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Transformational Leadership In Nursing: The Role Of Nursing Elders by katty : April 10, 2017, 05:49:25 AM
TRANSFORMATIONAL LEADERSHIP IN NURSING: THE ROLE OF NURSING ELDERS, A PAPER PRESENTED AT NURSING LEADERS CONFERENCE ORGANIZED BY NURSING & MIDWIFERY COUNCIL OF NIGERIA
BY DR. FARUK A. MAIYAMA (PHD, MBA, BSC, RNT, R/N, FIICA, FCIMN, MNIM) IN KADUNA ON WDNESDAY 29TH MARCH, 2017
• Salutations:
- Distinguished Personalities
- Participants etc.
 
Preamble
Transformational Leaders “arrange with others in such a way that leaders and followers raise one another to higher levels of motivation and morality” “Nursing is a profession uniquely prepared to apply transformational leadership theory into all practice settings”. (Doody O, Doody C.M., 2012).
 
Accordingly, it is believed that “Traditionally, nurses have been over-managed and led inadequately, yet today they face unprecedented challenges and opportunities.  Organizations, constantly face challenges that require an increasingly adaptive and flexible leadership.  This type of adaptive leadership is referred to as ‘transformational’ under it, environments of shared, responsibilities that influence new ways of knowing are created”. (Doody O, Doody C.M, 2012). In the light of the foregoing, transformational leadership in Nursing:  The Role of Nursing Elders as a topic was most appropriately selected by Nursing & Midwifery Council of Nigeria, taking cognizance of the caliber and status of the conference participants. This is more so, as the topic revolves around the theme of the conference, which is consolidating on the gains of Nursing and Midwifery Education Reforms in Nigeria.
 
The education reforms transform nursing training to education, from enrolment of Primary School leavers, to Secondary School dropouts to WASC/GCE failures then to WASC/GCE holders, to holders of a minimum of 5 credits in WASC/GCE and now plus minimum 230 cut of points in Joint Admission and Matriculations Examinations (JAME) for B.Sc Nursing Degree Course.
 
Nursing Leaders
In this context, Nursing Elders refers to all categories of Nursing Leaders with prerequisite qualification, conferred with legitimate Authority, charged with the responsibilities of piloting the affairs of Nursing/Nurses and providing leadership either in service or educational institutions /establishments for the achievement of Nursing, Nurses and organizational objectives within specific period of time. So for the purpose of this paper, let’s consider Nursing Elders as synonymous with Nursing Leaders.
 
In order to provide required role of transformational leadership for flexibility and adaptability, Nursing Elders need to meet certain qualities as follows:-

i. Education and professionalism – They must acquire minimum required qualification and professional experience.
ii. Conferred with moral and legitimate authority i.e. appointed, posted or assigned to head/lead an organization, Department, Section or Unit.
iii. Posses the required competences, skills and qualities for ability to respond to leadership challenges.
iv. Capable of exercising control i.e. ability to reward and discipline subordinates.
v. Control and management of Resources, which is power and ability to handle human and material resources effectively and efficiently.
vi. Power and ability to motivate subordinates for achievement of the organizational objectives.
vii. Demonstrate ethics and etiquettes in Nursing administration and personal management.

Accordingly, transformational leadership is applicable to both Nursing education and practice.  As stated by Kevin Pang (2014) “the most effective Nurse thrive under strong leadership from their Nursing leaders, managers or supervisors.  It’s no surprise, then, that the management style and overall morale set by the Nursing Leader, directly correlates with attitudes and outcomes of the nursing staff”.  This could be enunciated figuratively underneath.
 
 1: Correlations of Nurse Leader Management Styles on Staff Morale and Care outcome.
Four Components Of Transformational Leadership
There are basically four components of transformational leadership highlighted by Kevin Pang (2014) notably:-
i. Intellectual stimulation – encourages staff to exercise skills in problem solving and critical thinking.
ii. Individualized consideration – appreciates staff strengths weaknesses, needs and feelings for opportunities in professional development.
iii. Inspirational motivation – nurturing relationship with staff through leadership by inspiring confidence & highlighting the vision, goals and objectives of care delivery processes or activities of the place.
iv. Idealized influence – serving as a role model in deals and actions, in terms of punctuality, competence, reliability, dependability, honesty, sincerity and enthusiasm in discharging his/her duties. i.e.”Walks the talks” Rose O Sherman (2012).  This influence builds confidence, admiration, respect and trust, (Bass et al, 2003).
 
