1. Thompson, Elizabeth M. MSN, RN, CNOR

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In a few of my editorials, I've discussed leadership, both with the perioperative nurse at the bedside and the OR manager. Leadership failure has been identified as a major contributor to errors. Each one of us is a leader and manager of our environment, and every surgical suite and each OR needs a good leader.

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Leadership styles differ, and how perioperative nurses and managers lead their team affects outcomes. In our institution, relationship-based care is the nursing model upon which we base our practice. The role of a transformational leader is recognized as one of the roles in the nursing model that the nurse needs to develop and exhibit. This leadership style is one which, I believe, translates well into the perioperative nursing role.


Transformational leadership can be defined based on the effect it has on those who follow the leader, and leads to positive changes in followers. Transformational leaders "motivate and inspire people by helping group members see the importance and higher good of the task. These leaders are focused on the performance of group members, but also want each person to fulfill his or her potential."1 The model has four components: intellectual stimulation, individualized consideration, inspirational motivation, and idealized influence.


Through intellectual stimulation, the transformational leader encourages problem solving and critical thinking, and empowers followers to do what's best for the organization. For example, using the OR team wisely is an exercise in fiscal responsibility. By including staff in the decision making (an example of individualized consideration), managers promote creativity and ownership of solutions, and increase staff retention.


With inspirational motivation, the leader keeps the primary vision, in this case the best outcome for the patient, as the focal point and helps followers to share this vision. Keeping lines of communication open, supporting, and encouraging others is key in the perioperative nursing role to preserve relationships in the OR and maintain the primary vision.


Nurse managers can inspire and motivate staff through visibility and presence. By being visible, managers can develop and maintain relationships with staff and surgeons. Presence and visibility provide evidence that managers care about the practice and are interested in what staff and surgeons have to say.


Individualized consideration identifies the strengths in individual followers and supports growth. Preceptorship and mentorship of others, involvement in committees as well as providing staff development through education supports this component of transformational leadership. Role modeling exemplifies the characteristic of idealized influence. Members of the perioperative team will assimilate the behaviors of the leader into their practice. Speaking up, professionalism, supporting policies and procedures, as well as inclusion of all team members in decision making are all examples of positive influence.


All members of the operative team can take a leadership role during different points during the operative procedure. A good team allows for this toggle of leadership exchange and recognizes the value of promoting each member to engage in this role. The patient, organization, and the individual benefits when each member of the operative team takes a leadership approach and uses transformational leadership strategies.


Elizabeth M. Thompson, MSN, RN, CNOR

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Editor-in-Chief Nursing Education Specialist Mayo Clinic, Rochester, Minn.




1. Cherry K. What is transformational leadership? [Context Link]