leadership

profileyfemi
EssentialsofNursingLeadershipandManagement5thEditionbyDianeK.RNWhiteheadSallyA.WeissRuthM.Tappenz-lib.org.pdf

Essentials of Nursing Leadership and Management

f i f t h e d i t i o n

2208_FM_00i-xii.qxd 11/6/09 6:03 PM Page i

2208_FM_00i-xii.qxd 11/6/09 6:03 PM Page ii

Essentials of

Nursing Leadership and Management

f i f t h e d i t i o n

Diane K. Whitehead, EdD, RN, ANEF Associate Dean, Nursing

Nova Southeastern University

Fort Lauderdale, Florida

Sally A. Weiss, EdD, RN, CNE Associate Chair, Nursing

Nova Southeastern University

Fort Lauderdale, Florida

Ruth M. Tappen, EdD, RN, FAAN Christine E. Lynn Eminent Scholar and Professor

Florida Atlantic University College of Nursing

Boca Raton, Florida

2208_FM_00i-xii.qxd 11/6/09 6:03 PM Page iii

F. A. Davis Company

1915 Arch Street

Philadelphia, PA 19103

www.fadavis.com

Copyright © 2010 by F. A. Davis Company

Copyright © 2007, 2004, 2001, 1998 by F. A. Davis Company. All rights reserved. This book is protected by copyright.

No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic,

mechanical, photocopying, recording, or otherwise, without written permission from the publisher.

Printed in United States of America

Last digit indicates print number: 10 9 8 7 6 5 4 3 2 1

Acquisition Editor: Joanne Patzek DaCunha, RN, MSN

Project Editors: Kim DePaul, Tyler Baber

Manager of Art & Design: Carolyn O’Brien

As new scientific information becomes available through basic and clinical research, recommended treatments and drug

therapies undergo changes. The author(s) and publisher have done everything possible to make this book accurate, up

to date, and in accord with accepted standards at the time of publication. The author(s), editors, and publisher are not

responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed

or implied, in regard to the contents of the book. Any practice described in this book should be applied by the reader

in accordance with professional standards of care used in regard to the unique circumstances that may apply in each

situation. The reader is advised always to check product information (package inserts) for changes and new informa-

tion regarding dose and contraindications before administering any drug. Caution is especially urged when using new

or infrequently ordered drugs.

Library of Congress Cataloging-in-Publication Data

Whitehead, Diane K., 1945-

Essentials of nursing leadership and management / Diane K. Whitehead, Sally A. Weiss, Ruth M. Tappen. -- 5th ed.

p. ; cm.

Includes bibliographical references and index.

ISBN 978-0-8036-2208-1 (pbk. : alk. paper)

1. Nursing services--Administration. 2. Leadership. I. Weiss, Sally A., 1950- II. Tappen, Ruth M. III. Title.

[DNLM: 1. Nursing--United States. 2. Leadership--United States. 3. Nursing--organization & administration--

United States. 4. Nursing Services--organization & administration--United States. WY 16 W592e 2010]

RT89.T357 2010

362.1'73068--dc22 2009017339

Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients, is grant-

ed by F. A. Davis Company for users registered with the Copyright Clearance Center (CCC) Transactional Reporting

Service, provided that the fee of $.25 per copy is paid directly to CCC, 222 Rosewood Drive, Danvers, MA 01923. For

those organizations that have been granted a photocopy license by CCC, a separate system of payment has been

arranged. The fee code for users of the Transactional Reporting Service is: 8036-2208-2/10 0 + $.25.

2208_FM_00i-xii.qxd 11/6/09 6:03 PM Page iv

Dedication

To my sister Michele:

Your bravery and spirit inspire me every day.

Diane K. Whitehead

To my granddaughter Sydni,

Whose curiosity and wonder continuously remind me

of the reasons I became a nurse educator.

Sally A. Weiss

To students, colleagues, family and friends,

Who have taught me just about everything I know.

Ruth M. Tappen

v

2208_FM_00i-xii.qxd 11/6/09 6:03 PM Page v

2208_FM_00i-xii.qxd 11/6/09 6:03 PM Page vi

Preface

We are delighted to bring our readers this Fifth Edition of Essentials of Nursing Leadership and Management. This new edition has been updated to reflect the current health-care environment. As in our

previous editions, the content, examples, and diagrams were

designed with the goal of assisting the new graduate to make the

transition to professional nursing practice.

