693309

research-article2017
NSQXXX10.1177/0894318417693309Nursing Science QuarterlyClarke / Scholarly Dialogue

Scholarly Dialogue

Nursing Science Quarterly

Transformational Leadership in Nursing

2017, Vol. 30(2) 124­–128
© The Author(s) 2017
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DOI: 10.1177/0894318417693309
https://doi.org/10.1177/0894318417693309
journals.sagepub.com/home/nsq

Shelly Ann Fischer, RN; PhD1

Abstract
Transformational leadership is a trending style and competency that has been embraced by many industries and nursing
practice settings. Similar positive influence on follower engagement, teamwork, and solidarity might be experienced if
transformational leadership is employed by administration and faculty as a guiding framework for nursing education. The
impact of embedding a teamwork culture in basic nursing education could be significant on students and ultimately on the
nursing profession. Further research is needed to develop and test application of the transformational leadership framework
in nursing education.

Keywords
academic work culture, incivility, nursing education, transformational leadership

Nurses entering practice today must be prepared to meet
continually increasing demands for rapid-cycle improve-
ment within a turbulent environment of shifting demograph-
ics, advancing technology, and diminishing resources.
Healthcare has always been a team sport, yet current
demands require unprecedented team-building and negotia-
tion skills for nurses to collaborate effectively with an inter-
professional team to meet these challenges. Despite a
plethora of research emphasizing the importance of team-
work to patient outcomes (Berry et al., 2016; Blouin &
McDonagh, 2011; Salas & Rosen, 2013), nurses continue to
struggle with establishing themselves as integral team play-
ers, both interprofessionally and intraprofessionally. For
example, large healthcare systems still fail to consistently
have the voice of nursing at the senior leadership table, and
decision-making boards and public policy bodies all too
often lack the perspective of nursing, the largest group of
healthcare professionals (Kavey et al., 2009). Within the
profession, opportunities for promoting and advancing nurs-
ing have been waylaid by infighting and lack of professional
solidarity, with subsequent inability to gain consensus on
foundational topics, such as entry level for practice.
Significant opportunity exists for the improved collegiality,
teamwork, and solidarity that may result from consciously
and passionately prioritizing leadership development in
nursing education.
The quality and success of the nursing workforce, hence
the profession’s future, depends on solid education programs
with healthy team cultures, as professional values and expec-
tations begin to form during the educational process. Faculty
modeling of teamwork, collegiality, and solidarity for stu-
dents strengthens development of value structures in students
that incorporates collegiality and teamwork at their core.
Nursing can realize its potential only when linking elbows
with inter- and intraprofessional colleagues to tackle the
challenges of today’s and tomorrow’s healthcare environ-
ments. Building faculty team cultures that produce students
with the necessary knowledge, skills, and attitudes to prepare
them to be strong team players is key; embracing transforma-
tional leadership (TFL) as a framework for developing lead-
ership competencies in academic administrators, faculty, and
students is one opportunity for cultivating a team-focused
faculty culture. By increasing TFL competencies among edu-
cational administrators, nurse faculty, and nursing students,
many current challenges might be addressed and stabilized.
TFL and Education: An Historical
Perspective
While clearly not a panacea to all challenges, TFL is trending
as a style and competency (Fischer, 2016) due largely to the
growing body of evidence supporting its effectiveness in
engaging and unifying the workforce (Buck & Doucette,
2015; Lewis & Malecha, 2016; Manning, 2016; Steaban,
2016). Presumably, many of the positive follower outcomes
associated with TFL in other industries can be predicted to
occur similarly in the academic practice setting. Some
outcomes may be even greater than average in academe,
1
University of Wyoming, Laramie, WY, USA
Contributing Editor:
Pamela N. Clarke, RN, PhD, FAAN, University of Wyoming, 1000 E.
University Ave, Dept 3065, Laramie, WY 82070, USA.
Email: pclarke@uwyo.edu
Clarke / Scholarly Dialogue 125
such as the influence on teamwork. The improvement oppor-
tunity for teamwork in education may be greater than other
practice settings or industries, because historically, the fac-
ulty role has been characterized as a solo and entrepreneurial
venture (Bergquist & Pawlak, 2008; Twale & DeLuca, 2008),
particularly in the research-focused tenure-track position.
Consistent with the “collegial culture” (Bergquist & Pawlak,
2008, p. 15), and subsequent to the value placed on academic
freedom, higher education faculty are predominantly autono-
mous. Faculty are not incented to perform as a team. For
example, faculty that frequently co-author manuscripts are
considered suspect in the tenure and promotion process; fac-
ulty members lacking solitary scholarly production could be
perceived as inadequate or worse, as slackers, jeopardizing
the ultimate reward of tenure. It might even be said that com-
peting successfully is better rewarded than team-oriented or
