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Nursing Leadership

Literature Review

March 2007
ARNNL Nursing Leadership Literature Review

Table of Contents

Introduction ......................................................................................................... 1
Leadership ........................................................................................................... 1
Theories...................................................................................................... 2
Nursing Leadership Skills/Attributes ......................................................... 3
Leadership Competencies........................................................................... 3
Leadership Issues in Health Care ........................................................................ 4
Leadership Barriers & Facilitators ............................................................. 6
Implications for Leadership........................................................................ 6
Leadership Development..................................................................................... 7
Models & Theories..................................................................................... 7
Programs..................................................................................................... 8
Leadership Strategies ................................................................................. 9
Conceptual Framework for Leadership Development
in Newfoundland & Labrador............................................................................ 12
Summary............................................................................................................ 13
References ......................................................................................................... 15

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ARNNL Nursing Leadership Literature Review

Introduction Leadership
The health care system has undergone The terms leader and leadership have
dramatic reforms in recent years as been conceptualized in various ways
organizations attempt to reduce or in the literature. There is general
maintain costs while increasing qual- agreement that a leader is one who
ity and outcomes. There is a renewed has a vision, moves forward, takes
interest in leadership development in risks, influences and guides.
acknowledging the central role it Tourangeau (2003) stated that “ exem-
plays in relation to complex health plar leaders are those who challenge
care issues. the process, inspire a shared vision,
enable others to act, model the way,
In this review, the meaning of leader- and encourage the heart” (p. 625). A
ship will be explored. An overview of leader is sometimes addressed through
selected theories and research related identification of roles/attributes, in-
to leadership will be presented as a cluding advocate for quality care, col-
background to understanding the con- laborator, role model, articulate com-
tinuing development of the concept. A municator, mentor, risk taker, and vi-
discussion of leadership in health care sionary (RNABC, 2001). “One of the
will include an analysis of issues, primary roles of leadership is to en-
highlighting facilitators of and barri- courage and inspire others in a way
ers to leadership in practice, and im- that keeps them committed to the di-
plications for nursing leadership. Dis- rection and values of the organiza-
cussion of leadership development tion” (Porter O’Grady, 2003a, p. 109).
will include selected models and pro-
grams and suggested strategies as The discussion of leadership and man-
identified in the literature. A concep- agement is often interrelated in the
tual framework for leadership devel- literature, and there is not always
opment in Newfoundland and Labra- clear distinction between a leader and
dor will be presented. a manager (Hibberd, Smith & Wylie,
2006). Management involves an obli-
Nursing leadership exists at all levels gation to achieve organizational goals; Nursing leadership exists
(Ferguson-Pare, Mitchell, Perkin, & leadership emphasizes interpersonal at all levels (Ferguson-
Stevenson, 2002). While nurses in relationships. Leadership is essential Pare, Mitchell, Perkin, &
direct care roles have content exper- for management effectiveness. Effec- Stevenson, 2002). While
tise, nurses in leadership and manage- tive managers apply leadership strate- nurses in direct care roles
ment roles have context expertise, gies, and leaders consider manage- have content expertise,
attending to the environment and re- nurses in leadership and
ment implications. Leaders may be
management roles have
sources required for the provision of formal or informal and do not always context expertise, attending
direct care. “Both context and con- have delegated authority. to the environment and
tent knowledge is critical to ensure resources required for the
quality patient/client care is provision of direct care.
achieved” (Ferguson-Pare ,et َ al., p. 6)
This review will address leadership at
all levels, including nurses in direct
care positions.

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ARNNL Nursing Leadership Literature Review

