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Gifted leadership occurs where heart and head—feelings and thought—meet. These are the two wings that allow a leader to soar.

—Goleman, Boyatzis, & McKee (2002, p. 33)

Introduction

Leadership does not occur in isolation. Leaders influence change by helping group members to accomplish their objectives. This chapter will provide you with a deeper understanding of the behaviours associated with the following terms: leadership, management, mentorship, and followership. The development of emotional and social intelligence will also be discussed as an integral aspect of effective leadership.

 

1.1 Management, Leadership, Followership, and Mentorship

Managers

Management has traditionally consisted of five essential functions: planning, organizing, commanding, coordinating, and controlling. In the late 1930s, these five functions were modified and expanded to include seven elements known by the acronym POSDCORB (MacLeod, 2012). Planning refers to the action of determining goals for the future. Organizing requires the manager to design an efficient and effective workplace. Staffing refers to the manager’s responsibility for recruiting, hiring, training, and maintaining staff, while also directing or guiding the organization to meet specific objectives, and coordinating or synchronizing the activities and use of resources. Finally, the manager demonstrates success in achieving goals by reporting (communicating progress and results) and budgeting (using scarce resources wisely). Although critics consider POSDCORB to be an overly simplistic view of management, each of the seven elements continues to be evident within management practices.

Leaders

The responsibilities of managers and leaders within a group or organization are closely linked. Leadership is regarded by many as the ability to guide others into actions that meet the needs of the organization. MacPhee describes leadership as “the process of engaging and influencing others” (2015, p. 6). Health care leaders identify the needs of clients, establish what is required for health (for both individuals and organizations), and then encourage others to engage in actions that meet these needs. Porter-O’Grady and Malloch (2011) state that the health care leader does not have to be an expert in operations or problem solving, but rather must be a “good signpost reader.” In addition, the leader transmutes this “signpost” knowledge of the future into action for followers. Leaders are recognized as providing visions and strategies, while managers are responsible for operationalizing those visions and strategies (Pangman & Pangman, 2010).

Leadership by individuals is evident throughout health care. Not all leaders are appointed to formal positions of leadership. Nurse leaders have the knowledge and skill sets required to assist individuals in leading healthy lives and to support health care organizations in building a quality health care system. Leaders communicate their vision for the future to others through a combination of words and actions. These health care leaders create and follow a vision for the future. Action is much louder than words alone. Leaders make a difference.

The Canadian Nurses Association’s (CNA) Position Statement on Nursing Leadership (2009) states:

Nursing leadership is about the competent and engaged practice of nurses, who provide exemplary care, think critically and independently, inform their practice with evidence, delegate and take charge appropriately, advocate for patients and communities, insist on practising to their full and legal scope and push the boundaries of practice to innovative new levels.

Followers

Followership is frequently described as the “upward influence” of individuals on their leaders and their teams. The actions of followers have an important influence on staff performance and patient outcomes (Whitlock, 2013). Being an effective follower requires individuals to contribute to the team not only by doing as they are told, but also by being aware and raising relevant concerns. Effective followers realize that they can initiate change and disagree or challenge their leaders if they feel their organization or unit is failing to “promote wellness and deliver safe, value driven and compassionate care” (Spriggs, 2016, p. 637). Leaders who gain the trust and dedication of followers are more effective in their leadership role (Hibberd & Smith, 2006). Everybody has a voice and a responsibility to take ownership of the workplace culture, and good followership contributes to the establishment of high-functioning and safety-conscious teams (Whitlock, 2013).

Mentors

Experienced and thoughtful mentors play an important role in the development of nurse leaders. Mentorship is defined as “a formal supportive relationship between two or more health professionals that has the potential to result in professional growth and development for both mentors and mentees” (Ontario Ministry of Health and Long-Term Care, 2017, p. 1). It is a reciprocal relationship between an expert and a novice; the expert provides advice, feedback, and guidance, and the novice assists the mentor with projects while maintaining a relationship of respect, loyalty, and confidentiality (Evans, 2015).

