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Angela Scott, RN, BSNMentoring Emerging Nurse LeadersUniversity of Saint MaryAbstractNurses are more receptive to leadership roles if their employers are willing to assist in their development. In an effort to help grow emerging nurse leaders in the rural hospital setting. The participants were provided with the Transformational Leadership Survey and provided with the articles from the literature review. The participants were eager to learn new skills and provided positive feedback at the conclusion of the project. The articles were in regards to mentorship, transformational leadership, and leadership styles. At the conclusion of this project, the clinical leads commented that their leadership skills improved and serve as role models to the staff. Mentoring Emerging Nurse LeadersIntroductionThe Transformational Nurse Theory was used for guiding this project. The goal of the Transformational Nurse Theory is to guide nurse leaders toward the future culture of the facility. The project utilized the evidence evaluation design.New leaders in the hospital setting lack the training and mentorship to succeed in a competitive environment. New leaders are often promoted from a staff floor positon. These nurses may have qualities that are sought in leaders. Emerging nurse leaders need guidance and tutelage to achieve professional goals. Nurse leaders, such as clinical leads and managers, are liaisons to directors and senior leaders. Nurse leaders can often feel overwhelmed and feel it is their duty to do everything that needs to be done in order to keep the units safe and effectively running to ensure employee satisfaction. This can lead to stressful situations for the nurse leader. This project paired clinical leads with a mentor. The mentor was able to guide the clinical lead into becoming a greater and more effective leaders.At the facility, clinical leads are imperative to the workflow of the unit. They are not counted in the staffing numbers and therefore are not expected to take a patient load. In times of high census or staff shortage, the clinical leads will take patients. It is common for the clinical leads in the progressive care unit and second floor to take a patient load. Contributing factors may be the need for upgraded patients to have a bed and for the care of pediatric patients on the second floor. Clinical leads are crucial members of the unit. They are able to educate staff on new policies and equipment. They meet daily with case managers and social workers to focus on patients who are at high risk for readmission and round frequently to ensure staff are providing safe care. They are able to teach employees and patients due to the fact that they do not carry a patient load. The senior leaders want the clinical leads to impact patient satisfaction scores and decrease the number of hospital readmissions. Clinical leads are essential in driving and leading the floor staff to meet the goals of the hospital. Clinical leads are not managers, yet they are leaders who can relay the concerns of staff and patients to the appropriate people. Although they are not able to make policy changes, their voices can assist in changing the culture of the facility. Clinical leads are able to participate in employee retention due to the assistance they are able to provide the staff (Shirey, 2006). “Implementation of authentic leadership can affect not only the nursing workforce and the profession but the healthcare delivery system and society as a whole. Creating a healthy work environment for nursing practice is crucial to maintain an adequate nursing workforce…” (Shirey, 2006, p. 256). A great number of current nurse leaders will be retiring and their positions will be given to Generation Y nurses. Many of these nurses are without proper training in leadership. Shirey (2006) stated that there is not enough guidance to help provide a healthy work environment.The Generation Y nurses want to develop leadership skills, yet are reluctant to obtain a master’s degree in administration (or a similar role). These nurses are more receptive to leadership roles if their employers are willing to assist in the development of the leadership skills needed (Dyess, Sherman, Pratt, and Chiang-Hanisko, 2016).Purpose StatementThe purpose of this study was to mentor emerging nurse leaders to become transformational leaders. The surveys completed at the beginning and the end of the project revealed the strengths and weaknesses of the clinical leads. The mentor evaluated their participation and leadership during their participation. Literature ReviewThe following articles addressed the role of nurse leaders and their implications at a facility. Ward (2002) interviewed eight leaders in various situations, such as via email or in person. She found that all the leaders shared qualities described such in the American Organization of Nurse Executives competencies: integrity, shaping their environment for success, motivating others, and attempting to improve the life of others. Medley and Larochelle (1995) wrote that retention is 85% in facilities that have transformational nurse executives. This leadership method helped employees toward “self-actualization.” Employees were motivated by leaders who are charismatic, have intellectual stimulation, and have individualized consideration. Employees can assess the type of leadership style their leaders possess. The senior leaders can also reflect on their style of leadership. A leader who is able to assess his or her style is perhaps able to change in order to make the environment better for the staff. The clinical leads train new employees and their leadership qualities are observed. These qualities can be a reason why employees stay. The hospital conducts exit interviews and asks why the employee resigned. There have been exit interviews in which the reason for resignation was due to the leadership and management of the unit. McCloughen, O’Brien, and Jackson (2014) studied mentorship in an Australian hospital. Mentorship provided growth and development on the mentee’s personal and professional lives. Morrison, Jones, and Fuller (1997) used surveys to ask about leadership styles, empowerment, and job satisfaction. Their results showed “transformational and transactional leadership were positively related to job satisfaction.”McGuire and Kennerly (2006) studied management and staff. They showed that transformational leaders do more than manage; they are able to motivate and influence their staff and co-workers. Staff who believed their management was transformational also showed more signs of commitment to the facility. Transformational leaders tend to coach their staff rather than control them. This provides a supportive work environment that allows for individual differences to be recognized.There are numerous theories that explore the effectiveness and the perception of leadership. The transformational nurse theory helps nurse leaders visualize and change the future of the facility’s culture. Collective leadership is similar to the transformational nurse theory as they create something significant, such as a vision. This paper focused on the transformational nurse theory. MethodsThe project proposal asked clinical leads to complete a survey, (Clark, 2011) to describe their transformational leadership skills (see Appendix). Based on the results, an in-service and one on one trainings were provided to discuss the survey. The project focused on their strengths, weaknesses, and needs. They were paired with a seasoned leader and surveyed toward the end of the project; the entire project took 16 weeks. The assessment of the knowledge and leadership skills attained occurred after the participants completed their pre-survey and the in-service. The in-services taught leadership styles based on the literature review. The goal was that the clinical leads grew as leaders and appreciated the knowledge that has been taught.This project utilized an evidence evaluation design. The setting was a rural hospital in Northwest Arizona. Clinical leads from the medical surgical / remote telemetry department participated.The emergency department, Clinical Decision Unit, and surgical clinical leads were not included. The clinical leads in these department are fixed into the budget. The Senior Director of Patient Practice assisted in this project. She assisted in reaching out to the clinical leads and their directors so that their surveys were completed in a timely manner. The in-services were provided to the participants on a one-to-one basis. The project was specific to one unit and served as a pilot program. The risk was that clinical leads would not want to participate in the survey. Also, the leads may have felt that they did not need guidance. The benefit would be a relationship with the facility’s senior leaders and professional growth that is aligned with the vision and goals of the hospital. A greater benefit will also be the retention of current clinical leads and floor staff.The main survey used was be the transformational leadership survey. The survey had the clinical leads score themselves on their comfort level according to the question. The score revealed their strengths and weaknesses. The clinical leads were able to add notes or statements in regards to their concerns with leadership and training. These concerns were addressed with their directors and senior leaders. Staff did not receive corrective action from these surveys. The mentor to the clinical leads was their director. The clinical leads were able to better understand other aspects of the hospital, such as the business aspect. Many of the clinical leads know who the hospital leaders are but may not fully understand their role in fulfilling the mission and vision of the organization. The in-services and teachings occurred at this