leadership. Two recent studies found that nurse leaders who practiced transformational leadership more effectively inspired and engaged staff.1,7 (Level B) At the same time that Burns published the theory of transformational leadership, he described a leadership style called transactional leadership. Transactional leadership is based on an understanding between a manager and subordinates; the transaction consists of an acceptable salary, benefits, and working conditions in exchange for job performance. Transactional leadership is based on contingent reward, i.e., a reward that depends on delivery of the work product. The leader establishes goals, provides direction, and rewards employee progress in meeting goals by using praise and recognition, as well as merit increases and job promotion.5 Leaders using a transactional style reward good behavior, punish negative behavior, and maintain control at the top of the hierarchy.8 In the exchange that occurs in a transactional management agreement, the basic needs of both the leader and the follower are met, but they may not have a common vision for nursing practice.6 The employee agrees to complete tasks as assigned and to meet work deadlines. Evaluation comments for a nurse working under this style of leadership might read: “Cathy Smith completes her work on time, has fewer than the standard number of allowed absences, and has made no medication errors during this rating period.” As is evident, this leadership style is unlikely to fuel a high level of job satisfaction and organizational commitment. Nursing departments that use this leadership style may publish a vision statement and goals that have been developed by senior management, with minimal staff input. At the unit level, a nurse manager may be asked to develop a unit vision statement and goals that reflect senior management’s vision.9 (Level B) The manager may reference this document in staff meetings or place it in orientation folders for new employees, but rarely does it have an impact on nursing practice and patient care. Healthcare organizations, being highly bureaucratic, have traditionally used transactional leadership strategies, which include a task-and-reward orientation, management by exception, few opportunities for creative thinking, decision making by senior management, and limited opportunities for employees to be involved.6 Although transactional leadership can help organizations meet their goals in the short term, it will not provide the inspiration to create and nourish a new culture for nursing practice and patient care. In contrast, evidence-based research supports that a transformational leader can influence attitudes and behavior to create a new culture for nursing practice and patient care, because the vision resonates with staff members and they are involved in making it become a reality.10,11,12 (Level B)
Transformational leaders use the following four elements when leading others:13 • Idealized influence • Inspirational motivation • Intellectual stimulation • Individual consideration Idealized influence, sometimes called charisma, describes a leader’s ability to inspire high standards and serve as a role model for outstanding professional practice. Such a leader gains the trust and respect of staff. Inspirational motivation refers to the leader’s ability to communicate a vision others can understand and of which they want to be a part. For example, a nurse leader with a transformational style would find creative ways to inspire staff with a vision for the future, including meeting with groups of staff or using staff e-mails to lay out goals and ways of reaching them. Intellectual stimulation is provided by a leader who asks for and values staff input, who challenges followers to develop creative and innovative solutions, and who continually seeks ways to provide growth and development opportunities. A climate in which intellectual stimulation is supported prompts staff to challenge assumptions, to reframe problems, and to look at new ways of doing things. For example, a transformational leader would provide time for nurses to work with resource staff to incorporate evidence-based practice findings into patient care. Leaders who support intellectual stimulation find ways to encourage nurses to voice their own ideas about improving patient care and pave the way for innovations to be tested and incorporated into the nursing culture. Individualized consideration refers to the commitment of the leader to coaching and mentoring, and the leader’s awareness of and concern for the needs of nursing staff. A transformational leader knows individual staff members’ career aspirations and is often in a position to guide subordinates to invaluable mentoring opportunities. Healthcare organizations face myriad challenges, the most significant of which is the need to transform the way patients receive high-quality, cost-effective care in the future. Having input from those who provide hands-on care is a vital part of this paradigm shift. The Institute of Medicine Report on the future of nursing, for example, emphasized the need for nurses to become involved in healthcare reform.14 The focus of transformational leadership on empowerment, viewing errors as learning opportunities, and valuing innovation means that staff members have a means of continually providing input about how to improve care. As a result, transformational leadership can revitalize healthcare from the point of patient care and more.2 In addition, the leadership style of nurse managers has a critical impact on nurse job performance and on nurse retention — factors vital for providing excellent patient care.10 Managers who use transformational leadership principles create a climate in which nurses have a greater commitment to their organizations and high levels of morale, job satisfaction, and work performance. Several studies have found that nurse leaders who are seen as having a transformational leadership style promote an enhanced sense of job satisfaction, well-being, and organizational commitment in their staff.9,10,11 (Level B) ,12 (Level B) Transformational leaders use the following four elements when leading others:13 • Idealized influence • Inspirational motivation • Intellectual stimulation • Individual consideration Idealized influence, sometimes called charisma, describes a leader’s ability to inspire high standards and serve as a role model for outstanding professional practice. Such a leader gains the trust and respect of staff. Inspirational motivation refers to the leader’s ability to communicate a vision others can understand