Organizational Structures and Leadership_ 3 of 4 Discussion
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the_hidden_treasure_in_nursing_leadership.pdf
The hidden treasure in nursing leadership: informal leaders
MARTY DOWNEY P h D , R N 1, SUSAN PARSLOW P h D , R N 1 and MARCIA SMART P h D , M B A 2
1Associate Professor of Nursing, Boise State University, Boise, ID and 2Leadership Strategist, Smart Leadership Solutions, Boise, ID, USA
Informal leaders
In today�s complex, dynamic healthcare management environment, it is imperative that nurse managers take a
more focused look at nursing leadership within the
arena of direct patient care in their organizations.
The current and evolving nursing shortage, as well as
the uncertainty of the healthcare climate, is creating
significant challenges to contemporary nurse manage-
ment and leadership. The goal of the present article was
to generate awareness of characteristics of informal
leaders in health care with the emphasis on nurses in
acute care settings. To discuss this phenomenon,
informal interviews took place with nurse managers in
two large urban medical centres in the United States
mountain west.
Now, more than ever, nursing needs energetic, com-
mitted and dedicated leaders to meet the challenges of
the healthcare climate and the nursing shortage. This
article presents a very important, timely and alternative
perspective to assist nurse managers dealing with cur-
rent challenges.
Correspondence
Marty Downey
Boise State University
1910 University Drive
Boise
ID 83725-1840
USA
E-mail: [email protected]
D O W N E Y M . , P A R S L O W S . & S M A R T M . (2011) Journal of Nursing Management 19, 517–
521
The hidden treasure in nursing leadership: informal leaders
Aim The goal of the present article was to generate awareness of characteristics of informal leaders in healthcare with the emphasis on nurses in acute care settings.
There is limited research or literature regarding informal leaders in nursing and how
they positively impact nursing management, the organization and, ultimately, patient care. Identification of nurses with leadership characteristics is important so
that leadership development and mentoring can occur within the nursing profession.
Background More than ever, nursing needs energetic, committed and dedicated
leaders to meet the challenges of the healthcare climate and the nursing shortage.
This requires nurse leaders to consider all avenues to ensure the ongoing profit-
ability and viability of their healthcare facility.
Key issues This paper discusses clinical nurses as informal leaders; characteristics of
the informal nurse leader, the role they play, how they impact their unit and how
they shape the organization.
Implication for nursing management Informal nurse leaders are an underutilized
asset in health care. If identified early, these nurses can be developed and empow-
ered to impact unit performance, efficiency and environmental culture in a positive
manner.
Keywords: informal leaders, informal nurse leaders, informal leadership, leadership in healthcare, nursing management, nursing leadership
Accepted for publication: 18 February 2011
Journal of Nursing Management, 2011, 19, 517–521
DOI: 10.1111/j.1365-2834.2011.01253.x ª 2011 The Authors. Journal compilation ª 2011 Blackwell Publishing Ltd 517
Shortell and Kaluzny (2000) describe Leadership as a
process through which an individual attempts to
intentionally influence others to accomplish a goal. A
great deal has been written about nursing leadership,
ranging from its impact on the nursing shortage, job
satisfaction, retention and turnover to patient safety
and outcomes. Others have focused on nursing leader-
ship competencies and behaviours as well as pathways
to leadership positions and education requirements. The
literature and research generally focuses on formal
leadership (Cummings et al. 2008). However, there is
very little, if any, literature or research regarding
informal leaders in nursing and how they might posi-
tively impact nursing management, the organization
and ultimately, patient care. It is vital to the future of
the nursing profession that those with leadership char-
acteristics are identified for development and mentoring
to occur.
There is no question that positive nursing leadership
is a critical component of a successful health care
organization. On the other hand, what about the
informal leader and their impact on the organization?
This question is the focus of the present investigation.
In a landmark study on leadership, Dr Marcia Smart
(2005) researched an evolving phenomenon called
�Informal Leadership�. Outside the boundaries of formal authority is a phenomenon, in which leadership is dri-
ven by a network of people who make things happen
primarily through subtle power and influence.