The Fifth Edition of Essentials of Nursing Leadership and Management focuses on the necessary knowledge and skills needed by the staff nurse as a vital member of the health-care team and manag-

er of patient care. Issues related to setting priorities, delegation, qual-

ity improvement, legal parameters of nursing practice, and ethical

issues were updated for this edition.

We are especially excited to introduce a new chapter, Quality and

Safety. This chapter focuses on the current quality and safety issues

and initiatives that affect the current health-care environment. In

addition, the updated finance chapter and a new chapter on health-

care policy will be available on the F.A. Davis Web site, DavisPlus. We continue to bring you comprehensive, practical information on

developing a nursing career. Updated information on leading, manag-

ing, followership, and workplace issues continues to be included.

Essentials of Nursing Leadership and Management continues to provide a strong foundation for the beginning nurse leader. We want

to thank the people at F.A. Davis for their assistance as well as our

contributors, reviewers, and students for their guidance and support.

Diane K. Whitehead Sally A. Weiss

Ruth M. Tappen

vii

2208_FM_00i-xii.qxd 11/6/09 6:03 PM Page vii

2208_FM_00i-xii.qxd 11/6/09 6:03 PM Page viii

Contributors

Patricia Bradley, MEd, PhD, RN Coordinator, Internationally Educated Nurses

Program Faculty, Nursing Department York University Toronto, Ontario, Canada

Kristie Campoe, MSN, RN Adjunct Faculty Nursing Department Nova Southeastern University Fort Lauderdale, Florida

Patricia Welch Dittman, PhD, RN, CDE Graduate Program Director/Assistant Professor Nursing Department Nova Southeastern University Fort Lauderdale, Florida

Denise Howard, BSN, RN Adjunct Faculty Nursing Department Nova Southeastern University Fort Lauderdale, Florida

Marcie Rutherford, PhD, MBA, MSN, RN Assistant Professor Nursing Department Nova Southeastern University Fort Lauderdale, Florida

Wendy Thomson, EdD(c), MSN, BSBA, RN, CNE, IBCLC Assistant Director of Technology and

Simulation/Assistant Professor Nursing Department Nova Southeastern University Fort Lauderdale, Florida

ix

2208_FM_00i-xii.qxd 11/6/09 6:03 PM Page ix

2208_FM_00i-xii.qxd 11/6/09 6:03 PM Page x

Table of Contents

unit 1 Professional Considerations

chapter 1 Leadership and Followership 3

chapter 2 Manager 13

chapter 3 Nursing Practice and the Law 21

chapter 4 Questions of Value and Ethics 39

chapter 5 Organizations, Power, and Empowerment 57

unit 2 Working Within the Organization

chapter 6 Getting People to Work Together 73

chapter 7 Dealing With Problems and Conflicts 91

chapter 8 People and the Process of Change 103

chapter 9 Delegation of Client Care 115

chapter 10 Quality and Safety 131

chapter 11 Time Management 157

unit 3 Professional Issues

chapter 12 Promoting a Healthy Workplace 171

chapter 13 Work-Related Stress and Burnout 197

chapter 14 Your Nursing Career 217

chapter 15 Nursing Yesterday and Today 239

xi

2208_FM_00i-xii.qxd 11/6/09 6:03 PM Page xi

Appendices

appendix 1 Codes of Ethics for Nurses 257

American Nurses Association Code of Ethics for Nurses 257

Canadian Nurse Association Code of Ethics for Registered Nurses 257

The International Council of Nurses Code of Ethics for Nurses 258

appendix 2 Standards Published by the American Nurses Association 259

appendix 3 Guidelines for the Registered Nurse in Giving, Accepting, or Rejecting a Work Assignment 261

Index 267

Bonus Chapters on DavisPlus

Finance

Triaxial of Action: Policy, Politics, and Nursing

Canadian Nursing Practice and the Law

xii

2208_FM_00i-xii.qxd 11/6/09 6:03 PM Page xii

1 unit

Professional Considerations

chapter 1 Leadership and Followership

chapter 2 Manager

chapter 3 Nursing Practice and the Law

chapter 4 Questions of Values and Ethics

chapter 5 Organizations, Power, and Empowerment

2208_Ch01_001-012.qxd 11/6/09 5:54 PM Page 1

2208_Ch01_001-012.qxd 11/6/09 5:54 PM Page 2

chapter 1 Leadership and Followership

OBJECTIVES After reading this chapter, the student should be able to: ■ Define the terms leadership and followership.

