Choosing a Leadership Style (Marquis & Huston, 2012)
DISPLAY 3.6 Using Reflections in Leadership
1. How can you bring the power of reflection to bear on your day-to-day work?
2. How could you amplify the effectiveness of your decision making and empower your teams to step up and participate in the decision making process?
Source: Sherwood, G. D., & Horton-Deutsch, S. (2015). Reflective organizations. On the front lines of QSEN & reflective practice implementation. Indianapolis, IN: Nursing Knowledge International.
Quantum Leadership
Quantum leadership is another relatively new leadership theory that is being used by leader-managers to better understand dynamics of environments, such as health care. This theory, which emerged in the 1990s, builds on transformational leadership and suggests that leaders must work together with subordinates to identify common goals, exploit opportunities, and empower staff to make decisions for organizational productivity to occur. This is especially true during periods of rapid change and needed transition.
Building on quantum physics, which suggests that reality is often discontinuous and deeply paradoxical, quantum leadership suggests that the environment and context in which people work is complex and dynamic and that this has a direct impact on organizational productivity. The theory also suggests that change is constant. Today’s workplace is a highly fluid, flexible, and mobile environment, and this calls for an entirely innovative set of interactions and relationships as well as the leadership necessary to create them (Porter O’Grady & Malloch, 2015).
Quantum leadership suggests that the environment and context in which people work is complex and dynamic and that this has a direct impact on organizational productivity.
Because the health-care industry is characterized by rapid change, the potential for intraorganizational conflict is high. Porter O’Grady and Malloch (2015) suggest that because the unexpected is becoming the normative, the quantum leader must be able to address the unsettled space between present and future and resolve these conflicts appropriately. In addition, they suggest that the ability to respond to the dynamics of crisis and change is not only an inherent leadership skill but it must now also be inculcated within the very fabric of the organization and its operation.
Transition From Industrial Age Leadership to Relationship Age Leadership
In considering all of these emerging leadership theories, it becomes apparent that a paradigm shift has taken place early in the 21st century—a transition from industrial age leadership to relationship age leadership (Scott, 2006). Scott (2006) contends that industrial age leadership focused primarily on traditional hierarchical management structures, skill acquisition, competition, and control. These are the same skills traditionally
associated with management. Relationship age leadership focuses primarily on the relationship between the leader and his or her followers, on discerning common purpose, working together cooperatively, and seeking information rather than wealth (Table 3.1). Servant leadership, authentic leadership, reflective thought and practice, human and social capital, and EI are all relationship-centered theories that address the complexity of the leader–follower relationship.
A paradigm shift is taking place early in the 21st century—a transition from industrial age leadership to relationship age leadership.
Covey (2011) concurs, noting that the primary drivers of economic prosperity in the industrial age were machines and capital—in other words, things. People were necessary, but replaceable. Covey argues that many current management practices come from the industrial age where the focus was on controlling workers, fitting them into a slot and using reward and punishment for external motivation. In contrast, relationship age leadership is all about leading people who have the power to choose. It is about requiring leaders to embrace the whole person paradigm (Covey, 2011).
Yet the leader-manager in contemporary health-care organizations cannot and must not focus solely on relationship building. Ensuring productivity and achieving desired outcomes are essential to organizational success. The key, then, likely lies in integrating the two paradigms. Scott (2006) suggests that such integration is possible (Fig. 3.1).
Technical skills and competence seeking must be balanced with the adaptive skills of influencing followers and encouraging their abilities. Performance and results priorities must be balanced with authentic leadership and character. In other words, leader-managers must seek the same tenuous balance between leadership and management that has existed since time began.
This certainly was the case in research conducted by Blanchard (2015) that compared strategic leadership with operational leadership (management focused). The study found that operational leadership was often undervalued. If this aspect of leadership is done effectively, employee passion and customer devotion will follow the positive experiences and overall satisfaction people have with the organization. In contrast,
strategic leadership had only an indirect effect on organizational vitality. Researchers concluded that both strategic and operational leadership were needed (see Examining the Evidence 3.1).
