CE Article

AUTHENTIC LEADERS CREATING HEALTHY WORK ENVIRONMENTS FOR NURSING PRACTICE
By Maria R. Shirey, MS, MBA, RN, CNAA, BC. From Shirey & Associates and the College of Nursing and Health Professions, University of Southern Indiana, Evansville, Ind.

Implementation of authentic leadership can affect not only the nursing workforce and the profession but the healthcare delivery system and society as a whole. Creating a healthy work environment for nursing practice is crucial to maintain an adequate nursing workforce; the stressful nature of the profession often leads to burnout, disability, and high absenteeism and ultimately contributes to the escalating shortage of nurses. Leaders play a pivotal role in retention of nurses by shaping the healthcare practice environment to produce quality outcomes for staff nurses and patients. Few guidelines are available, however, for creating and sustaining the critical elements of a healthy work environment. In 2005, the American Association of Critical-Care Nurses released a landmark publication specifying 6 standards (skilled communication, true collaboration, effective decision making, appropriate staffing, meaningful recognition, and authentic leadership) necessary to establish and sustain healthy work environments in healthcare. Authentic leadership was described as the “glue” needed to hold together a healthy work environment. Now, the roles and relationships of authentic leaders in the healthy work environment are clarified as follows: An expanded definition of authentic leadership and its attributes (eg, genuineness, trustworthiness, reliability, compassion, and believability) is presented. Mechanisms by which authentic leaders can create healthy work environments for practice (eg, engaging employees in the work environment to promote positive behaviors) are described. A practical guide on how to become an authentic leader is advanced. A research agenda to advance the study of authentic leadership in nursing practice through collaboration between nursing and business is proposed. (American Journal of Critical Care. 2006;15:256-268)

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Notice to CE enrollees: A closed-book, multiple-choice examination following this article tests your understanding of the following objectives: 1. Discuss the current literature related to creating healthy work environments. 2. Discuss current literature related to authentic leadership. 3. Identify key components of authentic leadership for further research.

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shortage of 400 000 registered nurses is expected by 2020.1 The healthcare work environment as a source of overwork and stress has been implicated in the shortage of nurses.2 Because stress-related illness contributes to rising healthcare costs and disability,3 creating a healthy work environment is a priority for maintaining an adequate nurse workforce. Nurse managers play an integral role in creating the healthcare work environment. Few specific guidelines, however, are available on how to create and sustain the critical elements of a healthy work environment. This void in specific leadership guidelines is alarming given research indicating that the greater the stress faced within complex organizations, the more important the “soft” side of leadership becomes.4
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AMERICAN JOURNAL OF CRITICAL CARE, May 2006, Volume 15, No. 3

For example. true collaboration. Sigma Theta Tau International. we must take the conceptual and theoretical frameworks of healthy work environments and authentic leadership and translate this knowledge into practice. The review established that the early notions of a healthy 257 AMERICAN JOURNAL OF CRITICAL CARE. only English-language sources were reviewed.14 ment to hold together a healthy work environment. Fourth. From a broader perspective.In 2001. Further. the document is not explicit about how individuals become authentic leaders. is the glue that holds together a healthy work environment. a call for transforming the work environment with leaders as key partners has also been echoed by other influential organizations. First. and respectful for patients. May 2006. Second. sources published between 1990 and 2005 were identified by using the Ovid MEDLINE database. Among the 60 members of the alliance9 are AACN. Volume 15. The Honor Society of Nursing. the American Organization of Nurse Executives has produced a 2-volume series11 of exemplars of the healthy work environment. a research agenda to advance the study of authentic leadership in nursing practice is proposed. a practical guide based on the current understanding of authentic leadership and providing explicit directions on how to become an authentic leader is advanced. Second.2. the proposed mechanisms by which authentic leaders create a healthy work environment for practice are discussed. both anecdotal and empirical sources were included. Review of the Literature Healthy Work Environments: Search Strategy Authentic leadership. and communities. How is a healthy work environment created and sustained? The review of the literature produced 16 articles. healing. 3 . AACN has contributed with its document5 on standards for a healthy work environment. the American Association of Colleges of Nursing has issued a document 1 0 describing the hallmarks of the professional nursing practice environment. Third. so important is leadership in establishing the principles and elements of a healthy work environment for practice7 that a coalition of 60 nursing organizations known as the Nursing Organizations Alliance8 has supported a set of principles that each member organization has been asked to discuss and endorse. Third.15-30 Healthy Work Environments: Findings What Is a Healthy Work Environment? In the literature. the American Association of CriticalCare Nurses (AACN) made a commitment to promote the creation of healthy work environments that are safe.org A review of the literature on healthy work environments was conducted. not just any leadership. Thus. then the focus in advancing the merits of the AACN landmark document5 should be on engaging and developing authentic leaders to transform nursing practice. the American Organization of Nurse Executives. and the American Academy of Nursing. the