Are you a transformational leader?

Smith, Mary Atkinson, FNP-BC

Author Information
Nursing Management: September 2011 - Volume 42 - Issue 9 - p 44-50
doi: 10.1097/01.NUMA.0000403279.04379.6a

Healthcare in the United States is constantly changing and becoming increasing

more complex. An essential portion of the recent Institute of Medicine report, The
Future of Nursing: Leading Change, Advancing Health, focuses on the significance
of nurses as leaders in healthcare.1 The American Nurses Association continues to
encourage and support nurses to play a more proactive leadership role in the various
settings in which they practice and at the state and national level. 2

Due to the continually metamorphic nature of this country's healthcare system, it's
imperative for nurse managers to employ a transformational leadership style, which
encourages adaptation to change. The transformational leadership style allows for
the recognition of areas in which change is needed and guides change by inspiring
followers and creating a sense of commitment. Adopting the qualities of a
transformational leader will allow nurse managers to feel more comfortable and
confident when engaging in the development of healthcare policies, the ever-
changing components of healthcare technology, and the mentorship of new graduate
nurses. Transformational leadership is also one of the five Magnet® components.

Transformational leadership is a theory that was developed by James McGregor

Burns in 1978. He developed this theory to further address the aspects of an
organization that lead to success, encourage enthusiasm among an organization's
employees, and identify the values employees place on their work. 3 The
transformational leadership style inspires others to develop and implement effective
leadership characteristics. The ultimate goal of transformat ional leadership is for the
leader and the follower to discover meaning and purpose in relation to their work, in
addition to growth and maturity.

The roles
The roles of the transformational leader in the healthcare setting include promoting
teamwork among staff, encouraging positive self-esteem, motivating staff to function
at a high level of performance, and empowe ring staff to become more involved in
the development and implementation of policies and procedures. The
transformational leader portrays trustworthiness and serves as an inspiration to
others, possessing an optimistic, positive, and encouraging outlook. A
transformational leadership presence is vital, especially in clinical areas where new
graduate nurses are present. Transformational leadership qualities promote a
healthy environment for employees and staff, which will produce improved staff
satisfaction, retention, and patient satisfaction.4

The characteristics
Transformational leadership comprises charisma, inspiration, intellectual stimulation,
and individual consideration.5 Charismatic leaders possess self-confidence, self-
direction, and an absence of internal conflict. They have insight into their followers'
needs and utilize this to positively influence their followers. An inspirational leader is
motivational, sensitive, determined, and able to convey the organization's vision and
encourage pride within the organization. Transformational nursing leaders in the
clinical setting intellectually stimulate other nurses by encouraging the use of
evidence-based practice and addressing the "why" and "how" of specific clinical
actions. Four important characteristics of the transformational leader include being
an effective communicator, possessing inspirational traits, having a trustworthy
character, and promoting teamwork. (See Characteristics of a transformational
leader.)

Effective communication. A leader who communicates effectively focuses closely

on what other individuals are attempting to convey and what points are important to
those individuals. Effective communicators adapt their communication style based on
each individual person's ability to process and comprehend the interaction. This is
important because each individual person possesses a different style of
communication, and these styles vary greatly in the way incoming information is
processed and perceived. It's also important to understand and have respect for
diversity among various cultures. This will allow for adaptation of communication
styles when interacting with people from different cultural backgrounds.

An effective communicator learns from previous experiences and applies these

experiences to future interactions with others. This is also true for mistakes that have
been made and realizing where a certain action should be done differently the next
time around. Effective communication leads to a flourishing and vigorous
atmosphere for employees and patients alike.4

Characteristics of an effective communicator include empathy, avoiding sarcasm,

asking and not commanding, and avoiding talking down or up to individuals. Effective
communication consists of having respect for what others have to say. This respect
can be displayed by taking the time to be an attentive listener and giving others the
opportunity to express their opinions, thoughts, and concerns. The Pareto Principle,
also known as the 80/20 rule, states that 20% of people take up 80% of our time that
involves some aspect of communication. Therefore, effective communication is vital
for successful outcomes to be produced.6

Nurse managers who are effective communicators will routinely meet with the
nursing staff so that complaints, concerns, recommendations, or general comments
may be discussed. The nurse manager who communicates effectively will allow staff
members to voice their concerns and have respect for their employees by taking the
time to carefully listen to them. The nurse manager utilizing effective communication
will avoid responding to staff in a sarcastic and defensive manner. This might require
that you actively monitor yourself and the reactions of your staff to ensure no
defensive behavior exists. Effective communication and the absence of defensive
behavior will allow for the nursing staff to be more receptive to criticism and change.

