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Transformational Leadership: A Growing Promise for Nursing
Rose O. Sherman, EdD, RN, NEA-BC, CNL, FAAN, and Maureen Habel, MA, RN
This course is 1 contact hour
Course must be completed by November 30, 2019
Goals and objectives: The goal of this continuing education program is to inform nurses about transformational leadership in healthcare. After studying the information presented here, you will be able to:
  1. State the four components of transformational leadership
  2. Compare and contrast transactional and transformational leadership styles
  3. Discuss the relationship between transformational leadership in Magnet healthcare organizations, job satisfaction among nurses, and positive patient outcomes


Nurse.com educational activities are provided by OnCourse Learning. For further information and accreditation statements, please visit Nurse.com/Accreditation. The planners and authors have declared no relevant conflicts of interest that relate to this educational activity. OnCourse Learning guarantees this educational activity is free from bias. See “How to Earn Continuing Education” to learn how to earn CE credit for this module or visit http://ce.nurse.com/instructions.aspx.
Allison has been an assistant nurse manager in a Magnet-designated hospital on the evening shift for the past year. Emily, her nurse manager, knows Allison is interested in a leadership role and has agreed to be her mentor. Before Emily goes on vacation, she asks Allison to move to the day shift for two weeks to be in charge of the unit. Emily suggests that Allison keep a notebook describing why and how she makes important decisions during her absence.
Magnets attract
Transformational leadership is a key ingredient in establishing a nursing environment that achieves Magnet designation. More than two decades ago, the American Academy of Nursing began to look at hospitals that retained highly qualified nurses during serious nursing shortages.1 An analysis of these organizations revealed that they had several things in common; these commonalities became known as the forces of magnetism.

Today, there are more than 460 Magnet hospitals in the United States and seven in four other countries recognized by the American Nurses Credentialing Center for their excellence in nursing practice.2 Magnet designation is considered the hallmark of nursing practice excellence, and research has demonstrated that Magnet-level nursing care has a profoundly positive impact on nursing practice and patient care.3 The Magnet program was expanded to include long-term care facilities in 1998; in 2000, it was further expanded to include international healthcare organizations.1,2 In 2008, the American Nurses Credentialing Center published a Magnet model that emphasized the importance of using a leadership style known as transformational leadership.4

Transformational leadership has been shown to be particularly effective in turbulent and uncertain environments, such as those found in today’s healthcare organizations.3 Although not every organization will achieve Magnet status, nurses at all organizations can learn how to use the principles of transformational leadership to support a professional practice environment that results in outstanding patient care.
Transformational leadership is a key ingredient in establishing a nursing environment that achieves Magnet designation. More than two decades ago, the American Academy of Nursing began to look at hospitals that retained highly qualified nurses during serious nursing shortages.1 An analysis of these organizations revealed that they had several things in common; these commonalities became known as the forces of magnetism.

Today, there are more than 460 Magnet hospitals in the United States and seven in four other countries recognized by the American Nurses Credentialing Center for their excellence in nursing practice.2 Magnet designation is considered the hallmark of nursing practice excellence, and research has demonstrated that Magnet-level nursing care has a profoundly positive impact on nursing practice and patient care.3 The Magnet program was expanded to include long-term care facilities in 1998; in 2000, it was further expanded to include international healthcare organizations.1,2 In 2008, the American Nurses Credentialing Center published a Magnet model that emphasized the importance of using a leadership style known as transformational leadership.4