sources had to answer at least 1 of the following 3 questions: 1.”6(p2) In fact. patients’ families. and authentic leadership) crucial to creating and sustaining healthy work environments in nursing practice. and nurses. Expanding the discussion relative to the definition of authentic leadership and strategies to develop authentic leaders should help advance the work of AACN and assist in the implementation of the standards. humane. an expanded definition of an authentic leader and the documented attributes of such a leader are presented.5 To this end. If authentic leadership is so crucial to holding together a healthy work environment. organizations. not just any leadership. effective decision making. No. patients’ families. This crucial action should help retain nurses in the profession and should also make a difference in the lives of patients.13. Sigma Theta Tau International has actively engaged in a call to shape the future through renewal. These organizations to some extent have incorporated the principles of healthy environments as part of their organizational strategic plans. How is a healthy work environment manifested? 3.aacnjournals.5 The role of leaders is so pivotal that authentic leadership. has been identified as “the glue that holds together a healthy work environment. healthcare colleagues. Sources that met the following 4 inclusion criteria were selected. Although the AACN document5 on a healthy work environment identifies authentic leadership as a key elehttp://ajcc. nurses. the AACN recently released a landmark publication specifying the standards necessary to establish and sustain healthy work environments in healthcare. First. the terms healthy work environment and healing work environment appear to be used as synonyms.5 Authentic leadership was identified as one of the 6 standards (skilled communication. appropriate staffing. Purpose This article has 4 purposes. meaningful recognition. the American Association of Colleges of Nursing. What is a healthy work environment? 2. the document does not provide an expanded definition for authentic leadership.12 and the American Academy of Nursing has through its members broadly contributed in the health policy arena. Last.

work environment date back to the days of Florence Nightingale. and external environmental stimuli are variables that affect therapeutic outcomes.28 and joyful workplaces. Second. and cheer is evident within work teams and the organization as a whole.26 For example. Fourth. risk taking.”18(p3). sounds. are patient-focused. Figure 1 Healthy work environments and their interdependence with clinical excellence and optimal outcomes for patients as conceptualized by the American Association of Critical-Care Nurses. and authentic leadership (Figure 1). healthy and effective work environments exhibit a strong sense of trust between management and employees.19. and reduces decision making not solely to considerations of money. Nightingale’s original assumptions about healing environments appear consistent with the findings of environmental psychology that colors. A sense of family is commonly reported in healthy work environments. Third.30 The literature expands the nomenclature of the healthy work environment to include organizational classifiers and philosophical approaches that have common characteristics of effective work environments. but also to consideration for the impact of decisions on the organization’s mission and its members. healthy work environments should have the necessary infrastructures to create “sanctuaries of healing” that are beneficial for all caregivers. Similarly. joyful workplaces.33 Healthy work environments are supportive of the whole human being. These organizations engage and empower employees in decision making. May 2006. concern and value for each person as an individual are apparent. How Is a Healthy Work Environment Manifested? Regardless of whether an organizational classifier or a philosophical approach is used to describe the work environment. Magnet-designated hospitals. and patient-focused environments.23 As is well documented in Nightingale’s Notes on Nursing.aacnjournals. views individuals as assets.22 First. Volume 15. http://ajcc. employees are treated in a respectful and fair manner. common characteristics of healthy work environments include 4 elements. Baldridge organizations exemplifying best demonstrated practices). effective decision making. a healthy work environment is “a work setting in which policies.31 an environment conducive to healing is one in which patients have a sense of warmth and wellbeing.34(p741) The term healthy work environment with its humane elements appears to be used interchangeably to incorporate healing work environments. meaningful recognition. healthy work environments supportive of the whole human being. healthy and effective work environments have an organizational culture that supports communication and collaboration. in healthy and effective work environments.32 Beyond the requirement to provide a healing and aesthetic physical work environment for patients is the more contemporary assumption that the healing environments must also extend to the nurses who care for patients. procedures. true collaboration. Philosophical approaches associated with healthy and effective work environments include learning organizations. healthy and effective work environments have a “feeling tone” in which individuals are encouraged to feel physically and emotionally safe. and are joyful workplaces.23 Magnet-designated nursing cultures. No. A sense of “family” is commonly reported in healthy work environments and cheer is evident within work teams. organizational classifiers associated with healthy and thus effective work environments include world-class organizations (eg. and facilities designated as Fortune magazine’s 100 best companies to work for in the United States. Ideally. 3 . These 4 elements of a healthy work environment appear to be consistent with the AACN standards5 for establishing and sustaining healthy work environments that include skilled communication. and personal and professional growth. and systems are designed so that employees are able to meet organizational objectives and achieve personal satisfaction in their work.5 By definition.org 258 AMERICAN JOURNAL OF CRITICAL CARE. appropriate staffing.

