For this discussion, you will use information from your assigned readings and the literature to answer the following:
· Changing clinical practice or staff behavior can be challenging. Please describe Lewin’s Theory of Change. Give an example where you or organization used this theory to implement change. Was the change successful or unsuccessful? Why? Include change theory elements in your rationale. If the change was unsuccessful, what could the organization have done differently (include utilization of a different change theory)?
Your initial post must be posted before you can view and respond to colleagues, must contain minimum of two (2) references, in addition to examples from your personal experiences to augment the topic. The goal is to make your post interesting and engaging so others will want to read/respond to it. Synthesize and summarize from your resources in order to avoid the use of direct quotes, which can often be dry and boring. No direct quotes are allowed in the discussion board posts.
Post a thoughtful response to at least two (2) other colleagues’ initial postings. Responses to colleagues should be supportive and helpful (examples of an acceptable comment are: “This is interesting – in my practice, we treated or resolved (diagnosis or issue) with (x, y, z meds, theory, management principle) and according to the literature…” and add supportive reference. Avoid comments such as “I agree” or “good comment.”
· Initial Post: Fri, Nov 5 by 11:59 p.m. Eastern Standard Time (EST) of the US.
· Response Post: Sun, Nov 7 by 11:59 p.m. Eastern Standard Time (EST) of the US – (the response posts cannot be done on the same day as the initial post).
· Initial Post: Minimum of two (2) total references: one (1) from required course materials and one (1) from peer-reviewed references.
· Response posts: Minimum of one (1) total reference: one (1) from peer-reviewed or course materials reference per response.
· Initial Post: Minimum 200 words excluding references (approximately one (1) page)
· Response posts: Minimum 100 words excluding references.
OVER THE COURSE of their prelicensure program, many nurses had a class titled something along the lines of Leadership in Nursing. Typically, this course is taken in the final semester, along with a precepted clinical experience. It may have been taught by a former nurse manager or another healthcare ad- ministrator, focusing on the following: • organizational structures • delegation to certified unlicensed assistive personnel • roles and responsibilities of nurse managers or charge nurses • workings of the healthcare team • performance evaluation • job descriptions • unit budgets • personnel issues.
While these courses are valuable, they do not necessarily prepare nurses to be effective leaders or followers. But that is what all nurses should strive to be: leaders and effective fol- lowers. This article examines the differences between leaders
BY THERESA M. VALIGA, EdD, RN, CNE, ANEF, FAAN
Leaders, managers, and followers:
Working in harmony
Abstract: All nurses have the po- tential and responsibility to effect positive change in nursing practice and healthcare. This article details the characteristics of leaders and effective followers and clarifies that one does not need to be in a management position to function as a leader.
Keywords: followers, leaders, managers, transactional leaders, transformational leaders
Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.
46 l Nursing2019 l Volume 49, Number 1 www.Nursing2019.com
and managers, describes the role of effective followers, and applies those qualities to nurses across the spec- trum of healthcare.
Who leads? Leadership literature is plentiful both inside and outside of the healthcare industry, but these often focus on the role of a CEO or another manager or administrator who deals with em- ployees. This suggests that the term leader applies only to individuals in top-level administrative positions, that only a small number of individu- als might be considered leaders, and that those who are led have a limited impact on the success or future di- rection of their organization. In real- ity, nothing could be further from the truth. Leaders can be found in every walk of life, any position or role, and every field. Those expected to follow leaders must know how, when, and whom to follow for success.
Over the years, evolving leader- ship theories provided new perspec- tives on leadership, but they failed to acknowledge the complexity of leadership and the importance of followers (see Changing perspectives on leadership). More contemporary theories acknowledge that effective leadership depends on the person, the situation, and the qualities and maturity of the followers.1-4 Leader- ship is not a random occurrence in these theories; rather, it is purposeful and involves communication, vision,
engagement, and inspiration to ener- gize a group.