Transformational leadership was first defined by downton (1973) and was popularized by the works of Burns (1978) who differentiated transactional and transformational leadership, expressing that “one prohibits the other and that they are at opposite ends of the continuum… However good leaders demonstrate both transactional and transformation characteristics”.
 
The difference between transactional and transformational leadership is that transactional leader emphasized achievement of organizational objectives through reward and punishment focusing on supervision, group performance and organization.  While, transformational leader motivates and engage subordinates by directing their behaviour towards a common course, goals and shared vision.

2 Transformational Vs Transactional Leadership Style
However, “transformational leadership is viewed as the most effective model of leadership because, while it recognizes, the importance of rewards, it goes further to satisfy the higher needs of the follower by engaging this person emotionally and intellectually” (Surakku, 2013). 
 
This is because it’s “a process that motivates followers by appealing to higher ideas and moral values, where the leader has a deep set of internal values and ideas and is persuasive at motivating followers to act in a way that sustains the greater good, rather than their own interests” (Burns, 1978).
 
Application of Transformational Leadership Style in Nursing
“Nurses may hold the key to transforming health care and dragging it into the 21st century in terms of work practices and reform” (Thuyer, G.L. 2003).  In both Nursing education and practice there are various levels of leadership role such as those in direct leadership at unit, section, department, institution or directorate level “this can often lead to conflict and control seeking, especially when final decisions need to be made.  While staff ideas are transmitted through the direct leadership roles,  it can place direct leaders in vulnerable position, when they strive to meet the needs of staff and client, but are restricted by the upper leaders, who have greater emphasis on the strategic and organizational issues… due to budgetary constraints and other matters of which the direct leader is unaware of (Casida and Parker, 2011).
 
In applying Transformational Leadership Style in Nursing practice “Nurse leader should motivate and empower his/her subordinates by involving them in decision making process, nursing care plans, duty rosters, postings, transfer and giving them opportunity to voice their opinions on client care delivery “this empowers staff to take ownership for the effective management and efficiency of the unit from day to day perspective” (Doody O & Doody C.M, 2011).
 
Generally, Nursing Elders/Leaders need to imbibe the general principles and theories of management to enable them have a better appreciation of transformational leadership style, to provide effective leadership as a key to successful achievement of goals and objectives of the Unit, Section, Department, Directorate, Institution or the Organization as a whole “Effective Nursing Leadership is a vehicle through which health care delivery and consumer demands can be fulfilled” (Bowles A. & Bowles N.B, 2000).
 
Some of the earliest theories and principles of management which are still very relevant in the administration of human and material resources includes:  Henry Fayol’s work which was one of the first comprehensive statements of a general theory of management (Wren, D. A., et al 2002).  He proposed four which, were later expanded to six primary functions and fourteen principles of management as itemized below:-
Functions of Management:
• Forecasting
• Planning
• Organizing
• Commanding
• Coordinating
• Controlling
 
Fayol’s 14 Principles of Management
i. Division of Work:
Division of work to individuals and group which is applicable not only in technical job but in all work setting in order to focus attention on the tasks assigned to person or group leading to specialization, increased skills, efficiency, output and better outcomes.
 
ii. Authority and Responsibility:
In this a leader must have both moral and legitimate authority in his/her capacity as the head.  It was defined by Fayol as the right to give orders and the power to exact obedience.  While responsibility involves being accountable i.e you must exercise authority and responsibility in accordance with the laid down rules & regulations and be ready to account for your actions or inactions.
 
iii. Discipline:
Implies that rules and regulations must be respected by all the employees.
 
iv. Unity of Command:
This means an employee should take orders from one Superior Officer to whom he is responsible and accountable, otherwise, chain of command is violated, authority is undermined, discipline in danger, order disturbed and stability threatened.
 
v. Unity of Direction:
This was explained as “one head one plan” i.e. activities with the same objectives should be directed by one manager, leader or head using one plan for achievement of one common goal (Witzel, M. 2003).
 
vi. Subordination:
That is subordination of individual interests to general interest i.e. individual or group interests shall not take precedence over the interests of the organization.
 