or belief. In a search for book sources on authentic leadership on the Amazon. and strengths. No.50.16 overall superior outcomes.5 One conceptual definition of authentic leadership is proposed by Avolio et al41 as part of the beginning development of a theoretical framework to guide future research. the scope of leadership influence may be extended when leaders (both formal and informal) are cultivated at all levels of the organization. (4) involving workers in decision making pertaining to work design and work flow. Ideally. almost 50% were related to the book by George45 on authentic leadership. rests with the ability of leaders to translate the evidence related to healthy work environments into nursing practice at the bedside. How does one become an authentic leader? The literature review produced 8 sources. Although empirical data on effective management practices is often difficult to locate and often lags behind evidence-based clinical practices. particularly journal articles. The works of 2 other prominent authors were cited: the third volume of the theory and research-based scholarly studies of Gardner et al49 and the field-based anecdotal work by Cashman.51 Clearly. First. Third. strong evidence supports the 5 management practices enumerated.com Web site. When the literature search was expanded beyond the nursing and healthcare disciplines and the Business Source Premier database was used. 7 sources were found. the published sources http://ajcc. A similar strategy with the Cumulative Index to Nursing and Allied Health Literature produced 4291 sources on leadership.27. and (5) using knowledge management to establish the organization as a learning organization. (3) actively managing the process of change. What are the mechanisms by which authentic leaders create a healthy work environment for practice? 4.org What Is Authentic Leadership? George45 describes an authentic leader as an individual in a position of responsibility who is genuine. but only 5 of those sources provided a reference when the terms authenticity and leadership were combined.20-23. 3 .17. How does authentic leadership differ from other types of leadership? 3. Sources that met the following 4 inclusion criteria were selected. trustworthy. only publications from 1998 or later were found. was difficult.41-48 Even though AACN5 has identified authentic leadership as “the glue that holds together a healthy work environment. Fourth.aacnjournals. (2) creating and sustaining trust throughout the organization. which proposes that leaders who are authentic “conform to fact” or speak the truth and therefore are worthy of trust. What is authentic leadership? 2. Five evidence-based management practices are consistently necessary elements of the healthcare work environment: (1) balancing the tension between production and efficiency. and believable. aware of the context in which they operate. and collegial support 25 necessary to create healthy work environments. reliance.According to Disch. hopeful.40 Authentic Leadership: Search Strategy answered at least 1 of the following 4 questions: 1.22 Conversely. both anecdotal and empirical articles were included. 38 sources on authentic leadership were found. however. When the term authentic leadership was searched for. Volume 15. When the term authenticity was added. Magnet-designated hospitals) clearly have more positive perceptions of the work environment.43.35-39 and other attributes desirable in healthy work environments. trusting relationships. 9 books were found.”41(p804) 259 AMERICAN JOURNAL OF CRITICAL CARE.30 The Institute of Medicine2 has identified the key role of leaders in transforming the work environment for nurses and in keeping patients safe. and who are confident. and high on moral character. May 2006. These researchers define authentic leaders as “those individuals who are deeply aware of how they think and behave and are perceived by others as being aware of their own and others’ values/ moral perspective. knowledge. Teamwork and partnerships underscore the importance of communication. Second. 1 8 a common theme that describes the experience of a healthy work environment is the sense of team or community that is evident across disciplines in order to get the work of the organization done. How Is a Healthy Work Environment Created and Sustained? The literature consistently supports the key role of the leader in creating and sustaining healthy work environments for nursing practice. resilient. Of the 38 sources identified. optimistic. only 4 journal sources were found.”6(p2) few published sources address the concept of authentic leadership. A database search of the term leadership in Ovid MEDLINE produced 18 224 sources. particularly in nursing practice. Authentic Leadership: Findings The literature on authentic leadership was reviewed. locating published sources on authentic leadership. only Englishlanguage sources from both books and journal articles were reviewed. reliable. This description is consistent with the AACN definition of the term authentic. sources published between 1990 and 2005 were sought.2 The key to success in transforming nurses’ work environments. however. not only do unhealthy work environments pose a threat to healthcare organizations and to workers22 but also the conditions evident in unhealthy work environments threaten the quality of patients’ care and patients’ safety. Organizations known for having supportive work environments (eg.

org . identities. reliance. Fundamental to authenticity is the notion of the individual remaining true to his or her core values. According to George. AMERICAN JOURNAL OF CRITICAL CARE.Passion Purpose Compassion Heart Authentic leader • Inner self • Being present Values Behavior Self-discipline Relationships Consistency Connectedness Figure 2 Characteristics of authentic leaders in complex adaptive systems. An extensive discussion of the differences between the various types of leadership styles. 3 http://ajcc.45 authentic leaders have 5 key characteristics (Figure 2): the abilities to understand their own purpose. however. the more authentic these individuals are thought to become.aacnjournals. this understanding helps explain the evolution of authentic leadership: the more individuals remain true to their core values. establish enduring relationships.55 Authentic leaders conform to fact or speak the truth and therefore are worthy of trust. Adapted from George. Authentic. May 2006. or belief. The conceptual definition of authentic leadership can be further clarified by determining the characteristics of 260 authentic leaders.54 and thus the instruments cited may not be adequate proxies to measure authentic leadership. and practice self-discipline. Inc. servant. Adequate instruments for exclusively measuring authentic leadership are not yet available. preferences. Instruments that measure some elements of authenticity are the Servant Leadership Behavior Scale52 and the Multifactor Leadership Questionnaire53 used to measure transformational leadership. lead with heart. Volume 15.45 Reprinted with permission from John Wiley & Sons. practice solid values. and transformational leadership styles have distinct differences. and emotions.41. empirical research to identify markers of authentic leadership46 and to advance the development of instruments to measure it41 are in progress. No. however. is beyond the scope of this article.