Theories In an attempt to further understand


successful leadership, contingency
Theories of leadership date back to theory focused on variables that might
the beginning of the 20th century as determine the leadership style that is
psychologists, political scientists and best suited for a specific situation
experts in various fields attempted to (Hibberd, et al., 2006). According to
understand what makes successful this theory, leadership styles need to
leaders (Leatt & Porter, 2003). vary according to the circumstances.
Effective leadership is influenced by
Early theories focused on traits, and the leader-member relations, the de-
proposed that people who have spe- gree of structure of the task to be ac-
cific qualities or traits are better suited complished, and the position or per-
to leadership (Marquis & Huston, ceived authority of the leader.
2006). Traits of prominent leaders in
history were considered important, Other theories considered leadership
including intelligence, charisma, self- to be a process of influencing and in-
confidence, emotional control, domi- teracting with others. These include
nance, assertiveness, dependability transactional and transformational
and independence (Hibberd et al., theories that emphasize the relation-
2006). Trait theories focused on the ship between the leader and the fol-
leader, rather than leadership, and lower (Hibberd, et al., 2006). The
there was no understanding of how transactional leader is focused on the
leadership could be developed. task and achievement of a standard
performance, and is concerned with
Behavioral theories focused on the the day to day operations. In contrast,
action of leaders; i.e., how they organ- the transformational leader is vision-
ize their work in order to achieve ary, inspires others, and aims to
goals. Based on the work of Lewin achieve a higher level of performance
(1951) and White & Lippitt (1960), (Leatt & Porter, 2003).
three leadership styles were com-
pared: autocratic, democratic, and During the 1990’s, the concept of
laissez-faire (cited in Marquis & emotional intelligence addressed the
Huston, 2006). Autocratic leaders ex- relationship of the leader with his/her
ercise a great deal of control, make all followers (Hibberd, et al., 2006). It
of the decisions, and give detailed includes self-awareness, impulse con-
directions about work to be done. De- trol, persistence, self-motivation, and
mocratic leaders maintain less control, social awareness. In applying this the-
are more flexible, and involve others ory, the behaviors of the leader have
in decision making. Laissez-faire an impact on the behaviors of the
leaders have limited control, and are team (Porter-O’Grady, 2003a). The
very flexible, with decisions being emotions of each member also influ-
made by the group. According to ence the other members of the team.
these theories, people can learn to be Four skill sets are considered as es-
leaders. sential for leaders: self awareness
(emotional awareness, self-

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ARNNL Nursing Leadership Literature Review

assessment, self-confidence), self new ways of working), influencing


management (self-control, openness, (providing meaningful information to
adaptability), social awareness others), respecting (alert to and re-
(empathy, political awareness), and spectful of others), and supporting
relational management (influence, (supporting others through change).
developing others, team work,
change, conflict management) Antrobus & Kitson (1999) researched
(Goleman, Boyatzis, & McKee, 2003, socio-political factors that impact on
cited in Hibberd, et al., 2006). nursing leadership. According to
study findings, nursing leadership can
Nursing Leadership Skills/ shape and influence both nursing
Attributes practice and health policy. It was pro-
posed that future nurse leaders would
While leadership theories have be: influential operators (work with
evolved from the work of various dis- and empower others), strategic think-
ciplines and have been applied to ers (create meaning and facilitate
nursing, a number of research studies learning), developers of nursing
have been conducted to explore nurs- knowledge, reflexive thinkers
ing leadership, and to determine the (understand self and recognize values,
skills/attributes of successful leaders purpose and personal meaning), and
in nursing. process consultants (work with and
through others).
In a phenomenological study of 6 hos-
pital-based managers, King (1999) In exploring the work of leaders, re-
found their ability to scan and reflect search findings indicate that caring for
contributed to their effectiveness as self is important. Effective nurse
leaders. Scanning and reflecting leaders are knowledgeable, reflective,
helped them to understand the behav- and creative, have consideration and Effective nurse leaders are
ior, needs, uniqueness, and perspec- respect for others, and influence oth- knowledgeable, reflective,
and creative, have consid-
tives of others; the needs, values and ers through working with them.
eration and respect for
abilities of self; and the needs of the others, and influence oth-
situation. Reflection helped shape Leadership Competencies ers through working with
their leadership and contributed to them.
accomplishment of goals. Leadership competencies are iden-
tified as occurring in four domains
Cook and Leathard (2004) studied of practice: education, research,
nursing leaders who were involved in
administration/ management, and
providing direct clinical care and in-
clinical practice (CNA, 2003). A po-
fluenced others in providing quality
tential future domain will include pol-
care. These leaders worked in various
icy development and health reform. In
roles in hospital and community-
each domain, competencies are organ-
based settings. Five key attributes of
ized into categories of knowledge and
effective clinical leaders were identi-
skills related to leadership: visioning,
fied: creativity (generating new ways
change, caring, leading self, leading
of working), highlighting (looking for
others, policies/politics, managing,