collaborative behaviors, particularly in the current era of
scarce funding for research. A paradigm shift in nursing edu-
cation that counters tradition and moves toward a team-
focused culture could be driven by embracing the essentials
of TFL in the academic environment at all levels. If adminis-
trators model the attributes and behaviors of TFL, faculty
leadership skills also develop and in turn model the same for
nursing students. The cascading effect of TFL skill develop-
ment may result in increased professional conduct and col-
legiality and decreased divisive behaviors, thus cultivating a
team focused culture.
Making the Case: Preventing and
Addressing Incivility
One example of the team-building benefit of embracing TFL
is the way it counters alienating behaviors such as incivility.
Horizontal hostility or lateral violence continues to challenge
nursing, in all areas of practice. A full 85% of nurses report
experiencing lateral violence in the workplace (Buck &
Doucette, 2015), and even in facilities with Magnet® and
Pathway to Excellence® recognition, incivility continues to
exist (Lewis & Malecha, 2011). For decades, nursing authors
have written about professional conduct and pleaded, “Can’t
we all just get along?” (Roberts, 2015). The divisive nature
of unprofessional conduct detracts from the solidarity of
nursing, the very thing needed for the profession to realize
full potential as described by the Institute of Medicine
(Institute of Medicine [IOM], 2010). Nurses cannot be cata-
lysts without being collaborators, nor can nurses model the
change needed in regard to civility (Sherman, 2016a, 2016b).
Some assume that academic nursing practice rises above
the rest of the professional practice settings in terms of civility,
and the assumption is justifiable; in general, higher education
broadens perspective and tolerance (Easterbrook, Kuppens, &
Manstead, 2016). In reality, however, academic nurses experi-
ence at least as much incivility as that found in the practice
environment, if not more (Twale & DeLuca, 2008). According
to Clark (2013), faculty-to-faculty incivility is one of the most
underresearched areas, hence one of the least understood phe-
nomena. Proposed antecedents or contributing factors include
faculty competition for diminishing resources (Clark, 2013),
issues of rank and power (Cleary, Walter, Horsfall, & Jackson,
2013), reward structures and inadequate development of men-
toring and peer review processes (Twale & DeLuca, 2008),
leadership style and administrative avoidance of the problem
(Peters, 2014), and lack of institutional policy or procedure for
addressing the issue (Clark, 2013). With the United States fac-
ing profound faculty shortage, coupled with unprecedented
growth in demand for nurses (Bureau of Labor Statistics, U.S.
Department of Labor, 2016), opportunity for embracing TFL
as one solution for enhancing teamwork within the academic
nursing environment looms large. Further research is needed
exploring TFL and teamwork among nurse faculty, especially
in the context of the reappointment, tenure, and promotion
process.
While much is not understood in detail related to faculty
culture and incivility, what is known is that minimizing
uncivil conduct begins with strong leadership skills at all lev-
els. Bravely naming the behavior and confronting it consis-
tently with a process for individual and collective
accountability works to decrease unprofessional conduct
(Clark, 2013), yet doing so clearly requires TFL knowledge,
skills, and attributes. It has been understood for some time
that “what you permit, you promote” (Kerfoot, 2009). The
leader of any group establishes the expectations for conduct
among followers. As such, leaders that allow unprofessional
or destructive behaviors among faculty to go unaddressed
inadvertently reinforce these behaviors and can foster a dan-
gerous spiral of aggression within the culture. It is crucial for
behavior standards to be developed and disseminated
throughout nurse faculty as early as possible, and it is even
more important for administrators to swiftly address devia-
tions from standards (Twale & DeLuca, 2008; Wright & Hill,
2015). In turn, recognition programs that highlight and rein-
force a working unit’s values and standards are very effective
in promoting and fortifying a team culture (Kerfoot, 2009).
Embracing a “developmental culture” (Bergquist & Pawlak,
2008, p. 73), and consistently modeling these leadership
responses requires courage, confidence, passion, and other
TFL skills related to communication and follower support.
“Fear and anxiety will only be fully addressed when people
feel they are being freely served with the skills, knowledge,
strategies, and resources of all members of the academy—
regardless of culture” (Bergquist & Pawlak, 2008, p. 13).
Making the Case: Enhancing Academic-
Practice Relationships
In addition to addressing faculty comportment, another
opportunity exists for TFL as a framework for informing
leadership development in the academic nursing setting,
namely improving relationships with the nursing practice
environment. Linkages with practice sites are often weak
126 Nursing Science Quarterly 30(2)
(American Association of Colleges of Nursing, 2016) due to
tensions between academic and practice nurses secondary, in
part, to many of the same cultural factors that prevent effec-
tive teamwork among faculty (Bartunek & Rynes, 2014).
Likewise, expanding TFL competencies among faculty may
contribute to the skillsets required to help bridge gaps