one must first believe in the purpose. Leading with heart requires compassion. and coworkers and by cultivating mentoring relationships.aacnjournals. and acting in a manner consistent with those values may be more readily communicated by George’s euphemism of “when in Rome. celebrations. May 2006.45 it is easy to state one’s purpose relatively early in life. making difficult decisions.45 authentic leaders develop heart and compassion by getting to know the life stories of those with whom they work and by engaging the coworkers in shared meaning. Authentic leaders are open to close. George45 cites the example of a mentor who understands and subscribes to the mission of the mentor’s organization. Additionally. 3 . Authentic leaders “see themselves as stewards of the assets they inherit and servants of all their stakeholders. This observation underscores the importance of the attributes of authentic leadership (gifts and talent) that.”54(p329) Avolio and Gardner54 suggest that authentic leadership can incorporate other forms of positive leadership 261 http://ajcc. or avoid punishments. Establishing enduring relationships requires a sense of connectedness and shared purpose of working toward a common goal.” The essence of being steadfast with one’s values. authentic leaders search for meaning along life’s journey. According to George.45 developing one’s personal energy requires a journey of reflection and renewal. Practicing values involves testing one’s fortitude under the most difficult situations that may challenge individual values.”45(p127) This particular characteristic of authentic leaders takes on significant meaning when society’s increasing scrutiny of leaders’ ethical behavior (or lack of it) is considered. compassion. and difficulties. and demonstrating relational transparency that differentiates authentic leadership from other types of leadership. understanding the roots of discrimination. don’t follow the Romans. Authentic leaders reduce the stress associated with high-demand positions by engaging in activities such as meditation. Since actions speak louder than words. values. and traveling through developing countries to understand people’s lives and the human condition.44 and Zen leadership. and ethics.59 How Does Authentic Leadership Differ From Other Types of Leadership? The literature reviewed associates authentic leadership with transformational leadership. The key distinction of authentic leaders is that they are anchored by their own deep sense of self and know where they stand on important issues. Self-discipline in multiple aspects of life helps authentic leaders become predictable and behave with consistency independent of situations and of settings. The notion of understanding purpose and passion is exemplified by the old adage of “walking the talk”: modeling behaviors the leader wants repeated or having the leader’s actions match their words. and make difficult decisions in the context of your values. prayer. the ability of the leader to demonstrate passion for the mission by describing the mission and enlisting employees to jointly live the mission is an example of authentic leadership.57 Practicing self-discipline involves incorporating balance into one’s personal and professional life in order to deliver consistent results. the behavior of authentic leaders builds relationships through personal expression that is consistent with values and not merely the result of a desire to please. No. enhanced over a lifetime of learning. Relationships built on connectedness grow in the face of pressures and adversity.48 Although these leadership theories may all be closely related. . and beliefs. and “find voice”56 to extol its virtues.45 the rewards of the journey lie in having a fulfilling life that helps individuals become better persons to then become better leaders. often times through their actions. allow individuals to lead in a timeless way. Authentic leaders develop heart by engaging in intimate relationships with family.42 servant leadership. and personal hobbies. According to George. According to George. attain rewards. hardships.In understanding their own purpose. connectedness. According to George.45 Authentic leaders build a sense of connection through sharing life’s stories and developing trust and intimacy.54 it is the authenticity component inclusive of character. George45(p37) asserts “only in the crucible will you learn how to cope with pressures to compromise your values . Developing the qualities of an authentic leader (purpose. Volume 15. is the process by which passion for one’s purpose develops. behavior. More difficult. values. sporting events. internalize its intrinsic worth. however. what they represent in terms of principles.org AMERICAN JOURNAL OF CRITICAL CARE.54 Authentic leaders “stay their course and convey to others. Some ways that authentic leaders may develop compassion include taking on community service projects. consistency) requires a never-ending and nonlinear journey through life’s experiences. Authentic leaders develop heart and compassion by getting to know the life stories of those with whom they work and by engaging coworkers in shared meaning. friends. having international students living in the leader’s home. knowing oneself. personal relationships and embrace the full range of life’s challenges. To find passion and be able to articulate the passion. .”58(p3) Practicing self-discipline requires leaders to engage in activities and habits that keep a person’s mind sharp and body in shape. not just words.

