Leadership

1. Define leadership and nursing leadership.

● Leadership is commonly defined as a process that involves influencing the thinking and actions
of others with respect to achieving a goal (Institute of Medicine, 2010), and a person can be a
leader without having the formal authority of a management position (Grossman & Valiga, 2013).
○ Formal leadership describes a person in a position of authority or a sanctioned, assigned
role within an organization that connotes influence, such as a clinical nurse specialist
(Northouse, 2001).
○ informal leader is an individual who demonstrates leadership outside the scope of a
formal leadership role or as a member of a group, rather than as the head or leader of the
group. The informal leader is considered to have emerged as a leader when she is
accepted by others and is perceived to have influence
2. Describe characteristics of effective leaders.

three fundamental qualities of effective leaders

● Guiding Vision - A vision statement outlines what an organization wants to be

and focuses on tomorrow (i.e., the preferred future ); it is inspirational (i.e., it has
reach) and it provides a reference point to guide the nature of all decision making
(Industry Canada, 2004). Nursing leaders focus on a professional and purposeful
vision that provides direction toward the preferred future.
● Passion - Passion, as expressed by the leader, involves the ability to inspire and
align people toward the promises of life. Passion is an inherent quality of the
nurse leader. This passion about assisting clients to recover helps the client and
the client's significant others live life to the fullest extent possible.
● Integrity - is based on knowledge of self, honesty, and maturity, which is
developed through experience and growth . As a nurse leader, integrity is
important and is enhanced throughout one's life span. McCall (1998) describes
how self-awareness knowing our strengths and weaknesses can allow us to use
feedback and learn from our mistakes. Daring and curiosity are also basic
ingredients of leadership. Leaders draw on these capacities when they take risks,
and they learn from what works as much as from what doesn't work (Bennis &
Nan us, 1985).

emotional intelligence, or EI - the ability both to recognize the meaning of emotions and their relation-
ships and to reason and solve problems on the basis of emotions. Goleman (2006) further explored the
concept of EI and hypothesized that EI can be learned and improves with age. EI is a component of
leadership and refers to the capacity for recognizing your own feelings and those of others, for motivating
yourself and for man-aging emotions well in yourself and in your relationships. It describes abilities
distinct from, but complementary to, academic intelligence.
Emotional intelligence includes these five basic emotional and social competencies:
1. Self-awareness: knowing what you are feeling in the moment and using your preferences to guide your
decision making; having a realistic assessment of your own abilities and a well-grounded sense of
confidence.
2. Self-regulation: handling your emotions so that they facilitate rather than interfere with the task at
hand; being conscientious and delaying gratification to pursue goals; and recovering well from emotional
distress.
3. Motivation: using your deepest preferences to move and guide you toward your goals, to help you take
initiative and strive to improve, and to persevere in the face of setbacks and frustrations.
4. Empathy: sensing what people are feeling; being able to take their perspective; and cultivating rapport
and being in tune with a broad diversity of people.
5. Social skills: handling emotions in relationships well and accurately reading social situations and
networks; interacting smoothly; using these skills to persuade and lead and negotiate and settle disputes;
for cooperation and teamwork (Goleman, 1998).

Nurse leader competencies :

1. a global perspective regarding health care and professional nursing issues
2. technology skills, which facilitate mobility and portability of relationships, interactions, and
operational processes
3. expert decision-making skills rooted in empirical science
4. the ability to create organization cultures that permeate quality health care and client/worker safety
5. understanding and appropriately intervening in political processes
6. highly developed collaborative and team building skills
7. the ability to balance authenticity and performance expectations; and
8. being able to envision and proactively adapt to a health care system characterized by rapid change and
chaos. (Huston, 2008) *

