tencies: holding the truth, intellectual and emotional self, discovery of potential, quest for the adventure towards knowing, diversity as a vehicle to wholeness, appreciation of ambiguity, knowing something of life, holding multiple perspectives without judg- ment, and keeping commitments to one’s self. Again, there is little evidence of empirical testing. Some models from nursing include specific characteristics of transformational leadership, but most fall short of identifying clinical applications, and many borrow from models in business and healthcare management.
Competencies are necessary, of course, to provide a framework to document and as- sure performance, especially in areas of productivity, accuracy, and efficiency, but it is difficult to inspire workers or even endear clients or patients with catalogs of expecta- tions. Without vision, competencies are only chore lists for managers. Porter-O’Grady and Malloch (2007, p. 421) reminded that “Leadership is not simply as set of skills [and competencies], but a whole discipline.” Wear (2008, p. 625) warned that while competen- cies are important, turning every measure of practice into a competency “is an ill-advised leap that transforms a complex educational [clinical, and leadership] mission into a bottom-line venture.” It is important that we broaden the focus to include “ongoing re- flective processes and humility that mark the lifelong development of skilled, empathic”
clinicians and leaders (Wear, 2008, p. 625).
As you consider new roles or simply a new perspective for existing clinical leadership role with advanced preparation at the highest level of clinical practice, it would be most unfortunate if you were to reinvent the entire concept of competency. Think about what is most needed. Search the evidence for the empirical foundation and then ask: What habits and skills must the next generation of leaders possess? Is healthcare leadership only about skills? What are common assumptions and expectations? What needs might be uniquely met by a leader rooted in a clinical focus? Who and where are the leaders?
entire organization. It must inspire a commitment, loyalty, caring, and genuine interest in personal involvement in the enterprise. The vision should reflect the unique culture, values, beliefs, strengths, and the direction of the organization. It must “fit.” The vision always promotes the feeling among followers that they are part of something greater than themselves, that their daily work is more than operational, but part of some greater future. Such a vision challenges others to stretch, to reach, and to produce beyond their own expectations.
The leader who sets such a vision will have the larger perspective not only of the offi- cial vision statement or strategic plan but also beyond. Nevertheless, the effective vision- ary leader does not only see the big picture of the vision, but also is able to sensitively support others in the daily work of all members of the organization. To the perceptive leader, the vision is more than a rallying cheer. It represents a substantive direction for action and achievement. The vision is only one aspect of a strategic plan for action, but it is the vital life force of that plan. Inspiring leaders have the courage and the drive to dream. In times of near despair, confusion, chaos, or even routine and boredom, we need dreams. As a leader, you must believe in your dream; you must believe that it can hap- pen. Kouzes and Posner (2007, p. 17) observed:
Every organization, every social movement, begins with a dream. The dream of vision is the force that invents the future . . . . Leaders gaze across the horizon of time, imagining the at- tractive opportunities that are in store . . . . They envision exciting and ennobling possibilities.
Leaders have a desire to make something happen, to change the way things are, to create something that no one else has ever created before.
One of my most visionary students reminded me of the story of Ferdinand de Lesseps, a French diplomat assigned to areas of the Mediterranean and the Middle East. His dream was a passage from the Mediterranean to the Red Sea, eliminating the long sea journey around Africa. He was not an engineer, but a diplomat and leader with a vision who used his influence to build the Suez Canal. Not satisfied with one dream, he then went to work to begin the Panama Canal. Deterred by a significant difference in geography, he did not live to see its completion—but his dream was eventually fulfilled by subsequent leaders who shared his vision (W. M. Scott, personal communication, September 13, 2009;
BBC, 2009).
Dreams that actually become fulfilled are shared among members of a critical mass.
A leader must have followers. Solitary vision that is not shared is only daydreaming.
Transformational leaders must be vigilant that they do not follow their own light so far in the distance that followers are left in the dark. Shared dreams “fit,” and they grow in the hearts of those committed to the organization. Stichler (2006, pp. 255–256) reminded:
The nurse leader is responsible for creating a vision for the organization and clearly articu- lating that vision to others. The vision must be so compelling that others can feel passionately enough about it to direct their efforts toward achieving the vision. The vision must be viewed as being for the “common good,” and the [leader] must foster that sense of common commit- ment so that others are willing to follow on the quest toward the vision . . .
Along with the vision, the [leader] is responsible for defining the philosophy of care and translating that philosophy with others into care delivery models . . . . [The leader] directs the
care delivery process and accomplishes the mission and goals of the organization through others in a manner that empowers nurses and other professional providers to achieve auto- nomy in their practice.
A vision statement is a helpful way to articulate the dream. The most effective vision statements are short (two to three sentences), reflect the values of the organization, and reflect a picture of what the organization is about to become. It is a helpful exercise to engage people in creating a vision statement. When brainstorming to develop the vision statement, be bold to use metaphor, poetry, images, stories, and emotion. People need to truly experience the image. As the leader, you guide them through the adventure and to the place you see ahead. Vividly describe it, discuss it, and encourage all to share their view of it. Then articulate it in a clear, succinct statement—one that is so clear that the only response is, “Yes! That’s who we are. That’s what we want to be. That’s where we are going!”
A shared vision gives perspective. It allows everyone to look up from many lists of competencies and the daily grind that hovers over nearly every organization at some time or another. As a leader with a vision in your heart, you are the guardian of perspec- tive. You are able to critically appraise what is important and what simply appears to be urgent at the time. You help people to cut through the daily lists of “stuff” that must be done to see what really might be done for the better future. Sometimes, it is just a mo- ment of reflective reminder; sometimes, it is a change of schedule or procedure; some- times, it is a different use of language. Language is important in the vision statement, particularly. It must be beautiful in that it clearly reflects the image of where you are going, the picture of the desired future.
The leader who believes and constantly carries the vision is able to critically analyze decisions, solve problems, and effectively predict next steps. The vision is not about you, your career goals, or your personal desires. It is about the organization as a living organ- ism, as a community, perhaps even as a family. You are the steward of the vision of the organization. For your vision to be authentic, you must love the place, the people, and the work you are doing. One of the best bits of wisdom of my career was shared by a nurse manager at a children’s hospital where I worked as a young graduate nurse. She said, “If you don’t love it here, please don’t stay.” Stichler (2006, p. 257) counseled that
“The new executive must have a love for people because [he/] she must trust them to do the work to accomplish the mission and vision. That trust empowers others to be autono- mous, accountable for their own actions and fulfilled with a sense of accomplishment.”
There are so many opportunities for service in health care that you do not need to work anyplace or do anything as a leader that you do not love. You must love the vision, the place, and the work (Bryant, 2009; Secretan, 2006).
Because the vision is integrated into your being as the leader, many plans and decisions will seem to automatically flow in the direction of the vision. Opportunities will appear, or you will suddenly see opportunities in a new way to allow you to move toward the vision. The vision becomes your habit. It will not be easy, but a clear vision allows pur- poseful critical analysis and helps to winnow away issues that cloud direction. It allows you to better trust your decisions because you know where you are going, and your ac- tions are more likely to be trusted because you have the creditability of a clear direction.
Critical analysis becomes easier, almost second nature, because you have set your own benchmark. You know where you are going.