54 Chief findings of the positive psychology body of research suggest that positive subjective experiences. Components of Zen leadership overlap with those of authentic leadership.41 Specifically. and marked opportunity exists for theory building and research. No. “authentic leaders are able to enhance the engagement. courage. and performance outcomes have not been fully developed. hope. behaviors. the positive psychological capacities of confidence. May 2006. In establishing a theoretical and scientific base for authentic leadership. and meaningfulness. the model by Avolio et al41 has been expanded and modified to incorporate healthy work environments as a performance outcome (Figure 3). courage. resiliency. Authentic leadership. and performance outcomes.60 In contrast to authentic leadership and its theoretical foundations based on positive psychology. With business scandals such as the Enron.org AMERICAN JOURNAL OF CRITICAL CARE. indicates that both focus on integrity. The recent interest in authentic leadership seems to stem from an apparent shift in which timeless and genuine attributes are sought in our leaders. trust. The psychological engagement (proximal or more immediate outcome) of employees by authentic leaders may be a key http://ajcc. What Are the Mechanisms by Which Authentic Leaders Create Healthy Work Environments? The conceptual and empirical links between authentic leadership. optimism. self-regulation). and involvement required from followers to constantly improve their work and performance outcomes.49-51 supports the assumption that authentic leaders create lasting organizational value that extends well beyond bottom-line success. The model contends that the “unique stressors facing organizations throughout society today call for a new leadership approach aimed at restoring basic confidence. Volume 15. optimism. hope. Zen leadership.61 The combined work of multiple contributors41. and this area of psychology is supported by a well-established track record of empirical research. may or may not be charismatic. and positive emotions and identifies these constructs as mediating variables by which authentic leaders facilitate followers’ attitudes.59 The early research-based work on authentic leadership supports the field-based and anecdotal observations of successful authentic leaders. even arrogant leadership of the past to a more sustaining type of authentic leadership that exemplifies character. the public 262 seems to be demanding a shift from the expected charismatic.”54(p331) Further.”41(p804) On the basis of this proposed model. Additional simultaneous concept analysis may assist in the development of valid and reliable instruments to measure authentic leadership and to develop the theory base. trust. Avolio and his colleagues at the University of Nebraska-Lincoln are pursuing a program of research in authentic leadership.such as transformational leadership. “servant leadership theory has been largely atheoretical and not grounded or supported by empirical research. especially when life (personal or at work) is seen as meaningful. The research-based literature on authentic leadership is relatively new. trust. hope. lacks a strong research base of its own. Findings from studies on integrity.43. literature is lacking to document the contributions of servant leadership to the creation of sustainable values in organizations. Little empirical work is evident in both the business46 and healthcare literature. and perseverance (resilience). Comparisons between authentic leadership and other types of leadership may help increase our understanding of the critical attributes and core components of the various types of leadership. Through personal identification with followers and social identification with the organization. but these studies may not necessarily be aligned within the context of leadership theory. followers’ attitudes and behaviors. these component parts have generally been studied as individual concepts. Servant leadership and authentic leadership share elements of self-awareness and commitment to service.41 The theoretical and empirical base of authentic leadership is in its infancy. 4 5 According to Bennis. The inaugural scholarly summit on the development of authentic leadership was hosted by the Gallup Leadership Institute at the University of Nebraska-Lincoln in 2004. however. positive individual traits.44 Drawing on the propositions of positive organizational psychology. satisfaction. commitment. behavior. Authentic leadership is grounded in the positive and social psychology literature. motivation. and Health South debacles in the forefront.59(p5) character (as seen in authentic leaders) more than charisma signals “real leadership” for the long run. and performance outcomes.”41(p802) Hence. Tyco.54 A comparison of authentic leadership with Zen leadership. 3 .45. a spiritual leadership style. hope.62 Avolio et al41 have developed a beginning theoretical model for linking authentic leadership to followers’ attitudes. however. and resilience can be found in the literature (eg.54 Groundbreaking articles on authentic leadership have appeared in business and leadership journals only since the early 2000s.aacnjournals. however. a healthy work environment (distal or long-term outcome) may logically be assumed to result from a process of employee engagement in which authentic leadership is configured to be the input (or antecedent). For the purposes of this article. and positive institutions improve quality of life and well-being. and resiliency have been identified as personal resources of authentic leaders. the model prominently incorporates hope.