Transformational leadership has been shown to be particularly effective in turbulent and uncertain environments, such as those found in today’s healthcare organizations.3 Although not every organization will achieve Magnet status, nurses at all organizations can learn how to use the principles of transformational leadership to support a professional practice environment that results in outstanding patient care.
What it looks like
How to earn continuing education
THIS COURSE IS 1 CONTACT HOUR
1.
Read the Continuing Education article.
2.
Go online to Nurse.com/CE to take the test for $12. If you are an Unlimited CE subscriber, you can take this test at no additional charge. You can sign up for an Unlimited CE membership at Nurse.com/UnlimitedCE for $49.95 per year.
3.
If the course you have chosen to take includes a clinical vignette, you will be asked to review the vignette and answer 3 or 4 questions. You must answer all questions correctly to proceed. If you answer a question incorrectly, we will provide a clue to the correct answer.
4.
Once you successfully complete the short test associated with the clinical vignette (if there is one), proceed to the course posttest. To earn contact hours, you must achieve a score of 75%. You may retake the test as many times as necessary to pass the test.
5.
All users must complete the evaluation process to complete the course. You will be able to view a certificate on screen and print or save it for your records.
In support of improving patient care, OnCourse Learning is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

OnCourse Learning is also an approved provider by the Florida Board of Nursing, the District of Columbia Board of Nursing, and the South Carolina Board of Nursing (provider # 50-1489). OnCourse Learning’s continuing education courses are accepted by the Georgia Board of Nursing. OnCourse Learning is approved by the California Board of Registered Nursing, provider #CEP16588.
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Stressing transactions
At the same time that Burns published the theory of transformational leadership, he described a leadership style called transactional leadership. Transactional leadership is based on an understanding between a manager and subordinates; the transaction consists of an acceptable salary, benefits, and working conditions in exchange for job performance.

Transactional leadership is based on contingent reward, i.e., a reward that depends on delivery of the work product. The leader establishes goals, provides direction, and rewards employee progress in meeting goals by using praise and recognition, as well as merit increases and job promotion.5 Leaders using a transactional style reward good behavior, punish negative behavior, and maintain control at the top of the hierarchy.8 In the exchange that occurs in a transactional management agreement, the basic needs of both the leader and the follower are met, but they may not have a common vision for nursing practice.6 The employee agrees to complete tasks as assigned and to meet work deadlines. Evaluation comments for a nurse working under this style of leadership might read: “Cathy Smith completes her work on time, has fewer than the standard number of allowed absences, and has made no medication errors during this rating period.”

As is evident, this leadership style is unlikely to fuel a high level of job satisfaction and organizational commitment. Nursing departments that use this leadership style may publish a vision statement and goals that have been developed by senior management, with minimal staff input.

At the unit level, a nurse manager may be asked to develop a unit vision statement and goals that reflect senior management’s vision.9 (Level B) The manager may reference this document in staff meetings or place it in orientation folders for new employees, but rarely does it have an impact on nursing practice and patient care. Healthcare organizations, being highly bureaucratic, have traditionally used transactional leadership strategies, which include a task-and-reward orientation, management by exception, few opportunities for creative thinking, decision making by senior management, and limited opportunities for employees to be involved.6

Although transactional leadership can help organizations meet their goals in the short term, it will not provide the inspiration to create and nourish a new culture for nursing practice and patient care. In contrast, evidence-based research supports that a transformational leader can influence attitudes and behavior to create a new culture for nursing practice and patient care, because the vision resonates with staff members and they are involved in making it become a reality.10,11,12 (Level B)
Transformational leaders use the following four elements when leading others:13Idealized influenceInspirational motivationIntellectual stimulationIndividual consideration Idealized influence, sometimes called charisma, describes a leader’s ability to inspire high standards and serve as a role model for outstanding professional practice. Such a leader gains the trust and respect of staff. Inspirational motivation refers to the leader’s ability to communicate a vision others can understand and of which they want to be a part. For example, a nurse leader with a transformational style would find creative ways to inspire staff with a vision for the future, including meeting with groups of staff or using staff e-mails to lay out goals and ways of reaching them. Intellectual stimulation is provided by a leader who asks for and values staff input, who challenges followers to develop creative and innovative solutions, and who continually seeks ways to provide growth and development opportunities. A climate in which intellectual stimulation is supported prompts staff to challenge assumptions, to reframe problems, and to look at new ways of doing things. For example, a transformational leader would provide time for nurses to work with resource staff to incorporate evidence-based practice findings into patient care.

