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.