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ARNNL Nursing Leadership Literature Review

teambuilding, project management, tice and increase patient safety


and communicating. The competen- (McGillis Hall, Doran, & Pink, 2004).
cies in each category include abilities In a study by Daiski (2004), staff
and skills that can be performed and nurses expressed concern about the
measured, forming a basis for devel- lack of support they received from
oping standards of performance. managers. Nurses, who feel they do
not have management support, have
Leadership Issues in less commitment to the organization
and are less satisfied with their careers
Health Care (CNA).
From the traditional bureaucratic or- The closure of hospital beds and the
ganizational structures of the past, to early discharge of patients have re-
the dramatically reformed system of sulted in a rapid turnover of patients
health care of today, the resulting in hospitals, with nurses providing
changes present many challenges to care for patients with an increased
nursing leadership. Following a brief level of acuity. Nurses in the commu-
review of the impact of these changes nity are challenged to provide services
on nursing, barriers and facilitators to for patients who experience an early
leadership will be identified, and the
discharge home, and for families
implications for leadership will be
highlighted.
who require additional support.
Nurses require increasingly com-
Health care reforms during the early plex decision-making skills at a
1990’s have resulted in restructuring, time when mentoring and support
closure of acute care beds, downsizing from managers have been with-
of personnel, and reduced funding. In drawn.
addition, technological advances have
had a major impact on the health care The role of the manager is seen as
system. increasingly demanding, with time
being spent on paper and budgets,
During restructuring, employers rather than working with patients
eliminated many chief nurse, head (CNAC, 2002). Recruitment of man-
nurse, and unit manager positions agers is difficult, and younger nurses
(CNAC, 2002). Decision-making was have little interest in assuming these
decentralized, leaving managers with roles. In a study by Sherman (2005b),
a greater span of control. The de- nurses reported that current leaders
mands of management increased, tak- consistently gave a negative percep-
ing the manager away from the unit tion of leadership positions, with
(Porter O’Grady, 2003a). As a result, stress associated with the role being a
the mentoring and guidance tradition- key factor. The areas of most concern
ally provided for nurses were no in relation to taking a leadership posi-
longer available. (CNA, 2006). Sup- tion was compensation, lack of con-
ports such as mentoring and unit- trol over decision making, and level
based education are needed by less of responsibility.
experienced nurses to improve prac-

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ARNNL Nursing Leadership Literature Review

Downsizing of personnel resulted in likely to rate the quality of care as fair


staff shortages at all levels, which fur- or poor (Aiken, Clarke & Sloan,
ther contributed to the stress of pro- 2002). Reports indicate that they are
viding services (Porter O’Grady, frustrated, trying to provide quality
2003a). In order to cope with the nurs- care in a more complex environment.
ing shortage, senior managers require In addition to an increased nursing
nurses to work overtime, sometimes workload, nurses are expected to do
involuntarily (CHSRF, 2006). This the work of other staff. This decreases
may increase the risk of errors, when self-esteem and creates the perception
nurses who work long hours become that the work of nursing is not valued.
fatigued (Rogers, Hwang, Scott, While nurses often perform non-
Aiken, & Dinges, 2004). The amount nursing duties, they are sometimes
of overtime worked may also be one restricted from doing what they are
contributing factor to the high rate of qualified to do. Nurses need the free-
absenteeism in the workforce, since dom to work to their full scope of
nurses who work overtime are more practice and feel that their skills are
likely to report absent from work. recognized and valued (CNAC).
When compared with other workers in
Canada, nurses have had the highest Due to limited funding, resources for
or second highest rate of absenteeism education have been cut (CNAC, When compared with other
for the past 15 years (CNA, 2006). 2002; CHSRF, 2006). Nurses report workers in Canada, nurses
have had the highest or
Reasons for absenteeism include ill- there is little support for continuing
second highest rate of ab-
ness, injury, burnout or disability, and education in the workplace. They of- senteeism for the past 15
may be related to the work nurses do ten find it difficult to attend scheduled years (CNA, 2006). Rea-
or their place of work. inservices, since there is no one to sons for absenteeism in-
replace them and they are unable to clude illness, injury, burn-
There was a reduction in the number leave the patient units. There are few out or disability, and may
of full-time positions in nursing and opportunities for professional devel- be related to the work
an increase in part-time and casual opment or for promotion. While nurses do or their place of
positions. In 2004, almost half of the nurses have traditionally considered work.
nurses in Canada (42.2%) worked in their profession to be a long-term ca-
part-time and casual positions (CIHI, reer, the nurses of today are less toler-
2004). This may result in inefficient ant of the physical and emotional
use of existing personnel, and have an challenges of work (CNAC). Known
impact on the ability of the team to as Generation X, they are loyal to
function effectively. It may also im- friends and family and “have a differ-
pact patients by influencing continuity ent perspective on working long hours
of care. and making career sacri-
fices” (Sherman, 2005b, p. 126).
Work demands have increased and
heavy workloads are reported by Advances in technology also impact
nurses, resulting in work overload and nursing and health care. While tech-
job strain (CNAC, 2002; CHSRF, nology has contributed to advances in
2006). Nurses who work in hospitals health care and the resulting changes
with lower levels of staffing are more in the work setting, it provides access