and of which they want to be a part. For example, a nurse leader with a transformational style would find creative ways to inspire staff with a vision for the future, including meeting with groups of staff or using staff e-mails to lay out goals and ways of reaching them. Intellectual stimulation is provided by a leader who asks for and values staff input, who challenges followers to develop creative and innovative solutions, and who continually seeks ways to provide growth and development opportunities. A climate in which intellectual stimulation is supported prompts staff to challenge assumptions, to reframe problems, and to look at new ways of doing things. For example, a transformational leader would provide time for nurses to work with resource staff to incorporate evidence-based practice findings into patient care. Leaders who support intellectual stimulation find ways to encourage nurses to voice their own ideas about improving patient care and pave the way for innovations to be tested and incorporated into the nursing culture. Individualized consideration refers to the commitment of the leader to coaching and mentoring, and the leader’s awareness of and concern for the needs of nursing staff. A transformational leader knows individual staff members’ career aspirations and is often in a position to guide subordinates to invaluable mentoring opportunities. Healthcare organizations face myriad challenges, the most significant of which is the need to transform the way patients receive high-quality, cost-effective care in the future. Having input from those who provide hands-on care is a vital part of this paradigm shift. The Institute of Medicine Report on the future of nursing, for example, emphasized the need for nurses to become involved in healthcare reform.14 The focus of transformational leadership on empowerment, viewing errors as learning opportunities, and valuing innovation means that staff members have a means of continually providing input about how to improve care. As a result, transformational leadership can revitalize healthcare from the point of patient care and more.2 In addition, the leadership style of nurse managers has a critical impact on nurse job performance and on nurse retention — factors vital for providing excellent patient care.10 Managers who use transformational leadership principles create a climate in which nurses have a greater commitment to their organizations and high levels of morale, job satisfaction, and work performance. Several studies have found that nurse leaders who are seen as having a transformational leadership style promote an enhanced sense of job satisfaction, well-being, and organizational commitment in their staff.9,10,11 (Level B) ,12 (Level B) How to earn continuing education THIS COURSE IS 1 CONTACT HOUR Read the Continuing Education article. Go online to https://www.nurse.com/ce/transformational-leadership-a-growing-promise-for-nursing to take the test for $12 . If you are an Unlimited CE subscriber, you can take this test at no additional charge. You can sign up for an Unlimited CE membership at Nurse.com/UnlimitedCE for $49.95 per year . If the course you have chosen to take includes a clinical vignette, you will be asked to review the vignette and answer 3 or 4 questions. You must answer all questions correctly to proceed. If you answer a question incorrectly, we will provide a clue to the correct answer. Once you successfully complete the short test associated with the clinical vignette (if there is one), proceed to the course posttest. To earn contact hours, you must achieve a score of 75%. You may retake the test as many times as necessary to pass the test. All users must complete the evaluation process to complete the course. You will be able to view a certificate on screen and print or save it for your records. In support of improving patient care, Relias LLC is accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC) to provide continuing education for the healthcare team. Relias LLC is also an approved provider by the Arkansas State Board of Nursing, District of Columbia Board of Nursing, Florida Board of Nursing, Georgia Board of Nursing, New Mexico Board of Nursing, South Carolina Board of Nursing, and West Virginia Board of Examiners for Registered Professional Nurses (provider # 50-290). Relias LLC is approved by the California Board of Registered Nursing, provider # CEP13791. Relias LLC's continuing education (CE) contact hours are generally accepted by most professional nursing organizations and state boards of nursing. Relias LLC has made substantial efforts to obtain appropriate providerships for CE offerings. However, Relias LLC does not warrant that all professional organizations or licensing authorities will accept its CE contact hours. If in doubt, nurses are advised to contact their professional organizations or licensing authorities to confirm their acceptance of these contact hours. You can take this test online or select from the list of courses available. Prices subject to change. Complete course and take the test CE Direct subscriber? Complete course here © 2021 Nurse.com from Relias. All rights reserved. 1010 Sync Street Morrisville, NC 27560 How does transformational leadership improve communication?Transformational leaders have great communication skills. Their messages are authentic, inspiring, and consistent which enables them to catch their followers' attention and get their buy-in during important organizational changes and new initiatives.
How is transformational leadership used in nursing?The roles of the transformational leader in the healthcare setting include promoting teamwork among staff, encouraging positive self-esteem, motivating staff to function at a high level of performance, and empowe ring staff to become more involved in the development and implementation of policies and procedures.
Why is communication important in leadership in nursing?The ability to listen and communicate effectively in both speech and writing tends to make others think of you as trustworthy and enhances your ability to motivate and lead. More importantly, good communication skills lead to more positive patient outcomes, higher employee satisfaction and better overall health care.
Why is communication important in leadership in healthcare?The absence of effective communication can compromise patient safety and quality of care, so it is the responsibility of FLNMs to ensure effective communication, as well as to develop and maintain communication skills in the clinical setting [15].
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