1. Lal, M. Maureen MSN, RN


The pace of change in today's healthcare environment is unprecedented. What used to happen every few months now seems to happen every day. From rapidly shifting technology to evolving models of care to new payment systems, nursing leaders must navigate constant change to stay relevant. How well they manage it has a direct bearing on everything from patient safety and outcomes to nursing cohesion and satisfaction. In this month's Magnet(R) Perspectives column, we explore the essential elements that contribute to successful change management and the strategies leaders can employ to keep their nurses, and their organizations, forward-focused. In addition, we take a deep dive into the Magnet Model component of transformational leadership and examine its impact on creating and sustaining an environment where change flourishes and nurses thrive.


Article Content

Change is a permanent feature of the healthcare landscape and one of the most daunting challenges for chief nursing officers (CNOs) today. To compete and survive, healthcare systems must embrace continuous change.1 Everything from technology and care delivery to reimbursement and corporate structure is evolving on a near-constant basis. This relentless pace can lead to stress and burnout. Nurses are susceptible to change fatigue, which can compromise patient care.2 Ignoring change is not an option, and nursing leaders must find ways to successfully manage it to stay relevant and achieve success.

Figure. No caption a... - Click to enlarge in new windowFigure. No caption available.

Evidence shows that CNOs excel as change agents when they can both articulate new goals and objectives and inspire others to commit to achieving them.1 Nelson and Pilon3 found that a structured method for implementing organizational change is vital for success. In their best-selling book "Switch," brothers Daniel and Chip Heath4 say successful changes share a common pattern: they require a leader capable of influencing not just workers' physical environment, but also their hearts and minds.


Transformational Leadership: A Model to Drive Change

Transformational leadership is an evidence-based method to successfully drive and manage change. By fostering a culture of accountability, ownership, and autonomy, transformational leaders motivate teams to embrace volatility. This leadership style is built on creating and sustaining trust, actively engaging in the change process, involving employees in decisions, and ensuring that everyone pursues jointly held goals. Transformational leadership in healthcare not only motivates teams, but also improves outcomes. Researchers have found that transformational leaders strongly influence positive organizational culture and patient results.5,6


Transformational leaders focus not only on what to do, but also why to do it. They organize staff around an accepted, shared purpose that propels the organization to realize its goals. Traits that these leaders have in common include the following:


* communicating with full transparency;


* being visible-getting out from behind their desks and interacting with staff; and


* modeling the behavior they expect-they don't just tell their employees to do something, they show them how to do it.



Transformational Leaders in Magnet Organizations

It is no accident that transformational leadership is the 1st of the 5 components of American Nurses Credentialing Center's Magnet Model(R). As outlined in the 2019 Magnet(R)Application Manual, the transformational CNO communicates expectations, develops leaders, and evolves the organization to meet current and anticipated needs and strategic priorities.7


With a focus on communication, collaboration, and trustworthy leadership, Magnet organizations feature strong, visible, and accessible leaders. The environment is one in which nurses know their voices are heard, their input is valued, and their practice supported. Nurses at all levels are empowered to identify and bring forth concerns without fear of retribution. In fact, Magnet CNOs rely on input from clinical nurses to influence change in the organization. Magnet Standard TL4 specifically addresses the CNO's advocacy and influence. To achieve the Magnet credential, hospitals must provide evidence of how the CNO's leadership resulted in a strategic organizational change.


In an era of dizzying change, transformational leadership is more critical than ever. The Magnet environment not only advances the fundamental principles that enhance change management, but also gives leaders the tools to stay agile and adaptable as they continue to improve structures, processes, and expectations.




1. Daly J, Hill M, Jackson D. Leadership & Healthcare Change Management. Chapter 6, Nursing Contemporary Perspectives. 2nd ed. Chatswood, Australia: Elsevier Australia; 2015. [Context Link]


2. Holdren P, Paul DP, Coustasse A. Burnout Syndrome in Hospital Nurses. 2015; Paper presented at BHAA International; Chicago, IL. Accessed February 14, 2019. [Context Link]


3. Nelson KE, Pilon B. Managing organizational transitions: the chief nurse perspective. Nurse Lead. 2015;13(3):71-76. [Context Link]


4. Heath C, Heath D. Switch: How to Change Things When Change Is Hard. New York, NY: Broadway Books, Random House; 2010. [Context Link]


5. Fischer SA. Transformational leadership in nursing: a concept analysis. J Adv Nurs. 2016;72(11):2644-2653. [Context Link]


6. Deshpande S, Sahni S, Karemore T, Joshi J, Chahande J. Evolution of relationship between leadership style and job satisfaction amongst healthcare professionals. 2015. DOI: [Context Link]


7. 2019 Magnet(R) Application Manual. Silver Spring, MD: American Nurses Credentialing Center. [Context Link]