Journal of Nursing Education

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Leadership - What It Is and How To Teach It

Sally A Lawrence, RN, PhD; Rena M Lawrence, RN, PhD

Abstract

Leadership is an interaction between people and the ability to lead. Stogdill describes leadership as a process of influencing the activities of an organized group toward goal setting and goal-achievement (Stogdill, 1959, p. 20), and as an art of inducing compliance (StogdUl, 1974, p. 9). Moloney (1979, p. 11) views leadership as "an interpersonal process of influencing the activities of an individual or a group toward goal attainment in a given situation." Leaders are the persons responsible for implementing the leadership process. Closely associated with leadership is authority, power, and influence (Yura, Ozimek, & Walsh, 1981, p. 18). Bennis, Benne and Chin (1969, p. 296) define power as the perceived abüity to control appropriate rewards; and when this perceived ability resides in an agent acting as a leader it leads to influence. Sources of power for a leader come from (1) interpersonal and persuasive techniques; (2) group alliances and coalitions; (3) a charismatic leadership style; (4) direct confrontation; (5) negotiation strategies; and (6) revolution or over throw of an existing individual or private group (Leininger, 1974).

Authorities may differ in their definitions of leadership but regardless of these differences similarities do emerge. In essence, leadership is the ability to affect a change in the behavior of others and to work with others toward achievement of long- and short-term goals within a given social system. Leadership, as viewed by the authors, is a highly developed and sophisticated cognitive skill which consists of cognitive processes and affective behaviors whereby the nurse actualizes the human potentials of self and others to effect change. Leadership represents the combined cognitive efforts of the leadership process and the change process.

Leadership is not management or administration. Managers and administrators are appointed, have a bureaucratic power base, and utilize power to either reward or punish. Their influential capacity derives from the authority inherent in their formal position (Moloney, 1979). These individuals may or may not demonstrate leadership behavior. Leadership is not an experience in assuming the role of a team leader or head nurse; nor is it primary nursing. All of these terms are incorrectly equated with leadership.

Leadership for the Eighties; Underlying Social Forces

Leadership for the eighties is a new type of leadership. The directional forces for this leadership behavior are the societal forces and changes that Toffler calls the Third Wave (Toffler, 1980). The Third Wave began in the fifties and is characterized by the end of synchronization, standardization, centralization, and maximization (pp. 213-223). Technology and termination of the mass production system have brought about diverse employment patterns (Toffler, 1970, pp. 114-116; Toffler, 1980, pp. 261-280). An "ad-hocracy" has replaced the bureaucratic organization. Power and authority is being decentralized and is horizontal rather than vertical with more people sharing temporary decision making (Toffler, 1970, pp. 132-151; Toffler, 1980, pp. 273-281).

The Third Wave has brought about demaesification of the infro-sphere which is now characterized by diversity and computer technology. Information is being conveyed in short, organized, synthesized modular blips. Since 1970 there has been a dearth of many major magazines and an increase in mini-magazines that are directed toward small, special interest groups (Toffler, 1980, pp. 285-300). There is currently a diversity in family lifestyle and a rise in the number of single parent families, aggregate families, and polyparent families (Toffler, 1970, pp. 227-230). Traditional roles appropriate to the nuclear family are no longer relevant. Individuals are fighting to maintain differences and diversity. A prosumer movement is evolving because people are realizing that it is psychologically and economically better to produce for one's own consumption certain services or products than to continually try to…

Leadership is an interaction between people and the ability to lead. Stogdill describes leadership as a process of influencing the activities of an organized group toward goal setting and goal-achievement (Stogdill, 1959, p. 20), and as an art of inducing compliance (StogdUl, 1974, p. 9). Moloney (1979, p. 11) views leadership as "an interpersonal process of influencing the activities of an individual or a group toward goal attainment in a given situation." Leaders are the persons responsible for implementing the leadership process. Closely associated with leadership is authority, power, and influence (Yura, Ozimek, & Walsh, 1981, p. 18). Bennis, Benne and Chin (1969, p. 296) define power as the perceived abüity to control appropriate rewards; and when this perceived ability resides in an agent acting as a leader it leads to influence. Sources of power for a leader come from (1) interpersonal and persuasive techniques; (2) group alliances and coalitions; (3) a charismatic leadership style; (4) direct confrontation; (5) negotiation strategies; and (6) revolution or over throw of an existing individual or private group (Leininger, 1974).

