1. Henriksen, Janet PhD, MBA/HCM, BSN, RN

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Described as one of the most demanding work environments across multiple industries, the nurse practice environment is inundated with concerns over health and safety issues, including job-related injuries and stress, physical assaults, threats, and verbal abuse.1-3 Strong nursing leadership is needed to create practice environments and work climates that are healthier and safer for both nurses and patients.4,5 Nurse managers are recognized as leaders who have the ability to create practice environments that influence the quality of patient care, nurse job satisfaction levels, and the achievement of performance goals.6

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The primary goal of nurse managers is to enable the creation of nursing departments that are well structured, ensure that the organizational context supports the work of nurses, and provide skilled coaching to assist nurses in maximizing their performance processes as a means of harvesting the collective synergies of the nursing staff.7,8 In fact, because nursing care and practice are fundamentally based on relationships and social interactions, top-down, linear, power structure leadership models frequently don't result in effective outcomes or culture transformations.9


The ability of nurse managers to foster a new perspective that recognizes the complex relationships between a multiplicity of interacting forces as opposed to the actions and influences of the individual(s) may enable the creation of adaptive outcomes.10 Complexity leadership theory (CLT) suggests that leadership is a dynamic, emergent, and interactive process rather than a position of authority. Integrating CLT leadership education and clinical practice programs may be essential to the ability of the nurse manager to develop the important skills needed to enable the creation of positive practice environments.


Transformation ahead

A framework for leadership and practice environment transformation requires a refocusing of the nurse manager role. There are three leadership functions that are necessary to transform the role of the nurse manager and the practice environment. First, nurse managers enable the creation of adaptive and learning social systems as opposed to actions of authority.10 Second, nurse managers focus on the alignment and control of resources, tasks, strategies, and conflicts. Third, nurse managers enable and manage the creation of conditions that foster innovation, adaptability, and the flow of knowledge.10 To transform the role of the nurse manager, specific leadership skills are required.


Six key attributes of the nurse manager have been identified: visionary, expert, achiever, communicator, mentor, and critical thinker.6,11 The development of the six key leadership attributes is most effective when an innovative and continuous learning approach is integrated into all levels of an organization.6,11 Continuous leadership development through the use of varied teaching methods (classroom and clinical settings), feedback systems, and integrated learning strategies exposes the nurse manager to an optimal education paradigm.11


To be visionary, the nurse manager must create and clearly communicate a personal vision to guide change and enable others to achieve a purpose and move to action.9,11 This leadership skill requires nurse managers to have the competence and understanding to continually expand their ability to create the results they seek.9 The concepts of self-awareness and emotional intelligence (EI) are essential to being an effective visionary. Self-awareness is having an accurate understanding of one's strengths and weaknesses, including traits, behaviors, and feelings.12 It's a skill gained through reflection and feedback systems.13 EI may be defined as the ability to express, read, and understand emotions, and how emotions are communicated or relayed during social interactions.14 Nurse managers with high levels of self-awareness and EI are often committed to a vision aside from self-interests. They challenge the status quo, listen and encourage others, and engage in a shared vision.


To be an expert requires the acquisition of in-depth knowledge and skills through empiric and systems perspectives.11 Instead of learning from trial and error or on-the-job training that can result in role fatigue and burnout, nurse managers should engage in true leadership development, including a combination of theory and practical application.15 Self-assessment tools, such as the complexity leadership profile, can be a valuable resource for the nurse manager.9 Engaging in self-reflection and self-awareness activities is an important aspect of complexity leadership.


Being an achiever is about getting results-the achievement of desired outcomes.11 This skill requires the nurse manager to facilitate outcomes through collaborative relationships or networking, effective and efficient processes, and a shared vision as opposed to charisma or authority.11,16


Being a communicator is a skill of versatility-the ability of the nurse manager to create a culture based on multiple modes of communication, situational judgment, change management, interpersonal relationships, and continuous feedback systems.11,16 Nurse managers need strong communication skills to tackle tough conversations with staff, patients, families, and other healthcare providers while creating safe cultures.9 Using the commit, recognize, invent, and brainstorm, or CRIB, process may be an effective mechanism for nurse managers to develop their communication skills while developing safe practice environments.9 Nurse managers commit to seeking mutual purpose, recognizing the purpose of the strategy, inventing a mutual purpose, and brainstorming new strategies.9


To be a mentor requires the nurse manager to actively engage in professional self-development and the development of other nurses by establishing systems that support talent acquisition, retention, satisfaction, professional development, socialization, coaching relationships, and a community of leadership.11,17


To be a critical thinker, the nurse manager must acquire knowledge and practice using reflective learning cycle skills, such as planning, acting, observing, and reflecting.18 Consider the 4D cycle of discover (what works best), dream (what might be), design (what should be), and destiny (what will be) premised on the concept of appreciative inquiry.9 This approach builds on relationships as opposed to roles and highlights the importance of creativity, positive contributions, and diversity of ideas.


Dynamic and complex

The complex role of the nurse manager as a leader provides a unique perspective to better understand how to transform traditional nursing cultures into positive practice environments.19 Described as "chief culture builders," nurse managers assume the responsibility of creating healthy work and care delivery environments.20 Nurse managers are change agents who are in key positions to facilitate innovation and prevent clinical nurse discontentment by developing a need for change, establishing interdisciplinary rapport, diagnosing problems, establishing information exchange relationships, championing change, and translating intent into action.9


CLT is an effective approach for nurse managers to create professional practice environments that foster autonomy, self-awareness and reflection, interpersonal relationships, and independence.9 Nurse managers engage in continuous learning, shared visions, and appreciative inquiry while embracing chaos and ambiguity as a platform for dynamic, emergent, and interactive systems.




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