Mentors can provide emotional support and career guidance that advance new nurses and nurse managers to professional success. However, Porter-O’Grady and Malloch (2011) suggest that some mentorships are toxic. Toxic mentoring occurs when mentors perpetuate past practices that prevent necessary changes from happening, rather than encouraging growth and development. Toxic mentoring can also occur when the mentor fails to assist the mentee to develop his or her own identity and leadership style, so that when the mentor is no longer present, the mentee is unable to progress on his or her career path. Finally, the mentor may give unrealistic assignments to the mentee, which may remain unfulfilled, culminating in mentee failure. These examples of toxic mentoring illustrate the importance of mentees choosing their mentors carefully since this relationship requires trust and mutual positive regard.

 

1.2 Leadership Styles

Overview

A review of the literature on leadership reveals a multitude of leadership styles. Marquis and Huston (2015) organize their scientific study of leadership using connections between leadership themes and specific time periods. Research on leadership started in the early 1900s with a focus on the great man theory (or trait theory); this was the dominant theory of leadership until about 1940. Since the 1970s, leadership theory has evolved into a study of the relationship between leaders and followers within organizations. The advancement of leadership theories illustrates that what is “known” about leadership continually changes as leaders’ environments evolve and additional research is completed.

Adapting the individual nurse leader’s style to meet the needs of the organizational environment is critical for leadership success. A systematic review of the nursing literature by Cummings et al. (2010) helps us to understand these different leadership styles by dividing nurse leadership theories into the two separate categories of task-focused leadership and relationally focused leadership. Observing leadership theories from the perspective of relationships has become crucial as we move into the age of technology associated with chaos and complexity science.

Task-focused leaders tend to focus on the tasks to be completed or on the transactions between leaders, colleagues, and followers that are required to complete the tasks, rather than on the relationships between individuals within the organization. Relationally focused leaders, on the other hand, consider relationships rather than tasks to be the foundation for achieving positive change or outcomes (Hibberd & Smith, 2006). There are multiple examples of both task-focused and relational leadership in the research literature (Villeneuve & Wagner, 2015).

Research by Wagner et al. (2013) explores the relationship between a resonant leadership style (relational style of leadership with a focus on building relationships and managing emotion), empowerment of registered nurses (RNs) in the workplace, and workplace outcomes such as job satisfaction, organizational commitment, and spirit at work (SAW). The study of SAW, a holistic measure of workplace experiences, looks at the perceptions of engaging work, sense of community, spiritual connection (connection to something greater than self while at work), and mystical experience (sense of transcendence while at work) of the individual nurse. Ongoing research indicates a strong relationship between resonant leadership and SAW. Research also indicates that these holistic measures of SAW account for more variance in employee workplace outcomes than job satisfaction (Wagner et al., 2013; Wagner & Gregory, 2015).

 

1.3 Emotional and Social Intelligence in Leadership

Overview

The position of either leader or follower does not hold power. Rather, it is how we respond when we are in these roles, based on our emotional intelligence, that gives power to each role. Emotional intelligence has been described as the “ability to monitor and discriminate among emotions and to the use the data to guide thought and action” (Pangman & Pangman, 2010, p. 146). Goleman (1998), a researcher who has completed excellent work in the area of work performance, studied the importance of emotional intelligence in achieving personal excellence. He defines emotional intelligence in greater depth, stating that it is composed of “abilities such as being able to motivate oneself and persist in the face of frustrations; to control impulse and delay gratification; to regulate one’s moods and keep distress from swamping the ability to think; to empathise and to hope” (Goleman, 1995, p. 21). Goleman’s model of emotional intelligence contains five skills that comprise personal and social competencies (see Table 1.3.1 below). The three skills of self-awareness, self-regulation, and motivation relate to the individual’s personal competence. The remaining skills of empathy and social skills are classified as social competencies (Sadri, 2012, p. 537). Goleman stressed that all of the skills can be learned.

 

Table 1.3.1 Emotional Intelligence Skills and Competencies (Data Source: Table based on material from Sadri, 2012.)

Competency	Skill Area	Description
Personal	Self-awareness	Knowing one’s self
	Self-regulation	Managing one’s self
	Motivation	Sentiments and passions that facilitate the attainment of goals
Social	Empathy	Understanding of others and compassion toward them
	Social skills	Expertise in inspiring others to be in agreement

Developing Emotional and Social Intelligence

Students are at an ideal stage of their lives and careers to check their emotional intelligence. Completion of the emotional intelligence quiz at the link below may help you identify areas for growth.

