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Erin J. Ross DNP, MS, ANP-BC, CORLN

� SOHN Nursing Practice and Research Committee

� Sigma Theta Tau International: Alpha Mu Chapter

� Background

� Problem & Research Question

� Review of Literature

� Method

� Results

� Limitations

� Summary and Conclusions

� Questions

� The nursing profession is the largest segment of the nation’s health care workforce with more than 3 million members

� Identifies a need for resilient and proficient nursing leadership

� Nursing associations provide leadership development through mentoring and best practice opportunities for members

� Lack of research

� What are the transformational leadership practices of nurse leaders in professional nursing associations?

� Is a leadership style that inspires and empowers followers to achieve extraordinary outcomes while transcending individual self interests, aligning objectives and goals of the followers, the leader, groups and the organization (Bass & Avolio, 1993)

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� Transformational leadership (TL) practices were first described by James Burns (1978) in his theory of leadership

� TL was extended in the work of Bass (1985), who defined how transformational leadership could be measured and how it influences follower enthusiasm and performance

� Influenced by Bass and Avolio’s (1993) transformational model of leadership, Kouzes and Posner (1987) developed their model of exemplary leadership

� Inspiring Inspiring Inspiring Inspiring a shared a shared a shared a shared visionvisionvisionvision: : : : Envisioning the future by imagining exciting and ennobling possibilities; enlisting others in common vision by appealing to shared aspirations.

� Challenging Challenging Challenging Challenging the the the the processprocessprocessprocess: : : : Searching for opportunities by seeking new ways to change, grow, and improve, experimenting and taking risks, generating small wins and learning from mistakes.

� Enabling Enabling Enabling Enabling others to others to others to others to actactactact: : : : Fostering collaboration by promoting cooperative goals and building trust, strengthening others by sharing power and discretion along the way.

� Modeling Modeling Modeling Modeling the waythe waythe waythe way: : : : Finding voice and clarifying personal values by setting an example and aligning actions with the shared values of the team.

� Encouraging Encouraging Encouraging Encouraging the the the the heartheartheartheart: : : : Recognizing individual contributions, showing appreciation for excellence, celebrating victories by creating a spirit of community.

� Transformational Leadership (TL) has been studied extensively over the last several decades withinwithinwithinwithin (Xirasagar, Samuels, & Stoskopf, 2005; Larrabee, Janne, Ostrow, Witbrow, Hobbs, & Burant, 2003; Spinelli, 2006, Failla, & Stichler, 2008; Weberg, 2008; Corrigan, Diwan, Campion, & Rashid, 2003) and outsideoutsideoutsideoutside of health care environment (Bass B., M., & Riggio R., E. 2006, Bass, 2008).

� Leadership has been studied among nursing leaders (Weberg, 2010, Failla, K. R., & Stichler, J. F. (2008), Larrabee, Janney, Ostrow, Witbrow, Hobbs, & Burant, (2003), Bass (1985), Tuna, M., Ghazzawi, Tuna, A., & Çatir (2011),Wong & Cummings (2007)

� Dunham-Taylor (2000) found that as the nurse executive's transformational leadership score increased, the hospital organization was more participative

� Chiok Foong Loke, Leach (2001) and McGuire & Kennerly (2006) recognized significant relationships between TL practices and organizational commitment

� Wylie and Gallagher (2009) explored self-reported transformational leadership behavior profiles; seniority and prior leadership training were positively related to TL

� Failla and Stichler (2008) found a significant relationship between nurse manager transformational leadership style and job satisfaction

� Porter-O’Grady (2009) compared 71 Magnet chief nursing officers (CNOs) and 90 non-Magnet CNOs

� Results showed no significant differences between Magnet CNOs and non-Magnet CNOs using the Leadership Practices Inventory (LPI) self-report tool

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� Clavelle, Drenkard, Tullai-McGuiness and Fitzpatrick (2012) provided new evidence that the top two TL practices of Magnet CNOs: Enabling others to act and Modeling the way

� As CNOs gain experience and education, they exhibit more transformational leadership characteristics

� CNOs 60 years or older scored significantly higher than younger CNOs

� White and Olsen (2004) reported the reasons given by member nurses for joining their organization were: to increase knowledge (22%), professional benefits (21%), networking (21%), and to earn continuing education units (CEUs) (17%), social interaction and mentoring opportunities accounted for 9.3% and 7.9% of the benefits, respectively

� Deleskey (2003) reported the variables that most strongly influenced joining a particular professional nursing association were: self-improvement, education, new ideas, programs, professionalism, validation of ideas, improvement of the profession, personal work improvement, and maintenance of professional standards

� National descriptive study

� What are the transformational leadership practices of nurse leaders in professional nursing associations?