3. Identify factors that influence nursing leadership.

● Nursing history,-has a strong and rich history with deep roots in both religious and
military culture. nursing's military roots played in the continuation of a command-and-
control approach to achieve conformity in practice.
● Education -Nursing leaders must be lifelong learners with a thirst for knowledge and a
desire to maintain and enhance leadership competencies. To effectively manage in
chaotic and complex practice environments, leaders must be comfortable with and aware
of the constant need for change, possess budget and financial skills, and remain
committed to team building through effective management of personal growth (Gelinas
& Manthey, 1997).
● use of self- The concept of self and the ability to transact self in an effective and
authentic manner directly contributes to the quality of leadership
● organization structure and power - Leaders must function in various practice
environments where the characteristics of structure and power play a role in the quality of
leadership. Variation of leadership styles is affected by the organizational structure and
culture (i.e., the context) of the organization (Stordeur et al., 2000).
● organizational redesign - Nursing leaders have not only been changed by redesign but
also in the process of changing they have had to lead the redesign of clinical care,
delivery systems, and integrated care (Gelinas & Manthey, 1997). Leatt and Porter (2003)
 describe the need for nursing leaders to have an ability to work effectively across
disciplines given the increased emphasis on interprofessional team-based care, which is
prevalent in organizational redesign of health care.
4. Describe the RNAO Conceptual Model for Developing and Sustaining Leadership to demonstrate
an understanding of the leadership practices needed to achieve healthy work environments and
the organizational supports and personal resources that enable effective leadership practices.

The five Transformational Leadership Practices:

1. Building Relationships and Trust is a critical leadership practice that provides the foundation upon

which the remaining practices rest.

2. Creating an Empowering Work Environment depends on respectful trusting relationships among

members of the work setting. An empowered work environment entails having access to information,

support, resources, and opportunities to learn and grow within a setting that supports professional

autonomy and strong networks of collegial support.

3. Creating an Environment that Supports Knowledge Development and Integration involves

fostering both the development and dissemination of new knowledge and the instillation of a continuous

inquiry approach to practice within the work setting. This knowledge is used to inform efforts to

continuously improve both clinical and organizational processes and outcomes.

4. Leading and Sustaining Change involves taking a proactive and participative approach to

implementing change that results in improved clinical and organizational processes and outcomes.

5. Balancing Competing Values and Priorities entails advocating for necessary nursing resources to

ensure high quality patient care while recognizing the multiple demands that must be addressed in

organizational decision-making.

Oganizational Supports influence the successful implementation of the leadership practices and strong,

visible nursing leadership. These supports include:

■ valuing nurses’ critical role in the provision of patient/client care;

■ supplying sufficient and appropriate human and financial resources; and

■ providing necessary information and decision support.

The Personal Resources individuals bring to their leadership roles include a number of personal

attributes and resources that influence their success in implementing the five leadership practices.

Personal Resources include:

■ professional identity;

■ leadership expertise, education and experience;

■ individual attributes such as health and resilience; and

■ social supports including the persons and relationships that provide support.
Followership

Followership is an art—a skill that can be learned, cultivated, and consciously developed and exercised.

Followers need to be “self-directing, actively participating, practicing experts [who work] on behalf of the

organization and the mutually agreed upon vision and goals” (Sullivan, 1998, p. 469).

1. Compare and contrast the key behaviours and roles related to leadership and followership.
TYPES OF FOLLOWERS: Kelley
• Effective or exemplary followers: These individuals function independently, think critically about
ideas that are proposed or directions that are suggested, and are actively involved. They challenge the
ideas of the leader, suggest alternative courses of action, and invest time and energy to arrive at the best
possible solution for the group.
• Alienated followers: These individuals think critically about what the leader or other members of the
group are suggesting, but they remain passive and perhaps even somewhat hostile. They may complain
about the way things are being done,” are unhappy, and seem disengaged at times. Alienated followers
rarely invest time or energy to suggest alternative solutions or other approaches.
• “Yes” people: These are the conformists who are actively involved in the work of the group and
enthusiastically support the leader. They are eager to take orders, defer to the leader, yield to the leader’s
views and opinions, and please the leader. They enjoy a great deal of structure, order, and predictability.
“Yes” people are uncomfortable with having to make and live with decisions, and they find freedom
almost terrifying. They do not initiate ideas, think for themselves, raise questions, critique the ideas of
others, or challenge the group.
• Sheep:These are the passive individuals who are dependent and uncritical, going along with whatever
the leader tells them to do. They are easily led and manipulated, lack initiative, require a great deal of
direction, and never go beyond their given assignment. “Sheep” are not particularly committed to the
goals of the group and do not invest themselves to any great extent to see that the group continues to
move forward.
Pittman, Rosenbach, and Potter (1998):
Performance initiatives relate to the follower’s performance—how his or her assigned job gets done,
how good the person is at what he or she does, the standards the person sets for himself or herself, how
well the person works with others, and how valuable the person is to the organization
Relationship initiatives concern the follower’s relationship to the leader—how much the person
understands the leader’s perspective, the person’s willingness to give negative feedback or disagree with
the leader, and how the person demonstrates his or her reliability and trustworthiness