facility. Communication with the clinical leads and the director was via email and face-to- face interaction.The instruments for this study were the surveys and the feedback provided by the clinical leads. The mentor was able to evaluate the clinical leads to see if their leadership style had changed. The participants were informed that this was a capstone project for a MSN program and they signed consents in order to participate. The surveys were filled out by hand and scanned into a computer. Access to the laptop was only by the author.With the guidance of the preceptor, conclusions were drawn from the surveys. Many of the surveys that are available to the public (including students) have guidelines and proposed teaching methods. That information was used to analyze the surveys.Due to the fact that they may write about their training or lack of, it will be of utmost importance that their results and answers were not be used for disciplinary action or yearly evaluations. Both clinical leads are responsible for making assignments, rounding on all patients, expediting admissions and discharges, completing follow up calls, identifying at-risk patients for readmission and meeting with case management to develop plans for discharge, providing education for staff and patients, meeting daily with the house supervisor and other unit leaders to discuss staffing and readmission problems, and assisting the director with enforcing policies and coaching staff.The clinical leads were emailed a survey and they scored themselves using the transformation leadership survey. The director was provided the same survey along with a set of questions. The questions for the director were: Why did you become a nurse?Why did you choose to be a leader?Do you see yourself as a mentor?Is there a theory that you follow?Do you feel that you can influence emerging nurse leaders?Who is / was someone that inspired you to be the kind of leaders you are?What can you teach emerging nurse leaders?The transformational leadership survey was comprised of 18 questions. Each question asked the respondent to answer honestly. The score ranged from 18 to 72. The numbers reflected leadership skills on six factors: charisma, social, vision, transactional, delegation, and execution. A lower score indicated that the leaders should work on improving their weaknesses. A score of 54 or higher indicated that they are on track with being a transformational leader. Along with the survey, the director was provided questions that asked detailed reasons as to why he or she chose to become a nurse and a leader. Good mentors are not always taught; they may have traits that others do not have. Leaders may be born with leadership traits or have learned them due to various life and work experiences. Nurse leaders may have a personal reason as to why they became a nurse and why they chose to be a leader. Asking more direct questions in which they can tell their story is a way to match a mentor with a nurse. In this case, there was only one mentor for two clinical leads. “One of the reasons leadership theory and research have contributed little to leadership development is a long-standing focus linking personality with leadership” (Day, Fleenor, Atwater, Sturm, and McKee2014, p. 64).The clinical leads were provided with the articles in this paper. A Power Point presentation provided a review of the articles. The clinical leads knew that they were going to complete the transformational leadership survey at the end of the project to assess if there were improvements in their leadership skills. ResultsThe three participants completed the transformational leadership survey at the beginning and end of the project. Charisma, social, vision, transactional, delegation, and execution are the factors that comprise the leadership skills. There were 18 questions, with the nominal answers of one to four. Each section was grouped within three questions; the lowest answer was one and the highest was four. The highest total score was 72 and the lowest was 18. Any section of questions that is nine or below was a skill that needed improvement. The mentor had a total score of 69 with each survey. The lowest score was nine, in the section of delegation. The question with the lowest score was, “I rarely give direction or guidance to others if I sense they can achieve their goal.”Clinical Lead One had a total score of 53 and 57. Clinical Lead Two had a total score of 62 for each survey. The area of concern for Clinical Lead Two was delegation. The areas for Clinical Lead One that needed improvement were social, vision, transactional, and delegation. When the survey was re-taken, the vision and transactional sections improved for Clinical Lead One. The participants of the project found the survey useful in their roles as clinical leads. The mentor also supported this project. Clinical Lead One stated that she is a role model for other nurses on the unit. By being a role