Experimental studies related to methods of teaching authentic leadership are essential to establish cause-and-effect relationships and to build the teaching-learning scholarship. Both professional and personal mastery are needed for success as an authentic leader. does not dismiss the importance of professional competence and the need to build knowledge in one’s discipline. a person must develop an individual leadership style that is consistent with his or her personality and character. and renewal. this engagement may result in a sustainable healthy work environment that is characterized by positive people. reflection. Becoming an authentic leader requires courage to commit to a process of personal transformation “from the inside out. an individual pursuing a personal journey toward authenticity can begin by reading books on the subject43. Volume 15. and incorporating the work by George. self-improvement. executive coaching. To become an authentic leader. Similarly.68-70 Also available are executive coaching programs71.org AMERICAN JOURNAL OF CRITICAL CARE. 3 263 . To become an authentic leader requires that an individual pursue a personal journey of self-discovery. How Does One Become an Authentic Leader? The process of becoming an authentic leader appears to be a journey rather than a destination. Individuals interested in a certificate program in authentic leadership can find such a program available through multiple organizations.45. For example. understanding one’s strengths and weaknesses while simultaneously accepting one’s “shadow side” is an essential component of becoming an authentic leader. Adapted from Avolio. and quality outcomes.51 or seeking Internet sources to build the authentic leadership “toolkit.41 with permission from Elsevier. May 2006.”64 Organizations that assist in the development of authentic leaders are also available. financial.63 If we assume that engaged employees contribute positive emotions. Engagement may be viewed as an important consequence of authentic leadership that mediates its effects on followers’ outcomes.41 Engagement is currently being identified in the literature on stress and burnout as the key element in the long-term solution to chronic stress and burnout in the workplace. Discussion and Implications Healthy work environments for nursing practice are desirable for both nurses and patients.72 and a scholarly authentic leadership development institute. and behaviors to the workplace. http://ajcc.73 but evidence was not found of such courses being taught in schools of nursing. reflection. Although certificate programs.aacnjournals.45 Authentic leadership can be enhanced by the individual alone or by tapping into organizations dedicated to developing authentic leaders (Table 1). and renewal.45 mechanism by which the healthy work environment is created. No.Antecedent Mediating variables Proximal outcomes Distal outcomes Hope Authentic leadership • Incorporates elements described in Figure 2 Identification • Personal • Social Trust Followers’ work attitudes • Commitment • Job satisfaction • Meaningfulness • Engagement Healthy work environment Creation of sustained value demonstrated by performance outcomes related to: • People • Quality • Finance Followers’ behaviors • Job performance • Extra effort • Withdrawal behaviors Positive emotions Optimism Figure 3 Proposed mechanisms by which authentic leaders create a healthy work environment . few empirical studies (particularly those with controls for extraneous variables) have been done. attitudes. courses in authentic leadership are being introduced into the business school curriculum. however. Becoming an authentic leader requires a personal journey of self-discovery.74 Increasingly. selfimprovement.”43 Becoming an authentic leader. The evidence. and even practical guides to developing authentic leadership may be useful.

No. May 2006. friends.Table 1 How to become an authentic leader: a practical guide Personal development strategies Read books about authenticity in leadership Authentic Leadership: Rediscovering the Secrets to Creating Lasting Value45 Leadership From the Inside Out: Becoming a Leader for Life43 Awakening the Leader Within51 Seek Internet sources to enhance authenticity in leadership Authentic leadership: a toolkit for becoming more effective. This type of leadership supports the need for a solid moral foundation and mastery of a skill set not generally emphasized in charismatic types of leadership. contexts. and this work should assist in designing studies to cement the relationship between authentic leadership and healthy work environments. Although the role of leadership in serving as the glue that holds together a healthy work environment is strongly endorsed. heart. 3 http://ajcc. Healthy work environments. the process requires personal investment and commitment. which has a scientific and theoretical base of its own. exercise. and spiritual healing Complete a self-assessment of personal strengths66 and also explore and reconcile the “shadow side”67 Commit to mentoring a future leader within or outside your organization Coach or manage an amateur sports team such as a youth team or an adult league Devote time to family. Authentic leadership is proposed as the preferred style of leadership for creating and sustaining healthy work environments. and exceptional64 The Awakening Best Self Weekend65 Volunteer to serve on a community board and actively participate in the group’s service projects Participate as a team member in an organization-affiliated mission trip to an underdeveloped country or community Initiate a personal program of self-renewal inclusive of. efficient.org . produce superior outcomes for both staff nurses and patients. the support for authentic leadership can best be made through grounding in positive psychology.aacnjournals. and self-discipline. Volume 15. colleagues. It is evident from the literature that healthy work environments offer something special and should represent a workplace standard to achieve. Authentic leadership underscores an emphasis on hard work in character development that 264 AMERICAN JOURNAL OF CRITICAL CARE. the empirical and theoretical base to support the link between authentic leadership and healthy work environments needs further development. Becoming an authentic leader appears to involve a nonlinear journey of personal growth that is statelike (open to development and change) and multidimensional. guided by authentic leaders.54 If we assume that authentic leadership can be learned. supports the assumption that healthy work environments produce superior outcomes for both staff nurses and patients.71 University of Pennsylvania72) or enroll in a university-based course on authentic leadership73 Attend the annual authentic leadership development institute to learn more about the scholarly development of theory and research in authentic leadership74 particularly evidence from Magnet-designated hospitals. containing elements such as traits. University of Minnesota. behaviors. The fieldbased anecdotal work establishing a relationship between authentic leadership and healthy work environments is reportedly strong. and attributions. relationships. Currently. journaling. values. but not limited to. and self Find a new hobby or rediscover an old one Develop the art of listening and reflection Make time for celebrations and to express gratitude along life’s journey Insert humor into every aspect of life Seek the personal and professional advise of sages in the profession Commit to a philosophy of lifelong learning Organization-assisted development strategies Enroll in a certificate program in authentic leadership Annual certificate program in authentic leadership68 Summer program in authentic leadership69 Center for Authentic Leadership70 Participate in an executive coaching program available at major universities throughout the country (eg. meditation. The conceptual definitions of an authentic leader seem to go well beyond simply being genuine and reliable to include the important characteristics of purpose.