Approximately 80–90% of a typical health-care orga-
nization is non-management, and within this large
group are individuals who have the power and influence
to impact the level and quality of patient care at the
bedside (Lee & Cummings 2008). Anticipating the de-
mands for future nurse leaders, nurse managers should
consider identifying these individuals and begin defining
the roles they play in leadership. Additionally, nurse
leaders and managers should strive to understand how
informal nurse leaders gain their power and influence
and focus on the ways they can be mentored and sup-
ported.
Informal nurse leaders a hidden treasure
Smart (2005) stated that within most organizations
there lies a behind-the-scenes �shadow� organization made up of people and informal networks of people.
The leadership phenomenon within this network of
people and its cohorts is referred to as �informal lead- ership�. At the heart of the informal network is the informal nurse leader (INL).
Officially, every facility and unit has a formal orga-
nizational chart that delineates responsibilities and
identifies the chain of command. However, the manner
in which work is truly accomplished often follows an
undocumented and unacknowledged path, guided by
these individuals, the informal leaders, who are both
heavily relied upon and often taken for granted.
Informal leaders are individuals without formal title
or authority who serve as advocates for the business,
and heighten the contributions of others as well as their
own primarily through influence, relationship-building,
knowledge and expertise (Smart 2010).
Informal nurse leaders are ubiquitous, once they are
discovered. They represent an overlooked resource that
could be developed and supported to great advantage
by any manager savvy enough to take the time to
understand who they are, the roles they play and how
they function. Informal leaders rarely have the kind of
explicit qualifications that can be easily documented or
communicated, much less evaluated (Katzenbach &
Khan 2010). However, nurse managers equipped with
this understanding can appropriately identify, support,
reward and develop informal leaders.
How to identify informal leaders
Identifying informal leaders may appear to be a simple
process. It is often assumed that the person who is out
front, speaks up more often or seems to have the most
overt relationship with management would be an
informal leader. This assumption may not necessarily be
the case. In discussions with acute care nurse managers,
it was agreed upon that a critical distinction of informal
leadership is �influence�. Smart (2010) defines influence as the power to affect other people�s thinking and/or actions. Nurse managers can identify the influence of
informal leaders in the acute care setting primarily
through observation. Having an understanding of the
factors that contribute to nursing leadership is funda-
mental to ensuring a future supply of nurse leaders who
can positively influence outcomes for health care pro-
viders and patients (Cummings et al. 2008).
Informal leaders generally do not have formal titles as
defined by the organization. The following are traits of
informal nurse leaders identified by the nurse managers:
• expert nurses who want to share their knowledge; • nurses whose names are often mentioned to lead
teams or volunteer;
• recognized leaders amongst their peers – staff gen- erally migrate towards them;
M. Downey et al.
518 ª 2011 The Authors. Journal compilation ª 2011 Blackwell Publishing Ltd, Journal of Nursing Management, 19, 517–521
• nurses who elevate the whole team – �Pulls everyone together�; and
• nurses who have credibility and good track records with both peers and management – the high per-
formers.
These factors and attributes align with (Smart 2005)
criteria for identifying informal leaders.
How informal leaders stand out amongst their peers
The nurse managers interviewed for the present in-
vestigation stated that nurses who are informal leaders
have a strong work ethic (Grabowski & Logan 2009).
These nurses rarely have attendance problems, are
committed to patients, have integrity and always look
at the unit as a whole. One nurse leader stated that
informal nurse leaders have a sense of the �heartbeat of the unit� and take an interest in making it better. These leaders are strategic thinkers constantly absorbing and
analysing information and helping the team make better
decisions (Rath & Conchie 2008). With that broad
viewpoint, they can easily spot a coworker needing help
and are willing to help resolve the situation (Grabowski
& Logan 2009).
How informal leaders lead
Informal nurse leaders have varying forms of power.
