Courage to Lead: Transformational Nurse Leadership for a Healthy Work Environment
June Marshall, DNP, RN, NEA-BCSeptember 27, 2013
Objectives
• Describe transformational leadership qualities necessary for creating and sustaining healthy work environments.
• Define components and characteristics of healthy nursing work environments.
• Identify strategies for mitigating nurses’ workplace stress.
Transformational Nurse Leaders: Characteristics
• Effective communicator• Charismatic• Inspirational• Individual consideration• Intellectual stimulation• Empower others
Transformational Nurse Leaders: Characteristics
• Servant leader• Humble• Ethical• Transparent• Empathetic• Compassionate/Caring• Authentic
Transformational Nurse Leaders: Characteristics
• Strategic• Visionary• Committed to
EXCELLENCE• Passionate• Trustworthy
Transformational Nurse Leaders: Characteristics
• COACH• MENTOR
Transformational Nurse Leaders: Role Models
Florence Nightingale – Transformational Leader & Role Model• Self-knowledge• Authenticity• Expertise• Vision• Flexibility• Shared leadership• Influence• Inspiring others
Transformational Nurse Leaders: Role Models
Florence Nightingale – • Innovator• Change agent• Advocate • Reformer
Transformational Nurse Leaders: Role Models
Ildauro Murillo-Rohde, PhD, RN, FAAN – • Innovator• Change agent• Advocate • Reformer• Visionary• Instrumental in
founding NAHN
Transformational Nurse Leaders: Role Models
Henrieta Villaescusa, MPH, RN, FAAN – • Mentor • Role Model• Trailblazer • Advocate for Social
Justice
Transformational Nurse Leaders: Role Models
Mary Lou de Leon Siantz, PhD, RN, FAAN – • Interdisciplinary, Multicultural Educator
• Researcher & Translationalist
• Legislative Advocate
Transformational Nurse Leadership
• What do YOU see in the mirror?
Healthy Nursing Work Environments
• Skilled communication• True collaboration• Effective decision making• Appropriate staffing• Meaningful recognition• Authentic leadership (AACN, 2005)
Healthy Nursing Work Environments
http://ajcc.aacnjournals.org/content/14/3/187/F1.expansion
Interdependence of healthy work environment, clinical excellence,and optimal patient outcomes
Institute of Medicine Report
High-quality, patient-centered health care for all will require a transformation of the health care delivery system
One of the most-viewed online reports in IOM history
AJN Book of the Year Award
IOM Recommendations
1) Remove scope-of-practice barriers2) Expand opportunities for nurses to lead and diffuse collaborative improvement efforts3) Implement nurse residency programs4) Increase the proportion of nurses with a BSN degree to 80% by 20205) Double the number of nurses with a doctorates by 20206) Ensure that nurses engage in lifelong learning7) Prepare and enable nurses to lead change to advance health8) Build an infrastructure for the collection and analysis of interprofessional health care workforce data
IFN - Campaign Focus
Campaign for Action
Education Practice Collaboration Leadership Data
Diversity
Creating Healthy Work Environments
Ergonomics and Safety
Intergenerational Workforce
Just Culture
Mind, Body, Spirit Healing
Moral Courage/Distress
Nurse Leaders’ Roles in Healthy Work Environments
Structural Empowerment
Evidence and Outcomes
Transformational Leadership
Modeling the Way
Workplace Stress
• Complexity of nursing work environments
• Workplace stressors – patient acuity, technology, rapid cycle change, ethical dilemmas and bullying/violence
• Stress responses produce adverse physiologic, social, emotional, and behavioral reactions
Importance of Healthy Work Environments
• Key to recruiting and retaining “best talent” and providing care for patients
• “Feeling physically and emotionally safe”
• Culture with a sense of belonging and positive team relationships
Shirey (2006)
Multi-pronged Approach to Mitigating Workplace Stress
• Critical Incident Stress Management• Psychological Debriefing• Peer Support• Ethics Consultation• Employee Assistance Programs• The Nurse Advocate Role
Multi-pronged Approach to Mitigating Workplace Stress
• One Size Does NOT Fit All!