EXAMINING THE EVIDENCE 3.1
Source: Blanchard, K. (2015). Who is the best leader for performance? Retrieved October 17, 2015, from http://www.clomedia.com/articles/6345-who-is-the-best-leader-for-performance
This yearlong study included an exhaustive literature review of hundreds of studies conducted over 25 years. Researchers examined two kinds of
leadership: strategic and operational. Strategic leadership included activities such as establishing a clear vision, maintaining a culture that aligns a set of values with that vision, and declaring must-do or strategic imperatives the organization needed to accomplish. Operational leadership provided the “how”
for the organization: policies, procedures, systems, and leader behaviors that cascade from senior management to frontline workers (day-to-day management practices).
Researchers found that although strategic leadership is a critical building block to set tone and direction, it has only an indirect effect on organizational vitality. The real key to organizational vitality was operational leadership. If this aspect of leadership is done effectively, employee passion and customer devotion will follow the positive experiences and overall satisfaction people have with the organization. Researchers concluded that both strategic and operational leadership were important—in the right amount, at the right time and that both are needed for success in an organization.
LEARNING EXERCISE
3.7
Balancing the Focus Between Productivity and Relationships
Y
ou are a top-level nursing administrator in a large, urban medical center in California. As in many acute care hospitals, your annual nursing turnover rate is more than 15%. At this point, you have many unfilled licensed nursing positions, and local recruitment efforts to fill these positions have been largelyunsuccessful.
During a meeting with the chief executive officer (CEO) today, you are informed that the hospital vacancy rate for licensed nurses is expected to rise to 20% with the opening of an additional regional hospital in 3 months. The CEO states that you must reduce turnover or increase recruitment efforts immediately or the hospital will have to consider closing units or reducing available beds when the new ratios take effect.
You consider the following “industrial leadership” paradigm options:
1. You could aggressively recruit international nurses to solve at least the immediate staffing problem.
2. You could increase sign-on bonuses and offer other incentives for recruiting new nurses.
3. You could expand the job description for unlicensed assistive personnel and LVNs to relieve the registered nurses of some of their duties.
4. You could make newly recruited nurses sign a minimum 2-year contract upon hire.
You also consider the following “relationship leadership” paradigm options:
1. You could hold informal meetings with current staff to determine major variables affecting their current satisfaction levels and attempt to increase those variables that increase worker satisfaction.
2. You could develop an open-door policy in an effort to be more accessible to workers who wish to discuss concerns or issues about their work environment.
3. You could implement a shared governance model to increase worker participation in decision making on
the units in which they work.
4. You could make daily rounds on all the units in an effort to get to know your nursing staff better on a one-to-one basis.
A S S I G N M E N T:
Decide which of the options you would select. Rank order them in terms of what you would do first. Then look at your list. Did it reflect more of the industrial leadership paradigm or a relationship leadership paradigm? What inferences might you draw from your rank ordering in terms of your leadership skills? Do you think that your rank ordering might change with your age?
Your experience?
Integrating Leadership Roles and Management Functions in the 21st Century
Seemingly insurmountable problems, a lack of resources to solve these problems, and individual apathy have been and will continue to be issues that contemporary leader-managers face. Effective leadership is absolutely critical to organizational success in the 21st century. Becoming a better leader-manager begins with a highly developed understanding of what leadership and management are and how these skills can be developed. The problem is that these skills are dynamic, and what we know and believe to be true about leadership and management changes constantly in response to new research and visionary thinking.
Contemporary leader-managers, then, are challenged not only to know and be able to apply classical leadership and management theory but also to keep abreast of new insights, new management decision- making tools, and new research in the field. It is more important than ever that leader-managers be able to integrate leadership roles and management functions and that some balance be achieved between industrial age leadership and relationship age leadership skills. Leading and managing in the 21st century promises to be more complex than ever before, and leader-managers will be expected to have a greater skill set than ever before. The key to organizational success will likely be having enough highly qualified and visionary leader- managers to steer the course.
KEY CONCEPT
Many new leadership and management theories have emerged in the 21st century to explain the complexity of the leader–follower relationship and the environment in which work is
accomplished and goals are achieved.