• Partner: This follower is committed to high performance and building a positive,

reciprocal relationship with the leader. The partner may be thought of as a “leader-in-waiting”
(Pittman et al., 1998, p. 118).
• Contributor: This person does the job very well, is effective with coworkers, embraces
change, and successfully balances work and other aspects of life. The contributor does not,
however, try to understand the leader’s perspective or promote the leader’s vision, nor does he or
she negotiate differences maturely, communicate courageously, share her or his expertise and
knowledge, or take initiative.
• Politician: This individual is highly sensitive to and skilled with interpersonal
relationships. The person is willing to give honest feedback and supports the leader; however, he
or she may neglect the job and have poor performance levels.
• Subordinate: This type of follower may be competent at assigned tasks and do what he or
she is told, but there is no commitment to excellence in his or her performance. In addition, the
subordinate is not particularly sensitive to relationships, does not make an effort to support the
leader, is disaffected, and is not interested in giving anything extra.

Kellerman (2008) typology of followers based solely on one metric: level of engagement.:
• Isolates . . . completely detached, alienated, uninterested, uninformed, and do nothing. •
Bystanders . . . aware but deliberately disengaged, choosing to stand by and watch, rather than
stepping up and participating.
• Participants . . . invest some time, energy, or talent to try to have an impact, but do not “go
overboard” in doing so.
• Activists . . . eager, energetic, and engaged, working hard on behalf of leaders (or to undermine
them).
• Diehards . . . deeply devoted to the leader (or ready to remove them) and prepared to do anything
for the cause.

CHARACTERISTICS OF EFFECTIVE OR EXEMPLARY FOLLOWERS

• Strength and independence
• Critical thinking
• Ability and willingness to think for ourselves
• Ability to give honest feedback and constructive criticism, particularly in a timely fashion •
Willingness to be our own person
• Innovativeness and creativity
• Active engagement in all we do
• Cooperativeness and collaborativeness
• Being a self-starter
• “Going above and beyond the call of duty”—beyond our job assignments
• Willingness to assume ownership
• Taking initiative
• Positive sense of self-worth
• “Can do” aura (Kelley, 1992, p. 143)
• Attentiveness to what is happening around us
• “Holding up our end of the bargain”
• Being energized by our work and organizations
formula for successful leadership and effective leader–follower relations:
Honesty + Competence + Inspiration + Vision = Credibility

Compare and contrast French & Raven’s (1960) five sources of power (p. 91)

● Legitimate power comes from one’s title or position or role in a family or culture.

● Coercive power comes from the ability to penalize others. For example, in his discourses on

freedom in the fi rst century A.D., Epictetus said, “No one is afraid of Caesar himself, but he is

afraid of death, loss of property, prison, [and] disengagement.”

● Reward power comes from the ability to help and get things (e.g., money, praise) for others.

● Expert power comes from one’s knowledge or competence.

● Referent power comes from followers’ respect for and their desire to be liked and admired by

the leader. As Reed (2004) notes, “There is inherently more power and leverage in serving your

[followers] versus them attempting to simply serve you.”

Discuss what other ways one gains power (pp. 91-92)

One gains power by having information that she or he can control; from the people one knows and can

call on; and from a strong sense of self, knowing one’s values, being self-confident, being able and

willing to take risks, and standing up for that in which one believes

Nurses, too, can be powerful forces for change in complex health-care settings. That power

comes from their knowledge, the intimate and substantive relationships they develop with

patients and families, the holistic perspective they bring to care, and their sheer numbers. Such

power is retained by keeping current with best practices, involving the patient and family as part

of the health-care team, serving as an advocate for patients and for quality care, not allowing

oneself to become too narrowly focused or specialized, and collaborating with nursing and other

health-team colleagues to promote excellence in care. Nurses strengthen their power base by

speaking up in a knowledgeable, informed manner, calling on networks of colleagues who have

the expertise that may be needed in a particular situation, and constantly learning.

