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• W1974239101 abstract "Pick up just about any nursing article, and you will find somewhere in the discussion that leadership is required to implement new evidence, change policy and improve outcomes for nurses and patients. Yet, rarely is such leadership defined, described or articulated in terms of style, behaviour and mechanism of action. It is assumed that leadership is leadership (just like a nurse is a nurse, is a nurse), and that leadership is always a good thing in all cases. We are living in turbulent times – globally, and in our societies, communities, professions and healthcare systems. In our societies and communities, we are facing weather- and war-related disasters that appear to be unprecedented for our century, shifts in power and economic bases of governments, countries and individuals, and exponential growth in information, communication and knowledge. New technologies, values, boundaries, institutions and knowledge are shaping new ways of working, of developing relationships, of communicating, leading to new ways of achieving meaning in our daily lives. The constant growth and change has had an impact on employees generally. In 2006, Gallup reported on a management study where 64% of employees reported being depressed and anxious and wished they worked elsewhere (Konrad 2006). Additionally, 73% of workers reported being disengaged – 59% of workers could not wait to go home each day, and 14% were actively disengaged. Moreover, 87% of workers believed their work lacked any meaning beyond getting paid (Konrad 2006). The health of individuals continues to be of significant concern around the world. Nearly one billion people lack access to safe water, and 2·5 billion do not have access to improved sanitation (Water.org 2011). The health and economic impacts of this issue are staggering. Current healthcare systems also have numerous documented issues. Based on an extensive review, Grol and Grimshaw (2003) reported that 30–40% of patients did not receive care based on current evidence, and 20–25% of care provided was not needed or potentially harmful. In 2004, there were 10,000–20,000 annual preventable deaths from adverse events in the Canadian healthcare system (Baker et al. 2004). Research also suggests that the current reality for nurses in many countries who provide essential healthcare services includes poor work environments, overtime (paid/unpaid), heavy workloads, ill health, high job strain, patient safety issues, and poor leadership and supervision (CIHI National Nurse Survey 2005). Surely, the preferred future for nurses include being able to provide safe quality care based on evidence, influence patient outcomes, have meaningful and effective work, have a balance between life and work and work in a collaborative multidisciplinary team. Surely, someone needs to do something! Who will do something and what will they do? It is all about leadership for change! My definition of leadership is quite simple: leadership is being able to see the present for what it really is, see the future for what it could be and then take action to close the gap between today's reality and the preferred future of tomorrow. Being able to see today's reality is not simple, it involves seeing the successes and failures (despite considerable investment of time, energy and resources), the assumptions about what works, what does not and why, the values and beliefs that underlie action, and the interests that drive behaviour. Seeing the future for what it could be also entails being able to engage others into helping to build that future. This engagement of others – whether workers, colleagues or communities – reflects styles of leadership. Leadership styles describe how leadership is accomplished – how a preferred future is achieved. Styles of leadership also reflect the leader's approach to accomplishing the work to be done. Leadership styles arise from our personal self-awareness; they frame our relationships with others and lead to a variety of good or bad results. While leadership is usually perceived as only positive or good, Kellerman (2004) reported how some leadership styles, which include incompetent, rigid, intemperate, callous, corrupt, insular or evil leadership, also yield bad results. Many of the latter are still evident in any global news report of country leaders who are dictators, or are convicted of war crimes against humanity. I set out to study a variety of leadership styles in nursing and health care to document their effects for nurses, their work environments and patients in the health system. The framework that I have used most frequently to study leadership styles was reported by Goleman et al. (2002), founded on emotional intelligence as the basis for leader behaviour. This framework is based on four domains: how aware you are of your own emotions as you are having them, how well you manage those emotions, how aware you are of the socio-political relationships that are going around you in your work, community, government, etc. and how well you manage relationships with others. Styles that are high in emotional intelligence are resonant leadership styles: visionary, coaching, affiliative and democratic. Styles that reflect an absence of emotional intelligence because they focus more on the task to be accomplished than on the persons involved are dissonant leadership styles: pacesetting and commanding styles (Goleman et al. 2002). Individuals may not portray a completely resonant or dissonant leadership style in all situations, and our research suggests that many leaders are neither resonant nor dissonant but portray a mixed style which has implications for outcomes achieved for both nurses and patients. By conducting a series of systematic reviews and empirical research studies in the nursing and healthcare literature, I have examined the relationships between various leadership styles and (1) outcomes for managers and nurses, (2) outcomes for nursing work environments and (3) outcomes for patients. In my early work, I examined whether, during times of hospital restructuring, nurses who worked for nursing leaders with resonant