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Nursing Leadership StylesHelen McDonaldNursing Health Policy NUR503December 18, 2015State University of New York Polytechnic Institute Utica RomeAbstractBy 2020, National supply and demand projects a nursing shortage of 29% due to a 40% increase in demand (Swearingen & Liberman, 2004). Between the years 2000 and 2030 the population of 65 year old and over is expected to double (Swearingen & Liberman, 2004). Nurses are also aging; in 2004 an estimated 40-60% of the nursing workforce was estimated to retire before 2020 (Swearingen & Liberman, 2004). Hospitals can offer costly incentives and provide accredited diploma programs to keep and find nurses (Swearingen & Liberman, 2004). But, the fact remains, retention and new employment rates are poor in hospitals (Swearingen & Liberman, 2004). Unless hospital workplace environments are corrected, they will continue to be poor. Effective leadership holds the power to transform hospital workforce environments and improve nursing recruitment and retention (Swearingen & Liberman, 2004). This paper will review current literature available, representing transformational and transitional leadership styles. It will present a balanced review of these topics, representing both sides, to improve nursing leadership ideals and meet hospital organizational and nursing goals.Nursing Leadership StylesOverviewLeadership is a complex process of collective goal setting with staff motivation and support to meet prospective goal outcomes (Mannix, Wilkes & Daly, 2013). Effective leadership is essential in organizations to meet objectives in a chaotic, complex and highly variable environment (Mannix, Wilkes & Daly, 2013). Nursing atmospheres are influenced by shortages, multi-generational and ageing workforce concerns, staff skill mixes, clinical education challenges, diminishing resources, greater patient acuity levels, and amplified workplace violence, resulting in burnout and increased turnover rates (Mannix, Wilkes & Daly, 2013). Job satisfaction and self-rated performances are shown to improve with authentic leadership processes, positively influencing staff nurse outcomes (Wong & Laschinger, 2013). Nurses have a sense of empowerment, improved work satisfaction and enhanced reported personal performance when they observe managers as authentic with self-awareness and high ethical standards (Wong & Laschinger, 2013). Leadership effectiveness is contingent on the leader’s ability to instill a sense of support (Hamstra, Van Yperen, Wisse & Sassenberg, 2014). Nursing variables can influence and interact with leadership processes (Hamstra et al., 2014). Leadership behaviors are dynamic and fluctuate daily with its short-term effects impacting nursing outcome (Breevaart, Bakker, Hetland, Demerouti, Olsen & Espevik, 2014). The leader needs to engage its nurses emotionally and intellectually (Doody & Doody, 2012).Different leadership styles can affect leader’s emotions, regulation strategies and burnout (Arnold, Walsh, Connelly & Martin-Ginis, 2015). These styles expect a certain amounts of emotional display by leaders to meet organizational goals, causing some leader stress (Arnold et al., 2015). There are three defined types of emotional regulation; surface acting, deep acting, and genuine emotion (Arnold et al., 2015). These strategies are processes that influence which emotions leaders display, when they display them and how they experience and express them (Arnold et al., 2015). Surface acting is used when an individual needs to display an emotion during a given situation and their personal emotions are not the same (Arnold et al., 2015). Deep acting occurs when an individual changes their internal emotions to meet the emotion required for the situation, actively feeling the emotion that must be displayed (Arnold et al., 2015). Leaders need to regulate emotional intensities and make accurate positive and negative emotional judgements while considering how displayed emotions will affect nursing staff (Arnold et al., 2015). Two distinct types of leadership styles were first described by Bass in 1985 as transformational and transactional (Tremblay, 2010). Effective leaders will display each of these styles to varying degrees (Tremblay, 2010). The use of these styles depends on the environment of which each is employed (Tremblay, 2010). Transformational Leadership Transformational leadership encourages promotion-focused strategies (Hamstra et al., 2014). Transformational leaders set high expectations with long-term visionary goals (Hamstra et al., 2014). They provide freedom and autonomy allowing nurses to organize independent behavior, goals and unique viewpoints (Hamstra et al., 2014). These leaders aren’t afraid of personal risk emphasizing progress and innovation (Hamstra et al., 2014). Transformational leaders prompt ideal states of business (Hamstra et al., 2014). They are optimistic about visions, possibilities and outcomes (Hamstra et al., 2014). They concentrate on opportunities with confidence and high expectations of nurses (Hamstra et al., 2014). Transformational leaders motivate nurses to perform beyond basic expectation and encourage risk taking behavior (Hamstra et al., 2014). They create supportive, safe environments for followers to risk and extend boundaries of thinking and doing; creating energy, originality and innovation (Doody & Doody, 2012). Nurses are therefore more encouraged to try new novel ways of working (Hamstra et al., 2014). Transformational leadership displays positive emotions which positively affects followers and organizational outcomes resulting in resource gain (Arnold et al., 2015). They use deep acting to gain authenticity with followers by becoming empathetic and take on others’ perspective (Arnold et al., 2015). Genuine emotion can also be displayed spontaneously because they have support from followers and they don’t worry about resource loss because of its abundance (Arnold et al., 2015). These leaders are less likely to have mundane interactions with staff because they stimulate and motivate, inspiring