Measure the outcomes associated with existing programs for the development of authentic leadership to establish a teachinglearning scholarship related to instruction in authentic leadership. This research would address the antecedents of authentic leadership. From a practice perspective. Develop a predictive model for identifying characteristics that predispose to authentic leadership and then design targeted interventions based on a characteristic profile to produce authentic leaders. Design quantitative longitudinal studies to examine the sustainable effects of authentic leadership on healthy work environments. and policy. Engage in the development and psychometric testing of valid and reliable authentic leadership instruments. Test the effects of hope. Because a stronger link between leadership and the ability to create a healthy work environment needs to be established. May 2006. conduct both qualitative and quantitative studies to examine the progress that individuals follow in order to become authentic leaders.aacnjournals. The selection of subjects may begin with recruitment of leaders who are by reputation authentic leaders. The ability to test the effect of engagement on stress and burnout offers hope for a long-term solution to chronic stress and burnout that contributes to the perpetuation of unhealthy work environments. Methods Conduct qualitative research studies with nurses in practice to answer the following research questions: What is an authentic leader in nursing practice? What does an authentic leader in nursing practice look like? What is the skill set of an authentic leader in a healthcare work setting? Expand the research base to include both quantitative and qualitative studies to identify the mechanisms by which authentic leaders create healthy work environments for nursing practice. a stronger research base is necessary. A proposed research agenda to advance the study of authentic leadership in nursing practice is presented (Table 2). Certainly. Because many similarities exist between authentic leadership and other types of leadership. how is the “glue” in this relationship of variables formed? Is it through engagement. Although the proposed mechanisms by which authentic leadership creates performance outcomes (ie. Follow up by designing experimental studies that use the established mediating variables as targeted interventions. AACN) and business (Avolio and his colleagues at the Gallup Leadership Institute). In light of this observation. Establish a common conceptual and operational definition of authentic leadership that is measurable and amenable to instrumentation. At a minimum. No. and healthcare to initiate collaborative research on authentic leadership within the context of the healthcare work environment. may in years past have been assumed to develop somewhat innately or through osmosis. psychology. further simultaneous concept analysis is needed in theory development. the highquality work of Avolio et al41 shows great potential. both quantitative and qualitative. Conduct multisite studies with randomly selected subjects to enhance the generalizability of the findings related to authentic leadership.Table 2 Proposed research agenda to advance the study of authentic leadership in nursing practice Consensus building Assemble an interdisciplinary group of researchers and practitioners in the fields of business. organizational culture. healthy work environments) appear to be plausible. practice. the healthcare service setting can be a beta site for testing authentic leadership instruments and interventions. trust. http://ajcc. Interviews with leader-employee dyads may be useful for further exploration. or another mechanism that the glue develops? Assuming that authentic leadership is teachable. continuing to support field-based anecdotal work with authentic leadership until the science is more mature offers greater potential benefit than harm. Research.org An analysis of the role of authentic leadership in creating healthy work environments suggests further implications for research. is needed to develop appropriate authentic leadership instruments. this collaboration should extend to the development and teaching of leadership ethics in service and academic settings both in nursing and in business. a need exists to build the science of authentic leadership. and positive emotions in mediating the relationship between authentic leadership and proximal outcomes (followers’ work attitudes and behaviors) and distal outcomes (healthy work environments). As has been proposed. Of particular promise is the work in establishing a relationship between authentic leadership and the creation of a psychologically engaged workforce. with measurement of related teaching and learning outcomes. Volume 15. programs to develop authentic leadership as we under265 AMERICAN JOURNAL OF CRITICAL CARE. The opportunity exists for interdisciplinary research collaboration between nursing (eg. In other words. 3 .