One of the best-known perspec- tives on the complexity of leader- ship came from James MacGregor Burns in 1978.5 His influential work, Leadership, addressed the importance of followers and urged appreciation for the two forms of leadership: transactional and trans- formational. According to Burns, transactional leaders “approach fol- lowers with an eye to exchanging one thing for another: jobs for votes or subsidies for campaign contribu- tions.” In contrast, transformational leaders “[recognize] and [exploit] an existing need or demand of a poten- tial follower… [seek] to satisfy [their] higher needs, and [engage] the full person…” to pursue “compelling causes.”5 This distinction, along with the acknowledgment of transforma- tion and collaboration, has led to a careful analysis of the similarities and differences between leadership and management.5
Leadership vs. management When many talk about leadership, they refer to individuals in positions of authority, such as the president of a professional association, a CNO, the dean of a school of nursing, and so on. Followers are often thought of as sheep expected to accomplish whatever tasks the leader sets. A careful assessment of the distinctions between leaders and managers, as
well as those between sheep and ef- fective followers, is required for an awareness and effective execution of these different roles.
Many have built on the themes of Managers and Leaders: Are They Different? by Abraham Zaleznik in 1981.6 His work helped to distin- guish leaders from managers: • Leaders have a vision and draw on passion to engage others. • Managers typically work with oth- ers to realize the goals of an organi- zation—often with great skill, but not always with passion.
Leaders communicate their vision to inspire others to effect change for the benefit of those around them. The vision for leaders in nursing may re- sult in patients being admitted to the unit in a more effective and compas- sionate way, families being integrated into the patient-care process for a more positive experience, and staff having greater input on the policies and practices that affect them.
By comparison, managers often communicate policies and expecta- tions that have been established by the organization for compliance. Typ- ically, the task is still accomplished, but sometimes due to fear rather than a healthier motivator. It may also be that the staff feels as though they have no choice in the matter. Effec- tive followers choose to follow be- cause they also see value in the vision and are inspired by the passion with which an idea is communicated.
In their relationships, leaders uti- lize the strengths and talents of those around them to influence positive change, often empowering others to take on leadership roles of their own. They encourage, support, and mentor their followers. In turn, fol- lowers challenge leaders and suggest alternatives to their ideas. Managers also work effectively with teams but are expected to accomplish tasks and stay on budget by directing others.
Leaders achieve their status be- cause followers have allowed them
Changing perspectives on leadership12 Views on leadership have changed over the years. Initially, only individuals born into a noble family were thought of as leaders, having inherited those roles, but leader- ship involves more than having noble blood.
• The great man theory did not resonate well with the rest of the population, and scholars started to determine different characteristics possessed by those viewed as leaders.
• Trait theories evolved from this and identified some common leadership charac- teristics, but none were universal because the qualities of a leader varied based on circumstance.
• Situational theories recognized the significance of an individual’s environment or situations. These events may lead him or her to step up as a leader.
Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.
www.Nursing2019.com January l Nursing2019 l 47
to take the lead; managers are ap- pointed to their positions. As such, leaders’ power comes from their credibility, passion, and knowledge. Managers are in a position of author- ity, with their power coming from the ability to hire, fire, evaluate, and recommend employees.
Knowing their vision will not be achieved easily or overnight, leaders are creative and comfortable with disorder, take risks, and stay focused on their goals. By compari- son, managers seek to limit risks, often preferring order to maintain the status quo. As evidenced by “The Best Performing CEOs in the World 2017,” an article in the Har- vard Business Review that ranked CEOs based on their company’s success in production and financial returns, the primary objective of management is the health and fu- ture of the organization.7
Areas such as employee perfor- mance, organizational structure and operations, branding, big data, strategic planning, and the longev- ity of an organization weigh heavily into management decisions. These are important factors to consider, but they are not always of great signifi- cance to leaders. Leaders focus on getting people involved to develop and realize a vision based on passion, rather than just the bottom line, and they are exactly what is needed in nursing.
Despite seemingly opposite char- acteristics, the two are not mutually exclusive. Many nurses who are ef- fective leaders serve in management positions, but leaders do not require a position of authority. Given the current state of healthcare, increas- ingly diverse patient populations, the complexities of practice, and the tremendous explosions in knowl- edge and technology, all nurses must accept responsibility to be leaders in their respective organizations, communities, and professional associations.
Taking up the mantle Assuming a leadership role may seem overwhelming, and many think they do not have the time, energy, or qualities to take on the challenge. But those who hesitate can still rise to the challenge with some guidance. Consider the following: • Engage in honest self-reflection regarding individual strengths and weaknesses, including clini- cal expertise and proficiency, com- munication skills, or mentoring activities. • Attend seminars or workshops on leadership development and allow time for careful reflection. • Read books, articles, and blogs on leadership. • Carefully observe leaders both in- side and outside of the nursing field to identify their habits and charac- teristics, then work to develop or strengthen those abilities.
