Moat registered nurses entering an RN-to-MSN program believe that they know a great deal about leadership and management through experience, workshops, and on-the-job training. Preparing these nurses for future leadership and followership roles requires faculty to use creative approaches. An essential part of any leadership role is realizing the importance of good followership.
Everyone is a follower at times and flexibility is required to switch from one role to another (Falter & Lentz, 1989). Leadership/followership roles are intertwined depending on the situation and the group's need for expertise. Combining knowledge and experience of members of groups creates action-oriented behavior and provides an opportunity to change perceptions, attitudes, and behaviors within groups.
There is a paucity of literature regarding leader interactions with qualified and educationally prepared peers. Group activity with peers is common and, given the current nursing situation, is a necessity for efficiency and productivity. Successful planning and implementation of health care programs requires nurses to work with peers.
These authors developed a project to assist students to synthesize previous knowledge while enhancing and improving their leadership and followership skills. The basis for the project was to incorporate new information and behaviors with previous experiences that would result in better understanding of the ramifications of leadership/followership styles.
A review of the literature found many articles on preparation of future nurse leaders (McClure, 1989; Meighan, 1990; Trani-Shirley, 1990). Most of the articles focused on one major theme of leadership development such as mentoring (Coluccielo, 1990), networking (Trani-Shirley), and decision-making (Nagelkerk & Henry, 1990). Some authors recognized followership as an important component of leadership (Deane & Campbell, 1985; Prew, 1977; Guidera & Gilmore, 1988X
Strategic decisions made by nurse leaders are central to high-quality health care. Complex decisions may involve considerable anxiety, division of scarce resources, and personal risk (Nagelkerk & Henry, 1990). Solving complex problems in peer groups requires tolerance of ambiguity, prodding, and intensive involvement. Negotiation and compromise are a part of every step in a decision-making process (Nagelkerk & Henry). When nurses do work together, problems often arise that may not be resolved and can doom projects (Ciske, Verhey, & Egan, 1983).
Nursing leadership behavior can be either predominantly task-oriented or relationship-oriented and usually depends on the situation. In a study by Meighan (1990), staff nurses valued traits from both behaviors depending on the situation.
Stress is part of every position and certainly a part of nursing leadership and followership (Scalzi, 1988). Role conflict and role stress are problems related to organizational structure and interpersonal relationships. A key to dealing with role ambiguity and the accompanying stress is to clearly identify goals and objectives when moving from leadership to followership positions (Trani-Shirley, 1990.
According to McClure (1989), nursing leaders have dual roles. One role requires the ability to conceptualize practice, apply theory to practice, and provide insight and vision to organizational settings. In the second role, nurse leaders assume accountability and responsibility for all major aspects of large organizations. Both of these roles require follower commitment. Delegation provides leaders the opportunity to demonstrate competencies and abilities and allows completion of tasks by those most competent and responsible. Delegating leads to additional time to devote to tasks (McClure).
Frew (1977) found that when individuals understood their followership style, they were better able to understand leadership issues. A leader's success is dependent upon the general level of acceptance of leadership style by followers. Effective leadership and followership roles have many of the same characteristics (Guidera & Gilmore, 1988). According to Deane (1985), a leader often switches to a follower role and requires perceptiveness and maturity in the process.
This project was developed to provide a realistic clinical leadership experience requiring interaction between nurse peer members. These groups planned, implemented, and evaluated a client-centered nursing project. The class participating in this project consisted of 15 registered nurses who were students in a leadership and management course designed for the RN-toMSN student. These students represented a variety of nursing experiences, numerous years in nursing, and all of the students except four held administrative positions.
In an effort to meld theory and practical experience under supervision, the faculty developed a project that required students to function as leaders and/or followers. The leadership/followership project used peers as agents for socialization. During the first class, students were tested using the Leadership and Followership Questionnaire developed by David R. Frew to determine their style of leadership and followership. The Leadership and Followership instrument developed by Frew Í 1977) was a result of 20,000 interviews over a five-year period. Management teams composed of peer groups were formed by placing students with similar scores together. All four management teams were given the assignment of selecting a leader and a recorder, and identifying additional roles for the remaining two or three members. The task for each group was to plan, implement, and evaluate a client-centered nursing project.
The faculty established the project with specific objectives and described the expectations in sufficient written detail so that each group understood what must be accomplished. Clinical time was allocated to the project with scheduled weekly management team meetings. Faculty were available for consultation.
Group responsibilities included setting goals and objectives, determining the division of labor, and developing final written and oral project reports. The group process included role assumptions, planned group activities, and peer evaluation. A peer evaluation tool was developed to gather data regarding individual participation, preparation, and performance during the project. Each management group completed peer evaluations on team members. The management teams were to evaluate outcomes of their project by including the assessment process, teaching strategies, client reactions, and the effectiveness of their interventions. At the end of the course, each team presented an oral report critiquing the leadership/followership process and the effectiveness of their clinical interventions.
Group Project Resulte
According to Frew (1977), leadership and followership styles fall into five categories ranging from very autocratic to very democratic. The student scores fell into two categories: three groups were very autocratic and one group was very democratic. Interestingly, students' followership scores were similar to their leadership scores and corresponded to the traits identified by Frew.
Initially, the very democratic group had the most difficulty understanding the project, planning for nursing interventions, and determining their course of action. This group required repeated explanations of their role as a management team. Once they had a clear understanding of the requirements and parameters, they were able to make firm rules, use creative approaches, deal with conflict, and support each others* efforts. This group demonstrated a relationship-oriented behavior by expressing concerns for each other. Peer evaluations were very high regarding peer support and accountability.
Of the three highly autocratic groups, only one group was effective. This harmonious group recognized their highly autocratic style early and, after deciding on each member's role, allowed the individual freedom to function. The roles alternated between leading and following. On completion of each member's task, individuals came together to pool results and prepare their report. They developed their own structure in terms of time-frames, assignments, and planned meetings for feedback and evaluation of progress. Peer evaluations were positive regarding support and accountability.
The other two autocratic groups experienced difficulty with followership and, consequently, interpersonal relationships suffered. These two groups preferred independent functioning to a group-process approach. None of the members of these two management teams wanted to relinquish the role of leader and individuals had difficulty being followers. Members of these groups did not delegate responsibilities, resulting in poor communication. Each person tried to function independently. Lack of feedback resulted in frustration and isolation. Although the project was completed satisfactorily, team members expressed negative and hostile feelings toward each other. Receiving a grade in the class seemed to be the primarily driving force to complete the project. Peer evaluations were critical of all members and often included statements that they would not work on another project with the same team members.
During this project, students experienced first-hand the problems of working with peers having similar leadership and followership styles when planning a project, making decisions, and attaining goals. Although conflict and role ambiguity existed in all groups, management teams who had members with the ability to move flexibly to leadership and followership roles were successful in solving interpersonal issues. Groups with positive interpersonal relationships between leaders and followers worked toward a common goal; leadership roles rotated according to the expertise needed by the group as each member experienced being a leader or follower.
In groups with poor interpersonal relationships, followership roles failed to emerge and communication became stagnant or ineffective. Rote ambiguity, leading to role stress, was evident as each individual tried to be the leader and no one would assume the role of a follower. Followership roles did not emerge and they identified their problems as internally related to team members* ability or inability to make decisions. Rather than confront this issue or seek help, these groups informed the faculty that the project was progressing well. It was not until the end of the course that individual members felt free to write negative peer evaluations. Competition for group leadership and individual achievement seemed to be the greatest problems. The importance of assuming followership roles was not recognized by these two groups until they summarized their process activities during the oral report and became aware of hostilities.
Planning time together was the greatest obstacle to meeting the requirements for this project. Students reported that stress was inherent when working with peers and identified some team members as lacking in accountability. All management teams identified the waxing and waning of interest in the tasks, normal in group work. However, they enjoyed the mental stimulation, clarity of communication, and planning a project with peers. Students were surprised to find difficulty in working with peers with similar leadership and followership characteristics.
When groups leam ways to approach conflict and resolve issues before actually working on projects, skills developed in handling interpersonal relationships and energy can then be directed to creative and innovative problem-solving. Team-building exercises that include switching from leadership to followership roles prepare participants for the inevitable activities of group process.
Practical application of theory was beneficial to students involved in an actual nursing plan of care with clients. This type of project guided students within a controlled environment toward a common goal. The use of peer contracts could have alleviated some of the problems students encountered with this project. Peer contracts as described by Ciske et al. (1983) are a potentially useful tool for facilitating the development of positive group relationships by documenting members' expectations and roles within the group.
Variations of the presented project are needed with more time devoted to group dynamics. A practicum could be planned to place students into groups with a mixture of individual leadership and followership styles to compare group behaviors, interpersonal relationships, and completion of projects.
Leadership theory is important but a successful leader must at times be a follower. Leadership and followership concepts need to be taught together in a practical exercise. Decision-making, conflict, and resolving interpersonal communication problems are all part of both roles. As individuals become aware of their own leadership styles and inherent strengths and weaknesses, they will be more effective members of management teams. Nurses in leadership roles must work effectively with peers in group activity. To be successful in organizational decision-making, nurses must learn to work with individuals with similar leadership and followership styles as well as with differing points of view. Followership is as indispensable as leadership for success in nursing management roles.
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