1. Ulrich, Beth EdD, RN, FACHE, FAONL, FAAN

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Every person influences others whether they intend to or not. Too often, people think that they must have authority to influence, but nothing could be further from the truth. Indeed, using authority or power is a brute force approach. Getting things done requires working with others and others working with you. Influence is the path to true leadership and a critical skill for nursing professional development (NPD) practitioners.

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Influence can be intentional or unintentional. We often do not know who we influence or how much we influence others. I have a long-time colleague who one day told me that I was responsible for her staying in nursing education. She described in detail a relatively short conversation we had on the steps of the school of nursing building almost 20 years earlier. When she asked if I remembered the conversation, I answered her honestly and said I did not. But what she told me that day made me realize how often we influence others-positively or negatively-when we are not aware of it. An everyday conversation, how we treat other people, and how we live our values are all examples of how we influence others.


Role modeling can be a form of intentional or unintentional influence. When undergraduate students participate in clinical rotations, they may see both positive and negative role modeling from the registered nurses they observe in the clinical area. The adage, "Actions speak louder than words," holds true with influence. For example, positive role modeling is a critical component of precepting (Ulrich, 2019). Dissonance between what a preceptor tells a new graduate registered nurse (NGRN) and what the NGRN observes the preceptor doing delivers a mixed message that can lead to confusion and uncertainty for the NGRN. Authenticity is a critical component of influence.


Sometimes individuals ask for your influence when they are facing unfamiliar situations or decisions. In doing so, they are telling you that they respect your knowledge and expertise and they believe you can help them see a clearer picture of their situation and their choices. Saying yes requires a complex commitment-a commitment to time, to be fully present, to be objective, to elicit information, to listen carefully, and to always remember that it is about the other person and not you.



Leadership is a standard of practice expected of all nurses (American Nurses Association, 2021), not just those in formal leadership positions. In addition, leadership is one of the seven roles of the NPD practitioner, and Standard 12, "Leadership," in the NPD scope and standards addresses leadership competencies (Harper & Maloney, 2022). In the five levels of leadership described by leadership guru John Maxwell (2018), the lowest level is positional leadership (people follow because they have to) and the highest level-attained by influence-is respect (people follow you because of who you are and what you represent). Influence is not determined by position; it is determined by actions.


How do you influence others to change practice, to do (or not do) certain behaviors, and to work with you to improve such things as patient care, the practice and learning environments, or interprofessional collaboration? The Cohen-Bradford Model of Influence Without Authority is one path (Cohen & Bradford, 2017). This model is based on the law of reciprocity (quid pro quo, give and take). Influence is about trades-exchanging something of value to you for something of value to the person/people you are trying to influence. The essential components of the model include the following:


* Assume everyone is a potential ally. Allies are critical. As Cohen and Bradford note, "Few people can do anything significant alone" (p. 4).


* Clarify your goals and priorities. Know your preferred outcomes and nonnegotiables before you begin and be prepared to clearly articulate them.


* Diagnose the world of the other person. Put yourself into your potential ally's shoes. What does the world look like from their point of view? What do they care about?


* Identify relevant currencies-theirs and yours. What is important to them and what is important to you? What can you give them or what can they give you that would be of value? Currencies are often inspiration-related, task-related, position-related, relationship-related, or personal.


* Deal with relationships. Relationships are critical to influence. Consider your current relationship with the person you want to influence. Is it good or not-from your view and from the view of the other person? What would the other person like it to be? What would you like it to be?


* Influence through give and take. Reciprocity is key. Look for win-win outcomes.



Grenny et al. (2013), the team from VitalSmarts (now called Crucial Learning) who wrote Silence Kills and Crucial Conversations, concluded from their extensive research that the common thread that connects successful leaders, regardless of their objective or setting, is "their capacity to influence others to change their behavior in order to achieve important results" (p. 6). They are clear, as are Cohen and Bradford (2017), that influence does not mean "persuasion," nor does it mean manipulation of others to get what you want. Rather, it is understanding "why people do what they do and what it takes to help them act differently" (Grenny et al., 2013, p. 6).


Grenny et al. (2013) identified three keys to influence.


* Focus and measure. Be clear about the intended results and zealous about measurement.


* Find vital behaviors. Identify and focus on high-leverage behaviors that have been shown to drive the desired results for others and for your organization.


* Identify sources of influence behind the behavior you are trying to change and engage as many of those sources of influence as possible (preferably all six). The sources of influence identified by Grenny et al. include personal motivation and personal ability, social motivation and social ability, and structural motivation and structural ability. An example of identifying and engaging sources of influence can be found in a short YouTube video of scenarios, titled "All Washed Up," on influencing children to wash their hands (Crucial Learning, 2009).




The potential sphere of influence of NPD practitioners is wide. Knowing how to influence without authority is a critical competency because most NPD practitioners do not have direct authority over the people they influence (e.g., managers, academic colleagues who they work with on clinical rotations, student nurses, NGRNs, and collaborative partners in other departments). To be effective, successful influencers, NPD practitioners must be conscious of their potential for unintentional influence and deliberate on their use of intentional influence.




American Nurses Association. (2021). Nursing scope and standards of practice (4th ed.). Author. [Context Link]


Cohen A. R., Bradford D. L. (2017). Influence without authority (3rd ed.). Wiley. [Context Link]


Crucial Learning. (2009, September 22). All washed up! [Video]. YouTube.[Context Link]


Grenny J., Patterson K., Maxfield D., McMillan R., Switzler A. (2013). Influencer: The new science of leading change (2nd ed.). McGraw Hill. [Context Link]


Harper M. G., Maloney P. (2022). Nursing professional development: Scope and standards of practice (4th ed.). Association for Nursing Professional Development. [Context Link]


Maxwell J. C. (2018). The 21 irrefutable laws of leadership (10th ed.). Thomas Nelson. [Context Link]


Ulrich B. (2019). Mastering precepting (2nd ed.). Sigma Theta Tau. [Context Link]