Transformational leaders: Change agents for good

By Rene Steinhauer | 10/14/2016

​They walk the walk. Second of a seven-part series.​​​​

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A businessman told me, “We’re in the trust business. Our brand and integrity are everything.” He further explained that his worst-case scenario was bad public relations or finding his company on the front page of The Wall Street Journal as a result of negative publicity. In other words, the worst business situation he could imagine was an event resulting in loss of money.
 
I wondered, “How could he possibly appreciate failure where the consequence is loss of life?” Nurses understand that kind of failure. We lose sleep over it. We dedicate our lives to preventing it. Nurses are leaders unlike any others. As such, we must lead unlike any others.
 
All three of “the good, the bad, and the ugly” styles described in this series are critical components of nursing leadership, and some of us do not even realize we are practicing these styles. Many of us manage routine nursing activities with a vague understanding of these principles, but, in the most difficult of times, only the expert nurse leader will know when a particular style is most appropriate.
 
If you want to become an expert nurse leader, I encourage you to start by reading this series and following up with more detailed research, because there may come a time in your nursing career when you are thrust into the crucible of leadership and have the lives of many in your hands.
 
Goal: The right style at the right time
While the current emphasis in nursing is on transformational leadership, peer-reviewed literature and my personal experience support the need for nursing leaders to use multiple leadership styles in response to the dynamic environments in which they practice. Depending on the situation, nurse leaders employ a wide variety of leadership styles, but there are three primary styles they should be aware of as they seek to hone their leadership skills: transformational, autocratic, and laissez-faire.
 
A nurse may find him- or herself managing a disaster of epic proportions. When that occurs, the laissez-faire approach is unlikely to mobilize the most effective team for saving lives. Frequently, autocratic leadership is most effective in crisis management. However, transformational leadership may also be effective in lifting the spirits of nurses who are responding to a disaster for the first time. And regardless of how ugly laissez-fare leadership is portrayed within the business community, it can be the right response in many nursing situations.
 
What leadership style will you choose to employ when faced with a crisis? Have you mastered multiple leadership styles, or are you relying upon one go-to style for all of your leadership interactions?
 
Transformational leadership: The gold standard
Transformational leadership is perhaps the most difficult leadership style to emulate because it takes more than simply following a “cookie-cutter” paradigm of action and behaviors. It requires a full understanding of the leadership style combined with professional maturity, excellent communication skills, a true belief in the organization, and ability to trust others. It takes many years in the nursing profession to develop the skills required for transformational leadership.
 
Research continues to demonstrate the need for transformational leadership in both business and nursing environments, and the evidence shows improved outcomes in multiple settings when this type of leadership is practiced. Transformational leadership leads to greater safety, improved patient outcomes, and higher motivation and job satisfaction for staff members. It is thus the “golden child” of leadership styles. Is it any wonder why the American Nurses Credentialing Center identifies transformational leadership as one requirement for hospitals achieving Magnet designation?
 
A 2015 study published in the Journal of Nursing Administration discussed the implications of leadership style and patient safety. The author identified transformational leadership as a “positive contributor to safety climate,” whereas laissez-faire leadership had a negative impact on patient safety.
 
Walking the walk
The best description of a transformational leader is one who “walks the walk.” This is the individual whose words and deeds are consistent with the goals of the organization. In a system full of hospitals that range from healthy work environments to places where patients are lucky to live through the experience, it may be difficult to walk the walk. However, it is possible, and there are famous stories of those who believed in the system and were successful, even when it seemed the system was broken.
 
During World War II, the United States formed the 442nd combat regiment. By the end of the war, it was the most highly decorated unit in the military. These were the best of the best. But where did they come from, and why did they fight so hard and sacrifice so much for their country? The men of the 442nd were recruited from Japanese internment camps, and they sacrificed all they had for a government that had unjustly imprisoned them and their families.
 
What I learned was that, while the men of that regiment may not have agreed with the president of the United States, they wholeheartedly believed in the Constitution of the United States of America. They did not fight for the government that was in power. They fought for ideals they did not want erased from history. They were true patriots who walked the walk. Their story remains inspirational to this day, and the lessons they teach remain as relevant today as they were in 1945.
 
We can all be agents for positive change
Transformational leadership is not a role limited to nurse managers but a role for all nurses, regardless of their responsibilities. It is our job as nurses to walk the walk regardless of a facility’s safety climate. While it is wonderful when we find ourselves in workplaces that value transformational leadership, we can still do what is right for our patients and our nursing team even when senior leadership fails to embrace the best, evidence-based nursing theories and practices.
 
The next time you are on duty, will you walk the walk? Will you perform certain safety practices because you’re concerned that you might be noticed doing something wrong, or because you have such a strong commitment to the patient that taking every extra safety step is simply who you are?
 
Perhaps someone will notice you. Perhaps that person will notice that you follow every safety guideline or wipe every IV port before every connection. Maybe that person is a nurse who will notice you walking the walk and might decide to emulate your nursing style. Our younger nurses emulate us older nurses more than we know. Do we have a style worth emulating? I hope so.
 
Rene Steinhauer, RN, EMT-P, has served as a nurse on all seven continents—as flight nurse in Antarctica; as combat medic in Iraq; as disaster manager following the Indian Ocean tsunami (2004), Hurricane Katrina (2005), Haiti earthquake (2010), and Typhoon Haiyan, known as Yolanda in the Philippines (2013); and as chief nurse in an Ebola Treatment Unit in Liberia (2014). The author of Saving Jimani: Life and Death in the Haiti Earthquake, Steinhauer is presently working toward his MSN degree at Hawai’i Pacific University.
 
Part l: Nursing leadership? Reminds me of a movie.
Part 3: When ‘bad’ is good: A time and place for autocratic leadership
Part 4: Laissez-faire leadership: You’d have to be crazy to be this kind of leader
Part 5: Trish and Cheesy: A story about transformational leadership
Part 6: The most transformational leader I've ever known
Part 7: In crucible of crisis, "Trust me" not enough
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