Allison has been an assistant nurse manager in a Magnet-designated hospital on the evening shift for the past year. Emily, her nurse manager, knows that Allison is interested in a leadership role and has agreed to be her mentor. Before Emily goes on vacation, she asks Allison to move to the day shift for two weeks to be in charge of the unit. Emily suggests that Allison keep a notebook describing why and how she makes important decisions during her absence. Reviewing Allison’s notebook will allow Emily to reinforce effective decision-making skills and to identify areas for learning and mentoring. By developing a creative way to help Allison develop decision-making skills, Emily is demonstrating one of the characteristics of a transformational leader. In today’s healthcare environment, nurses seek leaders like Emily who help staff build self-esteem and empower them to realize their career aspirations.
This module explains what transformational leadership is, why transformational leadership is a key part of Magnet nursing organizations and how it can promote work satisfaction among nurses and improve care for patients.
Transformational leadership is a key ingredient in establishing a nursing environment that achieves Magnet designation. Over two decades ago, the American Academy of Nursing began to look at hospitals that retained highly qualified nurses during serious nursing shortages.1 An analysis of these organizations revealed that they had several things in common; these commonalities became known as the “forces of magnetism.” Today there are almost 400 Magnet hospitals in the United States recognized by the American Nurses Credentialing Center for their excellence in nursing practice.2 Magnet designation is considered the hallmark of nursing practice excellence, and research has demonstrated that Magnet-level nursing care has a profoundly positive impact on nursing practice and patient care.1
The Magnet program was expanded to include long-term care facilities in 1998; in 2000, it was further expanded to include international healthcare organizations.1,2 In 2008, the American Nurses Credentialing Center published a new Magnet model that re-emphasized the importance of using a leadership style known as transformational leadership.3 Transformational leadership has been shown to be particularly effective in turbulent and uncertain environments, such as those found in today’s healthcare organizations.4 Although not every organization will achieve Magnet status, nurses at all organizations can learn how to use the principles of transformational leadership to support a professional practice environment that results in outstanding patient care.
The Transformational Way
In his book “Leadership,” published in 1978, James MacGregor Burns introduced a leadership theory that he called transformational leadership. Burns, a political scientist and historian, was interested in the leadership styles used by key figures in history, including Mahatma Gandhi, Franklin D. Roosevelt and John F. Kennedy.5 Burns described transformational leadership as occurring when “two or more persons engage with others in such a way that the leader and followers raise one another to high levels of motivation and morality.”5 This theory differed significantly from older leadership theories because it proposed that meeting the needs of followers was vital to achieving high work performance.6
Burns’ work was influenced by Maslow’s Hierarchy of Needs, a model familiar to nurses who have taken growth and development courses. Psychologist Abraham Maslow described basic human needs as physiological stability, safety, belongingness and love, self-esteem and self-actualization. These needs are arranged in a hierarchical order starting with the need for physiological stability and ending with self-actualization. In general, higher-level needs are not seen as important until basic needs are fulfilled. For example, most people don’t strive for higher-level needs such as self-esteem or self-actualization until their basic physiological needs for food, water and sleep are met.
Historically, healthcare organizations have focused their energies on motivating employees by meeting the first three levels of Maslow’s hierarchy.5 For example, appropriate compensation allows employees to meet their basic physiological needs, workers’ safety is satisfied through a secure work environment, and strategies such as shared governance and participatory management promote a sense of belonging among employees.3
In Burns’ view, transformational leadership has the potential to motivate followers to satisfy higher-level needs, such as self-esteem and self-actualization. Those influenced by transformational leaders find meaning and value in their work, make significant contributions to the success of their employing organization and become leaders themselves.5
Burns’ view is that transformational leadership makes a profound difference in the life of individuals and organizations.5 In the past several decades, there has been a paradigm shift concerning what leadership is and what it can do. From a model that emphasizes tasks and controls, leadership is now seen as vital in developing a work culture in which individuals are successful. Essential to this effort are leaders who have a positive and compelling vision and followers whose needs are met.1
Transformational leadership depends on a high level of engagement between the leader and followers. Traditionally, nursing leaders have used management styles ranging from an autocratic style, in which engagement goes in only one direction, to a “hands-off” or laissez-faire style, in which the manager is nearly disengaged.6
A laissez-faire management style is basically an abdication of leadership; there are no followers in a work setting where a manager uses this style because there is no leader.6
Having a manager who is visible and collaborative is important for staff to perceive active and appropriate leadership. A recent study found that nurse leaders who practiced transformational leadership were able to more effectively inspire and engage staff.7 (Level B)
At the same time that Burns published the theory of transformational leadership, he described a leadership style referred to as transactional leadership. Transactional leadership is based on an understanding between a manager and subordinates; the transaction consists of an acceptable salary, benefits and working conditions in exchange for job performance. Transactional leadership is based on contingent reward, i.e., a reward that depends on delivery of the work product. The leader establishes goals, provides direction and rewards employee progress in meeting goals by using praise and recognition, as well as merit increases and job promotion.5 Leaders using a transactional style reward good behavior, punish perceived negative behavior and maintain control at the top of the hierarchy.8
In the exchange that occurs in a transactional management agreement, the basic needs of both the leader and the follower are met, but they may not have a common vision for nursing practice.6 The employee agrees to complete tasks as assigned and to meet work deadlines. Evaluation comments for a nurse working under this style of leadership might read: “Cathy Smith completes her work on time, has fewer than the standard number of allowed absences and has made no medication errors during this rating period.” As is evident, this leadership style is unlikely to fuel a high level of job satisfaction and organizational commitment. Nursing departments that use this leadership style may publish a vision statement and goals that have been developed by senior management with minimal staff input. At the unit level, a nurse manager may be asked to develop a unit vision statement and goals that reflect the vision of senior management.9 The manager may reference this document in staff meetings or place it in orientation folders for new employees, but rarely does it have an impact on nursing practice and patient care.
Healthcare organizations, being highly bureaucratic organizations, have traditionally used transactional leadership strategies, which include a task-and-reward orientation, management by exception, few opportunities for creative thinking, decision-making by senior management and limited opportunities for employees to be involved.6
Although transactional leadership can help organizations meet their goals in the short term, it will not provide the inspiration to create and nourish a new culture for nursing practice and patient care. In contrast, evidence-based research supports that a transformational leader can influence attitudes and behavior to create a new culture for nursing practice and patient care because the vision resonates with staff members and they are involved in making it become a reality.7,10,11 (Level B)