Nursing Leadership: Cognitive Dissonance, Change & Culture

Introduction

One of the more challenging aspects of healthcare in general, and nursing in particular, is the inevitability of change and the need to use evidence-based practices to promote optimal clinical outcomes. For this purpose, effective nursing leadership is required to ensure that organizational goals are met while providing clinicians and patients alike with the information they need to make informed decisions. This paper reviews relevant peer-reviewed literature concerning five current issues of interest to nursing leadership theorists and practitioners, followed by a summary of the research and important findings in the conclusion.

Defining Leadership in the Clinical Environment

Although definitions of leadership in general, and clinical leadership in particular, vary (Curtis, de Vries & Sheerin 2011), Taylor (2009) suggests that "a useful working definition as a means to explore clinical leadership is: '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 change'" (p. 40). This somewhat nebulous definition of clinical leadership is due in large part to a scarcity of nursing leadership literature. According to Stanley (2008, p. 520), "Current nursing leadership development is based on contemporary leadership theories and frameworks. . . . These theories, frameworks and models have developed from and are best suited to business and management functions, but appear to be simply superimposed on nursing and clinical nursing activities."

From a strictly pragmatic perspective, it is reasonable to posit that leadership in nursing is no different from leadership in any other enterprise, and this perspective has been used to superimpose various organizational leadership theories onto nursing leadership. Stanley (2008, p. 520) reports that, "There are a number of prominent leadership theories identified in relation to nursing leadership (and nursing management). These include transformational leadership, transactional leadership, authentic leadership, contingency theory, servant leadership and others, but to a lesser degree." Although all of these mainstream leadership styles have been applied to the nursing profession, Stanley (2008) reports that transformational leadership is the most salient for developing an understanding of clinical leadership. In this regard, Stanley (2008, p. 520) notes that, "Of these [leadership theories], the most commonly cited as a theory capable of supporting nurses' insights into clinical leadership is transformational leadership."

Developing a definitive definition of leadership and identifying an ideal model for the clinical environment is further complicated by the fact that definitions vary from country to country. In the United Kingdom, for instance, Giltinane (2013, p. 35) argues that, "The essence of clinical leadership is to motivate, to inspire, to promote the values of the National Health Service (NHS), to empower and create a consistent focus on the needs of the patients being served." This definition nonetheless contains the essence of an ideal leadership model for the clinical environment: the purpose of clinical leadership is to empower staff and create a consistent focus on the needs of the patients being served. This definition is congruent with the succinct formulation provided by Doody and Doody (2012, p. 1212), who state that "effective nursing leadership is a vehicle through which healthcare delivery and consumer demands can be fulfilled."

Cognitive Dissonance and Conflict During Change

It is reasonable to suggest that everyone has experienced some degree of cognitive dissonance, but many people may not be able to accurately define the experience. Fontenot, Hawkins and Weiss (2012, p. 506) report that, "Cognitive dissonance has been defined as discomfort experienced by persons trying to meet two or more conflicting demands at the same time, or from demands to engage in activities in conflict with their beliefs, thus creating a perception of incompatibility or dissonance."

This gap between personal expectations and personal realities varies in ways that are similar to concepts of self-esteem, which Fontenot et al. (2012) point out also plays a role in dissonance. According to these researchers, "Dissonance occurs when people perceive a discrepancy between their behavior and their expectations of themselves. To add to this dissonance, behaviors that fall short of normative expectations can have significant consequences and lead to stress and burnout" (Fontenot et al. 2012, p. 507).

Conclusion

The research showed that the nursing profession has been heavily influenced by various mainstream management theories, including transformational leadership, transactional leadership, authentic leadership, contingency theory, and servant leadership — most especially transformational leadership. The research also showed that definitions of clinical leadership vary, but a useful definition would encompass the empowerment of staff and a consistent focus on the needs of patients being served, as well as the notion that effective nursing leadership is a vehicle through which healthcare delivery and consumer demands can be fulfilled. In addition, the research demonstrated that cognitive dissonance can create conflict during periods of change, but that nursing leaders can take concrete steps to manage change more effectively. Understanding organizational culture is an important part of this process, and that understanding, combined with transformational leadership techniques, can help facilitate creativity and sustained improvement in the workplace.