Transformation Nursing Practice Leadership assignment
Transformation Nursing Practice Leadership assignment
-What is the nursing professional practice model? Describe one type of model.
– Visit YouTube on the internet. Search for “nursing” or “nurses.” So, what do you find? View one of the selections and critique the image portrayed. Moreover, discuss in a team with classmates.
Transformation Nursing Practice Leadership assignment
– Also, consider how the five core competencies might be used as a framework for a professional practice model. Describe your model in a narrative form and graphically on long paper. Post it in the classroom and explain your model.
Evidence-Based Management and Transformational Leadership
Creating work environments for nurses that are most conducive to patient safety will necessitate fundamental changes across many health care organizations (HCOs), including changes in how work is designed and personnel are deployed, as well as changes in how the organization’s culture understands and acts on the science of safety. These changes necessitate leadership capable of transforming not only the physical environment, but also the beliefs and practices of nurses and other health care workers providing care in that environment, as well as those in the HCO who establish the policies and practices that shape the environment—the individuals who comprise the organization’s management.
Behavioral and organizational research on work and workforce effectiveness, health services research, studies of organizational disasters and their evolution, and studies of high-reliability organizations (see Chapter 1) have identified management practices that are consistently associated with the successful implementation of change initiatives and the achievement of safety in the face of high error risk. These practices include (1) balancing the tension between production efficiency and reliability (safety), (2) building and sustaining trust throughout the organization, (3) actively managing the change process, (4) involving workers in work design and work flow decision making, and (5) using knowledge management practices to establish the organization as a “learning organization.” These five management practices, which are critical to patient safety, are not consistently implemented in nurse work environments.
The committee concludes that transformational leadership and action by each organization’s board of directors, senior and midlevel management, and other stakeholders are required to fully realize the benefits of these five management practices. Collaborations with other HCOs can facilitate more widespread adoption of these practices because HCOs vary in the extent to which they currently employ these practices as well as in their available resources.
This chapter delves into the critical roles of transformational leadership and evidence-based management in bringing about the changes needed in nurses’ work environments to improve patient safety. We begin by discussing transformational leadership as a necessary prelude to any change initiative. The five management practices enumerated above are then reviewed in turn, and their uneven application in nurses’ work environments is described. Following that, we present several models for evidence-based management in the workplaces of nurses. Finally, we look at how evidence-based management collaboratives can be used to encourage the adoption of quality improvement practices in health care. Throughout the discussion, we make four recommendations (highlighted in bold print) for improving nurses’ work environments through improved leadership and management practices.
THE ESSENTIAL PRECURSOR OF TRANSFORMATIONAL LEADERSHIP
The primary function of leadership is to achieve a common goal (Burns, 1978). Not surprisingly, leadership has been observed to be an essential prerequisite for achieving safety in a variety of industries (Carnino, undated), a critical factor in the success of major change initiatives (Baldridge National Quality Program, 2003; Davenport et al., 1998; Heifetz and Laurie, 2001), and critical to an organization’s competitive cost position following a change initiative. Only the chief executive officer’s (CEO) involvement in core clinical changes had a statistically significant positive effect on the cost outcomes of reengineering in a study of hospital reengineering initiatives in U.S. acute care hospitals from 1996 to 1997. (Walston et al., 2000). Leadership has also been linked to increased job satisfaction, productivity, and organizational commitment among nurses and other HCO employees (Fox et al., 1999; McNeese-Smith, 1995).
James Burns’ seminal study on leadership, which won the Pulitzer Prize, identifies the essential characteristics of leadership (as opposed to power wielding) and distinguishes “transactional” leadership from the more potent “transformational” leadership (Burns, 1978). He emphasizes that leadership, like the exercise of power, is fundamentally based on a relationship between the leader and the follower (s). In contrast to power, leadership recognizes and responds to—indeed, is inextricably linked to—the needs and goals of followers as well as those of the leader. Leadership is demonstrated by engaging and inducing followers to act in order to further specific goals and purposes “that represent the values and motivations, wants and needs, aspirations and expectations of both leaders and followers” (Burns, 1978: 19). The genius of leadership is found in how leaders see, act on, and satisfy the values and motivations of their followers as well as their own.
As a result, leadership can be transactional or transformational. Most leader–follower relationships are characterized by transactional leadership. It entails a “you scratch my back; I’ll scratch yours” exchange of monetary, political, or psychological goods. Each party to the bargain is aware of the other’s power and attitudes. Their goals are related and advanced only as long as both parties believe the relationship advances their individual interests. The bargainers do not have an enduring relationship that holds them together; as soon as a valuable item is perceived to be in jeopardy, the relationship may fall apart (Burns, 1978). Labor strikes as a result of a change in working conditions demonstrate this point. Labor compliance with management is based on an acceptable set of transactions; when the transactions change, the relationship may not be as strong. Burns observes that a leadership act occurs in such cases, but it is not one that “binds leader and follower together in a mutual and continuing pursuit of a higher purpose” (Burns, 1978:20). Transactional leadership is defined as “a bargain to aid the individual interests of persons or groups going their separate ways” rather than “a joint effort of persons with common goals acting for a collective purpose” (Burns, 1978:425).