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ARNNL Nursing Leadership Literature Review

to a vast amount of information


(Porter-O’Grady, 1999). Nurses now Implications for Leadership
work with a more educated consumer,
who expects higher quality services, Issues related to nursing have been
more information about treatment op- addressed in major reports globally,
tions, and more accountability for per- nationally, and provincially. A consis-
formance. tent theme is the need for strong nurs-
ing leadership in order to address the
The challenges to leadership in nurs- challenges in health care and achieve-
ing evolve from reforms in health care ment of quality outcomes. “Nursing
The challenges to leader- and impact on the practice and work requires strong, consistent, and
ship in nursing evolve from life of nurses. While many different knowledgeable leaders who are visi-
reforms in health care and aspects are relevant, the issues are ble, inspire others and support profes-
impact on the practice and interrelated and influence leadership
work life of nurses. While sional nursing practice”(CNA , 2002).
development. These leaders are needed in every
many different aspects are
relevant, the issues are level of the health care system hierar-
interrelated and influence Leadership Barriers and Facili- chy, including policy making and de-
leadership development. tators cision making positions.
Barriers to leadership and facilitators In many organizations, nurses who
are identified through discussion and have been promoted to positions of
analysis of issues that impact on nurs- authority have been the best managers
ing and health in a changing system of of patient care (Laurent, 2000). They
health care. then use these same skills in a man-
“Nursing requires strong,
consistent, and knowledge- agement role. In order to be effective,
Barriers to leadership include exces- nurses in positions of authority must
able leaders who are visi-
ble, inspire others and sive workloads, inadequate staffing, be both competent managers and
support professional nurs- overtime work, part-time and casual skilled leaders (ARNNL, 2005). Man-
ing practice (CNA, 2002)”. employment, wide span of control, agers are now expected to act as lead-
lack of managerial and employer sup- ers, coaches, and facilitators. They
port, lack of support workers, unclear must respond to and meet the expecta-
roles, inadequate funding, and lack of tions of both the organization and the
opportunities for education or profes- staff, and many have not been pre-
sional development. pared to take on this changed role
(Kramer, Schmalenberg, & Maguire,
Leadership facilitators include mana- 2004). The first step in becoming a
gerial, employer and organizational leader is to release control (Laurent).
support, narrow span of control, men-
torship, reasonable workload, positive Porter-O’Grady (2003a) addressed the
work environment, flexible work characteristics of leadership in a
schedules, opportunities to perform to changing fast-paced system of health
full scope of practice, role clarity, ac- care. In today’s environment, skills in
cess to information, opportunities to collective problem solving, communi-
learn, and strong alliance with co- cations, and team work are considered
workers. to be more relevant. In creating a new

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ARNNL Nursing Leadership Literature Review

guided by two different approaches: a


model/theory or a framework of pro-
context for practice, leaders must con- gram delivery (CNA, 2003). As a
front change in their own work and be background for developing a model
able to help others to confront change for leadership in nursing, selected ap-
(Porter-O’Grady, 2003b). proaches to development of a model
will be presented. Program delivery
Work life issues in nursing practice methods and leadership strategies will
also have implications for leaders. It be identified through discussion of
has been documented in the literature literature findings.
on magnet hospitals that addressing
work environments encourages and Models and Theories
rewards professional nurses (Morgan,
Lahman, & Hagstrom, 2006). Health Leadership development is conceptu-
care agencies that achieve Magnet alized in different ways, depending on
designation are recognized for nursing various factors, including the target
excellence, a contributing factor to group. These include professionals in
quality patient outcomes. According public health (Wright, Rowitz &
to Laschinger, Almost, & Tuer-Hodes Merkle, 2001), developing health care
(2003), professional practice in mag- leaders (Leatt & Porter, 2003), and
net hospitals is supported by work health care leaders in general
environments that provide access to (Thompson, 2004). Leadership in
information, support, resources, op- nursing may be guided by a frame-
portunities to learn, flexible job activi- work (Tourangeau, 2003) or a theory
ties, and strong alliance with cowork- (Laurent, 2000).
ers. In addition, professional working
environments for nurses contribute to Wright, Rowitz & Merkle (2001) ad-
patient safety. Laschinger and Leiter dressed aspects to be considered when
(2006) found both staffing adequacy developing a leadership program; ca-
and a nursing model of care to di- pacity development need, recruitment
rectly affect patient safety outcomes. target, geographic area, program con-
In a study of surgical patients, Aiken tent, learning level, learning approach,
et al., (2002) found there was a higher and implementation methods. These
mortality rate within 30 days of ad- stages were applied in a model to ad-
mission for patients in hospitals with dress leadership development for pro-
high patient-to-nurse ratios. fessionals in public health.

