1. Polacek, Michael J. MSN, NPD-BC

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In 2010, the Institute of Medicine published the report on The Future of Nursing: Leading Change, Advancing Health (Institute of Medicine, 2011), charging the nursing profession to become a full partner with other disciplines to reform health care. One interpretation of full partnership has been measured by the number of nurses on boards as a governance leader (Creviston & Polacek, 2018). This aligns with the vision of leadership being that of a manager/administrator leader. Sundean et al. (2019) noted that nurses may not recognize this role as part of their profession and lack the preparation necessary to contribute to the decision-making processes and might even feel uncomfortable in meeting culture. This leadership role is not limited to the manager/administrative nurse but also includes the nonmanagerial nurse who extends their influence into the community as a volunteer advocate and leader-the nurse policy entrepreneur (NPE; Gregg et al., 2018).

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The NPE role may be more in line with the nurse whose strengths do not lay in management and administrative leadership roles. Some nurses may be more adept at leading and operationalizing quality improvement projects and implementation of best practice within the community. Leadership is about expanding the capacity for people and systems to effectively achieve desired outcomes, and it is the lack of capacity that causes people and systems to act and function ineffectively. Transactional leadership is an important approach when creating and sustaining competence and processes, making clear expectations and consequences for adherence or nonadherence to organizational goals (Sow, 2017).


Transformational leadership, on the other hand, focuses on creating an environment that expands the capacity of people to function beyond competence and achieve exemplary practice. Transformational leadership supports the internal drive to achieve, whereas transactional approaches tend to rely on external motivation often through coercion. However, it is notable that the American Nurses Credentialing Center Magnet Recognition Program recognizes the preeminence of the transformational approach as a pillar underpinning the culture of Magnet by excluding transactional approaches within the Magnet Model (American Nurses Credentialing Center, 2020).


Both leadership approaches can support structural empowerment, but the transactional approach is significantly subordinate to transformational for healthy cultures of excellence. However, transformational leadership behaviors can be much more difficult than transactional behaviors, leading managerial leaders to rely on hierarchical relationships that embody processes rather than interpersonal relationships. It is not surprising that the first nursing theory after Nightingale was Peplau's (1997) theory of interpersonal relations that forms a core underpinning for the nursing profession (Delaney & Ferguson, 2014).


Self-leadership is another approach to leadership. As a professional, the nurse must feed the internal motivation to continuously conduct professional development activities. The Association for Nursing Professional Development's (ANPD) Nursing Professional Development: Scope & Standards of Practice (Harper & Maloney, 2016) includes 6 standards of nursing professional development, which are essentially the nursing process, and 10 standards of professional performance. To become a thought leader and influencer of healthcare reform, the nurse must be fully prepared to perform by activating all 16 standards. Preparing to be that agent of change demands the NPE must gain competence in meeting culture by serving on boards and committees and attain higher levels of academic preparation.


But what does all that look like? My journey began as a new nurse in 2010 with an eager vision of developing into a professional, and I set four general competency goals: (a) learn how to effectively function in meeting culture, (b) learn how to conduct research, (c) learn how to present in public, and (d) learn how to publish scholarly articles. What I did not realize at the time was that these were preparatory processes and not ends in themselves. I had no vision for why or what IT was that I was seeking to achieve (Polacek & Delaney, 2020).


Along the way, I found that getting elected to a national board of directors, receiving national recognition, presenting papers internationally, and other experiences were only markers that I was developing as a professional, but I still had not found my IT. Being active in my professional association, becoming a member of committees and boards of directors, and gaining advanced nursing degrees have helped me to understand how the system of healthcare functions in situ. Then I found my why.


Someone I know closely intimated that they had been struggling with suicide and described the various ways they had either actively or passively attempted to die. As a psychiatric-mental health nurse, I had prevented suicide for years by close observation, hiding the sharps, putting people into paper scrubs, and administering medication. But I realized that I knew nothing about the phenomena of suicide and had not been providing care in an authentically human way. I only completed processes. The epiphany was that, instead of seeing processes to complete as part of my job, I found myself surrounded by people treading life. Achieving zero suicide became my IT.


A leader often fills a role that enables them to be on center stage, has earned advanced degrees, enjoys a broad span of control, or enjoys a commanding authority. But as James MacGregor Burns noted in his Pulitzer Prize-winning book Leadership, the "ultimate test of leadership is transforming change" (Burns, 1978 p. 382). Leadership is not an attainment of power and control but generates outcomes that are person-centered and not just processes and data exhibitions to prove we are great processors.


A leader has uncoerced followers who have become inspired by the leader's vision, and out of that inspiration emerges an internal drive to do the same. The NPE is like a business entrepreneur in that they have the vision to meet an unmet need and will use any and every tool, including disrupting the status quo of an entrenched system. The entrepreneur is also keen to minimize failure by skills building, seeking out experts and mentors, along with identifying best practices to ensure success. There is a basic preparation such as becoming an exemplary practitioner, initiating a personal study of how to act in committees and on boards, joining Toastmasters International, and being professionally engaged in the community.


But the most valuable resource for personal leadership as an NPE is to take full advantage of what active ANPD membership offers. The Journal for Nurses in Professional Development keeps you up on current best practice; the conferences do so as well, along with developing a network of human resources. Committee work is the training ground for community workgroups, and presenting prepares the NPE for public speaking. The ANPD Leadership Academy prepared me to think on the same level as nonnursing program managers and how to develop political capital. As a matter of fact, I'm writing this article because of the relationship developed with an inspirational nurse leader during an ANPD conference.


Learning how to be a leader is a journey that has no end, and it looks different to each of us. The NPE is a leadership role that can achieve full partnership with other disciplines in healthcare reform if the nurse actively engages in a systematic approach to professional development. This includes becoming a student of transformational leadership; developing the basic skills set of meeting culture and public speaking; fostering professional networks, political and social capital; and growing issue expertise that validates you as a full partner. The bottom line is that the world needs the NPE more than ever before. But like all entrepreneurship, one must attack reform like a bear and not wait to be invited.




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