vii. Remuneration:
Payment  of  fair  wages  to  workers  for  their services.  Wage – rates and methods of payment should be fair, proper and satisfactory, base on mutual employer – employee agreement known as collective bargaining.
 
viii. Centralization & Decentralization:
Refer to one central control for overall direction of component parts.  This varies according to needs and situation with centralization in small units and decentralization in large organizations to maximize achievement of organizational objectives.
 
ix. Scalar Chain:
This is the line of authority from the highest to the lowest ranks.  Fayol define it as communication from “the chain of superiors, ranging from ultimate authority to the lowest rank”.  The flow of information between management and workers is must”.
 
X. Order:
This  is concerned  with  systematic  and  orderly arrangement of human and material resources in terms of land, office, machineries, tools, raw materials, equipments and employees such as in a hospital settings – Wards, laboratories, operation theatre, laundry, clinics, offices, mortuary etc, each should have appropriate location in an orderly fashion, while staff should be properly selected, appointed, posted and assigned in accordance with their professional expertise, competence, skills, qualification and experience.
 
xi. Equity:
This is a principle of justice, fairness, kindness, honesty and impartiality in the management of all employees.  In order to ensure loyalty, commitment and dedication of staff at all levels, there shouldn’t be any form of discrimination on the basis of race, religion, gender, tribe, ethnicity or caste system.
 
xii. Stability of Tenure:
This implies stable tenure of office for the employees, as high staff turn-over or indiscriminate replacement lead to inefficiency, sabortage, mismanagement, mal-administration and corruption.  The management should ensure stable tenure of office, orderly personnel planning, recruitment, placement and retirement at a fixed term or period of time.

xiii. Initiative:
Employees  should be encouraged  and  given opportunity to share ideas, experiences, findings and new initiatives with their management.  This enhances better ways and methods of work, assignment or task for the achievement of goals and objectives of the organization.  Similarly, employees should be encouraged to undertake research studies, formulate plans, ideas and findings which could be utilized to enhance productivity, efficiency and effectiveness.
 
xiv.  Esprit de corps:
This is the spirit of cooperation, understanding, coordination and integration of groups and individuals working as a team within the Unit, Section, Division, Department and the Organization as a whole at all levels; to achieve the best results, goals, vision, mission, aims and objectives.  This could be done through mutual respects, loyalty, motivation and informal social relationships, between employees and management, constructive engagement, welfare packages and fair remuneration (living wage).
 
For instance there are numerous researchable areas in Nursing which could be undertaken or encouraged by Nursing and Midwifery Council of Nigeria, Nursing Elders/Leaders in both Nursing Education and Service to enhance and improve Health Care, service, education, leadership initiatives and improve clients care such as:
• Impacts of poor Hospital Sanitation on patient care and duration of recovery.
• Effects of Hospital cross-infection on patient hospitalization.
• The role of professional competence on client management.
• Health – team operation as catalyst for effective health services.
• The role of regulatory Agencies in quality control of Health Care Services.
• The influence Nurse-Leader’s management styles on staff morale and quality of care.
• The effects of Nurse shortages on quality of Nursing education and service.
• The consequences of obsolete Health Care equipment, tools and materials on patient outcome.
• The repercussions of poor training of Health Personnel on Health Care, Education and Service.
• The ramifications of poor remuneration on Nurses morale, turn–over and quality of Nursing care, service and education.
• The value of education and research in professional development of Nursing profession, Nurses and standard of Nursing Care, education and service.
 
So in justifying the theme of this conference which is consolidating the gains of Nursing & Midwifery reforms in Nigeria and the topic of this paper, transformational leadership in Nursing:  The Role of Nursing Elders/Leaders, it’s pertinent to make the underlisted, Recommendations in order not only to consolidate the gains but also, improve the standard, status and quality of education, service and professional role of Nursing/Nurses in the Health Service industry.
 