 

 

Now that you have identified an area for growth, you may ask, “How can I increase my emotional intelligence?” Your brain has been developing neural pathways in response to your environment since early childhood. Over time these pathways become hard-wired in your brain, allowing you to respond rapidly to circumstances in your environment. In fact, it is believed that emotional responses occur faster than cognitive responses, thus you seem to act before you think. Siegel’s (2012) research in the area of interpersonal neurobiology shows that there is a way to change your brain’s response to stressors. Increasing your “mindfulness” can provide you with an opportunity to “break the link between environmental stimuli and habitual responses” (Gerardi, 2015, p. 60) and to choose a different course of action. Daniel Siegel (2010) coined the term mindsight to refer to the phenomenon of becoming aware of emotional reactions and changing them in real time. Gerardi (2015) stressed that working on developing mindsight is hard but valuable work for those who wish to become successful leaders.

 

 

As a nurse, gaining emotional and social intelligence and using mindsight are all critical to becoming a successful leader in the field. You will encounter and be required to cope with many different types of people, both colleagues and patients. It is extremely important to be self-aware, reflect on your feelings, and think about how emotions can influence both actions and relationships (or social interactions). That is, you must learn to reflect on your clinical experiences and think of how you could have changed a situation by using self-awareness or mindsight. In the words of Pattakos, “Between stimulus and response, there is a space. In that space lies our freedom and our power to choose our response. In our response lies our growth and our happiness” (as cited in Gerardi, 2015, p. 60).

1.4 Leadership in the Twenty-First Century

Advances in technology have brought the world from the industrial age into the information age. Porter-O’Grady and Malloch (2011) describe four factors, arising from technology, that are contributing to increased demands within health care and are associated with a depletion of resources: (1) endless change; (2) availability of information; (3) knowledge as a utility rather than a possession with knowledge users accessing the right knowledge at the right place and the right time; and 4) rapid advances that are changing the service relationship (i.e., technology-assisted procedures, which have reduced numbers and lengths of hospital stays). Dr. Keith A. Bezanson, the Canadian former director of the International Development Research Centre, concluded at a 1994 United Nations conference that society is experiencing a transformation so profound that it is impossible to forecast the future (Hibberd & Davies, 2006). Innovative areas of study, such as complexity science, are arising from this rapid convergence of empirical evidence around the world.

Complexity may be described as the “complex phenomena demonstrated in systems characterized by nonlinear interactive components, emergent phenomena, continuous and discontinuous change, and unpredictable outcomes” (Zimmerman, Lindberg, & Plsek, 1998, p. 263). At an international summit held at the University of Minnesota in 2003, one speaker described how Newton reductionism, which has guided scientific thinking for 300 years, has been replaced by complexity science in the twenty-first century (Hibberd & Davies, 2006). This same speaker stressed that

complexity science can guide our understanding of the health care system, a multi-layered system largely driven by rapidly changing technology and information. In health care … practitioners … make up a continuously evolving system because of their innovative, diverse and progressive adaptations (Holland, as cited in Hibberd & Davies, 2006, p. 500).

MacPhee (2015) describes complexity-informed health intervention as a system. In this system, decision making is distributed among the members of the organization (i.e., at the practice level) and health care providers encourage patients and families to take more personal responsibility and ownership of their care.

Each individual has the capacity to lead, manage, or follow as needed. The flow among these roles fosters an empowering environment that diminishes fear and organizational silence on matters that are critical to patients, staff, and organizational outcomes (MacPhee, 2015, p. 13).