Authorities may differ in their definitions of leadership but regardless of these differences similarities do emerge. In essence, leadership is the ability to affect a change in the behavior of others and to work with others toward achievement of long- and short-term goals within a given social system. Leadership, as viewed by the authors, is a highly developed and sophisticated cognitive skill which consists of cognitive processes and affective behaviors whereby the nurse actualizes the human potentials of self and others to effect change. Leadership represents the combined cognitive efforts of the leadership process and the change process.

Leadership is not management or administration. Managers and administrators are appointed, have a bureaucratic power base, and utilize power to either reward or punish. Their influential capacity derives from the authority inherent in their formal position (Moloney, 1979). These individuals may or may not demonstrate leadership behavior. Leadership is not an experience in assuming the role of a team leader or head nurse; nor is it primary nursing. All of these terms are incorrectly equated with leadership.

Leadership for the Eighties; Underlying Social Forces

Leadership for the eighties is a new type of leadership. The directional forces for this leadership behavior are the societal forces and changes that Toffler calls the Third Wave (Toffler, 1980). The Third Wave began in the fifties and is characterized by the end of synchronization, standardization, centralization, and maximization (pp. 213-223). Technology and termination of the mass production system have brought about diverse employment patterns (Toffler, 1970, pp. 114-116; Toffler, 1980, pp. 261-280). An "ad-hocracy" has replaced the bureaucratic organization. Power and authority is being decentralized and is horizontal rather than vertical with more people sharing temporary decision making (Toffler, 1970, pp. 132-151; Toffler, 1980, pp. 273-281).

The Third Wave has brought about demaesification of the infro-sphere which is now characterized by diversity and computer technology. Information is being conveyed in short, organized, synthesized modular blips. Since 1970 there has been a dearth of many major magazines and an increase in mini-magazines that are directed toward small, special interest groups (Toffler, 1980, pp. 285-300). There is currently a diversity in family lifestyle and a rise in the number of single parent families, aggregate families, and polyparent families (Toffler, 1970, pp. 227-230). Traditional roles appropriate to the nuclear family are no longer relevant. Individuals are fighting to maintain differences and diversity. A prosumer movement is evolving because people are realizing that it is psychologically and economically better to produce for one's own consumption certain services or products than to continually try to earn more money (Toffler, 1980). In response to this movement there are an increasing number of self-help services.

The Third Wave has brought changes in our population. In 1790, half of the population was 16 years of age or younger. By 1981 the median age will have passed 30, and by 2030 the median age will be 40 (Murray & Zenter, 1979, p. 360). As of July I1 1979, the number of people 60 years and older comprised 15.6% of the total population (Blumenfeld, 1980). Society is moving from a child-oriented society to an adult-oriented society. AU of these societal forces and changes have a tremendous impact on nursing and provide the directional force for leadership behavior in nursing.

Nursing Leadership for the Eighties

According to Yura, et al. (1981, p. 19), few nurses are granted leadership status in our culture until they reach middle age. Research findings indicate that physical characteristics have little to do with leadership (p. 37) and suggest that today's leader tends to be endowed with an abundant reserve of energy, stamina, and ability to maintain a high rate of energy output (Stogdill, 1974, p. 36). The key words to describe nursing's Third Wave leaders are intelligent, adaptable, flexible, and expert in communications and small group process. Interpersonal expertise is needed to work in this ad-hocracy, to coordinate health care services and to share in the decision-making process.

With the decentralization, destandardization, and demaximization of todays hospitals and medical centers there will be increased specialization of services offered by the acute care setting, and an increase in the number and diversity of services offered by small community centers. Clients in acute care facilities will receive primarily intensive nursing care. Nurses and other health care workers will be assigned to interdisciplinary teams to facilitate holistic health care. Specialization will increase and more nurses will be selfemployed. The diversity of work patterns will be infinite. Private nursing pools will increase in abundance. The nursing leader will need to develop new strategies to cope with these changes in the health care system, and deal with the novel problems not like any encountered thus far. The nursing leader of the 1980s will be more of a facilitator and coordinator and less of a manager to ensure holistic health care. This is different from the Second Wave's bureaucratic nursing managers, administrators, and directors who first simplified, then routinized, and finally fragmented patient care.