Explore how you can empower self and others (pp. 92-94)

● By affirming values , leaders help followers refl ect on and perhaps challenge their values and the

values of others. This helps followers become more powerful, as they come to know clearly what

it is they believe and are willing to invest in.

● By motivating followers, leaders unlock or channel motives, promote positive attitudes, and

encourage creativity, all of which empower followers to believe in themselves and take action.

● By striving to achieve a workable unity, leaders establish trust, cohesion, and mutual tolerance,

circumstances that empower followers to focus on the “big picture” and move out of their own

“little corner of the world.” Explaining helps followers understand the vision, why they are

being asked to do certain things, and how they can and do contribute to achieving the group’s

goals. Followers are thereby empowered by information and understanding.

 ● By serving as a symbol, a risk taker who acts as the group’s source of unity, voice of anger,

collective identity, and source of hope, the leader helps followers seize the power that comes

from debate, honest expression of feelings, and sharing in a struggle with others.

● Through the process of renewing, both leaders and followers are empowered to break routines,

habits, fixed attitudes, perceptions, assumptions, and unwritten rules, thereby allowing them to

grow.

Explain how you would develop effective followership skills (pp. 94-98)

“How to Start a Movement.” Sivers (2010) - we need to be willing to be the first follower,

• A leader needs guts to stand out and be ridiculed.

• The first follower is a crucial role, an underestimated form of leadership.

• He or she is embraced by the leader as an equal, and it becomes apparent that it is not about the

leader but about the followers and about the movement.

• He or she shows others how to follow. New followers emulate the follower, not the leader. More

followers join in, there is a tipping point, and a movement is born.

• As more join in, it is less risky to be a follower, and the movement can take off.

• Leadership is overglorified . . . If you really care about starting a movement, have the courage to

follow and show others how to follow as well.

The strategies to help each of us be a more effective or exemplary follower are the following:

1. Know Yourself and Your Organization and Continue to Grow as a Person and a

Professional
2. • Continue your education, both formal and informal. Knowledge is power and will serve you

well as a follower.

• Be committed to something other than your own career development. Find your passion in

life and be passionate about what you do. Know your organization. Know your values and

hold on to them. Set high standards. Others will model that. Seek mentors or accept an offer

of mentoring if it is made. Develop your professional networks— within and outside your

organization— and use them.

• Remain fully accountable for your actions.

• Share information rather than hoard it.

• Help colleagues grow and do their job well. Help them develop the skills of giving needed

feedback.

• Be reflective.

• Have a sense of humor and laugh at your own mistakes.

• Develop positive relationships with colleagues, rely on each other, and be responsible to

each other. Be a good team player.

• Continue to develop a wide array of skills in communication, assertiveness, clinical

practice, decision making, and writing.

• Analyze your performance by asking others for feedback and being honest in your own

self-appraisal. Do you engage in gossip? Do you use language that suggests you are not as

important as other people, or your ideas and suggestions are not as valuable as theirs? Do

you allow yourself to be subservient? Are you cynical? Do you allow the leader or others to
show disrespect for your coworkers’ ideas or views? Are you willing to take risks? Are you

destructive when you offer criticism?

• Give credit where it is due.

• Follow through on your commitments. Be credible.

• Know your job and do it well. Be competent, demonstrate your value to the group, and

make a difference to the organization.

• Be enthusiastic and spread that enthusiasm to others.

• Know yourself, and be honest with yourself.

• Be comfortable with uncertainty and ambiguity. Resist the understandable fear of the

unknown.

• Seek wise counsel.

• Develop self-confidence. Believe in and have faith in yourself.

• Remain calm. Do not be hostile.

• “Discover or create opportunities to fulfill [your] potential and maximize [your] value to the

organization” (Chaleff, 2009, p. 6).

• Develop a record of successes.

• Do deep-breathing or other relaxation exercises before having a conversation with an

authority figure.

• Do not give in to peer pressure.

• Ask for feedback.

 • Set personal goals and take responsibility to meet them.

• “Learn the ropes,” “pay your dues,” and prove yourself in the follower role. •

Be dependable and reliable.

• Be creative.

2. Be Involved and Speak Up

• Be involved in your practice setting. Have a sense of ownership and stewardship; do not be merely

a spectator. • Be involved in professional organizations.