2000. Accessed March 1. Evans JA. Conclusions The review of the literature indicates that most publications on authentic leadership appear to be anecdotal. Beglinger J. Volume 15. Larson E. Voice Nurs Leadership. standing of what authentic leadership is.30:24-25. 2004.28:2948-2954. Creat Nurs.org/member. 3. From a long-term perspective. From a policy perspective. Available at: http://www. 16. developing leaderful organizations implies a commitment to longitudinal research and to an emphasis on fostering leadership development at all levels in the profession. 9. 1992. Health and organizational issues in managing a multicultural workforce. Heath J. Accessed March 1. REFERENCES 1. Disch J. Thompson PA. Authentic leadership may not only be crucial to creating and sustaining healthy work environments for practice but also may hold promise in creating lasting organizational and professional value.18:1-8. 13. J Nurs Adm. Healthy work environments: a validation of the literature.jcaho. 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reliable. Which of the following is not a component of becoming an authentic leader? a.0 Fee: $12 Passing score: 9 correct (75%) Category: O Test writer: Diane Byrum. K a Kb Kc Kd 12. What supporting evidence exists correlating healthy work environments with superior outcomes for patients and nurses? a. Contact hours: 2. the organization supports communication and collaboration b. b. Skilled communication b. Magnet-designated organizations d. To define the attributes of authentic leaders b. To discuss the disadvantages of authentic leadership c. CCRN. Decreasing number of hospital beds 2.CE Test Test ID A0615032: Authentic Leaders Creating Healthy Work Environments for Nursing Practice. Which one of the following is not a key characteristic of an authentic leader? a. The healthcare environment is no more stressful than other organizations. An authentic leader has vision and purpose. Identify key components of authentic leadership for further research. Leads with heart 10. K a Kb Kc Kd 8. Leaders in the healthcare environment today need to be more authoritarian b. Organization leaders c. CA 92656 (800) 899-2226 State State Expiration Date The American Association of Critical-Care Nurses is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. Which of the following statements best describes the common characteristics of the healthy work environment? a. Which one of the following. d. Must understand one’s strengths and weaknesses d. K a Kb Kc Kd 11. 2008. A strong sense of trust is present. To provide a research agenda to study authentic leadership 5. d. Studies by the American Nurses Association b. Decreasing health benefits c. Yes K K K No K K K K K K Name Address City Country RN License #1 RN License #2 Payment by: K Visa K M/C K AMEX K Check Card # Signature Phone E-mail address State Member # ZIP Mail this entire page to: AACN 101 Columbia Aliso Viejo. Practices solid values b. Which of the following statements is correct? a. Overwork and stress of the healthcare work environment d. Proactive b. K a Kb Kc Kd 6. K a Kb Kc Kd 2. To describe mechanisms used by authentic leaders to create a healthy work environment d. Society d. JCAHO b. True collaboration d. Must be mentored by an authentic leader who guides the developing leader on his/her journey c. 1. a strong sense of trust is present. d. K a Kb Kc Kd 9. Increased decision making 4. from the inside out 11. Practice self-absorption c. An authentic leader demands the best from all employees. An authentic leader gathers facts and uses employee input to make decisions. Board of directors 8. FCCM Program evaluation Objective 1 was met Objective 2 was met Objective 3 was met Content was relevant to my nursing practice K My expectations were met K This method of CE is effective for this content K The level of difficulty of this test was: K easy K medium K difficult To complete this program. Appropriate staffing c. MSN. the more important the soft side of leadership becomes. CCNS. Guidelines from the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) 12. K a Kb Kc Kd 4. (3). Which of the following is not 1 of the 6 standards identified by the American Association of Critical-Care Nurses that are crucial to creating a healthy work environment? a. Employees d. the organization supports the physician as being the leader in patient care Test Answers: Mark only one box for your answer to each question. and employees feel physically and emotionally safe. a strong sense of trust is present. . 7. Must develop a leadership style consistent with his/her personality and character b. Decreasing compensation b. c. Which statement best describes an authentic leader? a. Healthcare delivery system 1. trustworthy. 9. the organization supports communication and collaboration c. according to the author. K a Kb Kc Kd Test ID: A0615032 Form expires: May 1. it took me hours/minutes. RN. Healing d. (2). Creative 6. Practices self-discipline d. a strong sense of trust is present. Employees are treated with respect. Who is key in creating and sustaining healthy work environments? a. Which of the following has been implicated as a reason for the nursing shortage? a. K a Kb Kc Kd 7. and believable. Discuss current literature related to authentic leadership. You may photocopy this form. Employees are allowed to create the environment in their units. Technology is the key to creating healthy work environments. Physicians b. Employees are directed in creating the environment in their units. Learning objectives: (1). AACN’s healthy Work Environment initiative c. K a Kb Kc Kd 10. would not be affected by development of authentic leaders in healthcare organizations? a. K a Kb Kc Kd 3. Must commit to a process of personal transformation. Which of the following is not a purpose of this article? a. 3. Resilient c. the organization supports the physician as being the leader in patient care. The greater the stress of the environment. An authentic leader is genuine. K a Kb Kc Kd 5. Discuss the current literature related to creating healthy work environments. Which term is used synonymously to describe the healthy work environment? a. c. Workforce and profession of nursing c.