■ Discuss the importance of effective leadership and followership for the new nurse.

■ Discuss the qualities and behaviors that contribute to effective followership.

■ Discuss the qualities and behaviors that contribute to effective leadership.

OUTLINE

Leadership

Are You Ready to Be a Leader?

Leadership Defined

Followership

Followership Defined

Becoming a Better Follower

What Makes a Person a Leader?

Leadership Theories

Trait Theories

Behavioral Theories

Task Versus Relationship

Motivating Theories

Emotional Intelligence

Situational Theories

Transformational Leadership

Moral Leadership

Qualities of an Effective Leader

Behaviors of an Effective Leader

Conclusion

3

2208_Ch01_001-012.qxd 11/6/09 5:54 PM Page 3

4 unit 1 | Professional Considerations

Nurses work with an extraordinary variety of people:

physicians, respiratory therapists, physical therapists,

social workers, psychologists, technicians, aides, unit

managers, housekeepers, clients, and clients’ families.

The reason why nurses study leadership is to

learn how to work well, or effectively, with other people. In this chapter, leadership and followership and the relationships between them are defined.

The characteristics and behaviors that can make

you, a new nurse, an effective leader and follower

are discussed.

Leadership

Are You Ready to Be a Leader?

You may be thinking, “I’m just beginning my career

in nursing. How can I be expected to be a leader

now?” This is an important question. You will need

time to refine your clinical skills and learn how to

function in a new environment. But you can begin

to assume some leadership right away within your

new nursing roles. Consider the following example:

Billie Blair Thomas was a new staff nurse at Green Valley Nursing Care Center. After orientation, she was assigned to a rehabilitation unit with high admission and discharge rates. Billie noticed that admissions and discharges were assigned rather hap- hazardly. Anyone who was “free” at the moment was directed to handle them. Sometimes, unlicensed assis- tant personnel were directed to admit or discharge residents. Billie believed that using them was inap- propriate because their assessment skills were limited and they had no training in discharge planning.

Billie thought there was a better way to do this but was not sure that she should say so because she was so new. “Maybe they’ve already thought of this,” she said to a former classmate. “It’s such an obvious solution.” They began to talk about what they had learned in their leadership course before graduation. “I just keep hearing our instructor say- ing, ‘There’s only one manager, but anyone can be a leader of our group.”

“If you want to be a leader, you have to act on your idea,” her friend said.

“Maybe I will,” Billie replied. Billie decided to speak with her nurse manager,

an experienced rehabilitation nurse who seemed not only approachable but also open to new ideas. “I have been so busy getting our new record system on line before the surveyors come that I wasn’t

paying attention to that,” the nurse manager told her. “I’m so glad you brought it to my attention.”

Billie’s nurse manager raised the issue at the next executive meeting, giving credit to Billie for having brought it to her attention. The other nurse man- agers had the same response. “We were so focused on the new record system that we overlooked that. We need to take care of this situation as soon as possible. Billie Blair Thomas has leadership potential.”

Leadership Defined

Leadership is a much broader concept than is man-

agement. Although managers should also be lead-

ers, management is focused on the achievement of

organizational goals. Leadership, on the other hand:

...occurs whenever one person attempts to influence the behavior of an individual or group—up, down, or sideways in the organization—regardless of the reason. It may be for personal goals or for the goals of others, and these goals may or may not be congru- ent with organizational goals. Leadership is influ- ence (Hersey & Campbell, 2004, p. 12)

In order to lead, one must develop three important

competencies: (1) ability to diagnose or understand

the situation you want to influence, (2) adaptation

in order to allow your behaviors and other resources

to close the gap between the current situation and

what you are hoping to achieve, and (3) communi-

cation. No matter how much you diagnose or

adapt, if you cannot communicate effectively, you

will probably not meet your goal (Hersey &

Campbell, 2004).

Effective nurse leaders are those who engage

others to work together effectively in pursuit of a

shared goal. Examples of shared goals are pro-

viding excellent client care, designing a cost-

saving procedure, and challenging the ethics of a

new policy.

Followership

Followership and leadership are separate but recip-

rocal roles. Without followers, one cannot be a

leader; conversely, one cannot be a follower without

a leader (Lyons, 2002).