Inspirational persona. During this time of healthcare reform, in addition to a

strained economy, it's more important than ever for leaders to display an inspirational
attitude. A survey of over 1,000 managers conducted by the British Department for
Business Innovation and Skills revealed that 55% of individuals desired their leaders
to possess an inspirational persona. In this same survey, only 11% of respondents
said their current leader was inspiring. 7

An inspirational persona consists of optimism, respect, passion, charisma, and

honesty. These characteristics allow the inspirational leader to gain the confidence
and trust of others, and this is crucial if a leader desires commitment and
responsibility of their followers. The inspirational nursing leader possesses a very
solid, patient-focused vision of where the organization or unit should be going in the
future, which is clearly communicated to the staff. Commitment to a strong vision
fuels and attracts winning individuals to strive to reach and maintain the vision.

Inspiring leaders regularly reflect upon themselves and have an insatiable desire for
continued learning. They encourage their followers to do the same. Inspirational
leaders are actively involved in the organization or unit from an actual "hands-on"
perspective. They regularly make informal and personal contact with others
throughout the organization or unit by talking with them, asking their opinion,
encouraging feedback, and working with them directly.

Nurse managers who display inspirational leadership qualities will spend time
actually working with the nursing staff. This will allow for the nurse manager to have
more personal contact with staff members and encourage them to develop a sense
of confidence and trust.

Trustworthy traits. Trustworthiness is a crucial trait of the transformational leader.

Trust is the foundation of every healthy relationship whether it's personal or work-
related. Broken trust leads to disorganization, chaos, and fear among one's
followers. This is why it's imperative for transformational leaders to gain the trust of
their staff. Developing and maintaining trust should be a top priority for the
transformational leader. There are distinct and concrete principle elements that make
up the basic foundation of trust, including integrity, courage, and stability. 8

Integrity refers to having high principles, being reliable, and possessing honesty.
Leaders who display integrity are consistent when it comes to their actions, values,
and expectations. Courageous leaders face problems head on and don't allow fear
to prevent them from doing so.9 They also protect their followers from malicious
actions and are loyal to them. The principle of stability allows for the development of
unquestionable confidence among staff. Stability is imperative in this constantly
changing world of healthcare. The principles of integrity, courage, and stability will
further encourage the evolution of trust between leaders and their followers.

A nurse manager can gain the trust of the nursing staff by avoiding dishonest actions
and displays of favoritism when communicating. The nurse manager can also gain
the trust of the staff by possessing honesty and sincerity. Nurse managers who
demonstrate traits of trustworthiness are up front, realistic, and fair when it comes to
addressing their expectations of the nursing staff. Nurse managers who possess
trustworthy traits are more likely to gain the confidence of their employees.
Engagement of stakeholders. An extremely influential characteristic of
transformational leadership in nursing is the act of engaging stakeholders in the
leadership process. Stakeholders in healthcare include, but aren't necessarily limited
to, healthcare providers, organizations, and institutions; state government
representatives; healthcare industries; healthcare academia; and patients. Other
stakeholders within the community who should also be engaged during times of
transformation include individuals involved in healthcare administration, policy
makers, media professionals, law enforcement, religious organizations, patient family
members, and caregivers.

The CDC recommends the engagement of stakeholders as the first step in any type
of program evaluation or potential change. 10 According to the CDC, the identification
and engagement of key stakeholders is vital when performing an initial program
evaluation or considering reorganization because they'll ensure pivotal points are
identified and addressed. This, in turn, ensures a greater likelihood of success.

A vital aspect of engaging leadership includes the promotion of teamwork and

collaboration. This will create an environment in which communication is open and
alternative ways of delivering healthcare services are encouraged, acknowledged,
and welcomed.11,12 Engaging all members of the healthcare team fosters participation
in the organization's vision, which will increase the likelihood of achieving the
organization's goals. Teamwork is at the core of success.

The implications
It's important for nurse managers to be familiar with the various nursing leadership
theories that are currently discussed in the literature and determine which leadership
style best reflects their own values. The leadership style utilized by nursing leaders
in the clinical setting has a direct effect on nursing staff satisfaction, which ultimately
has an effect on patient satisfaction.4 The presence of increased satisfaction among
nursing staff leads to an overall reduction in staff turnover, improved retention, and
an increase in patient satisfaction.4

With the current challenges healthcare is facing, it's vital for the nursing profession to
be on the forefront of healthcare reform and fully engaged in the implementation of
the changes that are expected to take place in our healthcare system.

Characteristics of a transformational leader

 Charismatic
 Engaging
 Inspirational
 Stable
 Optimistic
 Encouraging
 Honest
 Motivational
 Respectful
  Positive
 Team oriented
 Effective communicator
 Empowering
 Reliable
 Trustworthy
 Empathetic
 Mentor
 Visionary

REFERENCES

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