them to think in new ways (Arnold et al., 2015).Nurse’s respect and trust transformational leaders. The leader has a profound set of internal values and ideas which appeals to and motivates nurses (Doody & Doody, 2012). They are motivated by their leader's creative communication of appealing and optimistic future visions (Breevaart et al., 2014). Leaders are mentors and recognize every nurse’s individual needs and abilities (Breevaart et al., 2014). They challenge nurses to rethink ideas and take different perspectives on problems faced in the work environment (Breevaart et al., 2014). They encourage nurses to actively search for resources independently by inspiring independent thinking and decision making (Breevaart et al., 2014).These leaders are flexible and adaptive to changes in organizational structure and nursing staff challenges (Doody & Doody, 2012). New ways of knowing are created in environments of shared responsibility (Doody & Doody, 2012). They are able to persuade, not coerce, staff to sustain the greater good rather than individual interest (Doody & Doody, 2012). Bass, Hall et al and Barbuto (as cited in Doody & Doody, 2012) identified four components of transformational leadership; idealized influence, inspirational motivation, intellectual stimulation, and individual consideration (p 1212). Idealized influence. Idealized influence provides followers with a sense of mission by building self-confidence, appreciation, trust and respect (Doody & Doody, 2012). Effective nursing leaders have personal attributions of charisma, persuasiveness and self-confidence which in turn cause affection and commitment from staff (Doody & Doody, 2012). They are respected for high moral standing and sense mission (Doody & Doody, 2012). Nursing leaders are role models that staff wants to emulate, producing less resistance to change (Doody & Doody, 2012). A mission statement is created involving stakeholders in its design and implementation, generating a shared vision (Doody & Doody, 2012). Inspirational motivation. Inspirational motivation encourages staff to achieve personal and organizational goals simultaneously (Doody & Doody, 2012). Motivation is communicated by leaders with high expectations affecting staff performance and client care (Doody & Doody, 2012). Unit leaders represent frontline staff and ensure staff is represented on committees that influence executive decisions within the organization (Doody & Doody, 2012). Reinforcement theory, equity theory and goal-setting theory are examples of process theories that accent for how motivation drives an individual to perform and helps leaders predict employee behavior in different environments (Doody & Doody, 2012). Unit leaders anticipate staff development needs and provide in-service, continuing education, training and orientation (Doody & Doody, 2012). Unit leaders should combine motivational theories for a complimentary effect (Doody & Doody, 2012). To adopt inspirational motivation, the leader needs to influence staff with passion and enthusiasm while creating a nearly fantasy-like vision, provoking staff to compromise their own values for the greater good (Doody & Doody, 2012). Intellectual stimulation. Intellectual stimulation challenges staff beliefs and encourages problem solving innovation utilizing evidence-based practices (Doody & Doody, 2012). Resources for education need to be made available for staff to uphold best practices, including; nurse educators, libraries, computers and information technology ( Doody & Doody, 2012). Organizations support informal and formal education (Doody & Doody, 2012). Unit leaders need to encourage those who have undertaken further study to share their knowledge with other staff (Doody & Doody, 2012). Leaders need to be aware of potential burnout and increased staff stress when pressuring staff participation in intellectual stimulation (Doody & Doody, 2012). Individualized consideration. Individualized consideration promotes leaders to support individual needs to reach higher achievement levels (Doody & Doody, 2012). Positive feedback and staff appraisals provide support, increase self-esteem and performance (Doody & Doody, 2012). Peer evaluation can increase personal development through constructive criticism (Doody & Doody, 2012). However, they are time consuming and can become counterproductive without rules and appropriate facilitation (Doody & Doody, 2012). Transactional LeadershipTransactional leadership encourages prevention-focused strategies and task oriented goals (Hamstra et al., 2014). Transactional leaders use clear rules for nurses and pay close attention to errors (Hamstra et al., 2014). They emphasize task-specific, short-term success while scrutinizing performances (Hamstra et al., 2014). These leaders are concerned with rule making and enforcement (Hamstra et al., 2014). Tasks are defined in concrete ways with detailed direction (Hamstra et al., 2014). Nurses feel they need to do what is expected because leaders evaluate compliance to rules and not individual thinking (Hamstra et al., 2014). Nurses view work in terms of responsibility and obligation (Hamstra et al., 2014). Nurses aim for accuracy and adherence to meet minimal performance standards. Leaders use reward to encourage positive staff performance (Hamstra et al., 2014). According to Baa and Riggio (as cited in Arnold et al., 2015), there are three substyles of transactional leadership; “management by exception (monitoring followers’ mistakes), laissez-faire (avoiding involvement), and contingent reward (rewarding follower’s achievements) (p 483).Management by exception. Management by exception can be active or passive; management by exception- active (MBE-A) and management by exception-passive (MBE-P) (Arnold et al., 2015). MBE-A leaders actively monitor goal standard deviation and seeks out staff mistakes (Arnold et al., 2015). MBE-P leaders passively wait for deviations. This leadership style intensifies nursing emotional exhaustion and fosters high workplace conflict, resulting in negative outcomes (Arnold et al., 2015). It has, inevitably, been