Being an effective follower is as important to the

new nurse as is being an effective leader. In fact,

most of the time most of us are followers: members

of a team, attendees at a meeting, staff of a nursing

care unit, and so forth.

2208_Ch01_001-012.qxd 11/6/09 5:54 PM Page 4

chapter 1 | Leadership and Followership 5

Followership Defined

Followership is not a passive role. On the contrary,

the most valuable follower is a skilled, self-directed

employee, one who participates actively in setting

the group’s direction, invests his or her time and

energy in the work of the group, thinks critically,

and advocates for new ideas (Grossman & Valiga,

2000). Imagine working on a client care unit where

all staff members, from the unit secretary to the

assistant nurse manager, willingly take on extra

tasks without being asked (Spreitzer & Quinn,

2001), come back early from coffee breaks, com-

plete their charting on time, suggest ways to

improve client care, and are proud of the high qual-

ity care they provide. Wouldn’t it be wonderful to

be a part of that team?

Becoming a Better Follower

There are a number of things you can do to become

a better follower:

■ If you discover a problem, inform your team

leader or manager right away.

■ Even better, include a suggestion in your report

for solving the problem.

■ Freely invest your interest and energy in your

work.

■ Be supportive of new ideas and new directions

suggested by others.

■ When you disagree, explain why you do not

support an idea or suggestion.

■ Listen carefully, and reflect on what your leader

or manager says.

■ Continue to learn as much as you can about

your specialty area.

■ Share what you learn.

Being an effective follower will not only make you

a more valuable employee but will also increase the

meaning and satisfaction that you can get from

your work.

Most team leaders and nurse managers will

respond very positively to having staff who are

good followers. Occasionally you will encounter a

poor leader or manager who can confuse, frustrate,

and even distress you. Here are a few suggestions

for handling this:

■ Avoid adopting the ineffective behaviors of this

individual.

■ Continue to do your best work and to provide

leadership for the rest of the group.

■ If the situation worsens, enlist the support of

others on your team to seek a remedy; do not

try to do this alone as a new graduate.

■ If the situation becomes intolerable, consider the

option of transferring to another unit or seeking

another position (Deutschman, 2005; Korn, 2004).

What Makes a Person a Leader?

Leadership Theories

There are many different ideas about how a person

becomes a good leader. Despite years of research on

this subject, no one idea has emerged as the clear

winner. The reason for this may be that different

qualities and behaviors are most important in differ-

ent situations. In nursing, for example, some situa-

tions require quick thinking and fast action. Others

require time to figure out the best solution to a

complicated problem. Different leadership qualities

and behaviors are needed in these two instances. The

result is that there is not yet a single best answer to

the question, “What makes a person a leader?”

Consider some of the best-known leadership

theories and the many qualities and behaviors that

have been identified as those of the effective nurse

leader (Pavitt, 1999; Tappen, 2001).

Trait Theories

At one time or another, you have probably heard

someone say, “Leaders are born, not made.” In other

words, some people are natural leaders, and others

are not. In reality, leadership may come more easily

to some than to others, but everyone can be a

leader, given the necessary knowledge and skill.

Research into the traits of leaders is a continuing

process. A 5-year study of 90 outstanding leaders

by Warren Bennis (1984) identified four common

traits shared by all of these leaders. These traits

continue to hold true:

1. Management of attention. These leaders were

able to communicate a sense of goal or direction

to attract followers.

2. Management of meaning. These leaders created

and communicated meaning with clarity and

purpose.

3. Management of trust. These leaders demon-

strated reliability and consistency.

4. Management of self. These leaders were able to

know self and work within their strengths and

weaknesses (Bennis, 1984).

2208_Ch01_001-012.qxd 11/6/09 5:54 PM Page 5

6 unit 1 | Professional Considerations

Behavioral Theories

The behavioral theories are concerned with what

the leader does. One of the most influential theo-

ries is concerned with leadership style (White &

Lippitt, 1960) (Table 1-1).

The three styles are:

■ Autocratic leadership (also called directive, con- trolling, or authoritarian). The autocratic leader gives orders and makes decisions for the group.

For example, when a decision needs to be made,

an autocratic leader says, “I’ve decided that this

is the way we’re going to solve our problem.”

Although this is an efficient way to run things,

it usually dampens creativity and may inhibit

motivation.

