Journal of Nursing Education

How are We Preparing Nurse Leaders?: A Study of Baccalaureate Curricula

Claire M Manfredi, EdD, RN; Theresa M Valiga, EdD, RN

Abstract

ABSTRACT

What is leadership? Is it different from management? If so, how is it different? This study was designed to achieve several purposes: to clarify the conceptual differences between leadership and management; to identify the leadership/management concept included in baccalaureate programs in nursing; and compare and contrast the program content with the conceptual definitions. A review of eight program components contained in the National League for Nursing Self-Study Reports of 10 accredited programs in the mid-Atlantic region was conducted to achieve these purposes. This analysis revealed that despite their conceptual differences, nursing faculty generally use leadership and management interchangeably, and the emphasis in most programs is on management training rather than leadership development,

Abstract

ABSTRACT

What is leadership? Is it different from management? If so, how is it different? This study was designed to achieve several purposes: to clarify the conceptual differences between leadership and management; to identify the leadership/management concept included in baccalaureate programs in nursing; and compare and contrast the program content with the conceptual definitions. A review of eight program components contained in the National League for Nursing Self-Study Reports of 10 accredited programs in the mid-Atlantic region was conducted to achieve these purposes. This analysis revealed that despite their conceptual differences, nursing faculty generally use leadership and management interchangeably, and the emphasis in most programs is on management training rather than leadership development,

Introduction

What is leadership? Is it different from management? If so, how is it different? How do individuals develop leadership abilities? Such questions concern educators because, among other purposes, college is "the place to cultivate enlightened leadership" (Wheeler, 1985, p.92).

Leadership is "one of the most observed and least understood phenomena on earth" (Burns, 1978, p.2). It is a "universal human phenomenon" (Bass, 1981, p.5), and one that affects all aspects of life. Yet, it is a phenomenon about which we know much less than we might like to admit, and we know even less about how individuals develop leadership knowledge and skills.

Leadership is multidimensional and complex. It encompasses the wise use of power, the ability to envision future goals and directions, visibility and a willingness to "stick one's head above the crowd," pragmatism, and humanism. It must be concerned with goal attainment and task accomplishment, but not at the expense of the people involved. Indeed, leadership is effective only when it draws forth the best in people, is concerned with promoting the general welfare of human beings, and maintains group solidarity.

Many studies have been conducted regarding individuals as leaders (Bennis & Nanus, 1985; Iacocca, 1984; Maccoby, 1981; Nixon, 1982). However, although we may know a great deal about individuals as leaders, "we know far too little about leadership" (Burns, 1978, p.l). Burns (1978) described the crisis in leadership today. He asserted that our society is rampant with mediocrity and irresponsibility, and that leaders fail to address those issues and problems. Perhaps our lack of knowledge about this universal phenomenon is due to a failure to adequately distinguish it from other concepts, an idea supported by Rost (1985).

Leadership and Management

One of the concepts with which leadership often is confused is that of management. Although these two phenomena are related, they are not the same. For example, Rost (1985) recently explicated numerous similarities between leadership and management, but he also pointed out 12 distinctions between the two phenomena. Among the distinctions are that management must be understood as a position, but leadership may or may not be tied to a position of authority in an organization; leadership is a relationship of influence, whereas management must be understood as a relationship of authority with its resultant manager-employee relationships; leaders create, and managers regulate; and leaders enjoy and want ambiguity since it allows for change, but managers prefer predictability.

Zaleznik (1981) asserted that managers are problem solvers who emphasize rationality and control. They adapt impersonal attitudes toward goals, accepting those espoused by the organization; they dislike and avoid espoused by the organization; they dislike and avoid solitary activity, preferring to work with people; and they are "once-born" individuals, "whose lives have more or less been a peaceful flow from the moment of their births" (Zaleznik, 1981, p.29). Managers work to perpetuate existing institutions.

Leaders, on the other hand, are imaginative and are driven by ideas and possibilities, not assurances. They create their own goals in conjunction with the group and are highly invested in those goals; they are more empathie toward people, concerned with the meaning that events and decisions have for people, and are comfortable with solitary activity since it provides time for reflection and dreaming; and they are "twice-born" personalities, whose "lives are marked by a continual struggle" (Zaleznik, 1981, p.29). Leaders work in organizations but never belong to them.

Thus, leaders and managers - and leadership and management - are similar but distinct concepts. As Bennis and Nanus (1985, p.21) recently summarized, "managers are people who do things right and leaders are people who do the right thing." In some instances, an individual in a management position may function as a group's true leader, but this is not always the case. The opposite also is true: the person who is truly providing leadership to a group is not necessarily someone in a management position.

Leadership and Education

This lack of conceptual clarity about leadership and how it is distinguished from management is common among educators, and it certainly has implications for preparing individuals for leadership roles. It has, in fact, become a primary concern for the Council of Liberal Learning of the Association of American Colleges. As one author associated with that Council recently reported, "During the last few years - indeed, in the last few months - there has been a veritable explosion of interest on campuses across the country hi developing teaching and co-curricular programs to help students better understand the nature of leadership and to develop leadership skills themselves" (Spitzberg, 1986, p.3). It is important to realize, however, that this interest in the development of leadership through specific educational experiences is as much a concern in professional schools as it is in liberal arts programs; and in nursing, it is a concern that is not new.

The National League for Nursing (NLN), the national accrediting body for nursing education programs, mandates that the undergraduate curriculum "provides for the development of skills in leadership and management for beginning professional practice" ("Criteria," 1983, p.7), and that the undergraduate curriculum "provides for the development of leadership, management and teaching skills consistent with specified nursing role emphasis" ("Criteria," 1983, p.8). Thus, the mandates and expectations of the profession are clear: undergraduate and graduate programs should prepare individuals for leadership roles in nursing.

Despite these mandates, the "state of leadership in nursing may be succinctly described as severely deficient, both in quantity and quality" (Yura, Ozimek, & Walsh, 1981, p.24). Indeed, many authors (Cleland, 1982; Hammond, 1981; Smith & Mitry, 1986; Stevens, 1981) lament the lack of leadership in the field and plead for nurses who can provide decisive leadership in times of change, competition, and crisis.

Problem Statement

Today's arenas for nursing practice are more complex than ever, they are changing more rapidly than ever, and they require nurses to possess skills and knowledge as never before. The health-care delivery system is increasingly fraught with the problems of providing care to patients who are sicker and who are discharged from acute care institutions more quickly (Coleman & Smith, 1984). The cries for cost containment are ringing loud and clear (Joel, 1985), and there is a growing need for nurses to assume new and increasingly independent roles in health promotion, home care, and long-term care (Elliot & Osgood, 1982). All of these phenomena call for effective nurse leaders who can move the profession forward.

Perhaps this lack-of-leadership crisis in nursing is the result of those incredibly complex and ever-changing environments in which nurses practice. But it also may be related to the ineffectiveness of nursing education programs in preparing graduates for such roles and environments.

Could it be that in educational programs, more emphasis is placed on management training than on leadership development? In discussing educational programs in general, Rost asserted that "much of the training going on today under the title of leadership is not leadership training at all; it is management training" (Rost, 1985, p.2). Perhaps in nursing, the fact that the NLN criteria speak to leadership and management development may lead to the lack of conceptual clarity among nursing faculty about the distinctions between these two phenomena, and may result in greater emphasis being placed on management training than on true leadership development.

Purpose

In light of these developments and circumstances, a study was undertaken to determine how nurse leaders are being prepared in baccalaureate programs in nursing, One phase of that study which is reported here was a pilot study, designed to answer the following questions:

* Do baccalaureate nursing programs include a leadership or management course in the curriculum?

* Are there identifiable differences between leadership and management in the baccalaureate nursing curriculum?

Table

FIGUREDATA COLLECTION TOOL

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DATA COLLECTION TOOL

* Where is the emphasis placed in baccalaureate nursing programs: leadership development or management training?

* What is the relationship between the definitions of leadership and management synthesized from the literature and the way leadership and management are defined in baccalaureate nursing programs?

Definitions

According to Bass, "there are almost as many different definitions of leadership as there are persons who have attempted to define the concept" (Bass, 1981, p.7). He reported on nearly 100 definitions of leadership and classified them into 11 separate categories.

For the purposes of this study, the following definitions were used:

Leadership: An interactive process directed toward mutual goal achievement of leader and follower. Leadership occurs within any setting and is not tied to an organization. Its emphases are on goal achievement and change. The leader assumes the role of facilitator to influence others, shape the future, exercise power, mentor others, and promote the growth and personal development of group members.

Management: A process directed toward organizational maintenance. Management occurs within the context of an organization, and its emphasis is on achievement of organizational goals. A manager assumes the role of decision maker to manage subordinates, direct others, maintain the present, exercise authority, role model for others, and promote the development of personnel.

Procedures and Methodology

This descriptive study was designed to examine the preparation of leaders in baccalaureate nursing programs. Data were collected through a review of the NLN SelfStudy Reports prepared by nursing faculty prior to accreditation by the NLN.

Instrument

As a result of an extensive review of the literature and the definitions of leadership and management synthesized from the readings, 10 activities related to leadership and 10 related to management were identified. These activities were used to form a dichotomous scale for data collection (Figure). This scale was used to rate eight specific components within each Self-Study Report to determine whether these components addressed leadership or management.

Inter-rater reliability was assessed through percentage of agreement, an appropriate approach when categorical data are utilized. The investigators independently reviewed three Self-Study Reports and achieved a score of 89.2%, which indicates high agreement between the two raters. In addition, percentage of agreement was calculated for each of the eight components within the SelfStudy Reports. The scores ranged from 77% to 98%, indicating moderate to high agreement between the raters for these components.

Sample

Ten baccalaureate nursing programs accredited within the last 3 years and located in the Mid-Atlantic region were randomly selected from the list of NLN-accredited programs ("Degree programs," 1988). The list of randomly-selected schools was forwarded with a letter of request to the NLN, and permission was obtained to review the Self-Study Reports of the selected schools.

Thirty percent of the schools included in the study had both baccalaureate and masters programs; one had a program for registered nurses only. The size of the schools ranged from 20 graduates per year to 100 graduates per year. The number of faculty members ranged from 9 to 39.

Data Collection

Three of the Self-Study Reports were reviewed by both investigators to determine inter-rater reliability. Each investigator then reviewed one report independently and gave it to the other investigator for verification. Once consistency was established, the remaining reports were reviewed independently.

The following specific components contained within each Self-Study Report were reviewed: Philosophy of Nursing Program; Philosophy of Undergraduate Program; Purpose of Undergraduate Program; Conceptual Framework; Terminal Objectives; Level Objectives; Curriculum Threads; and Course Syllabi for Leadership/Management.

Using the instrument that was developed for this study, each investigator evaluated each component in terms of the extent to which leadership and management concepts were evident, and made any additional notes about the program that were relevant.

Data Analysis

Data were analyzed according to the original questions proposed at the onset of the study.

Do baccalaureate nursing programs include a leadership or management course within the curriculum? A review of the course descriptions contained within the 10 Self-Study Reporta revealed that 20% of the schools had a leadership course, 10% had a leadership/management course, and 20% had a course in management of healthcare systems or management of nursing-care systems. Thirty percent of the schools had courses that included some concepts related to leadership/management, but had other foci; these courses were titled Professional Issues/ Professional Nurse Power/Politics and Professional/ Managerial/Legal Implications. Twenty percent of the schools had no course identified specifically as leadership or management or that was in any way related to leadership or management. Sixty percent of the schools in this study reported a concurrent clinical component related to leadership or management; however, the description of that experience generally was vague. Descriptions that were offered tended to relate more to the management of patient care, and texts identified for such courses were ones that related specifically to patient care management.

Are there identifiable differences between leadership and management in the baccalaureate nursing curriculum? A review of the courses that were leadership or management in nature indicated that, in most instances, the terms leadership and management were used interchangeably. Content addressing staffing, assigning, budgeting, preparation of managers and leaders, personnel development, change within selected client groups, assertiveness, influencing others, advocacy, organizational goal achievement, and conflict resolution was included in leadership and management courses, and those courses related to both leadership and management as well. Whereas assigning, budgeting, staffing, personnel development, and organizational goal achievement are clearly activities related to management, influencing others is a leadership activity. Activities such as conflict resolution could be management-related, whereas assertiveness, advocacy, and change could be either a management or leadership activity. There were no distinctions made within any course outlines between leadership and management activities.

Where is the emphasis placed in baccalaureate nursing programs: leadership development or management training? As stated, a review of the leadership, management, and related courses indicated that the terms leadership and management appeared to be used interchangeably. The emphasis, however, seemed to be on management rather than leadership.

A review of the other components contained within the Self-Study Reports revealed that five terms appeared with some degree of consistency throughout the reports. These were accountability, autonomy, advocacy, responsibility, and collaboration. Fifty percent of the schools included these terms in the Philosophy and 80% included them in the Level/Terminal Objectives. Although these terms were not included in the original definitions of leadership and management, accountability, responsibility, and collaboration are often associated with management, whereas autonomy and advocacy are often associated with leadership.

Only 50% of the schools addressed leadership as a thread within the curriculum, and terms associated with this thread included advocacy or autonomy, role development, personal development, and accountability. It was interesting to note that these five terms appeared far less frequently in the leadership, management, or related courses. One could conclude, therefore, that although such concepts were explicated philosophically, they were not apparent operationally.

A review of the courses specific to leadership/ management revealed that, although some leadershiprelated terms appeared in other components of the Self-Study Reports, operationalization of these terms did not take place in the leadership, management, and related courses reviewed.

What is the relationship between the definitions of leadership and management synthesized from the literature and the way in which leadership and management are defined in baccalaureate nursing programs? When one considers the 10 activities derived from the leadership definition, the one most frequently cited in the Self-Study Report reviewed was personal development. Most schools cited such areas as personal change, personal growth, or personal development as goals or outcomes for students in the program; 80% included personal development in the Terminal Objectives, 60% in the Philosophy and Level Objectives, and 30% in the Curriculum Threads. Other leadership activities that appeared were facilitating (30% in Terminal Objectives); mutual goal achievement (40% in Terminai Objectives); and preparation of leaders (40% in Terminal Objectives). Those leadership behaviors that were addressed infrequently or not at all were leading others, exercising power, raentoring, and encouraging the growth of others.

In considering the 10 activities derived from the management definition, the one most frequently cited in the Self-Study Reports reviewed was organizational goal achievement; 40% of the schools included this in the Level Objectives, and 30% included it in the management course. Other management activities that were addressed included assigning, organizational growth, and personnel development, and these activities appeared in the leadership/management and related courses. Those management activities that were addressed infrequently or not at all were maintaining the present, exercising authority, and role modeling.

Conclusions and Recommendations

This study was designed through a review of Self-Study Reports of 10 NLN-accredited programs in the MidAtlantic region to examine how we are preparing leaders in baccalaureate nursing programs Although some leadership activities were addressed in the components contained within the Self-Study Reports reviewed, analysis of the leadership, management, and related courses indicated the emphasis was placed on management training rather than leadership development. There appeared to be little relationship between a definition of leadership that distinguished it from management and the content included in leadership courses in baccalaureate nursing programs. It appeared that more emphasis was placed on management activities, such as assigning, staffing, budgeting, and conflict resolution, than was placed on such leadership activities as leading others, exercising power, mentoring, and shaping the future.

The fact that the texts used in the leadership, management, and related courses were patient-care management texts would lead one to conclude that the emphasis was on patient-care management. The fact that 60% of the programs included a concurrent clinical experience related to patient care management would further support this conclusion. However, since 40% of the schools included the concept of organizational goal achievement in the Level Objectives and 30% included it in the leadership/ management course, one could conclude that organizational management was addressed, but perhaps to a lesser degree than patient-care management.

One could conclude from this study that baccalaureate nursing programs emphasize the preparation of nursing managers, specifically patient-care managers. This could be considered a very appropriate role for the baccalaureate-prepared nurse. Since baccalaureate nursing programs are responsible for preparing the beginning practitioner, one would expect that the emphasis at this level would be on patient-care management. However, we must not fool ourselves, then, into believing that we are preparing leaders at this level. Perhaps emphasis on nursing leadership is better left to graduate nursing programs, where nurses are better able to understand and deal with shaping the future, mentoring, influencing others, and exercising power.

It is clear from the study that the terms leadership and management are used interchangeably in baccalaureate nursing programs. If we are to be clear about our! educational goals, distinctions must be made between^' leadership and management, and faculty must agree on the definitions and subsequent selection of content to be included in relevant courses. Additionally, we should not be preparing baccalaureate nurses who are unaware of the distinctions between leadership and management both in theory and in practice. Perhaps it is time to look at our expectations regarding the preparation of baccalaureate nurses. Should baccalaureate nursing programs attempt to prepare nurse leaders? Should they prepare nurses who can assume management positions in health-care settings, or should they prepare knowledgeable/enlightened followers? A clear distinction between leadership and management will assist in dealing with these and other related questions.

The investigators reviewed the leadership, management, and related courses but did not review the clinical courses in the Self-Study Reports. It is conceivable that some of the leadership behaviors addressed in the SelfStudy Reports were operationalized in the clinical courses. It is unlikely, however, that heavy emphasis would be placed on leadership behaviors in these courses since they focus primarily on the development and enhancement of clinical practice in patient-care settings. In addition, if students are expected to translate theory into practice and the theory they are studying is management theory, then one should not expect to see leadership behaviors exhibited in the clinical area.

The need for a larger study to examine the preparation of leaders in baccalaureate nursing programs is evident from this pilot study. Studies using larger samples in other geographic areas would provide opportunities for generalizations regarding the study questions. Subsequently, studies regarding the preparation of leaders in graduate nursing programs should be conducted and comparisons made between baccalaureate and graduate preparation in leadership. Reviewing the Self-Study Reports is a timeconsuming, tedious process. Other methodologies might be devised to expedite data collection and provide a more comprehensive picture of the preparation of nurse leaders.

References

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FIGURE

DATA COLLECTION TOOL

10.3928/0148-4834-19900101-04

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