Stabilization & Acknowledgement of Events & Reactions
(Everly, 2001)
Critical Incident Impacting a Group of RNs Initiate CISM Program
Defusing in Small Groups – Including Introduction, Exploration, & Information (Mitchell, 2006)
Successful Work Reentry
Facilitation of Normal Recovery (Mitchell, 2006)
If Stress Responses Unresolved, Refer to Formal Individual or Group CISM Program
Stress Responses Completely Resolved Without Need for Ongoing Follow-up
Professional Practice-related Critical Incident Initiates Referral to Nurse Advocate (TNA, 2010)
Individual and Group Workplace Critical Incident Stress Management (CISM) for Registered Nurses (RNs) – Marshall (2010)
Critical Incident Impacts Individual RN
– Initiate CISM Program
Assist RN to Understand &
Normalize Events (Everly, 2001)
Encourage Actions to Facilitate
Effective Coping
(Everly, 2001)
If Stress Responses Resolve, Provide
Periodic Follow-up as Needed for Problems
If Stress Responses Continue, Refer for Follow-up Assessment & Interventions (Everly, 2001)
Stressful Workplace Incident Occurs & Individual or Group Peer Support Session Initiated
Multi-pronged Approach to Mitigating Workplace Stress
• Stress Support Work at UT Southwestern
• Staff Survey and Involvement in the Work
• EAP, Chaplain Support• Lessons Learned• Accomplishments • Next Steps
Multi-pronged Approach to Mitigating Workplace Stress – Additional Elements
• Ergonomics• Quiet Environments• Cultures of Safety• “Zero Tolerance” Policies for Abusive
Behavior• Healthy Work/Life Balance
Essential Characteristics
• Support for education• Working with clinically competent nurses• Collegial and collaborative interdisciplinary relationships• Autonomous nursing practice• Control over nursing practice• Supportive nurse managers• Perceived adequacy of staffing• Culture in which concern for the patient is paramount http://www.amsn.org/practice-resources/healthy-work-environment
Commitment to the Work
• What will YOU agree to DO?
Strategic Goals and Action Plan
GOALS
ACTIONS
OUTCOMES
The Future of YOUR Work Environment - Transformation
HEALTH WHOLENESS
The Future of YOUR Work Environment - Transformation
GOOD GREAT
Leaders’ Line of Sight
MIND
BODY
SPIRIT
Transformational Leadership Focus
Mission
Vision
Values
Personal Commitment
• What brought you to this work?
• What sustains your commitment?
• What is your vision for the future?
Questions & Comments
References
AACN (2005). AACN Standards for Establishing and Sustaining Healthy Work Environments: A Journey to Excellence. Aliso Viejo, CA: American Association of Critical-Care Nurses.
ANCC (2013). 2014 Magnet® Application Manual. Silver Spring, MD: American Nurses Credentialing Center.
Bowles, A. & Bowles, N.B. (2000). A comparative study of transformational leadership in nursing development units and conventional clinical settings. Journal of Nursing Management, (8), 69-76.
Clements, P.T. & Averill, J.B. (2006). Finding patterns of knowing in the work of Florence Nightingale. Nursing Outlook, 54, 268-274. http://dx.doi.org/10.1016/j.outlook.2006.06.003
Dossey, B.M., Selanders, L.C., Beck, D-M., Attewell, A. (2005). Florence Nightingale Today: Healing Leadership Global Action. Silver Spring, MD: American Nurses Association.
References
Everly, G.S., Flannery, R.B. & Mitchell, J.T. (2000). Critical incident stress management: A review of the literature. Aggression and Violent Behavior, 5(1), 23-40.
Florence Nightingale. (2012). Biography.com. Retrieved 12:01, May 09, 2012 from http://www.biography.com/people/florence-nightingale-9423539
Govier, I. & Nash, S. (2009). Examining transformational approaches to effective leadership in healthcare settings. Nursing Times, (105), 18.
Hutchison, M. & Jackson, D. (2013). Transformational leadership in nursing: Towards a more critical interpretation. Nursing Inquiry, 20(1), 11-22.
Maloney, C. (2012). Critical incident stress debriefing and pediatric nurses. Pediatric Nursing, 38(2), 110-113.
Marshall, J. & Zolnierek, C. (2012). Supporting nurses through critical practice incidents: The nurse advocate role. Nurse Leader, 10(2), 34-36,44.
References
McDonald, L. (2001). Florence Nightingale and the early origins of evidence-based nursing. Evidence Based Nursing, 4, 68-69. doi:10.1136/ebn.4.3.68 .
Swanson, K.M. & Wojnar, D.M. (2004). Optimal healing environments in nursing. The Journal of Alternative and Complementary Medicine, 10(1), S-43-S-48.
Sherman, R.O. (2012). What followers want in their nurse leaders. American Nurse Today, 7(9).
Smith, M.A. (2011). Are you a transformational leader? Nursing Management, 26(8), 44-47.