Karen Gross shares eight lessons learned about leadership that occurred not from leading per se but from the process of hiring an academic nursing leader. The search now successfully concluded gave her an opportunity to reflect on what type of health care leader they were seeking at Southern Vermont College (SVC). Although not a health care professional, she spent more than 15 months thinking about leadership in the context of nursing. The whole search process from creating the job description to identifying a quality candidates’ pool to interviewing and ultimately selecting a divisional chair to helping the successful candidate see the fit with the institution allowed her to consider what qualities are critical to nursing leadership within the academy. In an interesting way, the search for a leader in nursing enabled her to think more effectively about leadership, and in the world of unintended consequences, made her a better leader.
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Louise Woerner, the author has often been called a friend of nursing. From her perspective, she is an admirer of nursing and nurses. In fact, she is virtually in awe of nurses. She became part of the health care system through a turn in her business concept based on the regulatory environment in New York, and through that, an admirer of nurses. Over the course of her career, she has come to know there are many different types of nurse leaders. Leadership has to incorporate some exibility based on the situation and the goal. Home Care Rochester (HCR) began a successful “Roadway to Independence” program that took the home health aide employees from “bussers” to car owners, which enabled more care to be delivered in the hard- to-reach suburbs, and offered a new opportunity for both the patients and employees. Home care is a nursing-driven business with quiet leaders.
This chapter switches gears, away from what leadership means from the view-point of personal qualities to the perspective of what one need to do to achieve the goals of our workplace. Leadership is increasingly defined as the ability to work successfully with others to achieve the organization’s mission and goals. Stereotyped views of nursing stress virtue and busyness but not strength and innovation, thus reinforcing the notion that nurses are helpers, not leaders. The point of naming what one do is for others to see what one does and how one contributes to the organization as a whole. The more others see the contributions of nurses to the organization, the more nurses will be included in key decision-making forums. The more all nurses are expected to be leaders, the more nurse leaders cannot operate from a command-and-control framework but must lead by developing the leadership of others.
Career opportunities are projected to grow faster for nursing than all other occupations through 2026. The advantage of a career framework with multiple stages is that one doesn’t start out expecting to be fully developed at the beginning. Mentoring is needed throughout a career, not just at the start. This chapter provides an overview of the career model that the author has fleshed out over time, greatly influenced by Dalton, Thompson, and Price’s classic article (1977) on stages of a professional career and subsequent work. There are five career stages whereby the individual moves from: (a) becoming prepared, to (b) demonstrating the ability to work independently and interdependently in achieving professional goals, then (c) developing others and the home institution, then (d) advancing the profession and healthcare, and eventually (e) daring to be a truth teller. Exerting leadership presupposes complete career development, going through all five career stages.
Since ancient times, self-knowledge has been regarded as the key to effective leadership. No nurse is good at all aspects of nursing; therefore, each nurse needs to figure out what will be her or his area of special contributions. Instead of focusing largely on weaknesses, organizations should identify their employees’ strengths for the purpose of using them strategically and then managing to those strengths. It is better to admit one’s limitations early on, and deal with them, rather than spend years trying to hide them. No one really likes criticism, but criticism is the lifeblood of professional development and improvement; therefore, leaders need to know how to give and accept criticism in an ego-enhancing way. Self-knowledge is never complete; it is achieved through ongoing introspection, candor, figuring ourselves out in different situations, and looking at ourselves through the eyes of others.
This chapter focuses on leadership as transformational. Transformational leadership means moving a profession, an institution, or some aspect of healthcare down a new path with different expectations, structures, and ways of conceptualizing how the mission can be achieved in light of changing conditions. Looking back on all that nursing has achieved in the last half century can be energizing; it makes trying to do something different yourself not seem quite as daunting. Nursing is much stronger now as a profession than it has been in the past—larger, better educated, somewhat more diverse with a solid infrastructure, demonstrated outcomes, specialty expertise, a growing research base, more opportunities, and no longer time and place bound. Nursing’s commitment to the optimization of health and ability, alleviation of suffering, and advocacy hasn’t changed over time; values endure, but how they get expressed will vary as new sensibilities and knowledge become available.
This chapter helps the reader to describe Carper's patterns of knowing, identify the four metaparadigm concepts of nursing and to discuss how each pattern of knowing may inform evidence-based practice. It presents two scenarios that reflect real-world practice and the overall desire among nurses to influence healthcare outcomes for at-risk populations. Four types of evidence are needed for healthcare across diverse populations: research, clinical experience, patient experience, and information from the local context. Historically, empirical evidence has been the gold standard, which requires proof and observation. The four domains of knowledge required for nursing practice as posited by Carper are empirics, esthetics, personal knowledge, and ethics. Carper's pivotal work expanded knowledge necessary for nursing practice to include subjective ways of knowing. Understanding the concepts of the metaparadigm and their application within nursing theories helps to inform evidence-based practice within specific settings, thus adding to discipline-specific knowledge.
Communication styles and behaviors are dynamic and responsive to situations, environments, and personal experience. Even with good communication skills, challenges will continue to arise when working with diverse cultures and generations, as well as when using different modes, such as face to face, audio, email, and texting to communicate. This chapter discusses how effective communication is critical to the development of leadership and management roles in nursing. It discusses and illustrates the principles of effective communication and how to overcome negative styles in case studies. The chapter helps the reader to reflect on their current communication style and integrate new communication techniques to improve their leadership skills to promote a healthy work environment. Considering how to practice assertive communication style, using technology to enhance conveying messages, and appreciating different perspectives begin to strengthen effective communication for the individual and the organization.
This chapter presents two evidence-based practice (EBP) scenarios that focus on a major patient care problem, hospital-associated infections. Healthcare quality improvement (QI) is the systematic and continuous action that leads to quantifiable improvement in healthcare services and the health status of identified patient groups. Nursing has made significant contributions to QI. Defining and understanding quality, QI, healthcare quality, and how health-care systems function is essential knowledge for nurses who are involved in leading and/or participating in QI initiatives. QI knowledge, skills, and abilities provide the foundation to enact change that leads to patient-centered, safe, efficient, effective, timely, and equitable healthcare delivery. The chapter briefly describes a historical perspective of QI and patient safety. It discusses the concept of QI and the science supporting QI and introduces theories and models for planned change and QI management systems. The chapter concludes with a brief discussion about ethics in conducting quality improvement initiatives.
This chapter stresses that one has to be involved in resource development if one wishes to play a larger role in shaping an organization. Nurses have to be resourceful to accomplish their goals and realize their values. Nurses in hospitals, universities, and other settings should play an active role in any fund-raising campaigns mounted by their institutions to ensure that their priorities are front and center as the public is engaged. Resource development is essential to organizational effectiveness, so it must be an expectation of professional leadership and not just a responsibility of those with administrative titles. Resource development can take many forms, from helping others take advantage of opportunities already in place and developing strategic partnerships to lobbying for new programs and fund-raising. Fund-raising requires one to explain the nature of nursing to stakeholders, lining up the values of our profession with what others value.