At a time of change and uncertainty in Leatt and Porter (2003) applied the
health care, leaders must create an concept of life-long learning to a lead-
environment that supports quality out- ership development model. It should
comes for patients and professional include formal education, manage-
practice for nurses. ment training (field experiences, fel-
lowships, etc.), assessment and feed-
back, formal mentoring, and intense
Leadership Development leadership development experience.

Leadership development programs are

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ARNNL Nursing Leadership Literature Review

The model is competency-based and opportunity to fill a management posi-


assessment oriented, within a frame- tion, using the parameters established
work of quality improvement. by the leader. Accountability would
be shared, and employees would as-
According to Thompson (2004), a sume responsibility for their deci-
framework addresses the values, be- sions, actively participating in the
liefs, and behaviors for each leader. planning of the organization. In addi-
The dimensions are not dependent on tion, employees would learn leader-
the organizational characteristics and ship skills.
include: integrity, honesty, continual
learning, comfort with uncertainty, Models for leadership vary according
holding multiple perspectives without to the focus and the definition of the
judgement, discovery of potential, concepts. In general, they include de-
nurturing the emotional and intellec- velopment of leadership competencies
tual self, caring for one self, career and support the principles of lifelong
development, and embracing diver- learning.
sity.
Programs
The D. M. Wylie Leadership Institute
addresses competencies for nursing A variety of approaches to delivery of
leadership in each of 4 domains: nurs- leadership development programs are
ing practice, the business of health described in the literature. These pro-
care, leadership practices, and use of grams vary in length from a one-day
self (Tourangeau, 2003). Theoretical session, to achievement of learning
and experiential opportunities are of- goals over a period of time; e.g., 6-12
fered to develop leadership competen- months. The target group varies ac-
cies. Tourangeau used Leadership cording to the identified need and may
Practices Inventory by Kouzes & Pos- focus on a specific group, e.g., clinical
ner to measure the practices of partici- leaders, or a whole leadership team.
pants at that institute. Practices in- Basic B.N. educational programs also
cluded: challenge the process, inspire address leadership development.
a shared vision, enable others to act,
model the way, and encourage the The content of leadership programs
heart. varies according to the goals. A one-
day program, described by Sherman
Laurent (2000) discussed the applica- (2005a), included 4 critical skills:
tion of leadership theories to nursing, communication, supervision and dele-
and proposed using Oralando’s model gation, conflict management, and
for nursing and a dynamic leader– team building. In other programs,
follower relationship model. Using content was determined based on
this leadership model, the leader pro- learning needs identified by partici-
vides direction and guidance for the pants through an initial assessment
employees to choose their own plan. (Hill, 2003; McNally & Lukens,
An example of the application of this 2006; Sullivan et al., 2003; Mills,
model would be to give employees the 2005). In formal educational pro-

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ARNNL Nursing Leadership Literature Review

grams in schools of nursing, core con- (CHSRF, 2004; Thyer, 2003; Trofino,
cepts are identified based on literature 2000). A variety of strategies are dis-
findings (Heller et al., 2004). Other cussed as contributing to leadership
recommendations are made through development:
discussion of research findings. An-
trobus and Kitson (1999) recom- 1. Activities that support profes-
mended that leadership programs in- sional nursing practice contribute
clude the development of clinical to leadership development and
leadership skills, and the knowledge quality patient outcomes
and skills to work within academic, (Ferguson-Pare َet al., 2002).
management, and political domains. They include:
a. nursing newsletter and pro-
Learning activities include: small fessional publications that
group activities with peers for analy- include input from all
sis and reflection of issues (Leatt & nurses, including managers
Porter, 2003), professional coaching; (Trofino, 2000)
i.e., internal and external coach part- b. attendance at professional
nering in developing and implement- meetings (Trofino)
ing program (McNally & Lukens,
2006), interactive learning activities 2. Academic and continuing edu-
(Collins, 2000; Mills, 2005), experi- cation initiatives support lead-
ential learning (Cook & Leathard, ership development (Heller et
2004; Heller et al., 2004; Collins), and al., 2004; Sullivan, Bretschnei-
mentoring (Sullivan et al., 2003; der, & McCausland, 2003).
Heller et al.). They include:

Feedback mechanisms are important a. leadership education for


to include in the process of leadership experiences and new man-
development. Suggestions include: agers (Sullivan, et al., 2003)
self-assessment (Heller, et al., 2004); and nurses in practice
feedback from peers, instructors/ (Heller et al., 2004)
supervisors (Collins, 2000; Mills, b. adequate funding (Trofino,
2005); personal log for systematically 2000); e.g., tuition reim-
collecting and organizing learning bursement, scholarships,
experiences; observation of behavior bursaries, merit awards
and leadership styles (Heller et al.; c. replacement staff for
Hill, 2003). nurses to attend formal and
informal educational ses-
sions
Leadership Strategies d. networking opportunities
for nurses; e.g., professional
Literature sources support strategies meetings, workshops
that reflect transformational values (Tofino; Tracy & Nicholl,
and competencies to address leader- 2006)
ship issues in nursing practice e. evidence informed practice

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ARNNL Nursing Leadership Literature Review

(CNA, 2006) munication of respect


f. opportunities to learn (Daiski)
(Laschinger, 2003) c. staff recognition; e.g. lunch-
g. life-long learning (CNA, eons, plaques, awards, pub-
2006; Donner & Wheeler, lic recognition, etc.
2004) (Kerfoot, 2005)
h. participation in nursing re- d. communication of nursing
search (Trofino) goal achievement to divi-
i. self-assessment (Heller et sion, agency and commu-
al.) nity (Trofino)
j. career development e. focus on learning, rather
(Donner & Wheeler) than errors (Kerfoot)

3. Employers must implement 5. Role models effectively


processes to facilitate decision demonstrate leadership com-
making for nurses in practice petencies (Trofino, 2000).
(Trofino, 2000; Daiski, 2004). They include:
They include: a. self-confidence in goal set-
a. nursing committees chaired ting (Trofino)
by managers and expert b. problem solving, decision
clinical nurses (Trofino) making (Trofino)
b. participative communica- c. self management; e.g., time,
tions; meetings for problem caring for self (Leatt & Por-
solving, networking on all ter, 2003)
shifts (Trofino)
c. participation of all staff in 6. Organizational infrastructure
setting division/unit goals supports leadership in prac-
(Trofino) tice (Kerfoot, 2005). Exam-
d. interprofessional approach ples include:
to address quality issues a. a narrow span of control
(Trofino, Daiski) (CHSRF, 2004)
e. feedback at clinical level; b. care delivery models spe-
e.g., peer review, merit re- cific to the setting; e.g.,
view (Trofino) based on acuity, length of
stay and staff experience
4. Recognition of work quality (Deutschendorf, 2000)
promotes nursing leadership c. positive organizational cul-
(Trofino, 2000; Daiski. 2004). ture (Morgan et al., 2006)
Examples include: d. a nursing model of care
(Laschinger & Leiter, 2006
a. encouragement and positive e. visible managers
reinforcement (Daiski) f. open, truthful communica-
b. empowerment; a supportive tions with staff, even in un-
environment for creativity certain times
and decision-making, com- g. a d e q u a t e s t a f f i n g

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ARNNL Nursing Leadership Literature Review

(Laschinger & Leiter)


h. supportive work environ-
ment (Laschinger et al.,
2003)

7. Coaching and mentorship


(informal & formal) supports
leadership development
(Tracey & Nicholl, 2006;
Heller et al., 2004). Examples
include:
a. participation in interpro-
fessional team (Leatt &
Porter, 2003; Laschinger
& Leiter, 2006)
b. building and fostering
strategic relationships
c. articulation of a vision
(Donner & Wheeler,
2004)

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ARNNL Nursing Leadership Literature Review

Conceptual Framework for Leadership Development


In Newfoundland and Labrador
Based on literature findings, a conceptual framework for leadership development in
Newfoundland and Labrador is presented.