Strengths-based leadership focuses on the development or empowerment of workers’ strengths as opposed to identifying problems, improving underperformance, and addressing weaknesses and obstacles.
Level 5 Leadership is characterized by knowledge, team building skills, the ability to help groups achieve goals, humility, and the empowerment of others through servant leadership.
Servant leadership is a contemporary leadership model that puts serving others as the first priority.
Followers can and do influence leaders in both positive and negative ways.
Principal agent theory suggests that followers may have an informational (expertise or
knowledge) advantage over the leader as well as their own preferences, which may deviate from those of the principal. This may lead to a misalignment of goals.
Human capital represents the capability of the individual. Social capital represents what a group can accomplish together.
Emotional intelligence refers to the ability to use emotions effectively and is considered by many to be critical to leadership and management success.
Authentic leadership suggests that in order to lead, leaders must be true to themselves and their values and act accordingly.
Thought leadership refers to any situation whereby one individual convinces another to consider a new idea, product, or way of looking at things.
Thought leaders attract followers not by any promise of representation or empowerment but by their risk taking and vision in terms of being innovative.
Quantum leadership suggests that the environment and context in which people work is complex and dynamic and that this has a direct impact on organizational productivity.
A transition has occurred in the 21st century from industrial age leadership to relationship age leadership.
Additional Learning Exercises and Applications
LEARNING EXERCISE
3.8
Reflecting on Emotional Intelligence in Self
D
o you feel that you have emotional intelligence? Do you express appropriate emotions such as empathy when taking care of patients? Are you able to identify and control your own emotions when you are in an emotionally charged situation?A S S I G N M E N T:
Describe a recent emotional experience. Write two to four paragraphs reporting how you responded in this experience. Were you able to read the emotions of the other individuals involved? How did you respond, and were you later able to reflect on this incident?
LEARNING EXERCISE
3.9
Self-Regulation and Emotional Intelligence
Y
ou have just come from your 6-month performance evaluation as a new charge nurse in a long-term care facility. Although the Director of Nursing stated that he was very pleased in general with how you are performing in this new role, one area that he suggested you work on was to learn to be calmer in hectic clinical situations. He suggested that your anxiety could be transmitted to patients, coworkers, andsubordinates who look to you to be their role model. He feels that you are especially anxious when staffing is short and that at times you vent your frustrations to your staff, which only adds to the general anxiety level on the unit.
A S S I G N M E N T:
Create a specific plan of 6 to 10 things you can do to bolster your EI in terms of self-regulation during stressful times.
LEARNING EXERCISE
3.10
Human and Social Capital
E
xamine the institution in which you work or go to school. Assess both the human capital and social capital present. Which is greater? Which do you believe contributes most to this institution in being able to accomplish its stated mission and goals?LEARNING EXERCISE
3.11
Assessing Emotional Intelligence (Marquis & Huston, 2012)
Y
ou have just completed your first year as a registered nurse (RN) and have begun to think about applying for the next charge position that opens on your unit. You really like your unit manager and one of the charge nurses. However, a couple of the charge nurses are rather rude and not very empathetic when they are harried and overworked. At times, the charge nurses are very frustrated, the team members pick up their frustration, and the unit becomes chaotic. You feel that although these nurses are very good clinicians, they are not effective charge nurses. You know that you DO NOT want to be like them should you be promoted. You would love to emulate your manager who is calm, supportive, and well-groundedemotionally. She is an excellent role model of a person with emotional intelligence, something you are not sure you have.
A S S I G N M E N T:
Decide what you can do to determine your EI and identify at least three strategies you could use to reduce any deficiencies.
R E F E R E N C E S
Aiken, L., Clarke, S. P., Sloane, D. M., Lake, E. T., & Cheney, T. (2008). Effects of hospital care
environment on patient mortality and nurse outcomes. Journal of Nursing Administration, 38(5), 223–
229.
Ambler, G. (2015). Strengths based leadership. Retrieved January 29, 2016, from http://www.georgeambler .com/strengths-based-leadership/
American Association of Colleges of Nursing. (2015). Fact sheet: Creating a more highly qualified nursing workforce. Retrieved October 17, 2015, from
http://www.aacn.nche.edu/Media/FactSheets/NursingWrkf.htm
Avolio, B., Walumbwa, F., & Weber, T. (2009). Leadership: Current theories, research, and future directions.