� The Leadership Practices Inventory Self (LPI-self) and a demographic questionnaire

� Approved by the Case Western Reserve University Institutional Review Board

� Recruitment of nurse leaders via internet (n= 448) email invitation via Survey Monkey

� Sample: English speaking RNs who were President, VP, PP, or BOD of a PNA

� Informed consent

� Email reminders

� Minimum of 50 surveys returned (n=134)

� SPSS software utilized

� Leaderships Practices Inventory (LPI) Self

� 30 behavioral-based statements (1-10 Likert scale)

� Cronbach's alpha 0.70-0.84 (high internal consistency)

� My survey:0.70-0.88

� Test/retest reliability of 0.93—0.95

� Demographic survey

� LPI subscales: means and standard deviations

� To identify relationships between means of the LPI-S and amount of leadership training acquired, Pearson’s correlations were calculated

� To determine differences between office held and LPI-S, analysis of variance tests were conducted

� Comparison of Means of Previous Studies using LPI in Nursing

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� n=134 (30% return rate)

� Female: 84.4%

� Age: mean of 54.6 years old (30-78)

� Race: 95.5% White

� States: 38 of 50 represented

� Education: Masters 54.5% (DNP 15.7%)

� Certification: 73.1%

� Work status: Full-time (80.6%)

� Office held: BOD 29.9% (Pres. 26.1%)

� YRS in leadership: 6-10 yrs. (24.6%)

� # of members: 1001-5000 (35.1%)

� YRS in a PNA: >25 yrs. (25.4%),6-10yrs. (24.6%)

� AMT of leadership training: moderate amount (32.8%), a little/a lot (21.6%), none at all (9.7%)

� Over 50 different nursing specialties

� The top two transformational leadership practices of nurse leaders in a professional nursing association were Enabling others to act and Encouraging the heart

Challenge the

Process

Enable Others to

Act

Encourage the

Heart

Model the Way Inspire A Shared

Vision

N 134 134 134 134 134

Mean 8.1704 8.7724 8.6119 8.5037 8.2164

SD 1.09843 .66212 .89480 .92186 1.21017

Minimum 3.67 6.33 6.00 4.50 3.33

Maximum 10.0 10.0 10.0 10.0 10.0

� Respondent’s with more leadership training reported higher transformational leadership practices

� modeling the way (r =.296, p < .001), inspiring a shared vision (r =.320, p < .001), challenging the process (r = .240, p < .05), enabling others to act (r = .193, p < .05), encouraging the heart (r = .212, p <.05)

� There were no significant differences in five LPI subscales based on the office held

� challenge the process (F = 1.433, p = .227), enable others to act (F = .579, p = .678), encourage the heart (F = 1.021, p = .400), inspire a shared vision (F = 1.170, p = .328) modeling the way (F = 1.162, p = .331)

� Porter-O’Grady (2009) compared Magnet CNOs and non-Magnet CNOs: no statistically significant differences

� Clavelle et al.’s (2012): the top two TL practices of CNOs in Magnet organizations were enabling others to act and modeling the way

Model the Way Inspire a Shared

Vision

Challenge the

Process

Enable Others to

Act

Encourage the

Heart

Ross et al M 8.50

SD .921

M 8.21

SD 1.21

M 8.17

SD 1.10

M 8.77

SD .662

M 8.61

SD .895

Clavelle et al M 8.39

SD .872

M 8.22

SD 1.05

M 8.16

SD .909

M 8.70

SD .674

M 8.17

SD 1.10

Porter-O’Grady M 8.81

SD .67

M 8.51

SD .92

M 8.50

SD .85

M 9.17

SD .57

M 8.61

SD .95

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� The study is limited by being the first to study TL in nursing leaders of PNAs

� The closet nursing comparison group was the leadership practices of Magnet and non-Magnet CNOs

� The LPI was administered as self-assessment and was not combined with an observational 360-degree data collection process (members in the PNA)

� Sample size and response rate

� There was a difficulty obtaining emails of nursing leaders

� Potential limitations of the transformational model, it is possible that the claim made by advocates regarding the extent of transformational leadership in nursing is exaggerated (Hutchinson & Jackson, 2013).

� A larger sample, repeat the study

� Identify other leadership attributes with other types of instruments in leadership

� Expand on the finding that the more leadership training one had the more TL practices were reported

� Leadership development r/t improved outcomes

� Lack of research investigating TL and nurse leaders of PNAs on nursing and outcomes

� Are nurse leaders in PNAs really as transformational

� Further investigation with research into leadership development and improved outcomes is warranted

� Future opportunity exists with the variable of the current office held and researching each office independently looking at outcomes

� It would be interesting to further research the finding of low scoring means of challenge the process (why so low)

� Understanding why leaders rate this quality so low and changing this perception is important to complying with the recommendations of the IOM Report on the Future of Nursing

� Professional nursing associations have the opportunity to provide a culture that promotes and values leadership

� Transformational leadership is a model that provides an approach to foster organizational and personal change

� TL practices can be learned by those seeking to strengthen their abilities and maybe as easily adaptable to other settings such as professional nursing associations

� Professional nursing association’s nurse leaders must identify priorities for accomplishing the IOM’s report on the Future of Nursing recommendations and take responsibility for executing those recommendations

� PNAs and nurse leaders should make available leadership development and mentoring programs throughout their associations

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