Leadership theories and transformational approaches in nursing practice

Philosophy of Nursing Leadership

What are the best leadership theories when healthcare and nursing are involved? What style of leadership is most effective in today's healthcare environment? This paper addresses those questions and provides the scholarly literature on the topics in question.

Leadership Theories -- Nurses in Primary Health Care

"Leadership is seen in terms of unifying people around values and then constructing the social world for others around those values and helping people to get through the change" (Taylor, 2009). Moreover, leadership is needed -- and the development of leadership skills is needed -- in order to provide a vision, to bring people together, to sort out important values, and to facilitate the right actions to provide care for patients (Taylor, 40). Leadership doesn't usually just suddenly arrive in a person, it must be learned. According to Stubbs and Forbes-Burford (2009), leadership requires "courage, resilience and commitment" (Taylor, 41).

The author mentions several leadership theories, including "Great man theories," "Trait theories," "Situational-contingency theories," "transactional theories," and "transformational theories." The transformation theory will be discussed in detail later in this paper, along with transactional theories; but it is interesting to look into "Great man theories" because these theories take the position that leaders "are born and not made," and those kinds of leaders will "arise when a great need arises" (Taylor, 41). This theory seems rather shallow, and anyone can argue that leaders are not "born" but they are developed given the right motivation and environment.

As for "Trait theories," a leader is born with certain inherited traits, and develops certain behavioral characteristics that become useful in the sense of providing leadership along the path the person follows. People born with these traits -- assertiveness, adaptability, confidence, intelligence, and social skills -- are likely to become leaders, Taylor explains on page 41.

One negative as to trait leadership is that the "context in which leadership takes place is not acknowledged"

Transformational leadership

In the New York Times-owned journal about.com, Kendra Cherry explains that the concept of transformational leadership was launched by presidential biographer James MacGregor Burns. Burns believed that leaders and followers "…make each other to advance to a higher level of moral and motivation" (Cherry, 2010). The transformational leader, in this case the nursing leader who adheres to transformational style, uses strength of "vision and personality" to inspire others to change their "expectations, perceptions, and motivations" in pursuit of common goals (Cherry p. 1).

Bernard Bass worked to expand Burns' ideas; Bass believed transformational leaders "garner trust, respect, and admiration" from those who follow that leadership.

The basic components of transformational leadership are: a) "intellectual stimulation" (they encourage creativity and urge followers to "explore new ways of doing things"); b) "individualized consideration" (transformational leadership develops "supportive relationship" and this kind of leadership "keeps lines of communication open" so that followers are always feeling as though they are fee to share ideas and make contributions); c) "inspirational motivation" (the vision that transformational leaders have is articulated in understandable ways, and the passion transformational leaders exhibit motivates followers); and d) transformational leaders are role models, they "stimulate and inspire followers to both achieve extraordinary outcomes," and by doing so, they help followers to become transformational leaders) (Cherry, p. 2).

Meanwhile, Solman explains that situational leadership analysis is a "useful tool" for the leader that uses transformational leadership strategies. That is because the situational leadership can "aid in identifying the level of support" that is needed in a nursing environment that seeks "enlightenment" and "empowerment" (474). According to the work of Touchstone (2009), the framework that a situational leader works from assists in the "development of staff using a range of reflective supportive processes" (474).

An example of using critical social science in the nursing milieu

On page 474 Solman presents what she calls "a practical example" can be examined when a nursing staff "expressed problems getting through the day-to-day work of the patient care unit." The staff had problems identifying what the major "contributors were" to the situation they found themselves in, Solman explained (474). They worked hard and provided a high level of care, but they felt like they were in a crisis all the time, and weren't progressing (and were aware that the patients became "readmissions" regularly), Solman explained.

By using a transformational leadership style, a "range of questions" was used to help the nurses reflect on work practices, and in time, patients began to have shorter lengths of stay. So, using transformational leadership strategies, a new focus of care was established and this came as a "revelation" for the majority of nurses on the floor (Solman 475). The conclusion of Solman's piece emphasizes that innovative leadership in healthcare must be in place because changes in "policy, practice and the promotion of a healthy workforce that provides quality care to patients" (Solman, 475).

In conclusion, when it comes to personal growth in nursing and leadership in nursing, The American Association of Nursing Assessment Coordination emphasizes five leadership "types" for nurse leaders. They are: listening; acceptance; awareness; persuasion; foresight; commitment to the growth of others; and building community within the organization. Clearly there are a number of kinds of leadership and this paper references transformational leadership as likely the most closely linked to the unique dynamics within a nurse environment. It's always about team building, and transformational leaders are perhaps best suited to help build teams of nurses that support each other.