• Feel free to criticize because thoughtful feedback helps a leader make good decisions; but do not

just complain and walk away.

• Contribute as an equal partner.

• Figure out the steps needed for the group to achieve its goals, then be sure to be an integral part of

those steps rather than on the periphery of “the action.”

• Be cooperative with, rather than adversarial to, the leader.

• Appreciate the needs, goals, and constraints placed on the leader.

• Play devil’s advocate because effective leaders encourage and benefit from healthy dissent.

• Exercise a “courageous conscience . . . the ability to judge right from wrong and the fortitude to

take affirmative steps toward what [you] believe is right” (Kelley, 1992, p. 168).

• Understand the importance of speaking out . . . and do it!

• Speak up so others can benefit from your views. Speak the truth and be willing to “stand up, to

stand out, to risk rejection, to initiate conflict” (Chaleff, 2009, p. 7).

• Provide opportunities for the leader to talk about his or her vulnerabilities and concerns, as well as

his or her strengths and vision.

• Help sacred cows be “gently led to pasture” (Chaleff, 2009, p. 89) so that all subjects are open to

discussion and all options are possible. Do not discard what may seem like wild ideas before

considering them carefully.

• Express skepticism about ideas, proposals, and “pronouncements,” but do so in a respectful way.

3. Be Active

• Take initiative. Take action without being told to do so.

• When they impede progress, be willing to “bend, circumvent, or break the rules to get

things done” (Chaleff, 2009, p. 47).

• Accept a place at the table where decisions are made, or if such a place is not offered,

create such a place for yourself. For example, agree to serve on a committee when invited to

do so or volunteer to revise the admission data form if the one currently being used focuses

too much on patient weaknesses and limitations and does not adequately address patient

strengths and abilities.

• Be proactive. Advocate and be a catalyst for change.

• Independently think up and champion new ideas.

• Try to solve difficult problems rather than expecting the leader to do it all.

• Present your position in a forthright manner. Develop excellence in communication by using

a variety of channels.

• Stand up for and support your leader when he or she needs to make difficult decisions.
 • Ask a great deal of the leader, but do not expect perfection from him or her.

“keys to effective followership” may be summarized as follows:

• Be a critical thinker, not a “yes” person.

• Be consistent and dependable.

• Be humble and patient.

• Be able to receive and offer constructive criticism.

• Be a tireless worker.

• Be a disciplined student of study and work (theory and practice).

• Be persistent and consistent at developing leadership (and followership) skills.

What is meant by the term mindfulness (pp. 109 and 139)

The skill of mindfulness is the ability to be present in a nonjudgmental way. White (2014)

conducted a concept analysis using the Cumulative Index to Nursing & Allied Health Literature

(CINAHL) from 1981 to 2012 and identified five attributes of mindfulness from the search:

experience of being present, awareness, acceptance, attention, and a transformative process.

Nurses who become more mindful should be more reflective and more effective and as both

satisfied leaders who can role model for other health professionals and coach others to obtain a

balance between work and personal goals.

Reflective practice is a result of having more mindful awareness. The underlying neurophysiology

behind this process explains that repetitive use of reflective practice techniques will expand

emotional circuits in the brain and further develop an individual’s prefrontal cortex so one can think in

many different ways (Siegel, 2007). Those who go on to achieve increased mindfulness will augment
their resilience, flexibility, and emotional balance. This will undoubtedly influence their ability to be

more creative. The more we can increase our neural circuits with reflective practice, the more

neuroplasticity or reorganization of neural pathways occurs (Siegel, 2007). This increased

neuroplasticity causes expanded passion and knowledge about our work. More often than not,

leaders are made, not born, and they accept that the growth process includes making mistakes

(Bennis, 2009). This has relevance for the individual nurse who is a leader or an effective follower. It

is no longer acceptable for nurses to deal only with the here and now of a specific patient

assignment in the hospital or home setting. Nurse leaders need to partner with the patient and form

alliances with family members, community groups, and other health-care professionals to provide

health teaching, promote self-competence for the patient, and gather relevant data to determine

whether desired outcomes are being realized. It is time to change the belief that what is known is all

there is, and it is time to change the belief that how things are done has to be the way things

continue to be done.