Running Head: TRANSFORMING LEADERS

Transforming Leaders

Andrea DiMartino, RN

Delaware Technical Community College

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For nurses, leadership is an essential part of professional practice that is not limited to

management roles. In all aspects of the profession, nursing leadership roles include

responsibilities that range from delegation of tasks to unlicensed personnel to advocating for

patients while coordinating care with multiple disciplines in healthcare. Though there are many

types of leaders and leadership styles, not all leadership styles are a good fit for every situation,

especially with consideration for patient populations. From a standpoint of gerontological

medicine, transformational leadership is an effective tool in promoting patient outcomes as a

bedside nurse.

Transformational Leadership Theory

At the core of Transformational Leadership is the idea that the right kind of leader can

empower those around them in small and consistent ways to effect greater positive

organizational change. Though typically nurse leaders are viewed in management roles, all

nurses are, in their own way, leaders. The ways in which nurses embrace change within their

profession and organization can determine their success throughout their careers, but in

particular, the success of the relationships that are formed with the staff and patients they

encounter.

A large part of transformational leadership is helping other staff members to become

aware of their role in an organization as a guiding principle to help them to realize ways in which

they can contribute to the overall success of the organization. To do this, the nurse leader must

find ways to engage with staff members of all levels, which includes everyone from unlicensed

personnel to physicians. Helping staff to realize and better understand their role helps to cultivate

a deeper commitment to the organizational goals and can improve job satisfaction over time by

helping staff members feel like their actions make a larger impact. Individuals who feel invested
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in the goals of the organization are more motivated, have a more positive perception of the

organization, and are more likely to embrace changes to see the organization succeed (Peng,

Liao, & Sun, 2019).

A Vision of the Future

In order to be an effective transformational leader, a nurse needs to have a vision for their

future. A clear understanding of the end goal can be the compass that guides the ways in which a

nurse will navigate relationships and practice changes. Though a clear view of the end goal is

necessary, the ability to break down that goal into small and achievable pieces facilitates positive

momentum toward that goal with measurable progress. In gerontological medicine, the nurse is

less likely to see the long-term health of a patient improve due to the co-morbidities of the

patients in this population. Measuring progress by assessing shorter-term patient outcomes may

be necessary to evaluate trends to predict what outcomes would result over the long-term. These

outcomes might include goals such as decreased length of hospital stay, improved control of

chronic disease processes, and resourceful approaches to returning a patient to their baseline

ability of performing their activities of daily living.

Staying Ahead of the Curve

Keeping up with constant change on an organizational level can be difficult without

maintaining a vision for the end result. Finding ways to innovate and become a change agent in

the workplace helps a nurse maintain the momentum needed to keep up with organizational

change while helping to guide the direction of those changes toward their own vision of the

future. Being a change agent and encouraging others to adopt and adapt to change, helps the

nurse to achieve their goals toward their vision for the organization. Adopting a dedication to
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ongoing education and seeking expansion of an individual’s practice is one way to lead by

example as an agent of change. Though the nurse's organizational change impacts may be

localized to a specific unit or specialty, small changes can find their way into the practices for a

hospital system if the results are quantifiable. The impacts of the changes over time, and the

attitude with which the nurse and other staff surrounding that nurse accept that change, help to

promote a culture of professional improvement that works toward the final vision the nurse has

for the organization (Finkelman, 2016).

Becoming Transformational

Opportunities abound for a savvy nurse seeking to transform their organization. Within

Delaware’s major hospital system there are multiple opportunities for nurses to join focus groups

and practice councils to guide organizational change on large and small scales. A nurse can

participate in a leadership role on a practice council without taking on a management position,

and through that role can empower others on their unit or in their hospital system by researching

and implementing evidence-based practice changes to improve patient outcomes, reduce waste,

increase staff morale, and increase efficiency of the staff members. As with all things, leading by

example is vital in encouraging others to promote change in ethical ways (Guyton-Ringbloom,

2020).

In addition to catalyzing change through practice councils, the council itself helps to

foster a deeper connection to the job by improving the perception of nurse’s impact on the

organization as a whole. Seeing their contributions change practice in real time and observing the

ways in which those changes impact patient care can encourage a nurse to continue to work

toward their vision for the future of their career and result in increased job satisfaction and sense
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of empowerment for the nurse and other staff members involved in facilitating that change

(Cherian, 2016).