Annual Review of Psychology, 60, 421–449.
Blanchard, K. (2015). Chief Learning Officer, 14(7), 14.
Collins, J. (2001). Good to great: Why some companies make the leap . . . and others don’t. New York, NY:
HarperCollins.
Collins, J. (2005). Level 5 Leadership: The Triumph of Humility and Fierce Resolve. Harvard Business Review, 79(1), 66–76.
Covey, S. (2011). Lighthouse principles and leadership. Retrieved October 17, 2015, from https://www.ucumberlands.edu/downloads/give/mia/MorningIn AmericaVol2i3.pdf Econterms. (2014). What is human capital? Retrieved January 29, 2016, from
http://economics.about.com/cs/economicsglossary/g/human_capital.htm
Gill, E. (2015). Servant leadership: Quotes and definition of the model. Retrieved October 17, 2015, from http://www.concordiaonline.net/what-is-servant-leadership/
Goleman, D. (1998). Working with emotional intelligence. New York, NY: Bantam Books.
Greenleaf, R. K. (1977). Servant leadership: A journey in the nature of legitimate power and greatness. New York, NY: Paulist Press.
Marquis, B., & Huston, C. (2012). Leadership and management tools for the new nurse (1st ed.).
Philadelphia, PA: Lippincott Williams & Wilkins.
Mayer, J. D., & Salovey, P. (1997). What is emotional intelligence? In P. Salovey & D. Sluyter (Eds.), Emotional development and emotional intelligence: Implications for educators (pp. 3–31). New York, NY: Basic Books.
Mind Tools Editorial Team. (1996–2016). Level 5 leadership. Achieving “greatness” as a leader. Retrieved
January 29, 2016, from http://www.mindtools.com/pages/article/level-5-leadership.htm
Porter-O’Grady, T., & Malloch, K. (2015). Quantum leadership: Building better partnerships for sustainable health (4th ed.). Sudbury, MA: Jones & Bartlett.
Rath, T., & Conchie, B. (2008). Strengths based leadership. New York, NY: Gallup Press.
Scott Tyler, K. (2006, September 29). The gifts of leadership. Paper presented at the Sigma Theta Tau International Chapter Leader Academy, Indianapolis, IN.
Sherwood, G. D., & Horton-Deutsch, S. (2015). Reflective organizations. On the front lines of QSEN &
reflective practice implementation. Indianapolis, IN: Nursing Knowledge International.
Shirey, M. R. (2006). Authentic leadership: Foundation of a healthy work environment. Reflections on Nursing Leadership, 32(3), 16.
Smith-Trudeau, P. (2015). The journey to authentic nursing leadership at the point of care. Vermont Nurse Connection, 18(4), 3–4.
Thory, K. (2015). Understanding emotional intelligence. Occupational Health, 67(12), 16–17.
Tyler, L. S. (2015). Emotional intelligence: Not just for leaders. American Journal of Health-System Pharmacy, 72(21), 1849. doi:10.2146/ajhp150750
4
Ethical Issues
. . . when organizations and their leaders become fixated on the bottom line and ignore values, an environment conducive to ethics failure is nurtured.
—J. G. Bruhn . . . All my growth and development led me to believe that if you really do the right thing, and if you play by the rules, and if you’ve got good enough, solid judgment and common sense, that you’re going to be able to do whatever you want to do with your life.
