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Transformational Leadership Theory, Nursing Are Keys to Changing 21st Century Medicine

Higher Education Articles October 24, 2013

Nursing is a uniquely apt application point for transformational leadership theory nursing requires compassion, hard work, and integration into a hierarchical leadership structure that is often overburden and ripe for change.

According to Genevieve L. Thyer, RN, BN, MN, Dip Ed (in a transformational leadership theory/nursing article published in the Journal of Nursing Management), “Nurses may hold the key to transforming health care and dragging it into the 21st century in terms of work practices and reform.”

As the field continues to grow (by a predicted 26 percent through 2020, according to the U.S. Bureau of Labor Statistics), nurses can be a force for positive change.

If nurses hold the key, transformational leadership theory is the key.

What Is Transformational Leadership Theory?

Transformational leadership theory is an innovative theoretical viewpoint on the characteristics that catapulted major inspirational leaders to power. First given a name by James MacGregor Burns back in 1978 in his seminal book “Leadership,” the theory is finding resurgence in practical medical circles.

In his book, Burns describes transformational leadership as a leadership style that happens when “two or more persons engage with others, in such a way that the leader and followers raise one another to high levels of motivation and morality.” Burns, a historian and political scientist, took the leadership styles of famous historical leaders like Mahatma Gandhi and John F. Kennedy—and figured how those styles could be duplicated.

In practical terms, leaders who use transformational leadership ideas actively find ways to foster followers’ desires to live lives in line with values, morals, and humanitarian beliefs. Instead of using positions of power only to control and direct, transformation leaders use that power to instill a belief that their followers can do exceptional things.

The encouragement and leadership styles of transformational leaders inspire followers to perform beyond basic expectations (according to a transformational leadership PowerPoint presentation by Dr. Thelma Van Der Merwe).

In both practical work settings and classrooms, transformational leadership practices have shown to improve job satisfaction and patient outcomes—even enabling achievement of Magnet status. Such collaborative engagement brings leaders and followers together in pursuit of a shared vision, nurtures employees, directly addresses current nursing shortages, and facilitates practical reform of lagging medical systems.

What It Isn’t

To get a grip on what makes transformational leadership theory so powerful, it can help to pay attention to what it isn’t. Transformational leadership is not:

Autocratic: Classic in many hospital settings, autocratic leadership focuses on defined tasks and system-wide controls, with engagement in one direction—from the top down. Decrees come from the top; workers further down the hierarchy carry out certain functions.

Laissez-Faire: The laissez-faire style is a hands-off approach. The manager minimizes the number of “commands” in favor of allowing staff to take the initiative. Expert RNs, Habel and Sherman, on, state, “A laissez-faire management style is basically an abdication of leadership; there are no followers… because there is no leader.”

Transactional: Also defined by Burns, this style emphasizes concrete transactions between employer and employees—“I’ll pay you an agreeable salary and give you reasonable working conditions in exchange for your expected job performance.” Employee progress/loyalty is usually rewarded with a mix of praise and bonuses, such as salary increases or improved benefits.

These methods meet basic needs, but they do not unite leaders and followers with a common vision.

Transformational Leadership Theory: A Key to Lasting Change

Nurses with growth and development experience will recognize Burns’ reliance on Maslow’s Hierarchy of Needs. Abraham Maslow emphasized a spectrum of human needs: physiological stability (food and shelter), safety, “belongingness” and love, and self-esteem and self-actualization.

Healthcare organizations have traditionally relied on the fulfillment of Maslow’s first three tiers of needs, to motivate employees. Transformational leadership theory emphasizes the third and fourth levels—acceptance, self-esteem, and self-actualization—as keys to lasting motivation capable of bringing about drastic change.

For Burns, people who work with transformational leaders regularly see meaning and value in the work they do, have the tools to make a significant change, and possess the knowledge, skills, and freedom to become leaders themselves.

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