between the academic and practice settings. Meeting grow-
ing demands for bolstering the nursing workforce will
depend on expanded practice site access. Building academic-
practice relationships and teamwork may stabilize the foun-
dation for nursing student development and furthers point of
care research opportunities. Practice site-based research, in
turn, may expedite translation of research findings to care,
advance evidence-based practice, and further faculty devel-
opment (AACN, 2016). It stands to reason that improved
academic-practice relationships could foster recruitment of
practitioners to faculty positions as well. Overall, embracing
TFL as a framework for leadership development among fac-
ulty can improve external as well as internal teambuilding.
Making the Case: Improving Work
Environment Culture and Faculty
Retention
While faculty-to-faculty incivility, academic-practice ten-
sions, and the need for leadership development have signifi-
cant impact on educational and nursing workforce outcomes,
their impact on the nursing education workforce is signifi-
cant. Rising salaries and employment opportunities for doc-
torally prepared nurses within healthcare practice settings
are increasing (Fang & Bednash, 2014), posing escalating
competition for faculty. In conjunction with rapidly increas-
ing rates of retirement among nurse faculty (Auerbach,
Buerhaus, & Staiger, 2015), a “perfect storm” for nursing
academe is in the making. All sorts of creative solutions are
needed at this time, including a retention strategy related to
improving the work culture and environment in nursing edu-
cation. Incivility alone contributes to a significant loss of
nurse faculty every year (Clark, 2013). TFL is known to have
a significant positive effect on work environment culture and
job satisfaction (Brady-Germain & Cummings, 2010).
Faculty mentors with TFL characteristics are significantly
more effective than those without (Hill et al., 2014). If
embracing TFL as a framework for leadership development
in the academic setting can improve culture and job satisfac-
tion and, as a result, decrease turnover and loss of faculty to
retirement or other practice settings, the subsequent impact
on nursing workforce development could be significant.
TFL and Nursing Education
Interestingly, there is not a great deal of research evidence
related to effectiveness of leadership in higher education in
general (Bryman, 2007). A literature search exploring TFL
and nursing education results in few publications (Burger,
Kramlich, Malitas, Page-Cutrara, & Whitfield-Harris, 2014;
Chen & Baron, 2006; Hill, 2002; Isaac, 2010; Milesky,
Baptiste, Foronda, Dupler, & Belcher, 2015; Peters, 2014).
While little research has been published evaluating TFL in
the context of nursing education, evidence does exist to sup-
port the positive influence of TFL in higher education
(Roueche, Baker, & Rose, 1989; Cetin & Kinik, 2015) and in
many other industries (Aarons, 2006; Zohar & Tenne-Gazit,
2008).
Framing many of the TFL research studies is the Full
Range Leadership Theory (Burns, 1978), which identified
TFL as one type of leadership within the continuum of lead-
ership styles. Since that time, TFL has been conceptualized
in different ways, though the works of Bass and Avolio
(2002) and Kouzes and Posner (2007) seem to dominate the
literature. Leithwood (1994) specifically adapted the TFL
theory to education, with a focus on school principals. While
TFL is readily adaptable to nursing, the work has not yet
been conceptualized as nursing theory. To bolster nursing
science while honoring the contribution and expertise from
other disciplines, the next step should be to develop and test
an adaptation of the TFL framework to nursing education.
If we “unpack” the essential components of TFL, the sup-
portive role it can play in the nursing academic setting is
clear. Table 1 summarizes TFL elements according to Bass
and Avolio (2002) and Kouzes and Posner (2007) and pro-
vides a “call to action” for applying the framework to nurs-
ing education.
In summary, TFL competencies can and should be mod-
eled and taught in nursing education on a wholesale basis;
administrators, faculty, and students will benefit, as will the
profession and healthcare in general. Administrators should
model TFL skills and attributes to build teamwork within
faculty, address and prevent incivility, and increase retention
through enhanced job satisfaction. In turn, faculty benefit
from learning and embracing TFL and can improve practice
site relationships and serve as role models for students. In the
end, graduating nursing students may have stronger TFL
knowledge, skills, and attributes to bring to the bedside,
enhancing patient care outcomes, building solidarity within
the profession, and improving relationships with the inter-
professional team.
Conclusion
The professional potential for nursing is exciting—we are at
a precipice to play pivotal roles in policy development and
wholesale reform of the healthcare system. The time is right,
with political doors opening (IOM recommendations),
improving equality for women and female-dominated pro-
fessions, along with the bolstering of diversity in nursing
with growing numbers of millennials and males. Yet despite
good timing, nursing will realize its full potential only if a
collective voice and a united front is present. The time is now
to get serious about professional leadership development,
Clarke / Scholarly Dialogue 127