associated with ineffective performance improvement (Arnold et al., 2015).These leaders may use deep acting and genuine emotions sparingly, if at all, because they have few resources to expend (Arnold et al., 2015). These leaders do not display empathy and are more likely to have analogous encounters with their staff, fostering negative, unmitigated feelings (Arnold et al., 2015). Laissez-faire. Laissez-faire leadership has been associated with poor resource gains, spiraling resource losses, negative leader ability perceptions and negative outcomes (Arnold et al., 2015). These leaders do not engage in surface or deep acting emotion regulations because it requires too much cognitive effort (Arnold et al., 2015). They may use spontaneous genuine emotion because staff interaction occurs rarely and they don’t have the resources to grow emotional regulation strategies (Arnold et al., 2015).Contingent reward. Contingent reward is the most effective and positive part of this leadership style (Arnold et al., 2015). Leaders make their expectations clear and offer recognition or reward for meeting expectation (Arnold et al., 2015). Although this leadership style does increase resource availability due to positive outcomes, it is not as effective as the transformational leadership style (Arnold et al., 2015). They have fewer resources comparatively and are less capable of displaying genuine emotion (Arnold et al., 2015). This may cost them resources due to inappropriate displays of emotion (Arnold et al., 2015). Surface acting becomes more effective with the contingent reward leader (Arnold et al., 2015). It is less time consuming and more controllable than genuine emotion and is also less detracting from task focus (Arnold et al., 2015). However, deep acting is needed with psychological rewards because staff may be able to detect surface acting (Arnold et al., 2015).Leadership Style IntegrationLeaders influence work engagement through influences on the hospital environment (Breevaart et al., 2014). They shape and define work and social situations within the system (Breevaart et al., 2014). An important condition to actively change work environments to the benefit of nurses is through control over goal outcomes (Breevaart et al., 2014). Healthcare delivery and consumer demands are easily meet with effective nursing leadership (Doody & Doody, 2012). Downton (1973) first defined transformational leadership and Burns (1978) distinguished transactional and transformational leadership differences, describing them as opposite ends of a continuum (Doody & Doody, 2012). Effective leaders demonstrate both of these leadership characteristics (Doody & Doody, 2012).Transformational and transactional leadership encourage different goal-pursuit strategies (Hamstra et al., 2014). Both leadership models are proven to be effective under particular circumstances (Hamstra et al., 2014). Transformational leadership stresses higher goal outcomes versus meeting minimum standards (Hamstra et al., 2014). Transactional leadership utilizes contingent regard to meet a minimum performance standard, thereby, maintaining the status quo and minimize deviation from expectation (Hamstra et al., 2014). A multilevel regression analyses composed by Breevaart et al. (2014), showed transformational leadership and contingent reward increased follower engagement (Breevaart et al., 2014). Transformational and transactional leadership can help predict outcome variables such as motivation, leader job performance, leader effectiveness and satisfaction with the leader (Breevaart et al., 2014). Specific behaviors of transformational and transactional leaders influence job resource availability to nurses (Breevaart et al., 2014). Research has proven that these resources have motivating potential which leads to higher work engagement (Breevaart et al., 2014). Nurses are intrinsically motivated; they enjoy work and are drawn towards it when they feel engaged (Breevaart et al., 2014). Transformational leaders contribute to this intrinsic motivation by providing meaningful rational for followers work (Breevaart et al., 2014). They use effective communication and provide confidence in their staff’s ability to contribute to an appealing futuristic vision (Breevaart et al., 2014). Leaders stimulate nurses to help and learn from other nurses to achieve a common goal (Breevaart et al., 2014). Nurses are stimulated to work to the best of their ability and delegate tasks that match other staff’s skill levels (Breevaart et al., 2014). Contingent reward also has motivational power. Leaders who utilize contingent reward are able to set clear goals and rewards which motivates staff to meet these goals (Breevaart et al., 2014). Leaders are able to acknowledge good performance, develop skills, provide meaning to work, and increases work engagement (Breevaart et al., 2014). However, these leaders lack inspirational appeal (Breevaart et al., 2014). Transformational leaders are able to influence follower work engagement after controlling the influence of contingent rewards (Breevaart et al., 2014). Effects of leader behavior on staff my not always be apparent to the leader; feedback from them can improve leaders understanding of this and initiate behavior changes (Breevaart et al., 2014). ConclusionTransformational leadership is regarded as the most effective model (Doody & Doody, 2012). Transactional leaders can also be effective if staff performance is maintained with contingent rewards. Management by exception and laissez-fair leadership strategies are ineffective in hospital settings. Leaders who incorporate both transformational and transactional methods have been shown to have the greatest impact on nursing job satisfaction and performance measurements. When the hospital workplace environment is transformed with implementation of these leadership methods, nursing retention and recruitment will begin to improve. ReferencesArnold, K., Walsh, M., Connelly, C. E., Martin-Ginis, K. A. (2015). Leadership styles, emotionregulation, and burnout. 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