Transformational leadership, on the other hand, occurs when leaders collaborate with their followers to achieve common goals. Their goals, which may have begun as separate but related (as in the case of transactional leadership), have become entwined. Such leadership is sometimes referred to as “elevating” or “inspiring,” because those who are led feel “elevated by it and frequently become more active themselves, thereby creating new cadres of leaders” (Burns, 1978:20). Transformational leadership is essentially a mutual stimulation and elevation relationship that raises the level of human conduct as well as the aspirations of both the leader and those led, and thus has a transforming effect on both (Burns, 1978).
Transformational leadership is accomplished through specific actions taken by leaders. First, leaders take the initiative to establish and commit to relationships with their followers. This effort includes the development of formal, ongoing mechanisms that promote two-way communication, information exchange, and idea exchange. Leaders play a critical role in maintaining and nurturing relationships with their followers on an ongoing basis. Burns observes that, above all, leaders seek to satisfy their followers’ wants, needs, and other motivations as well as their own. Understanding the wants, needs, and motivations of followers can only be achieved through ongoing communication and the exchange of information and ideas. Leaders change and elevate their followers’ motives, values, and goals by addressing their followers’ needs and teaching them about their common goals. To do so, leaders may need to modify their own leadership in response to followers’ preferences, in anticipation of followers’ responses, or in pursuit of their common motives, values, and goals.
Although a transforming leader is primarily responsible for achieving the combined goal of the leader and followers, transformational leadership recognizes that leaders and followers are partners in a common enterprise and thus rely on one another. The premise of transformational leadership is that people are currently or potentially united in the pursuit of higher goals, regardless of their separate interests. The achievement of significant change through the collective or pooled interests of leaders and followers demonstrates this point. The extent to which intended change is actually accomplished and human needs and expectations are met determines the effectiveness of leaders and leadership (Burns, 1978).
Given the preceding discussion, Burns provides reassurance that transformational leadership is far more common than might be assumed. He observes that acts of transformational leadership are not limited to (and are often not found in) governmental organizations, but are common in everyday events, such as when parents, teachers, politicians, or managers tap into the motivations of children, students, the electorate, or employees in order to achieve a desired change.
Individuals in potential transformational leadership roles in acute care hospitals range from board-level chairmen and directors to chief executive, operating, nursing, and medical officers, and on down the hierarchy to unit managers. Such leadership in nursing homes can come from the facility’s owners, administrator, director of nursing, and unit managers. Leadership from these senior executives and oversight boards is critical to achieving the breadth of organizational change required to achieve higher levels of patient safety—changes in management practices, workforce deployment, work design and flow, and the organization’s safety culture (see Chapter 1).
However, if these individuals rely solely on a traditional, transactional approach to leadership, such substantive changes will be difficult to achieve and sustain, as leaders will need to conduct frequent, ongoing, potentially contradictory renegotiations with workers in response to rapidly changing external forces. Transformational leadership, on the other hand, seeks to engage individuals in the recognition and pursuit of a shared goal—in this case, patient safety. Individual nurses, for example, may have a wide range of preferences for the number of hours they want to work per day or week. Trying to secure their commitment to the organization by accommodating all such requests (transactional leadership) despite evidence that extended work hours may be detrimental to patient safety would be both time-consuming and ineffective. Instead, transformational leadership would engage nursing staff in a discussion about patient safety and worker fatigue, with the goal of developing work hour policies and scheduling that prioritize patient safety while accommodating individual scheduling needs within that framework. As knowledge was shared, such a discussion could have a transformative effect on both staff and management.
A leadership approach that aims to transform all workers—both managers and staff—in pursuit of the higher collective purpose rather than a plethora of individual goals can be the most efficient and effective means of achieving widespread and fundamental organizational change. In order to practice transformational leadership, leaders must engage managers and staff in an ongoing relationship based on the shared goal of patient safety, as well as communicate with and educate managers and staff about this higher collective purpose.
When teaching managers about the steps they can take to reduce threats to patient safety, HCO leaders should emphasize the five management practices listed earlier, which have been found to be consistently associated with the successful implementation of change initiatives and the achievement of safety in organizations with a high risk of errors. These management practices also serve as the foundation for all of the worker deployment, work design, and safety culture practices covered in the remaining chapters of this report.
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ADDITIONAL INSTRUCTIONS FOR THE CLASS
Discussion Questions (DQ)
- Initial responses to the DQ should address all components of the questions asked, including a minimum of one scholarly source, and be at least 250 words.
- Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source.
- One or two-sentence responses, simple statements of agreement, or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words.
- I encourage you to incorporate the readings from the week (as applicable) into your responses.
- Your initial responses to the mandatory DQ do not count toward participation and are graded separately.
- In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies.
- Participation posts do not require a scholarly source/citation (unless you cite someone else’s work).
- Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.
APA Format and Writing Quality
- Familiarize yourself with APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required).
- Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation.
- I highly recommend using the APA Publication Manual, 6th edition.
Use of Direct Quotes
- I discourage overutilization of direct quotes in DQs and assignments at the Masters’s level and deduct points accordingly.
- As Masters’s level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content.
- It is best to paraphrase content and cite your source.
- For assignments that need to be submitted to LopesWrite, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.
- Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.
- Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?
- Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.
- The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.
- Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.
- If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.
- I do not accept assignments that are two or more weeks late unless we have worked out an extension.
- As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.
- Communication is so very important. There are multiple ways to communicate with me:
- Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.
- Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.