Leaders who support intellectual stimulation find ways to encourage nurses to voice their own ideas about improving patient care and pave the way for innovations to be tested and incorporated into the nursing culture. Individualized consideration refers to the commitment of the leader to coaching and mentoring, and the leader’s awareness of and concern for the needs of nursing staff. A transformational leader knows individual staff members’ career aspirations and is often in a position to guide subordinates to invaluable mentoring opportunities. Healthcare organizations face myriad challenges, the most significant of which is the need to transform the way patients receive high-quality, cost-effective care in the future. Having input from those who provide hands-on care is a vital part of this paradigm shift. The Institute of Medicine Report on the future of nursing, for example, emphasized the need for nurses to become involved in healthcare reform.14 The focus of transformational leadership on empowerment, viewing errors as learning opportunities, and valuing innovation means that staff members have a means of continually providing input about how to improve care. As a result, transformational leadership can revitalize healthcare from the point of patient care and more.2 In addition, the leadership style of nurse managers has a critical impact on nurse job performance and on nurse retention — factors vital for providing excellent patient care.10 Managers who use transformational leadership principles create a climate in which nurses have a greater commitment to their organizations and high levels of morale, job satisfaction, and work performance. Several studies have found that nurse leaders who are seen as having a transformational leadership style promote an enhanced sense of job satisfaction, well-being, and organizational commitment in their staff.9,10,11 (Level B),12 (Level B)
Reviewing Allison’s notebook will allow Emily to reinforce effective decision-making skills and to identify areas for learning and mentoring. By developing a creative way to help Allison develop decision-making skills, Emily is demonstrating one of the characteristics of a transformational leader. In today’s healthcare environment, nurses seek leaders like Emily who help staff build self-esteem and empower them to realize their career aspirations.

This module explains what transformational leadership is, why transformational leadership is a key part of Magnet nursing organizations, and how it can promote work satisfaction among nurses and improve care for patients.
The transformational way
Transformational leaders use the following four elements when leading others:13Idealized influenceInspirational motivationIntellectual stimulationIndividual consideration Idealized influence, sometimes called charisma, describes a leader’s ability to inspire high standards and serve as a role model for outstanding professional practice. Such a leader gains the trust and respect of staff. Inspirational motivation refers to the leader’s ability to communicate a vision others can understand and of which they want to be a part. For example, a nurse leader with a transformational style would find creative ways to inspire staff with a vision for the future, including meeting with groups of staff or using staff e-mails to lay out goals and ways of reaching them. Intellectual stimulation is provided by a leader who asks for and values staff input, who challenges followers to develop creative and innovative solutions, and who continually seeks ways to provide growth and development opportunities. A climate in which intellectual stimulation is supported prompts staff to challenge assumptions, to reframe problems, and to look at new ways of doing things.

For example, a transformational leader would provide time for nurses to work with resource staff to incorporate evidence-based practice findings into patient care. Leaders who support intellectual stimulation find ways to encourage nurses to voice their own ideas about improving patient care and pave the way for innovations to be tested and incorporated into the nursing culture. Individualized consideration refers to the commitment of the leader to coaching and mentoring, and the leader’s awareness of and concern for the needs of nursing staff. A transformational leader knows individual staff members’ career aspirations and is often in a position to guide subordinates to invaluable mentoring opportunities. Healthcare organizations face myriad challenges, the most significant of which is the need to transform the way patients receive high-quality, cost-effective care in the future. Having input from those who provide hands-on care is a vital part of this paradigm shift. The Institute of Medicine Report on the future of nursing, for example, emphasized the need for nurses to become involved in healthcare reform.14 The focus of transformational leadership on empowerment, viewing errors as learning opportunities, and valuing innovation means that staff members have a means of continually providing input about how to improve care. As a result, transformational leadership can revitalize healthcare from the point of patient care and more.2 In addition, the leadership style of nurse managers has a critical impact on nurse job performance and on nurse retention — factors vital for providing excellent patient care.10 Managers who use transformational leadership principles create a climate in which nurses have a greater commitment to their organizations and high levels of morale, job satisfaction, and work performance. Several studies have found that nurse leaders who are seen as having a transformational leadership style promote an enhanced sense of job satisfaction, well-being, and organizational commitment in their staff.9,10,11 (Level B),12 (Level B)
Historically, healthcare organizations have focused their energies on motivating employees by meeting the first three levels of Maslow’s hierarchy.5 For example, appropriate compensation allows employees to meet their basic physiological needs, workers’ safety is satisfied through a secure work environment, and strategies such as shared governance and participatory management promote a sense of belonging among employees.5 In Burns’ view, transformational leadership has the potential to motivate followers to satisfy higher-level needs, such as self-esteem and self-actualization. Those influenced by transformational leaders find meaning and value in their work, make significant contributions to the success of their employing organization, and become leaders themselves.5 Burns’ view is that transformational leadership makes a profound difference in the life of employees and organizations.5 In the past several decades, there has been a paradigm shift concerning what leadership is and what it can do. From a model that emphasizes tasks and controls, leadership is now seen as vital in developing a work culture in which employees are successful. Essential to this effort are leaders who have a positive and compelling vision and followers whose needs are met.3 Transformational leadership depends on a high level of engagement between leader and followers. Traditionally, nursing leaders have used management styles ranging from an autocratic style, in which engagement goes in only one direction, to a “hands-off” or laissez-faire style, in which the manager is nearly disengaged.6

