Clinical nurse educators' roles in transformational leadership practice

Clinical Nurse Leadership

Nursing Leadership

Interview summary, literature review, and professional plan

Nurses are increasingly being called upon to fulfill clinical leadership roles as well as in their traditional spheres of practice. This is a very important moment in nursing history. Nursing roles are changing. It has been a long struggle for nurses to be accorded the dignity and respect equal to those of doctors in healthcare. Now nurses are assuming many of the duties once relegated to physicians. Nurses must find ways to balance their roles as patient advocates with their roles managing members of their own profession and also with the work of other healthcare professionals.

In the spirit of integrating practice with academic learning, this paper will describe an interview conducted with a nurse leader 'in the field' who describes her roles, responsibilities, and challenges. It will then contextualize the interview within the framework of existing research. Finally, it will conclude with a summary of how what I have learned will affect my own long and short-term goals in the field of clinical leadership.

Interview

The clinical nurse leader I interviewed was relatively young: she only graduated five years ago. Her specific designated role that of a clinical nurse educator. Clinical nurse educators serve the profession in a variety of capacities. They are nurses with advanced degrees and experience both in clinical practice and in the field of education; they may work in academia or in continuing education at a healthcare institution. This particular educator worked exclusively in the hospital setting, managing, planning, and coordinating the education going on at the hospital for student nurses, existing nurses, and newly employed and graduate nurses. She is also responsible for performance evaluations of nurses in all of these categories.

In addition to these formal qualifications, this nurse exhibited a great deal of personal charisma which helped her lead others, including myself. I would describe her as a true transformational leader in the sense that she motivates by example. She is also a great communicator because she communicates both by 'showing' as well as 'telling.' She embodies the values she wishes to transmit to other nurses. This has been particularly inspiring for me to see as she is my mentor.

This clinical nurse leader defined leadership in her own practice first and foremost as the ability to unify people around a common set of values. A leader must inspire others and also establish a clear direction and purpose for the organization. This is why the nurse leader described her style as fundamentally transformative in nature, with some aspects of "congruent" leadership (Stanley 2008). Congruent leadership is defined by Stanley (2008) as matching actions with clearly-demonstrated values and belief systems to create a positive impact on subordinates (conversely, a lack of congruency can be an impediment to leadership).

The concept of transformative leadership is repeatedly affirmed in the leadership-focused literature of nursing as a critical component of getting other nurses onboard to support positive changes in the healthcare environment and to combat the external stressors which affect healthcare, such as financial realities (Herzog & Zimmerman 2009). Without leadership that makes people want to perform above and beyond what they currently believe themselves to be capable of, there is no effective leadership. Leadership cannot simply be telling people what to do: subordinates must understand why they are doing something and why it is important. To inspire others in an intelligent fashion requires soliciting information from a variety of competent, professional sources.

According to the nurse leader, the workforce is changing and nurses must be prepared to change with it, specifically in their capacity to implement evidence-based practices into their work. There are many potential opportunities for nurses to exhibit and exercise leadership. But to do so, nurses must relate well to others. Knowing what to do in isolation is not exercising leadership: making people want to follow you without good communication skills is impossible. It is impossible to be an effective nurse leader without being a 'people person' in every sense of the word: a nurse must be liked and trusted by the staff and also possess psychological insight and acuteness. She must also have a great deal of self-knowledge and know her own limitations and prejudices, so she can rely on other people when needed and delegate appropriately if she is not up to a particular task herself. This need for self-knowledge was also affirmed in the literature review I conducted. The work of Horton-Deutsch & Sherwood (2008) and Lucas, Laschinger, & Wong (2008) underlines that although there is a need for nursing theory and a grounding in data-driven analysis, the experiential component is needed so nurses develop intelligence about how they operate in the field of practice and how others with different strengths and competencies do as well.

One maxim which this leader repeated to me when I began my own practice and which she repeated in the interview is that a true nurse leader does not wait until she has the title of 'leader' to practice leadership. A good nurse always acts as if she is being a role model to other nurses and to patients. Leadership is earned through daily actions, not the winning of awards, titles, bonuses, and promotions.

The nurse expressed her belief in the core role of preceptorship and mentorship in the development of all future nurse leaders. Even nurses without the formal role of clinical nurse instructor, she stressed, are always teaching other nurses and patients through explicit and implicit instruction. Leadership must be assumed confidently at all times and not designated to specific components of a nurse's day or career. Someone can be a leader without possessing a title and someone can have the title of leader and fail to exercise leadership at all.

Short-term goals

Even though I am still a relatively new nurse, I will strive to put into practice the ideal of being a nurse leader at the very beginning of my career as a nurse, as instructed by the leader I interviewed. I hope to act as a mentor and a role model for new nurses. The stereotype is that nurses 'eat their young' or are very unsupportive of new nurses. I wish to defy that stereotype in my own behaviors and actions.

Long-term goals

Although I firmly believe that becoming a nurse leader takes place in the here and now, not in the future, I am also very much aware of the value of higher, advanced education for nurse leaders. This means, for me, that there is a need to pursue graduate-level study as a nurse with a specific concentration in nurse leadership. Nurses with qualifications beyond the graduate level can command additional respect and formal leadership roles and hope to shape the futures of the institutions at which they work. Nurses must have insight and input into department policy beyond the individual level to create environments that are conducive to best practices. But although I will have this long-term goal in mind, I will still not forget about the need to have positive short-term everyday goals that lead to positive results.