model, she felt that she gained trust and respect. She made it a point that the floor nurses understand what is expected of them and if not, how to take action in real time yet not affect the morale of the team. Clinical Lead One demonstrated the most improvement in the project. Clinical Lead Two learned that she is a mentor to the floor nurses. She also stated that it was important to listen to their concerns and understand their needs. She also felt as though she was more respected by the floor nurses and other staff, such as the staffing office. The mentor stated that he had observed amazing leadership skills in both the clinical leads and highly recommended that the hospital implement this project. DiscussionThe participants were able to complete the surveys and read the articles that were provided in the literature review. The mentor actively participated in this project and encouraged the clinical leads to use the knowledge gained from the literature. The mentor guided the clinical leads to use feedback from the floor nurses and to deal with issues as soon as possible. The participants provided positive feedback from the project. The mentor wanted this project implemented in the hospital as an ongoing effort to improve leadership. Morrison, Jones, and Fuller (1997) explored leadership styles, empowerment, and job satisfaction. The participants in this project shared the same quality of job satisfaction. Two of the three participants have been employed for ten years or more. Their longevity at the facility confirmed their commitment and satisfaction at the hospital. Clinical Lead One stated that she is a role model for the nurses on the floor. Clinical Lead Two stated that she is a mentor to the nurses. The clinical leads also believed in coaching in real time. Each clinical lead believed that he or she can positively influence staff with effective leadership qualities. Their responses were consistent with the findings from McGuire and Kennerly (2006). They showed that transformational leaders do more than manage; they are able to motivate and influence their staff and co-workers. Transformational leaders tend to coach their staff rather than control them. This provides a supportive work environment that allows for individual differences to be recognized.This project had strengths and limitations. A strength was that each participant was fully involved in the project. There was support from nursing administration due to the fact that one of its goals was to implement a nurse leadership program. The plan was to use this project and incorporate this goal. A limitation of this project was the number of participants. The goal was to avoid using the director as the mentor of the clinical leads. The reason as to the limited number of participants was due to uncontrollable circumstances. In March 2018 the hospital experienced a flood on the first floor. Various departments and conference rooms were involved. This dramatically affected the amount of people that were able to participate due to the lack of rooms that were available. The project presented with a variety of implications. The clinical leads were eager to learn and grow their leadership skills. The clinical leads appreciated that they were provided with literature to assist in obtaining new skills. The mentor / director was surprised at the eagerness of the clinical leads. The director is known to be resistant to new programs. The director supported this project and its growth within the hospital. The project was useful in assessing the leadership styles of the clinical leads. Their strengths and weaknesses were presented to them in a manner that was not critical of their current skills. The clinical leads were able to improve their skills according to their scores. With the support of the mentor / director, this project will help other directors encourage their clinical leads to participate in future leadership projects. AppendixTransformational Leadership Survey Using the scale below, please mark the box to the left of the number that comes closest to your level of proficiency and comfort, with 1 being the least and 4 the most comfort and proficiency. Be honest about your choices as it is a self-assessment tool to learn and grow. I go out of my way to make students feel good to be around me. ? 1 ? 2 ? 3 ? 4 I help students with their self-development. 1 ? 2 ? 3 ? 4 I help students to understand my visions through the use of tools, such as images, stories, and models. ? 1 ? 2 ? 3 ? 4 I ensure students get recognition and/or rewards when they achieve difficult or complex goals ? 1 ? 2 ? 3 ? 4 I let students work toward their degree plan in the manner that they want. ? 1 ? 2 ? 3 ? 4 I get things done. 1 ? 2 ? 3 ? 4 I have an ever expanding network of people and students who trust and rely upon me. ? 1 ? 2 ? 3 ? 4 I provide challenges for my students to help them grow. 1 ? 2 ? 3 ? 