Seeking a mentor is another way a good leader can become a great leader. Finding a

leader who aligns with the nurse’s goals from whom they can learn and grow in a supportive

environment is an excellent way for a nurse leader to practice new skills they aren’t yet

comfortable with, in particular leadership skills. With the support of a mentor, nurse leaders can

pursue opportunities outside of their comfort zone to expand their understanding of delegation,

leading by example, and communication with patients and families. Selecting a mentor should be

a thoughtful and thorough process as the nurse leader seeks another nurse who exemplifies those

traits and skills the nurse leader wishes to develop in themselves. Additionally, finding such a

mentor within their own specialty can offer unique perspectives on how the needs of populations

can vary drastically, especially in the role of the nurse leader as an advocate.

Empowering Staff

If there were one defining characteristic of a transformational leader, it would be their

empowerment of others. Humility is another characteristic of a great leader. The ability to

recognize one’s own shortcoming and seek opportunities to expand and grow in nursing is a

constant necessity for any nurse, especially one in a leadership role. Cultivating the skills of

other nurses and staff to ensure that everyone continues to grow together as a team. Additional

qualities attributed to transformation leaders include honesty, loyalty, self-confidence, and self-

direction (Finkelman, 2016).

Structural empowerment is one of the core components of the Magnet Organizational

Model and is often a tool used in Transformation Leadership to improve nursing outcomes.
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Recognizing that nurses need to practice in a professional and autonomous manner, a

Transformational Leader seeks out additional opportunities to encourage staff to be innovative in

their approach to patient care, so long as innovation is within the scope of practice and maintains

patient safety. Promoting an atmosphere of inquisitive innovation helps to ensure that nurses can

continue to seek out practice improvements without fear of nursing management constantly

questioning their methods or motivations. Furthermore, encouraging improvement and

modification to practice creates greater opportunity for positive patient outcomes by maintaining

a staff culture of process improvement with a focus on health promotion and safety

enhancements (Clavelle, 2013).

Patient Empowerment through Advocacy

Advocating for patients is at the core of the nursing profession. Central to advocacy in

nursing is patient education which empowers patients to make informed decisions about their

health and increase compliance with their treatments. In gerontological nursing practice, seeking

ways to teach patients how to manage their chronic illnesses in ways that promote health while

preventing additional illness is key to prolonging quality of life. Though there are unique

challenges for aging individuals, there are opportunities to include the patient’s support system to

help them improve their treatment outcomes. Educating caregivers, utilizing additional

specialties such as occupational therapy, and seeking out resources to assist patients after

discharge are some of the small ways in which gerontological nurses empower their patients to

be a participant in their own care (Mccorkle, et al., 2011).

A culture of ongoing patient education allows patients to better understand their disease

processes and make informed decisions about their own care based on that understanding.

Though there are unique challenges with some gerontologial patients, including comorbidities,
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functional decline, and disease processes which impact cognitive processes, there are always

opportunities to educate and advocate for patients in the geriatric population. Tools are available

to patients that further allow them to dictate their care, such as the Five Wishes Program.

Actively encouraging patients to begin a conversation with their loved ones and develop their

plan for end of life care is one of many ways a geriatric nurse empowers their patient.

Becoming an effective nurse leader is a lifelong commitment to continually challenging

oneself and seeking opportunities to expand one’s skills and practice. Trying to define a specific

style of leadership that is ideal for every situation in nursing may not be possible, but for a

bedside gerontological nurse, the transformational leadership style is an aspiration worth

pursuing. Ongoing commitment to the vision a nurse leader has for their future and the type of

practitioner they wish to be should be the compass that guides their course when it comes to

determining what is best for their own practice.

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References

Cherian, U. K. (2016). Impact of meaningful recognition on nurses’ work environment in ICU:

A comparative exploration of nurse leaders’ and staff nurses’ perception. Impact of

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Exploration of Nurse Leaders’ & Staff Nurses’ Perception, 1.

Clavelle, J. T., O’Grady, T. P., & Drenkard, K. (2013). Structural empowerment and the nursing

practice environment in Magnet® organizations. The Journal of Nursing Administration,

43(11), 566–573. https://doi-

org.libproxy.dtcc.edu/10.1097/01.NNA.0000434512.81997.3f

Finkelman, A. W. (2016). Leadership and management for nurses: Core competencies for

quality care. Hoboken: Pearson.

Guyton-Ringbloom, C. (2020). Developing leaders for the future of him. Journal of AHIMA,

91(2), 18–21.

Peng, S., Liao, Y., & Sun, R. (2019). The influence of transformational leadership on

employees’ affective organizational commitment in public and nonprofit organizations: A

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10.1177/0091026019835233

Mccorkle, R., Ercolano, E., Lazenby, M., Schulman-Green, D., Schilling, L. S., Lorig, K., &

Wagner, E. H. (2011). Self-management: Enabling and empowering patients living with

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