Table 1.  Application of Transformational Leadership Theory to Nursing Education.

Bass & Avolio
Idealized influence
Inspirational motivation
Intellectual stimulation
Individualized consideration
 
Kouzes & Posner
Models the way
Inspires a shared vision
Challenges the process
Enables others to act
Encourages the heart
Application to Nursing Education Leadership Development
Value and develop emotional intelligence. Become clear on personal and
professional values and how they align with the school’s mission and
values. Frame all decisions in the context of mission and values, and
model them for faculty and staff.
Cultivate team spirit by encouraging involvement of all faculty and staff
across programs and tracks. Drive engagement by finding shared
meaning and purpose for a better future.
Incent innovative and disruptive thinking at all levels; enable trials (and
error) of new ideas, with open and honest evaluation methods to learn
from mistakes. Challenge constraints and barriers to improvement (old
ways of thinking, financial limitations, parochial systems).
Seek out the timid voice; foster broad participation of all faculty and
staff across programs and tracks. Look for insider/outsider phenomena
and speak of it openly, contrasting with school mission and values.
Value diversity of opinion and perspective; model constructive use of
inherent conflict.
Celebrate, early and often! Enable the development of behavior
standards by faculty and students, and actively promote them so
they become living documents. Develop a zero-tolerance policy for
deviation from these standards by consistently holding administration,
faculty, staff, and students to them. Offer and encourage collegial
support to develop individual and collective potential.

Source. Adapted from Bass and Avolio (2002) and Kouzes and Posner (2007).

embracing the tenets of TFL in all aspects of practice,
research, and education, to develop the competencies essen-
tial to solidarity of the nursing profession.
Reliving and owning victimization and oppression should
remain in nursing’s past. Now is the time to seize the power
potential of nursing, granted by public trust (Gallup, 2015) and
respect as well as the sheer volume of nursing professionals, to
influence healthcare and to create a foothold for future leader-
ship in healthcare. By modeling, cascading, and expanding
TFL competencies; reaching “across the aisle” to our partners
in other practice settings; and honoring each specialty for the
unique value and contribution it brings to the professional
table, nursing can, and must, do so much more than just “all
get along.” Nursing can be the collective voice for patient-
focused care and balanced budgets that advocate for quality
and safety in healthcare, a far greater purpose.
Declaration of Conflicting Interests
The author declared no potential conflicts of interest with respect to
the authorship and/or publication of this review.
Funding
The author received no financial support for the authorship and/or
publication of this review.
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