■ Democratic leadership (also called participative). Democratic leaders share leadership. Important

plans and decisions are made with the team

(Chrispeels, 2004). Although this is often a less

efficient way to run things, it is more flexible

and usually increases motivation and creativity.

Democratic leadership is characterized by guid-

ance from rather than control by the leader.

■ Laissez-faire leadership (also called permissive or nondirective). The laissez-faire (“let someone do”) leader does very little planning or decision

making and fails to encourage others to do so.

It is really a lack of leadership. For example,

when a decision needs to be made, a laissez-faire

leader may postpone making the decision or

never make the decision. In most instances, the

laissez-faire leader leaves people feeling con-

fused and frustrated because there is no goal, no

guidance, and no direction. Some very mature

individuals thrive under laissez-faire leadership

because they need little guidance. Most people,

however, flounder under this kind of leadership.

Pavitt summed up the difference among these three

styles: a democratic leader tries to move the group

toward its goals; an autocratic leader tries to move

the group toward the leader’s goals; and a laissez-

faire leader makes no attempt to move the group

(1999, pp. 330ff ).

Task Versus Relationship

Another important distinction in leadership style is

between a task focus and a relationship focus

(Blake, Mouton, & Tapper, 1981). Some nurses

emphasize the tasks (e.g., reducing medication

errors, completing patient records) and fail to real-

ize that interpersonal relationships (e.g., attitude of

physicians toward nursing staff, treatment of

housekeeping staff by nurses) affect the morale and

productivity of employees. Other nurses focus on

the interpersonal aspects and ignore the quality of

the job being done as long as people get along with

each other. The most effective leader is able to bal-

ance the two, attending to both the task and the

relationship aspects of working together.

Motivating Theories

The concept of motivation seems fairly simple. We

do things to get what we want and avoid things that

we don’t want. However, motivation is still sur-

rounded in mystery. The study of motivation as a

focus of leadership began in the 1920s with the

historic Hawthorne study. Several experiments were

conducted to see if increasing light and, later,

improved working conditions would improve pro-

ductivity of workers in the Hawthorne, Illinois,

table 1-1

Comparison of Autocratic, Democratic, and Laissez-Faire Leadership Styles Autocratic Democratic Laissez-Faire

Amount of freedom Little freedom Moderate freedom Much freedom

Amount of control High control Moderate control Little control

Decision making By the leader Leader and group together By the group or by no one

Leader activity level High High Minimal

Assumption of responsibility Leader Shared Abdicated

Output of the group High quantity, good Creative, high quality Variable, may be poor quality

quality

Efficiency Very efficient Less efficient than Inefficient

autocratic style

Adapted from White, R.K., & Lippitt, R. (1960). Autocracy and Democracy: An Experimental Inquiry. New York: Harper & Row.

2208_Ch01_001-012.qxd 11/6/09 5:54 PM Page 6

chapter 1 | Leadership and Followership 7

electrical plant. Those workers who had the

improved working conditions taken away continued

to show improved productivity. Therefore, the

answers were found not in the conditions of the experiments but in the attention given to the work- ers by the experimenters. Similar to the 1954

Maslow Hierarchy of Needs theory, the 1959

Motivation-Hygiene theory developed by Frederick

Herzberg looked at factors that motivated workers

in the workplace. Following closely after Herzberg

was David McClelland and his 1961 Theory of

Needs. Clayton Alderfer responded to Maslow’s

theory with his own Existence, Relatedness, and

Growth (ERG) theory. Table 1-2 summarizes these

four historical motivation theories.

Emotional Intelligence

The relationship aspects of leadership are a focus

of the work on emotional intelligence (Goleman,

Boyatzes, & McKee, 2002). Part of what distin-

guishes ordinary leaders from leadership “stars”

is consciously addressing the effect of people’s

feelings on the team’s emotional reality. How is

this done?

First, learn how to recognize and understand

your own emotions, and learn how to manage

them, channel them, stay calm and clear-headed,

and suspend judgment until all the facts are in

when a crisis occurs (Baggett & Baggett, 2005).

The emotionally intelligent leader welcomes con-

structive criticism, asks for help when needed, can

juggle multiple demands without losing focus, and

can turn problems into opportunities.

Second, the emotionally intelligent leader listens

attentively to others, perceives unspoken concerns,

acknowledges others’ perspectives, and brings peo-

ple together in an atmosphere of respect, coopera-

tion, collegiality, and helpfulness so they can direct

their energies toward achieving the team’s goals.