—Barbara Jordan
This chapter addresses:
BSN Essential II: Basic organizational and systems leadership for quality care and patient safety BSN Essential VIII: Professionalism and professional values
BSN Essential IX: Baccalaureate generalist nursing practice MSN Essential II: Organizational and systems leadership MSN Essential VI: Health policy and advocacy
MSN Essential IX: Master’s level nursing practice AONE Nurse Executive Competency III: Leadership AONE Nurse Executive Competency IV: Professionalism ANA Standard of Professional Performance 7: Ethics
ANA Standard of Professional Performance 10: Collaboration ANA Standard of Professional Performance 11: Leadership
ANA Standard of Professional Performance 15: Professional practice evaluation QSEN Competency: Patient-centered care
The learner will:
define ethics and ethical dilemmas
compare and contrast the utilitarian, duty-based, rights-based, and intuitionist frameworks for ethical decision making
identify and define nine different principles of ethical reasoning
use a systematic problem-solving or decision-making model to determine appropriate action for select ethical problems
evaluate the quality of ethical problem solving in terms of both outcome and the process used to make the decision
describe the limitations of using outcome as the sole criterion for the evaluation of ethical decision making
distinguish between legal and ethical obligations in decision making
identify strategies leader-managers can use to promote ethical behavior as the norm
describe how differences in personal, organizational, subordinate, and patient obligations increase the risk of intrapersonal conflict in ethical decision making
demonstrate self-awareness regarding the ethical frameworks and ethical principles that most strongly influence his or her personal decision making
role model ethical decision making congruent with the American Nurses Association (ANA) Code of
Ethics and Interpretive Statements and current professional standards
Introduction
Unit II examines ethical, legal, and legislative issues affecting leadership and management as well as
professional advocacy. This chapter focuses on applied ethical decision making as a critical leadership role for mangers. Chapter 5 examines the impact of legislation and the law on leadership and management, and Chapter 6 focuses on advocacy for patients and subordinates and for the nursing profession in general.
Ethics is the systematic study of what a person’s conduct and actions should be with regard to self, other human beings, and the environment; it is the justification of what is right or good and the study of what a person’s life and relationships should be, not necessarily what they are. Ethics is a system of moral conduct and principles that guide a person’s actions in regard to right and wrong and in regard to oneself and society at large.
Ethics is concerned with doing the right thing, although it is not always clear what that is.
Applied ethics requires application of normative ethical theory to everyday problems. The normative ethical theory for each profession arises from the purpose of the profession. The values and norms of the nursing profession, therefore, provide the foundation and filter from which ethical decisions are made. The nurse- manager, however, has a different ethical responsibility than the clinical nurse and does not have as clearly defined a foundation to use as a base for ethical reasoning.
In addition, because management is a discipline and not a profession, it’s purpose is not as clearly defined as medicine or law; therefore, the norms that guide ethical decision making are less clear. Instead, the organization reflects norms and values to the manager, and the personal values of managers are reflected through the organization. The manager’s ethical obligation is tied to the organization’s purpose, and the purpose of the organization is linked to the function that it fills in society and the constraints society places on it. So, the responsibilities of the nurse-manager emerge from a complex set of interactions. Society helps define the purposes of various institutions, and the purposes, in turn, help ensure that the institution fulfills specific functions. However, the specific values and norms in any particular institution determine the focus of its resources and shape its organizational life. The values of people within institutions influence actual management practice. In reviewing this set of complex interactions, it becomes evident that arriving at appropriate ethical management decisions can be a difficult task.
In addition, nursing management ethics are distinct from clinical nursing ethics. Although significant research exists regarding ethical dilemmas and moral distress experienced by staff nurses in clinical roles, less research exists regarding the ethical distress experienced by nursing managers. A recent study by Ganz, Wagner, and Toren (2015) found that middle-level managers in nursing experienced less ethical dilemmas and moral distress than staff nurses, but that administrative dilemmas still caused them significant moral distress.
The researchers concluded that more efforts must be directed at investigating and improving the
administrative aspects of the nurse manager ethical work environment (see Examining the Evidence 4.1).
EXAMINING THE EVIDENCE 4.1
Source:Ganz, F. D., Wagner, N., & Toren, O. (2015). Nurse middle manager ethical dilemmas and moral distress. Nursing Ethics, 22(1), 43–51.
Using the Ethical Dilemmas in Nursing–Middle Manager Questionnaire and a personal characteristics questionnaire, researchers studied a convenience sample of middle managers from four hospitals in Israel. Study findings were that middle managers reported low to moderate levels of frequency and intensity of ethical dilemmas and moral distress but did have some high scores for administrative dilemmas. Some of the highest scoring administrative ethical dilemmas included the following: