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A critical component for nurse leaders
Servant Leadership: Patricia T. Campbell, MSN, RNC, and Pamela T. Rudisill, MSN, MEd, RN, CCRN
A Critical Component for Nurse Leaders
HEALTH CARE ENVIRONMENT Nurse leaders in 2005 are faced with many challenges, demands, and opportunities. At work, they are faced with relentless demands. These demands center around achieving a positive financial bottom line, ensuring quality standards are met, and ensuring a competent and satisfied workforce. In addition, the goal exists to meet and exceed patient and family satisfaction. Many times, these demands can lead to feelings of work stress, being overwhelmed, and a sense of urgency. For years, leadership theories and strategies have been examined. The question exists about which theory applies and is workable for a successful nurse leader in 2005. “Servant leaders” possess many of the characteristics seen in successful nurse leaders as well as health care leaders. This article will present some of the characteristics of servant leaders. In addition, some case presentations will be shared. The article will also reveal the importance for nurse leaders of focusing and being goal-driven.
LEADERSHIP QUALITIES Servant leadership has been successfully implemented in many settings. Robert Greenleaf first popularized servant leadership in 1970. The definition simply places serving others as the number one priority. This idea of servant leadership has particular relevance today in health care. Many hospitals now have a major strategic initiative of maintaining and rewarding exceptional employees. June 2005
Organizations are now developing and administering employee satisfaction surveys. These tools obtain information related to the employee satisfaction level with work environment, management and supervision, and compensation packages. Information is also obtained on the employee’s satisfaction with teamwork, coworkers, and peers. There are examples in which major changes have been made in the ergonomic work setting related to employee feedback. Literature suggests that positive employee satisfaction levels influence and correlate with positive patient and family satisfaction. Characteristics of servant leaders include but are not limited to listening, empathy, awareness, persuasion, foresight, stewardship, and commitment to the growth of people.1 Each of these characteristics is defined as follows: • Listening has been described as the most important communication skill that exists. Stephen Covey, in his book, Seven Habits of Highly Effective People, discusses the need to listen before responding.2 Health care provides a great example of the importance of listening. Many times, leaders focus on a patient concern without taking into consideration the variables within and outside of our control that contributed to the concern. • Awareness of a situation or in-
dividual need is an important characteristic. This characteristic permits the nurse leader to plan and implement strategies to address needs in a proactive manner. An example relates to low work environment scores on employee satisfaction surveys. Frustration existed among the nurses in the intensive care nursery because of lack of enough phototherapy lights. The manager obtained this information from a follow-up employee questionnaire. As a result, action was taken to obtain additional equipment, which had a positive impact on the employees’ perceptions. • Persuasion is defined as the ability to convince, do, or believe something. Persuasion in nursing is correlated with how the leader is perceived by the staff. The leader who is viewed as a consistent, fair, and reasonable individual is one who can exhibit a strong persuasive influence. Understanding the peer and trying to persuade is essential, as well as is encouraging questions and responding in a direct manner.3 • Foresight is an essential characteristic of a nurse leader. Nurse leaders must be visionary leaders with a road map in place for followers. Leaders must have the ability to create and change the direction for nursing, if Nurse Leader 27
Figure 1. Staff nurse teaching cultural diversity
needed. The nurse leader’s visionary direction is being recognized because a number of health care organizations throughout the country are seeking excellence in the delivery of patient care. This quality care is measured through awards such as Magnet status, Baldridge recognition, and various quality initiativesdriven mechanisms. • Stewardship is defined as being in charge of accounts, an individual serving as an administrator. As nurse leaders, we all have the responsibility and accountability for managing resources in an appropriate manner. The successful nurse leader views this as an opportunity and challenge. It implies that an appropriate budget be operationally successful. The successful leader will involve others in the process. A key is successful staff communication related to stewardship. • Commitment to the growth of individuals creates a win-win situation for the organization and the individual.4 The involvement of nursing staff in the decisionmaking process results in positive outcomes. One example is a nurse with a culturally diverse background who was provided the opportunity to become a facilitator for the organization’s system-wide cultural diversity training program. After obtaining facilitator training, she became a tremendous resource in this field. This role has provided her with a new challenge and goal to achieve in 2005 (Figure 1).
CASE EXAMPLE Another aspect of servant leadership is leadership development for health care management. Mentoring potential 28 Nurse Leader
health care executives has proven successful in many environments. Pieper5 identifies a six-phase mentoring plan, which includes choosing a mentor and mentee, getting acquainted, setting goals, growing the relationship, ending the relationship, and evaluating the success. An example of leadership development involves a nurse who was hired to work as a nursing supervisor and also wanted to meet a personal goal of obtaining a master of science in nursing degree. Over the next year, the assistant chief nursing officer (CNO) resigned, and the nurse supervisor was identified by the CNO as a possible replacement. The relationship between the two grew as the mentee functioned in interim management roles of nurse manager for the medical/surgical and emergency departments. During this time, the nurse supervisor received guidance and experience in budget planning, hiring, and disciplining staff. Gradually, the mentor recognized the potential in her protégé to obtain a chief nurse executive position. Goals were mutually set (i.e., mentee getting experience with organizational structure and planning, attending leadership meetings, and becoming involved in professional organizations). After 2 years, the mentee interviewed and accepted a position as CNO. The relationship has not ended, and the mentee remains in contact with the mentor for follow-up and seeks advice as needed via e-mail, telephone, and direct meetings. The success of the relationship is measured through reversal of roles. The mentor has actually contacted the mentee on several occasions for advice on health care issues. This situation has created a win-win situation for two individuals and consequently for two hospitals. June 2005
LEADERSHIP FURTHER DEFINED Stephen Covey describes the eighth habit of leadership as a mindset and skill set to constantly look for the potential in people. This leadership skill communicates to people their worth so they see it in themselves. To convey this skill, Covey states that all four roles of leadership must be utilized: modeling (setting a good example), path finding (jointly determining the course), aligning (managing systems to stay on course) and empowering (focusing talent on results).6
PERSONAL QUALITIES It is important to demonstrate characteristics of servant leadership. In addition, leaders of 2005 must process and manage personal energy. Jim Loeki and Tony Schwartz, in their book, The Power of Full Engagement, suggest that managing energy, not time, is the key to high performance and personal renewal. 7 They further suggest that great leaders are stewards of organizational energy. Leaders begin by effectively managing and controlling their own energy. Leaders must mobilize, invert, channel, and expand the energy of others. Loeki and Schwartz identify the 10 most important physical energy management strategies as follows: • Go to bed early and wake up early. • Go to sleep and wake up consistently at the same times. • Eat five to six small meals daily. • Eat breakfast daily. • Eat a balanced, healthy diet. • Minimize simple sugars. • Drink 48 to 64 ounces of water daily. • Take breaks every 90 minutes during work. • Get some physical activity daily. • Do at least two cardiovascular interval workouts and two strength training workouts a week. A nurse leader of 2005 needs to be fully engaged on and off the job. This implies that the leader is physically energized, emotionally connected, mentally focused, and spiritually aligned. How many times, as a nurse leader, are you in a meeting and your mind drifts to the employee issue you are waiting to resolve or on the strategic plan to be presented or maybe to thoughts related to a personal issue? Loeki and Schwartz suggest that this results in less than full engagement. Time needs to be focused and directed to one issue at a time.
results you want. Healthcare Executive 2005;20:16-8; 22, 24. 4. Goleman D, Boyatzis R, McKee A. Primal leadership. Boston: Harvard Business School Publicity; 2002. 5. Pieper S. The mentoring cycle: a six-phase process for success. Healthcare Executive 2004;19:16-8. 6. Covey S. The 8th habit: from effectiveness to greatness. New York: Free Press; 2004. 7. Loeki J, Schwartz T. The power of full engagement. New York: Free Press; 2003.
Patricia T. Campbell, MSN, RNC, is the executive director of women’s and children’s services at Presbyterian Hospital in Charlotte, N.C. Pamela T. Rudisill, MSN, MEd, RN, CCRN, is associate executive director/chief nursing officer at Lake Norman Regional Medical Center in Mooresville, N.C., and can be reached at [email protected]. 1541-4612/2005/ $ - see front matter Copyright 2005 by Elsevier Inc. doi:10.1016/j.mnl.2005.02.003
CONCLUSION It is our responsibility as leaders to stay focused and lead by example. To do this, a balance must exist in our personal and professional responsibilities. Nurse leaders who display these characteristics who will succeed and excel in 2005 and beyond! References 1. Prosser S. Servant leadership. Professional Nurse 2002;18:238. 2. Covey S. Principle-centered leadership. New York: Simon & Schuster; 1991. 3. Hauser J, Preston P. Communication strategies for getting the
June 2005
Nurse Leader 29
A Critical Component for Nurse Leaders
HEALTH CARE ENVIRONMENT Nurse leaders in 2005 are faced with many challenges, demands, and opportunities. At work, they are faced with relentless demands. These demands center around achieving a positive financial bottom line, ensuring quality standards are met, and ensuring a competent and satisfied workforce. In addition, the goal exists to meet and exceed patient and family satisfaction. Many times, these demands can lead to feelings of work stress, being overwhelmed, and a sense of urgency. For years, leadership theories and strategies have been examined. The question exists about which theory applies and is workable for a successful nurse leader in 2005. “Servant leaders” possess many of the characteristics seen in successful nurse leaders as well as health care leaders. This article will present some of the characteristics of servant leaders. In addition, some case presentations will be shared. The article will also reveal the importance for nurse leaders of focusing and being goal-driven.
LEADERSHIP QUALITIES Servant leadership has been successfully implemented in many settings. Robert Greenleaf first popularized servant leadership in 1970. The definition simply places serving others as the number one priority. This idea of servant leadership has particular relevance today in health care. Many hospitals now have a major strategic initiative of maintaining and rewarding exceptional employees. June 2005
Organizations are now developing and administering employee satisfaction surveys. These tools obtain information related to the employee satisfaction level with work environment, management and supervision, and compensation packages. Information is also obtained on the employee’s satisfaction with teamwork, coworkers, and peers. There are examples in which major changes have been made in the ergonomic work setting related to employee feedback. Literature suggests that positive employee satisfaction levels influence and correlate with positive patient and family satisfaction. Characteristics of servant leaders include but are not limited to listening, empathy, awareness, persuasion, foresight, stewardship, and commitment to the growth of people.1 Each of these characteristics is defined as follows: • Listening has been described as the most important communication skill that exists. Stephen Covey, in his book, Seven Habits of Highly Effective People, discusses the need to listen before responding.2 Health care provides a great example of the importance of listening. Many times, leaders focus on a patient concern without taking into consideration the variables within and outside of our control that contributed to the concern. • Awareness of a situation or in-
dividual need is an important characteristic. This characteristic permits the nurse leader to plan and implement strategies to address needs in a proactive manner. An example relates to low work environment scores on employee satisfaction surveys. Frustration existed among the nurses in the intensive care nursery because of lack of enough phototherapy lights. The manager obtained this information from a follow-up employee questionnaire. As a result, action was taken to obtain additional equipment, which had a positive impact on the employees’ perceptions. • Persuasion is defined as the ability to convince, do, or believe something. Persuasion in nursing is correlated with how the leader is perceived by the staff. The leader who is viewed as a consistent, fair, and reasonable individual is one who can exhibit a strong persuasive influence. Understanding the peer and trying to persuade is essential, as well as is encouraging questions and responding in a direct manner.3 • Foresight is an essential characteristic of a nurse leader. Nurse leaders must be visionary leaders with a road map in place for followers. Leaders must have the ability to create and change the direction for nursing, if Nurse Leader 27
Figure 1. Staff nurse teaching cultural diversity
needed. The nurse leader’s visionary direction is being recognized because a number of health care organizations throughout the country are seeking excellence in the delivery of patient care. This quality care is measured through awards such as Magnet status, Baldridge recognition, and various quality initiativesdriven mechanisms. • Stewardship is defined as being in charge of accounts, an individual serving as an administrator. As nurse leaders, we all have the responsibility and accountability for managing resources in an appropriate manner. The successful nurse leader views this as an opportunity and challenge. It implies that an appropriate budget be operationally successful. The successful leader will involve others in the process. A key is successful staff communication related to stewardship. • Commitment to the growth of individuals creates a win-win situation for the organization and the individual.4 The involvement of nursing staff in the decisionmaking process results in positive outcomes. One example is a nurse with a culturally diverse background who was provided the opportunity to become a facilitator for the organization’s system-wide cultural diversity training program. After obtaining facilitator training, she became a tremendous resource in this field. This role has provided her with a new challenge and goal to achieve in 2005 (Figure 1).
CASE EXAMPLE Another aspect of servant leadership is leadership development for health care management. Mentoring potential 28 Nurse Leader
health care executives has proven successful in many environments. Pieper5 identifies a six-phase mentoring plan, which includes choosing a mentor and mentee, getting acquainted, setting goals, growing the relationship, ending the relationship, and evaluating the success. An example of leadership development involves a nurse who was hired to work as a nursing supervisor and also wanted to meet a personal goal of obtaining a master of science in nursing degree. Over the next year, the assistant chief nursing officer (CNO) resigned, and the nurse supervisor was identified by the CNO as a possible replacement. The relationship between the two grew as the mentee functioned in interim management roles of nurse manager for the medical/surgical and emergency departments. During this time, the nurse supervisor received guidance and experience in budget planning, hiring, and disciplining staff. Gradually, the mentor recognized the potential in her protégé to obtain a chief nurse executive position. Goals were mutually set (i.e., mentee getting experience with organizational structure and planning, attending leadership meetings, and becoming involved in professional organizations). After 2 years, the mentee interviewed and accepted a position as CNO. The relationship has not ended, and the mentee remains in contact with the mentor for follow-up and seeks advice as needed via e-mail, telephone, and direct meetings. The success of the relationship is measured through reversal of roles. The mentor has actually contacted the mentee on several occasions for advice on health care issues. This situation has created a win-win situation for two individuals and consequently for two hospitals. June 2005
LEADERSHIP FURTHER DEFINED Stephen Covey describes the eighth habit of leadership as a mindset and skill set to constantly look for the potential in people. This leadership skill communicates to people their worth so they see it in themselves. To convey this skill, Covey states that all four roles of leadership must be utilized: modeling (setting a good example), path finding (jointly determining the course), aligning (managing systems to stay on course) and empowering (focusing talent on results).6
PERSONAL QUALITIES It is important to demonstrate characteristics of servant leadership. In addition, leaders of 2005 must process and manage personal energy. Jim Loeki and Tony Schwartz, in their book, The Power of Full Engagement, suggest that managing energy, not time, is the key to high performance and personal renewal. 7 They further suggest that great leaders are stewards of organizational energy. Leaders begin by effectively managing and controlling their own energy. Leaders must mobilize, invert, channel, and expand the energy of others. Loeki and Schwartz identify the 10 most important physical energy management strategies as follows: • Go to bed early and wake up early. • Go to sleep and wake up consistently at the same times. • Eat five to six small meals daily. • Eat breakfast daily. • Eat a balanced, healthy diet. • Minimize simple sugars. • Drink 48 to 64 ounces of water daily. • Take breaks every 90 minutes during work. • Get some physical activity daily. • Do at least two cardiovascular interval workouts and two strength training workouts a week. A nurse leader of 2005 needs to be fully engaged on and off the job. This implies that the leader is physically energized, emotionally connected, mentally focused, and spiritually aligned. How many times, as a nurse leader, are you in a meeting and your mind drifts to the employee issue you are waiting to resolve or on the strategic plan to be presented or maybe to thoughts related to a personal issue? Loeki and Schwartz suggest that this results in less than full engagement. Time needs to be focused and directed to one issue at a time.
results you want. Healthcare Executive 2005;20:16-8; 22, 24. 4. Goleman D, Boyatzis R, McKee A. Primal leadership. Boston: Harvard Business School Publicity; 2002. 5. Pieper S. The mentoring cycle: a six-phase process for success. Healthcare Executive 2004;19:16-8. 6. Covey S. The 8th habit: from effectiveness to greatness. New York: Free Press; 2004. 7. Loeki J, Schwartz T. The power of full engagement. New York: Free Press; 2003.
Patricia T. Campbell, MSN, RNC, is the executive director of women’s and children’s services at Presbyterian Hospital in Charlotte, N.C. Pamela T. Rudisill, MSN, MEd, RN, CCRN, is associate executive director/chief nursing officer at Lake Norman Regional Medical Center in Mooresville, N.C., and can be reached at [email protected]. 1541-4612/2005/ $ - see front matter Copyright 2005 by Elsevier Inc. doi:10.1016/j.mnl.2005.02.003
CONCLUSION It is our responsibility as leaders to stay focused and lead by example. To do this, a balance must exist in our personal and professional responsibilities. Nurse leaders who display these characteristics who will succeed and excel in 2005 and beyond! References 1. Prosser S. Servant leadership. Professional Nurse 2002;18:238. 2. Covey S. Principle-centered leadership. New York: Simon & Schuster; 1991. 3. Hauser J, Preston P. Communication strategies for getting the
June 2005
Nurse Leader 29