What kind of nursing leadership is called for in the age of complexity science? Experts stress that nurse leaders must understand the principles of a complex adaptive system, supporting change by ensuring that trust, risk taking, and flexibility flourish, thus permitting new ideas to emerge (Pangman & Pangman, 2010). Translated into action, this requires that leaders look at the organization through the lens of complexity, with unit leaders allowing issues on the unit to emerge. Leaders use good enough vision to solve difficulties by allowing individuals to develop and use innovative approaches within their work environment, rather than providing specific directions. Pangman and Pangman stress the need for the nurse leader to balance data (clockware) and intuition (swarmware) by circulating around the workplace, observing and providing support or suggesting a different way of doing things when a problem is identified. The real differences that occur between organizational goals and the day-to-day performance of the unit (paradox and tension) are identified through the leader’s openness to challenging “sacred cows”—those ideas or systems that are generally considered beyond questioning or above criticism. The leader is aware of the different formal and informal networks (shadow systems) that influence the behaviour of staff. This awareness guides the leader in the exploration and endorsement of differing views. Overall, the leader values both cooperation and competition among staff, realizing that both behaviours, when encouraged and guided, can lead to increased productivity (Pangman & Pangman, 2010).

Relationally Focused Leadership Styles

Situational and contingency–based leadership theories, most popular from 1950 to 1980, suggest that no one leadership style is ideal for every situation. Leadership must be adapted according to the needs of the leader, the employees, and the environment (Marquis & Huston, 2015). Some examples of responses to the increasing complexity of our system include relationally focused leadership styles such as strengths-based leadership, in which leaders strive to empower workers’ strengths rather than identify problems (Wong, 2012) and authentic or congruent leadership, wherein followers are inspired to act (Avolio, Walumbwa, & Weber, 2009). Robert Greenleaf espoused servant leadership, in which leaders’ primary responsibilities are service to others and recognition that the role of organizations is to create people who can build a better tomorrow (Parris & Peachey, 2013). By contrast, principal agent theory emphasizes that the leader must provide incentives for followers to act in the organization’s best interest, since not all followers are inspired to act in the leader or employer’s best interest.

Another relationally focused nursing leadership style espoused widely across North America is the transformational leadership style. These leaders demonstrate four prevailing characteristics that include idealized influence, inspirational motivation, intellectual stimulation, and idealized consideration. They are sensitive to the requirements of others and endeavour to realign the existing organizational culture with a new vision (Bass & Avolio, 1993). Feminist leadership, founded on the principles of transformational leadership, further emphasizes an ethic of care expressed through the use of collaborative, relational skills and the development of gender equitable and empowering organizational goals (Christensen, 2011).

Quantum leadership, a direct response to the constant change present in the complex environment, “builds upon transformational leadership and suggests that leaders must work together with subordinates to identify common goals, exploit opportunities and empower staff to make decisions” (Marquis & Huston, 2015, p. 63). Another leadership style, developed in response to the increasing complexity of strategic issues that are cross-functional in nature, is dyad leadership, which involves the development of mini teams consisting of two or more individuals. Sanford and Moore (2015) described dyad leadership as “a model of formal leadership in which two individuals with different skill sets, education, and background are paired to better fulfill the mission of the organization” (p. 7).

Task-Focused Leadership Styles

The literature abounds with examples of task-focused leadership styles that place an emphasis on the accomplishment of assigned tasks, rather than on the development of productive relationships within the workplace. Task-oriented styles, such as transactional leadership—wherein the leaders tend to explain expectations and reward good performance, correct departures from expectations, and finally attempt to prevent future problems (Xirasagar, 2008)—can prove useful in fast-paced and high-stress environments, such as the emergency department. However other task-oriented leadership styles such as laissez-faire, which describes leaders who refuse to take responsibility and who are not concerned about organizational outcomes or follower behaviours (Avolio, Bass, & Jung, 1999), may have detrimental effects upon an organization.

The effectiveness of different task-oriented leadership styles depends on the needs of the organization. Additional commonly found types of task-oriented leaders include those who manage by exception, who focus on providing correction when tasks are not completed appropriately; instrumental leaders, who focus on strategy and expedition of work outcomes rather than on making values-based decisions (Antonakis & Atwater, 2002); passive avoidant leaders, who avoid taking action until problems become serious and corrective action is required (Avolio, Bass & Jung, 1999); and finally, dissonant leaders, who lack emotional intelligence and tend to be negative, without empathy for followers (Goleman, 1998).

 

Summary

The rapid societal changes and increasing complexity of society are demonstrated by the appearance of many different leadership styles. Excellent nurse leaders are aware of the circumstances within their own workplace environments and demonstrate a willingness to adapt their leadership styles accordingly. Outstanding leaders ensure the provision of quality patient care while also promoting the achievement of organizational goals and objectives.