A laissez-faire management style is basically an abdication of leadership; there are no followers in a work setting where a manager uses this style because there is no leader.6 Having a manager who is visible and collaborative is important for staff to perceive active and appropriate leadership. Two recent studies found that nurse leaders who practiced transformational leadership more effectively inspired and engaged staff.1,7 (Level B)
The role of transformational leadership in nursing
Earn 1 credit hour with this continuing education course
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EDITOR’S NOTE: Rose O. Sherman, EdD, RN, NEA-BC, CNL, FAAN, is an associate professor and director of the Nursing Leadership Institute at the Christine E. Lynn College of Nursing at Florida Atlantic University. She has 25 years of nursing leadership experience with the Department of Veterans Affairs and frequently writes and speaks on nursing leadership development. Maureen Habel, MA, RN, is an award-winning nurse author living in Seal Beach, Calif.
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Contents
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Understand Magnet nursing
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Interim director discusses past and future of the Magnet program.
Magnet hospitals - nurse giving thumbs up sign
The Magnet difference
Experts discuss some of the unique characteristics of Magnet hospitals.
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Find your Magnet hospital
A breakdown by state of all the Magnet hospitals in the U.S.
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Magnet has global appeal
Hospitals in other countries are seeking Magnet recognition.
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Frontline nurses take the lead
Nurses are taking on leadership roles as Magnet Champions.
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Free CE: From Novice to expert
Build your expertise by adding to your skills and experience.
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Magnet can be a lifesaver
Read first-hand account of how Magnet hospitals saves lives.
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Seeking Magnet: Pros and cons
A look at some of the benefits and costs of pursuing Magnet status.
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Improve patient care
Research suggests Magnet status can improve patient outcomes.
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Nurses battle Hurricane Harvey
Nurses at Magnet hospitals in Houston stepped up during crisis.
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Achieve accreditation
Key steps hospitals can take to help them in the Magnet process.
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Lifelong learning in nursing
Magnet program places a strong emphasis on continuing education.
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continuing education catalog
Continuing education catalog
A look at courses that can help nurses on the Magnet journey.
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APRNs and Magnet nursing
Magnet status can elevate nurse educational standards.
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When you get the Magnet call
Read testimonial from CNO of one of the newest Magnet hospitals.
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What being Magnet means
Learn about the continuing journey of the nation's first Magnet hospital.
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Achieve nursing excellence
Read stories of recent Magnet Nurses of the Year winners.
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It takes a special leader
Find out how transformational leadership leads to satisfaction.
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RNs gain support
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The Magnet culture dictates fitting education into nurses' routine.
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IOM goals are top of mind
Magnet supports education targets for 2020.
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RNs are at the helm
Transformational leadership plays big role in Magnet process.
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