“The enthusiastic, caring, and supportive leader

generates those same feelings throughout the

team,” wrote Porter-O’Grady of the emotionally

intelligent leader (2003, p. 109).

Situational Theories

People and leadership situations are far more complex

than the early theories recognized. In addition, situa-

tions can change rapidly, requiring more complex

table 1-2

Leading Motivation Theories Theory Summary of Motivation Requirements

Maslow, 1954 Categories of Need: Lower needs (below, listed first) must be fulfilled before others are activated.

Physiological

Safety

Belongingness

Esteem

Self-actualization

Alderfer, 1972 Three categories of needs, also ordered into a hierarchy:

1. Existence: Physical well-being

2. Relatedness: Satisfactory relations with others

3. Growth: Development of competence and realization of potential

Herzberg, 1959 Two factors that influence motivation. The absence of hygiene factors can create job dissatisfaction, but their presence does not motivate or increase satisfaction.

1. Hygiene factors: Company policy, supervision, interpersonal relations, working conditions, salary

2. Motivators: Achievement, recognition, the work itself, responsibility, advancement

McClelland, 1961 Motivation results from three dominant needs. Usually all three needs are present in each individual but vary in importance depending on the position a person has in the workplace. Needs are also shaped over time by culture and experience.

1. Need for achievement: Performing tasks on a challenging and high level

2. Need for affiliation: Good relationships with others

3. Need for power: Being in charge

Adapted from Hersey, P. & Campbell, R. (2004). Leadership: A Behavioral Science Approach. Calif.: Leadership Studies Publishing.

2208_Ch01_001-012.qxd 11/6/09 5:54 PM Page 7

8 unit 1 | Professional Considerations

theories to explain leadership (Bennis, Spreitzer, &

Cummings, 2001).

Adaptability is the key to the situational

approach (McNichol, 2000). Instead of assuming

that one particular approach works in all situations,

situational theories recognize the complexity of work

situations and encourage the leader to consider many

factors when deciding what action to take.

Situational theories emphasize the importance

of understanding all the factors that affect a partic-

ular group of people in a particular environment.

The most well-known and still practiced theory is

the Situational Leadership Model by Dr. Paul

Hersey. The appeal of this model is that it focuses

on the task and the follower. The key is to marry

the readiness of the follower with the task behav-

ior at hand. “Readiness is defined as the extent to

which a follower demonstrates the ability and will-

ingness to accomplish a specific task” (Hersey &

Campbell, 2004, p. 114). The task behavior is

defined as “the extent to which the leader engages

in spelling out the duties and responsibilities of an

individual and a group” (Hersey & Campbell,

2004, p. 114).

Followers’ readiness levels can range from unable

and unwilling (or insecure) to able, willing, and

confident. The leader’s behavior will focus on appro-

priately fulfilling the follower’s needs, which are iden-

tified by their readiness level and the task. Leader

behaviors will range from telling, guiding, and direct-

ing to delegating, observing, and monitoring.

Where did you fall in this model during your first

clinical rotation compared with where you are now?

In the beginning, the clinical instructor was giving

you clear instructions and guiding and directing you.

Now, she or he is most likely delegating, observing,

and monitoring. However, as you move into your

first nursing position, you may return to the guiding

and directing stage. On the other hand, you may

have become a leader/instructor for new students,

and you may be guiding and directing them.

Transformational Leadership

Although the situational theories were an improve-

ment over earlier theories, there was still something

missing. Meaning, inspiration, and vision were

not given enough attention (Tappen, 2001). These

are the distinguishing features of transformational

leadership.

The transformational theory of leadership

emphasizes that people need a sense of mission

that goes beyond good interpersonal relationships

or the appropriate reward for a job well done (Bass

& Avolio, 1993). This is especially true in nursing.

Caring for people, sick or well, is the goal of the

profession. Most people chose nursing in order to

do something for the good of humankind: this is

their vision. One responsibility of leadership is to

help nurses achieve their vision.

Transformational leaders can communicate

their vision in a manner that is so meaningful and

exciting that it reduces negativity (Leach, 2005)

and inspires commitment in the people with whom

they work (Trofino, 1995). If successful, the goals of

the leader and staff will “become fused, creating

unity, wholeness, and a collective purpose” (Barker,

1992, p. 42).

Moral Leadership

The corporate scandals of recent …