Leadership Perspectives: Advancing the Nursing Profession Begins With Leadership

Abstract

This bimonthly department, sponsored by the American Organization of Nurse Executives (AONE), presents information to assist nurse leaders in shaping the future of healthcare through creative and innovative leadership. The strategic priorities of AONE anchor the editorial content. They reflect contemporary healthcare and nursing practice issues that challenge nurse executives as they strive to meet the needs of patients.

Nurse leaders will serve a primary role in leading change to meet the current and future demands of our healthcare system. Nurse leaders must be progressive, collaborative, and pioneering to accomplish this challenge. Leaders must understand the current healthcare challenges, implement evidenced-based leadership into clinical practice, and transform healthcare through innovation. To accomplish this charge, nurse leaders must develop expertise in transformational leadership (TL) and emotional intelligence (EI).

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Transformational Leadership

Transformational leadership defines leaders who are inspiring, motivating, and admired by their followers. Transformational leadership is the process in which leaders and followers motivate each other to attain and achieve levels of success. Transformational leaders are leaders with the ability to recognize and build upon an individual's abilities-creating high-performance teams by inspiring and motivating their followers.1,2 These leaders effectively identify and communicate their vision. Transformational leaders are moral and ethical role models, and their followers trust them and work harder for their admiration.2 Transformational leaders have the ability to alter entire systems, using these skills to create change, new cultures, and value systems. They take the initiative; they have the ability to mobilize teams and followers, encouraging and empowering them. They motivate their teams to exceed expectations.1

Transformational leadership describes leaders with the ability to transform organizations. These leaders challenge themselves, as well as their followers, to take risks, support creativity, and achieve success. They exhibit professionalism, teamwork, competence, and effective communication.2-6 They learn from their failures to develop future successes and demonstrate effectiveness in organizational change and commitment. Transformational leaders are authentic, innovative, and visionary.7,8

Emotional Intelligence

True transformational leaders also possess EI-the ability to adapt to their environment based upon their competence in emotional and social abilities and skills.9 These noncognitive abilities, once mastered, assist individuals to adapt to the demands and stressors in their environment. Mastery in EI improves general well-being and enhances individuals' ability to succeed in life. Emotional intelligence combines individuals' behavior as well as social and environmental factors, both contributing factors in developing emotional skills, which relate to the potential for superb performance and, ultimately, success.9

Individuals with EI have the ability to self-reflect on their beliefs, biases, and behaviors. They identify their strengths as well as their opportunities for improvement. These individuals are flexible, manage stress well, and empathize with others.10-12

High levels of EI have been linked to individuals' achievements. Individuals who are well functioning, successful, and emotionally healthy possess some degree of EI, reflected in average or above-average scores on EI assessment tests. The higher the EI scores are, the more positive the likelihood for general successes will be in meeting environmental demands and pressures.9

Goleman 13 believes that EI affects all areas of life: work, school, and home. Goleman13 and Snow14 consider EI to be twice as important as technical skills and intelligence quotient (IQ) for jobs at all levels. Goleman13 states that when comparing top performers with average performers in senior leadership positions, 90% of the measurable differences between the groups' profiles are related to EI factors.

Experts say that IQ predicts between 1% and 20% of success in a professional role, whereas EI has been associated with 27% to 45% of job success. Of significance, IQ is relatively set at an early age, whereas EI develops as individuals age and can be enhanced through educational opportunities. Emotional intelligence rises steadily in both men and women, with age and peaks around age 50 years with a slight decline thereafter.10 Researchers support that highly emotionally intelligent leaders are more likely to advance professionally.9,10,13

Passion and motivation are necessary in nursing leadership to drive an organization to full potential. Developing skills in EI leads to passion,15 and passion can motivate teams and increase overall performance and creativity.3,6,15,16 Developing nursing leadership skills in EI will have an impact on employee, peer, organizational, and patient satisfaction, as well as promote personal and professional growth.3,12,17,18 Emotionally intelligent nurse leaders assist their organizations in maintaining the competitive advantage.14,19

Impact on Nursing Leadership

Nurse leaders should seek programs to assist in developing TL skills as well as enhancing their EI. Nurse leaders have been given an opportunity, and have an obligation, to partner with healthcare providers to take the lead in changing healthcare through visionary and progressive leadership. With the signing of the Affordable Care Act (ACA) by President Obama,20 nursing has been given a chance to advance their profession. The ACA focuses on increasing access to quality care, reducing health disparities, strengthening the healthcare workforce, and extending healthcare coverage for all Americans. The passing of this law is forecasted to bring an estimated 30 million additional Americans into the healthcare system.20

The implementation of the ACA has afforded nursing a voice in redesigning the healthcare delivery system, and nurse leaders must immediately act upon this opportunity using visionary leadership. Using TL and EI skills, nurse leaders can be assertive, creative, and progressive in advancing the health of the populations we serve. Identifying opportunities to use advanced practice nurses to lead care coordination is essential. This includes, but is not limited to, new nurse-led inpatient and outpatient care delivery models, as well as increasing the number of advanced practice nurses. There is a need to improve the transition of patient care between healthcare settings and then through discharge home. Developing nurse-led transitions of care programs will improve self-management of disease and reduce readmission rates to the acute care setting. Nurse leaders must support substantial professional gains to remove scope of practice barriers supporting independent advanced practice, to offset the predicted physician shortage,21 which now stands at a shortage of approximately 13000 physicians but is expected to increase 10-fold by 2024.22

It is estimated that more than 581500 estimated new nursing positions will be created by 2018, increasing the nursing workforce by 22%, to meet the demands of healthcare reform.23 Meeting these numbers will require sufficient numbers of competent nurse leaders to meet the projected need of 260000 RNs by 2025.24 The current nursing shortage is anticipated to become twice as large as any nursing shortage experienced since the 1960s.24 This shortage underscores the need for nursing leadership at every level in all healthcare organizations.25

Leadership begins with an individual who is motivated and self-aware. Leaders need to be self-expressive and to listen to their inner voice to develop character and vision. Vision should align with core values and beliefs. Leaders must continue to learn, accept responsibility, and hold themselves accountable.7 Through advancement in knowledge of EI and TL skills, nurse leaders can recognize their strengths as well as their opportunities for growth.9,17 Using these skills, they will be able to promote teamwork, develop passion in themselves and their staff, and advance the nursing profession and their organizations.15