4 I use simple words, images, and symbols to convey to students what we should or could be doing. ? 1 ? 2 ? 3 ? 4 I direct students by setting standards that we agree on. 1 ? 2 ? 3 ? 4 I rarely give direction or guidance to others if I sense they can achieve their goal. 1 ? 2 ? 3 ? 4 I consistently provide coaching and feedback so that my students know how they are doing. 1 ? 2 ? 3 ? 4 Students listen to my ideas and concerns not out of fear, but because of my skills, knowledge, and personality. 1 ? 2 ? 3 ? 4 I provide an empathic shoulder when others need help. 1 ? 2 ? 3 ? 4 I help others with new ways of looking at new and complex ideas or concepts. 1 ? 2 ? 3 ? 4 I ensure poor performance gets corrected. 1 ? 2 ? 3 ? 4 As long as things are going smoothly, I am satisfied. 1 ? 2 ? 3 ? 4 I monitor all students who are having problems to ensure they meet their goal. ? 1 ? 2 ? 3 ? 4 Scoring This survey measures your leadership skills on six factors: Charisma, Social, Vision, Transactional, Delegation, and Execution. Each factor is measured by three questions as shown on the back. Your score is determined by adding your three scores together for each factor in the chart below. Note that the lowest score you can get for each factor is 3, while the highest score is 12. Strength and Weakness Chart for Transformational Leadership Factors Charisma (questions 1, 7, 13) Total______ Social (questions 2, 8, 14) Total______ Vision (questions 3, 9, 15) Total______ Transactional (questions 4, 10, 16) Total______ Delegation (questions 5, 11, 17) Total______ Execution (questions 6, 12, 18) Total______ Total the scores and enter the number here ______. The highest score possible is 72 and the lowest possible score is 18. There are no correct answers. However, this survey gives you an idea of what factors you use the most and the ones you use the least. Generally, a score of about 54 or higher means that you are well on your way to becoming a transformational leader. However, don't be discouraged if you score lower — you simply have to reflect and then take action a little more as noted below. The highest scoring factors in the chart above are your strong leadership factors, while the lower scoring factors are you weak ones. You should spend some time reflecting and then taking action on the factors you scored 9 or less in. Look for opportunities to increase your knowledge and skills with the following factors: Charisma (questions 1, 7, 13): You are a role model that shows true dedication, trust, and respect to others, who in turn, do the same to you. Social (questions 2, 8, 14): You help others to learn by coaching and mentoring them. You create challenging environments to help them reach their full potential. When others have difficulties you are not afraid to empathize with them and help guide them. Vision (questions 3, 9, 15): You provide challenging visions and help people to understand them so that they are motivated to join in. Transactional (questions 4, 10, 16): You ensure others understand what you expect from them by using mutual agreement. In addition, you ensure that if poor performance does occur, you take action to ensure it does not affect the moral of the team. Delegation (questions 5, 11, 17): You delegate both the task and the authority to get things accomplished. Execution (questions 6, 12, 18): While I do delegate as many tasks as possible with the authority to accomplish them, as a good steward of my department’s resources, I do follow-up to ensure things are going as planned and we are not wasting times. ReferencesClark, D.R. (2011). Transformational Leadership Survey. Retrieved from , D. V., Fleenor, J. W., Atwater, L. E., Sturm, R. E., & McKee, R. A. (2014). Advances in leader and leadership development: A review of 25 years of research and theory. The Leadership Quarterly, 25(1), 63-82.Dyess, S., Sherman, R., Pratt, B., & Chiang-Hanisko, L. (January 14, 2016) "Growing nurse leaders: Their perspectives on nursing leadership and today’s practice environment" OJIN: The Online Journal of Issues in Nursing, 21(1) McCloughen, A., O'Brien, L., & Jackson, D. (2014). Journey to become a nurse leader mentor: Past, present and future influences. Nursing Inquiry, 21(4), 301-310.McGuire, E., & Kennerly, S. M. (2006). Nurse managers as transformational and transactional leaders. Nursing Economics, 24(4), 179.Medley, F., & Larochelle, D. R. (1995). Transformational leadership and job satisfaction. Nursing Management, 26(9), 64.Morrison, R. S., Jones, L., & Fuller, B. (1997). The relation between leadership style and empowerment on job satisfaction of nurses. Journal of Nursing Administration, 27(5), 27-34.Shirey, M. R. (2006). Authentic leaders creating healthy work environments for nursing practice. American Journal of Critical Care, 15(3), 256-267.Ward, K. (2002). A vision for tomorrow: Transformational nursing leaders. Nursing Outlook, 50(3), 121-126. ................
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