Recommendations
i. The Nursing & Midwifery Council of Nigeria need to organize professional and leadership training of this nature on contemporary health challenges, application of Information & Communication Technology (ICT) and research methodology.
ii. The council should also establish fully-funded and effective Nursing/Health Research Centre(s) and standard Professional Journal for publication of conference papers and Nursing research findings in accordance with international best practice.
iii. The Council should continuously liaise with international and domestic Health and Medical research institutions such as Nigerian Institute of Medical Research (NIMR) for research publication and sponsorship since Nurses are the first to bear the brunt of diseases outbreak, cross-infection and poor sanitation in Hospitals.
iv. Nursing Elders/Leaders should imbibe the spirit of education and research and should also encourage their subordinates to do the same to enhance Nursing Professional status and relevance in the health sector.
v. Nursing practitioners should work as a team with other health service providers not only in patient care but also in research, because no meaningful Hospital – based research could be successfully conducted without the inputs of Nurses, but they hardly share in the credit.
vi. Nursing Institutions at all levels should be encouraged/assisted to educate/train their students in ICT and research methods to enable them transform Nursing care and the profession in accordance with international standard.
vii. Nursing Elders/Leaders should harness the potentials of younger Nurses in advancing the quality of Nursing and health care through transformational as opposed to transactional leadership which is; outdated, unhealthy, unwarranted and unprofessional in modern health service industry.  This is because as pointed out by Thyer, et al (2005) “the notion of leadership is constantly changing, with theories and framework available.  Today’s organizations face ever-increasing change, which need a more adaptive leadership”.
 
In conclusion, I wish to express my sincere appreciation to the Nursing & Midwifery Council of Nigeria for considering me worthy of this paper presentation and also commend its leadership for their commitment and dedication to improvement of the standard, status and quality of Nursing education, care, service and advancement of the profession as a whole.  I am also grateful to the participants for your rapt attention.
 
Thank you.

References
1. Barbuto J.E. (2005) motivational and transactional, charismatic and transformational leadership: a test of antecedents, J. Leadership organ stud 11(4): 26 – 40.
2. Bass B.M, Riggio R.E (2006) transformational leadership, 2nd Ed,Lawrence Erlbaum Associates, Mohwah, New Jersey.
3. Bishop V. (2009) what is leadership? In Bishop V, Leadership for Nursing & Allied Health care Professionals, Open University Press, Berkshire – 9 – 31.
4. Bowles A, Bowles N.B. (2000) A comparative study of transformational leadership in Nursing Development Units and Conventional Clinical settings. J. Nurs. Mgt, 8(2): 69 – 76.
5. Bryant S.E. (2003) The role of transformational and transactional leadership in creating, sharing and exploiting organizational knowledge, J. Leadership Oryan stud 9(4): 32 – 44.
6. Burns J. M. (1978) Nursing & Transformational Leadership Theory. Haper & Row Wikes Nursing J. New York.
7. Casida J., Parker J. (2011) Staff Nurse perceptions of Nurse Manager Leadership Styles & outcomes. J. Nurse Mgt 19(4): 478 – 86.
8. Doody C.M., Doody O. (2011) Introducing evidence into Nursing practice: using the 10WA Model. Br. J. Nurs. 20(11): 661 – 664.
9. Downton J. V (1978) Rebel leadership: Commitment & Charisma in a revolutionary press. Free Press, New York.
10. Fayol H. (1917) Administration industrielle et generale; Prevoyance, organization, commandment, coordination, controle (in French), Paris, H. Dunod et E. Pinat, OCLC 40224931 (Jump up).
11. Jooste K. (2004) Leadership: a new perspective. J. Nurs. Mgt. 12(3): 217 – 223.
12. Pang K. (2014) Nursing Leaders: How to apply the 4 components of Transformational Leadership. J. Nurs. Mgt 15, 508 – 521.
13. Ralston  R. (2005) Transformational Leadership: Leading the way for Midwives in the 21st century, RCM Midwives 8(1): 34 – 37.
14. Sherman R. O (2012) Becoming a Transformational Nurse Leader, J. Nurs. Mgt, in emergingrnleader.com (2012).
15. Surakka T (2008) The Nurse Manager’s work in the Hospital environment during 1990’s and 2000’s: responsibility, accountability & expertise in nursing leadership: J. Nurs. Mgt. 16(5): 525 – 534.
16. Wren, D. A. (2001) “Henri Fayol as a Strategist: a nineteenth century corporate turn – around” (Jump up to a.b.c) Management Decision.
17. Wiltzel M. (2013) The Fundamentals of Management, The Financial times, New York.

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