With the prosumer movement there will be a further increase in self-help groups and there will be increased consumer participation in these self-help groups. Many health promotion and maintenance measures currently done by the nurse such as blood pressure screening and health teaching will be done by self-help groups and the prosumers. Nursing leaders will need to help nurses undergo role analysis and role clarification to allow for integration of nursing into the emerging self-care culture. Coordination of services provided by self-help groups, and channeling them into the main stream of health care delivery will be a primary directive, consequently nursing leaders must become involved and participate in community activities. They will share in the decisionmaking process and become more knowledgeable of legal and political ramifications. The result will be increased activity in the political arena at all levels.

Third Wave leaders will need to assimilate large amounts of data and at times much of it will be conflicting. They will need research skills and expertise in the research process to identify priorities and alternative means to cope with the accelerated speed of change. The Third Wave will bring with it many stress-related illnesses which will be manifested among both health care providers and consumers. Burn-out will accelerate to greater heights than ever before among nurses. Nursing leaders will need to identify strategies to eliminate and neutralize the effects of stress and implement programs directed toward stress reduction.

Leaders are not born and leadership skills do not magically appear. Leaders are developed and leadership skills are highly developed cognitive and affective behaviors that must be learned. A logical question is how does one teach leadership skills and behavior which are essential characteristics of professional nursing?

Teaching Leadership/ Skills and Behaviors

Two nursing faculty members in a small baccalaureate nursing program have developed a unique learning experience that is directed toward teaching leadership skills and behavior. Faculty help students to progressively develop leadership skills over a two-and-a-half-year period while working with a voluntary health agency. Faculty meet with students at regular intervals and agency personnel receive a written description of the experience and learning objectives.

This experience begins with the first nursing course, which is in the spring of the sophomore year. The initial experience is directed toward developing community involvement and commitment, basic communication styles, leadership roles, and need for nursing input and participation. Students conduct a survey of available voluntary health agencies and self-help groups. This experience provides the initial contact with the community and other health providers, and allows students to conduct a beginning analysis of society's health needs and community services. Then students select an agency and conduct an indepth study of the agency's goals and services.

Agency personnel are interviewed to provide an opportunity to develop interpersonal skills essential to development of leadership styles and behavior. Students assess channels for nursing input into the group and develop their own role based upon an analysis of the agency goals and staff roles. The role emphasizes that of a facilitator and coordinator. In cooperation with agency staff, students develop goals for participation and a work-time schedule which is flexible and variable. Finally a contract is negotiated.

In the junior year the foci are working with other health disciplines, developing influential relationships, and implementing change strategies. Students work as volunteers in the agency or self-help group and follow through with the goals previously established in the sophomore year. Goals are continually assessed and evaluated to ensure congruence with agency goals, otherwise change is not a meaningful undertaking (Mauksch & Miller, 1981, p. 23). Influential relationships with agency staffare developed and used to help meet agency goals. Influential relationships are essential to develop a strong power base for effecting future change.

Emphasis is given to helping the student to develop characteristics of a leader and change agent. Students use various strategies to effect change within the system. This change can be either horizontal or vertical; it may be initiated at top, bottom, or middle of the hierarchy; and it may move up and down the hierarchy (Mauksch & MUler, 1981, p. 24). Students have effected change from the bottom as a volunteer and, later, in the senior year, from the middle as a committee member and from the top as a board member. Students have effected horizontal change by helping famüy units to alter the behavior of one of its members. For example, a student is working with families who have asthmatic children. The goal is to alter behavior so as to decrease the number of clinic visits by 25%. Change has been effected at all levels. During the junior year most change effected is microscopic change which has minor affect on the system (p. 27).

Students help to coordinate and channel services offered by the agency and self-help group with other agencies that fall more directly in the mainstream of health care delivery. Variables that pose resistance to change are identified, analyzed, and explored in an attempt to revise these variables so that change is effected.

Students have served as volunteers in a variety of ways. They have taught life support courses for the American Heart Association, participated in health fairs sponsored by the American Red Cross, and conducted screening programs to detect breast cancer for the American Cancer Society. They did genetic counseling to prevent birth defects for the March of Dimes and conducted support groups for Parents Without Partners. Students, working with a CathoUc social agency, counseled unwed mothers to help them cope with stress inherent in being a single parent as well as providing health guidance. Students worked as a member of interdisciplinary health teams with the American Lung Association's Family Asthma Program and Planned Parenthood to do extensive teaching and counseling. These are but a few of the many diverse experiences used to help students develop leadership skills and behaviors.

In the senior year the emphasis is directed toward the student functioning as a leader and change agent and sharing in the decision-making process. Students attend general meetings of the agency and official board meetings. They are appointed to committees and actively participate. Students have served on committees that developed screening programs, health fairs, education programs, and poUcy. One student served on a committee that developed a cancer detection seminar for the elderly. He served as a primary speaker and member of an interdisciplinary panel. Another student served as chairperson for a committee which had as its purpose to revise and update the policy manual for teaching about hypertension.

Students identify the effect that current legislation is having on the services provided by the agency. They attend various meetings concerned with legislation and have helped to make agency needs known to politicians via letters.

Research skiUs are used to identify (1) problems where change is needed, (2) target populations, (3) alternatives to cope with the problem; set up a program of change; implement the change; and evaluate the effectiveness of the change. Two students identified that the elderly with hypertension were experiencing recurrent episodes of hypertension. They identified that the problem was related to lack of knowledge and compliance with medications. They developed, implemented, and evaluated a planned education program oriented toward compliance with drug therapy. Two different students working with the American Lung Association identified the increasing incidence of smoking among teenagers. They diagnosed the problem of lack of early prevention. The target population identified was the schoolage child. They formed a committee to develop an educational program that would bring about change in the incidence of teenage smoking. Then they presented the program which was directed toward informing children (second and third graders) of the effects of smoking. The focus of the program was "Pete the Dragon."

Emphasis is directed toward advocating planned change which is predictable, intended, deliberate, and anticipated (Mauksch & MiUer, 1981, p. 34). Students emphasize both truth credibility, which is the honest commitment that the change is necessary and appropriate, and technical credibility, which means that the change agent has the knowledge and skill necessary to effect the change (Zaltman & Duncan, 1977, p. 203).

Conclusion

This article describes a leader who has the nursing skills and behaviors needed in a society which is experiencing accelerated change. A learning experience used to help prepare this leader has been implemented for several years. The community has responded weU to the nursing input and leadership. Each year more agencies ask to participate in this experience. The true value of this experience is evident by the number of graduates who have leadership roles in the community.

References

  • Bennis, W.G., Benne, K.D., & Chin, R. (1969). The planning of change, ed. 2. New York: Holt, Rinehart, and Winston.
  • Blumenfeld, H. (1980, July 12). Growing old. The Sunday News, Lancaster, PA: p. F-12.
  • Leininger, M. (1974). The leadership crisis in nursing: A critical problem and challenge. Journal of Nursing Administration, 40, 32.
  • Mauksch, LG. , & Miller, M.H. (1981). Implementing change in nursing. St, Louis: The CV. Moeby Co.
  • Moloney, M.M. (1979). Leadership in nursing. St. Louis: The CV. Mosby Co.
  • Murray, R., & Zenter, J. (1979). Nursing assessment and health promotion through the life span, ed. 2. Englewood Cliffs, NJ: Prentice Hall.
  • Stogdill, R.M. (1959). Individual behavior and group achievement. New York: Oxford University Press.
  • Stogdill, R.M. (1974). Handbook of leadership. New York: The Free Press.
  • Toffler, A. (1970). Future shock. New York: Random House.
  • Toffler, A. (1980). The third wave. New York: William Morrow.
  • Yura, H., Ozimek, D., & Walsh, M.B. (1981). Nursing leadership: Theory and process, ed. 2. New York: Appleton-Century-Crofts.
  • Zaltman, G, & Duncan, R. (1977). Strategies for planned change. New York: John Wiley & Sons.

10.3928/0148-4834-19840401-15

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