Concepts of Model

Education: Basic and continuing education (formal & informal)


Competencies: theory and practice

Support: Provided by: manager, employer, government, ARNNL,


NLNU
Includes: nursing standards, Code of Ethics, position
statements, funding, mentorship, work environment,
technology

Self-development: Professional development, ethical practice, career devel-


opment, reflection, continuing competence, networking,
political awareness, empowerment, lifelong learning

Leadership: Interrelationship between education, support and self-


development

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ARNNL Nursing Leadership Literature Review

Summary

This review of the literature explores


the meaning of leadership, including
the discussion of selected theories and
application to nursing. Nursing leader-
ship skills and competencies are iden-
tified. A discussion of issues in a sys-
tem of health care reforms highlights
complex challenges for leadership,
including barriers and facilitators to
leadership development. Implications
for leadership are discussed. As a
background to developing a model for
leadership development, selected mod-
els, programs, and strategies are dis-
cussed. A conceptual model for leader-
ship development in Newfoundland
and Labrador is presented.

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ARNNL Nursing Leadership Literature Review

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ARNNL Nursing Leadership Literature Review

References
Aiken, L. H., Clarke, S. P., & Sloan, D. M. (2002). Hospital staffing, organization
and quality of care: Cross-national findings. International Journal for Qual-
ity in Health Care, 14(1), 5-13.

Aiken, L. H., Clarke, S. P., Sloane, D. M., Sochalski, J., & Silber, J. H. (2002).
Hospital nurse staffing and patient mortality, nurse burnout and job satisfac-
tion. The Journal of the American Medical Association, 288,1987-1993.

Antrobus, S, & Kitson, A. (1999). Nursing leadership: Influencing and shaping


health policy and nursing practice. Journal of Advanced Nursing. 29(3), 746-
753.

Association of Registered Nurses of Newfoundland and Labrador. (2005) Position


Statement: Role of the Registered Nurse in clinical management positions.
St. John’s: Author.

Canadian Health Services Research Foundation. (2004). Impact of the manager’s


span of control on leadership and performance. Toronto: Author.

Canadian Health Services Research Foundation. (2006). What’s ailing our nurses?
A discussion of major issues affecting nursing human resources in Canada.
Ottawa: Author.

Canadian Institute for Health Information. (2004). Workforce trends of Registered


Nurses in Canada, 2004. Ottawa, Author.

Canadian Nursing Advisory Committee. (2002). Our health, our future: Creating
quality workplaces for Canadian nurses. Ottawa: Health Canada.

Canadian Nurses Association. (2002). Position statement: Nursing leadership. Ot-


tawa: Author.

Canadian Nurses Association. (2003). Nursing leadership development in Canada.


Ottawa: Author.

Canadian Nurses Association. (2006). Toward 2020: Visions for nursing. Ottawa:
Author.

Collins, P. (2000). Leadership clinical activities for baccalaureate nursing students.


Journal of New York State Nurses Association, 31(1), 4-8.

Cook, M.J., & Leathard, H. L. (2004). Learning for clinical leadership. Journal of
Nursing Management, 12, 436-444.

Daiski, I (2004). Changing nurses’dis-empowering relationship patterns. Journal of

15
ARNNL Nursing Leadership Literature Review

Advanced Nursing, 48(1), 43-50.

Deutschendorf, A. L. (2003). From past paradigms to future frontiers: Unique care


delivery models to facilitate nursing work and quality outcomes. Journal of
Nursing Administration, 33(1), 52-59.

Donner, G. J., & Wheeler, M. M. (2004). New strategies for developing leadership.
Canadian Journal of Nursing Leadership, 17(2) Available online: http://
www.nursingleadership.net/NL172/NL172Donner.html.

Ferguson-Pare , M.,
َ Mitchell, G., Perkin, K., & Stevenson, L. (2002). Academy of
Canadian Executive Nurses background paper on leadership. Canadian Jour-
nal of Nursing Leadership, 15(3), 4-8.

Heller, B. R., Drenkard, K., Esposito-Herr, M. B., Romano, C., Tom, S. & Valen-
tine, N. (2004). Educating nurses for leadership roles. The Journal of Con-
tinuing Education in Nursing 35(5), 203-210.

Hibberd, J. M., Smith, D.L., & Wylie, D.M. (2006). Leadership and leaders. In J.M.
Hibberd & D. L. Smith (Eds.), Nursing leadership and management in Can-
ada (3rd ed., pp. 369-394). Mosby: Toronto

Hill, K. S. (2003). Development of leadership competencies as a team. Journal of


Nursing Administration, 33(12), 639-642.

Kerfoot, K. (2005). On leadership: Building confident organizations by filling buck-


ets, building infrastructures, and shining the flashlight. Pediatric Nursing, 31
(1), 63-65.

King, T (1999). Scanning and reflecting: Major components of nursing leadership.


Health Care for Women International, 20, 315-323.