styles fared differently than those who worked for nursing leaders with dissonant styles (Cummings et al. 2005). Nurses who worked for resonant leaders reported significantly greater job satisfaction, workgroup collaboration, satisfaction with their leader, ability to complete their work and provide care to patients, as well as lower emotional exhaustion and burnout than did nurses who worked for dissonant leaders. These results led to a beginning theory of relational energy as the mechanism by which resonant nursing leaders invest in effective and supportive relationships with their nurses, leading to improved outcomes for both nurses and patients (Cummings 2004). These nursing leaders invest time, energy and interest in building relationships with nurses and managing emotions in the workplace. In 2010, we published a systematic review of the nursing research literature that examined outcomes of nursing leadership styles for nurses and their work environments (Cummings et al. 2010a). Of fifty-three research reports on such relationships, we found that the leadership style described in each study could be categorised into either relational leadership styles (focused on people and relationships) or task-focused leadership styles (focused on job completion, deadlines and directives). Relational styles included transformational, socio-relational, emotionally intelligent, resonant, relational and consideration. Task-focused leadership styles included transactional, instrumental, initiating structure, management by exception, passive avoidant management and laissez faire. We found evidence of highly differential effects of relational leadership styles from task-focused leadership styles. Relational leadership styles were associated with key outcomes such as significantly higher nurse job satisfaction, organisational commitment, staff satisfaction with work, role and pay, staff relationships with work, staff health and well-being, work environment factors, and productivity and effectiveness. Task-focused leadership styles were associated with significantly lower values of all these outcomes (Cummings et al. 2010a). In additional reviews, we found that relational approaches to leadership were associated with increased intentions by nurses to stay in the workplace (Cowden et al. 2011) and enhanced performance (Brady-Germain & Cummings 2010). Few studies have examined the relationship between leadership styles of nurses in management roles and outcomes for patients. Wong and Cummings (2007) reported on seven studies in their review, finding that transformational leadership styles were associated with fewer adverse patient events, lower comorbidities, increased patient satisfaction and, in one of three studies, lower patient mortality. Subsequently, we studied the contribution of nursing leadership styles in 90 hospitals in Alberta Canada to 30-day mortality of patients (Cummings et al. 2010b). We categorised the 90 hospitals by the leadership styles of the nursing leadership group within each hospital as reported by nurses. Each hospital was classified into one of five hospital leadership categories of leadership styles (highly resonant, moderately resonant, mixed, moderately dissonant and highly dissonant). In the study sample of 21,570 medical patients, 30-day mortality was 7·8% and varied across the hospital nursing leadership categories. After controlling for patient demographics, comorbidities, institutional and hospital nursing characteristics, resonant nursing leadership styles were related to significantly lower patient mortality across hospitals, and high-resonant leadership was related significantly to lower mortality (Cummings et al. 2010b). These results have some potentially far-reaching implications for health care and nursing leadership and for healthcare leadership researchers. Researchers need to study the relationships between leadership styles of healthcare administrators and managers and the resulting outcomes for patients in their facilities. Healthcare leaders have considerable influence given the designs and responsibilities of their roles. Therefore, they require a relational approach to achieving a preferred future and ideally a shared vision with their team. Engaging others into developing and achieving a shared vision is powerful and ultimately more lasting than pushing through a solo vision or commanding it to be done. A relational approach to leadership requires a principled approach to leadership development that begins with leading yourself (learning self-awareness and personal development in relational activities, establishing a personal vision and having clarity of values) before leading your team or ultimately leading the organisation (Sharlow et al. 2009). Leadership development involves taking some risks, supporting innovation and creativity in others, developing and empowering others, communicating effectively by listening more than speaking, and checking progress and results by seeking feedback from others. Development is an iterative process between continually developing and maintaining relationships, self-awareness and resilience, multifaceted feedback, and checking clarity and progress towards goals and objectives related to the shared vision. It can be discouraging to gain insight to your own behaviour, values, strengths and weaknesses, but it is important to remember that achieving self-awareness is the beginning of growth. Leadership in healthy workplaces is best described by Margaret Wheatley–‘In organizations, real power and energy is generated through relationships. The patterns of relationships and the capacities to form them are more important than tasks, functions, roles, and positions’ (Madsen 2008, p. 153)." @default.
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• W1974239101 date "2012-11-12" @default.
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• W1974239101 title "Editorial: Your leadership style - how are you working to achieve a preferred future?" @default.
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• W1974239101 doi "https://doi.org/10.1111/j.1365-2702.2012.04290.x" @default.
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