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.

The main message of this chapter is that a professional career requires sustained development in interpersonal, interprofessional, and communication effectiveness. Undergraduate and graduate courses are full of valuable information about communication—spoken, written, visual, electronic, and social media. Instead of trying to summarize the communication essentials that nurse leaders should have acquired along the way and will need to develop additionally over time, this chapter focuses on some communication skills important to goal achievement that the author learned to appreciate more with experience. They fall under the following headings: courtesies, self-presentation, negotiations, the importance of data arrays and publication, and the value of understanding the viewpoint of others. Self-monitoring, as a leadership ability, means the person seeks to shape how she or he is perceived in order to achieve professional objectives. Measurable outcomes and published results are important in building the image of the profession.

“Doing good” is the prime directive of health profession education, but everyone doing her or his personal best is no guarantee that excellence will prevail. Building clusters of excellence, one can get more productivity as resources are shared and people play off of each other’s ideas, positioning all concerned more effectively to seize new opportunities. Excellence is a “stretch” goal, but if everyone stretches a little, the shape and quality of the organization can be transformed. Even if one achieves only a small portion of what one wanted to accomplish in the name of excellence, this improvement can be just the upstream redirection needed to achieve something even more substantive downstream. Excellence is a journey full of next steps that can only be seen as you move forward and are able to catch a glimpse of what is now on the changing horizon.

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.

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.

Neediness cannot be banished, but it’s possible to learn from each shortcoming, determined not to be derailed by either hubris or core anxieties. Taking on new leadership roles, we have to get in touch with warring expectations on the way to a more textured view of leadership and our sense of ourselves as leaders. There are a number of normal-crazy thoughts that get in the way of leadership; for example, wanting to be liked by everyone; believing that if you’re not perfect then you’re no good; thinking things should not go wrong. To succeed, nurses must realize that failure is commonplace. Expect failure, recognize root causes, and then proceed to learn from the experience—this process builds personal resilience. Learning environments that foster a culture of potentiality enable fledgling practitioners to persist in the face of failure because the emphasis is on improving over time.

In more recent times, the leadership literature has seriously questioned the longstanding exclusive emphasis on whether the person in charge has the right stuff on the grounds that leaders are substantially influenced by the situations they encounter, including their ability to harness their followers. In this view, a person might be an effective leader in one situation but not in another one. The longing to figure out who has “the right stuff” and how it can be taught to others is strong. Leaders develop over time rather than being born with “the right stuff”. Nurses as a group possess many of the abilities that leaders are expected to have; for example, integrity, practical intelligence, and systems thinking. Leadership is less a matter of brilliance and more a matter of persistence and being able to access and use the collective wisdom of others.

Strategic planning involves examining how your professional and/or organizational mission is being affected by changing circumstances, setting goals with concrete actions and a timeline, and then figuring out needed resources and expected outcomes. “The vision thing” at its best involves periodically embarking on a process of strategic planning whereby you examine how your professional or organizational mission is being affected by changing circumstances, and then set short-term and long-term goals with concrete actions and a timeline that moves you in desired new directions. Transformational leaders are deeply committed to the organization and its mission/values, make use of consultants so that they are not limited by the boundaries of their expertise, are willing to try something new knowing that not all good ideas work out, combine vision with practicality in figuring out how to operationalize the change process, and know how to use a range of individuals to the organization’s advantage.

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.

There is no aspect of leadership as gratifying as helping others reach their potential. It is rewarding in a way that other things aren’t because any investment in people pays dividends forevermore. Appreciating others includes giving feedback that is customized to the person. There is growing evidence that indiscriminate praise doesn’t change behavior positively, particularly if the commendation is for something relatively immutable like being smart. Appreciating others includes a broad range of behaviors—valuing the contributions of different kinds of people; respecting what each generation contributes to the mix; developing a community of learning so all continue to grow and develop throughout their careers; understanding that investments in people have a ripple effect because those who have been helped tend to “pay it forward” and providing timely and effective feedback that encourages improvement or advancement. Appreciating others also means valuing what others have done to help your advancement.