Kramer, M., Schmalenberg, C., & Maguire, P. (2004). Essentials of a magnetic


work environment: Part III. Nursing, 34(8), 44-47.

Laschinger, H. K.S., Almost, J., & Tuer-Hodes, D. (2003). Workplace empower-


ment and magnet hospital characteristics. Journal of Nursing Administration,
33(7/8), 410-422.

Laschinger, H. K. S., & Leiter, M. P. (2006). The impact of nursing work environ-
ments on patient safety outcomes: The mediating role of burnout/
engagements. Journal of Nursing Administration, 36(5), 259-267.

Leatt, P & Porter, J (2003). Where are healthcare leaders? The need for investment
in leadership development. Healthcare Papers, 4(1), 14-31.

16
ARNNL Nursing Leadership Literature Review

Laurent, C. L. (2000). A nursing theory for nursing leadership. Journal of Nursing


Management, 8, 83-87.

Marquis, B. L., & Huston, C. J. (2006). Leadership roles and management func-
tions in nursing: Theory and application (5th ed.). Philadelphia: Lippincott.

McGillis Hall, L., Doran, D., & Pink, G. H. (2004). Nursing staffing mix models,
nursing hours, and patient safety outcomes. Journal of Nursing Administra-
tion, 34(1), 41-45.

McNally, K. & Lukens, R. (2006). Leadership development: An external-internal


coaching partnership. Journal of Nursing Administration, 36(3), 155-161.

Mills, C. (2005). Developing the ability to lead. Nursing Management, 12(4), 20-
23.

Morgan, S. H., Lahman, E., & Hagstrom, C. (2006). The magnet recognition pro-
gram: Transforming healthcare through excellence in nursing services. Jour-
nal of Nursing Care Quality, 21(2), 119-120.

Porter-O’Grady, T. (1999). Quantum leadership: New roles for a new age. Journal
of Nursing Administration, 29(10), 37-41.

Porter-O’Grady, T. (2003a). A different age for leadership, part 1: New context:


New content. Journal of Nursing Administration, 33(2), 105-110.

Porter-O’Grady, T. (2003b). A different age for leadership, part 2: New rules new
roles. Journal of Nursing Administration, 33(3), 173-178.

Registered Nurses Association of British Columbia. (2001). Policy statement:


Nursing leadership and quality care. Vancouver: Author.

Rogers, A. E., Hwang, W. T., Scott, L. D., Aiken, L. H., & Dinges, D. F. (2004).
The working hours of hospital staff nurses and patient safety. Health Affairs,
23(4), 202-212.

Sherman, R.O. (2005a). Don’t forget our charge nurses. Nursing Economics, 23(3),
125-143.

Sherman, R.O. (2005b). Growing our future nursing leaders. Nursing Administra-
tion Quarterly, 29(2), 125-132.

17
ARNNL Nursing Leadership Literature Review

Sullivan, J., Bretschneider, J., & McCausland, M. P. (2003). Designing a leadership


development program for nurse managers: An evidence-driven approach.
Journal of Nursing Administration, 33(10), 544-549.

Thompson, P. A. (2004). Leadership from an international perspective. Nursing


Administration Quarterly, 28(3) 191-198.

Thyer, G. L. (2003). Dare to be different: Transformational leadership may hold the


key to reducing the nursing shortage. Journal of Nursing Management, 11,
73-79.

Tourangeau, A. E. (2003). Building nurse leader capacity. Journal of Nursing Ad-


ministration, 33(12), 624-626.

Tracey, C., & Nicholl, H. (2006). Mentoring and networking. Nursing Management,
12(10), 28-32.

Trofino, A. J. (2000). Transformational leadership: moving total quality manage-


ment to world-class organizations. International Nursing Review, 47, 232-
242.

Wright, K., Rowitz, L., & Merkle, A. (2001). A conceptual model for leadership
development. Journal of Public Health Management Practice, 7(4), 60-66.

18
ARNNL is the professional organization representing all 6300 Registered Nurses and 89 Nurse Practitioners in
the province. In pursuit of its vision, “Healthy People in Newfoundland and Labrador,” ARNNL exists so there
will be excellence in nursing, public protection, quality health care, and healthy public policy.

Association of Registered Nurses of Newfoundland and Labrador


55 Military Road, St. John’s, NL. A1C 2C5
Web Site: www.arnnl.nf.ca, Email: info@arnnl.nf.ca
Telephone: 709-753-6040, Toll Free: 800-563-3200
Facsimile: 709 753 4940