• Speak up in the presence of injustice, disrespectful behavior, clinical errors, or ineffective prac- tices. This means clearly identifying an issue, offering a solution, and suggesting approaches to improve the situation. • Seek out mentors and apply to par- ticipate in leadership development academies, such as those offered by Sigma Theta Tau International.8
• Start small in familiar areas. Lead- ership does not mean becoming president of the American Nurses Association or tackling a major issue. Instead, it can be achieved by being an active, contributing member of a committee, submitting a proposal on a different way to do things, or writ- ing an article for your institution’s newsletter. • Ask for feedback from peers and colleagues regarding how particular situations were handled. • Function as an effective and ex- emplary follower by supporting col- leagues who are attempting to shape a better future.
Strong followers Being an effective follower is one route to becoming a leader. Follow- ers are often thought of as sheep, yes-people, or cheerleaders, and some do play those parts. But real- izing a vision and addressing com- pelling causes cannot be accom- plished by the leader alone.5 In fact, there would be no leaders without followers.
Individuals who are effective as followers think critically about ideas, proposals, and problems; offer dif- ferent points of view; invest in the group and its goals; and know who and when to follow.9 They both give and receive counsel and support, share responsibility for the group, uphold high values and standards, understand their strengths and weaknesses, and stay true to their own values; in addition, they will not abide individuals who abuse
Leaders direct the strengths and talents of those around them to
influence positive change.
Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.
48 l Nursing2019 l Volume 49, Number 1 www.Nursing2019.com
their position as a leader. These indi- viduals are strong, actively engaged, and primed to take on leadership roles. Like leaders, they are willing to take risks, communicate effec- tively, take initiative, and think for themselves.
Time to step up Nurses who have served as effective followers and attended to strength- ening and developing their leader- ship qualities and characteristics may be ready to take on a more active role. Nurses can provide leadership in their units or organizations in sev- eral ways, including: • chairing a unit-based team or council for professional governance • providing alternate approaches for process improvement initiatives • identifying practice or care issues to peers and supervisors to ensure that they are not ignored • seeking out and advocating for the development of evidence-based ap- proaches to resolve an issue • promoting the professional de- velopment of nurses and volun- teering to help orchestrate these opportunities • standing up to injustice or inequity and working to create a culture that will not tolerate such behaviors • serving as a preceptor and mentor for new staff members or students.
Many paths to leadership There are many ways to identify, develop, and strengthen leadership skills. Sometimes an educator, nurse manager, or colleague will see leader- ship potential in an individual and provide the encouragement, support, and opportunity for him or her to develop in that role. Nurses in this position should consider themselves fortunate and take full advantage of the situation. More often, however, nurses are not tapped by someone else and must take the initiative to move forward.
Each nurse makes a difference in the lives of patients and their fami- lies, but they should also seize the opportunity to have a broader im- pact on healthcare and the nursing profession as a whole for the benefit of patients and colleagues alike. Con- sider what kind of difference can be made by advocating for: • local quality improvement projects • access to follow-up care for the homeless population after discharge from acute care settings • representation of clinical nurses on all major boards and committees within an institution • a new approach to scheduling that allows nurses to pursue advanced education or research.
There are approximately three million nurses in the US.10 They are trusted and valued by the public and guided by their commitment to others.11 Imagine the impact nurses
could have if even half of them truly functioned as leaders. Who would be in a better position to make signifi- cant changes in healthcare? ■
Grossman S, Valiga TM. The New Leadership Challenge: Creating the Future of Nursing. 5th ed. Philadelphia, PA: F.A. Davis; 2017.
Huston CJ. The Road to Leadership. Indianapolis, IN: Sigma Theta Tau International; 2018.
Kouzes JM, Posner BZ. The Leadership Challenge: How to Make Extraordinary Things Happen in Organizations. 6th ed. Hoboken, NJ: John Wiley & Sons; 2017.
Lapierre LM, Carsten MK. Followership: What Is It and Why Do People Follow? Bingley, United Kingdom: Emerald Publishing Limited; 2014.
Marshall ES. Transformational Leadership in Nursing: From Expert Clinician to Influential Leader. 2nd ed. New York, NY: Springer Publishing Company; 2016.
Theresa M. Valiga is professor emerita at Duke University School of Nursing in Durham, N.C.
The author has disclosed no financial relationships related to this article.
Despite seemingly opposite characteristics, leaders and managers
are not mutually exclusive.
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