Webster�s Dictionary (2009) defines power as the ability to do, act; strength; having great influence. In physics,
power is defined as the potential or capacity for action,
a mobilizing force that overcomes resisting forces. In
human behaviour, power is the underlying force of all
social exchange (Bass 1990). In health care organiza-
tions, as in other organizations, power can be seen as
the ability to take actions and initiate interactions. It is
the capacity to ensure the outcomes one wishes and to
prevent those one does not desire.
Nurse managers and leaders might take a moment
and consider their own unit or organization. They
might think of a nurse who has not been officially
vested with formal status, but has attained a position of
power and influence, is able to mobilize the people
around them to act even though they have not been
officially designated as leaders. Seek the nurse who is
adept at using his or her influence to establish team
norms and values, and coordinate group efforts. A
nurse with these qualities is the informal leader. Their
power and influence is based on being effective com-
municators, building and sustaining strong relation-
ships, and always having a good �read� on how the organization works (Smart 2010).
More qualities found in informal nurse leaders
Informal leaders want to be involved in discussions and
in shaping the direction of the unit or organization.
They are seen as standing up, speaking out, actively
listening and creating a safe comfortable environment
for others. These nurses are the leaders of the informal
and social networks. Informal networks are especially
important in knowledge-intensive sectors where people
use personal relationships to find information to do
their jobs (Cross et al. 2002).
The nurse managers stated that they hold informal
leaders in high regard because, when they consult with
them or make a request, the nurse manager is confident
the INL will follow through with the task at hand. Staff
and peers also gravitate towards informal leaders as
non-management because they are knowledgeable,
exude confidence and are trustworthy (Grabowski &
Logan 2009). Informal leaders are always willing to
help and are generally friendly and open allowing peers
to confide in them. INLs lead through relationship
building which is the essential glue that holds a team
together (Rath & Conchie 2008). For example, if a staff
nurse is new on the patient care unit and has a question,
the new nurses tend to feel more comfortable
approaching the nurse who is open and willing to share
information for the answer (Grabowski & Logan
2009).
How informal leaders view themselves
Informal leaders do not view themselves as special or
even as leaders necessarily. They think of themselves as
nurses doing their job. They come to work because it is
their �calling�. They have a sense of �ownership of the unit� and they feel responsible for outcomes of patient care (Grabowski & Logan 2009). Smart (2005) found
that a trademark of an informal leader is a sense of
humility. They are humble and do not �blow their own horn� – trying to take credit; they simply focus on get- ting the job done.
Informal leaders may accept acknowledgement or
rewards for their accomplishments; however, many
oppose any formal title or visible recognition. While
they often get recognition for their service that is not the
objective of serving. Their giving and service is what
they contribute rather than what they are receiving
(Sanborn 2006). Informal leaders feel strongly that a
Informal leaders
ª 2011 The Authors. Journal compilation ª 2011 Blackwell Publishing Ltd, Journal of Nursing Management, 19, 517–521 519
formal title would change the dynamics of how they
operate. A title might inhibit their ability to work qui-
etly behind the scenes and could impact their ability to
create a trusting environment.
How to support informal leaders
Support of INLs begins with understanding how they
approach their professional and organizational role. For
example, when informal nurse leaders learn about a
change in the organization they mobilize resources and
can help integrate the change and enlist the support
of the staff. Nurse managers can capitalize on this
behaviour by remembering that these nurses are in the
trenches, they have the pulse of the unit, have a network
of resources and are privy to information about which
the manager may not know. However, it is important to
avoid asking them to betray confidences. One of char-
acteristics of the informal leader is their ability to create
a safe environment for others (Smart 2010).
The current economic situation is creating an envi-
ronment where we manage and live on tight schedules
and tighter budgets. Time is the biggest challenge for
nurses within the context of delivery of effective patient
care. Bedside nursing takes nearly 100% of nurses� time and energy. One of the top characteristics identified in
nurse satisfaction studies is having good nursing lead-
ership (Chambers & Mazzei 2008). Because the infor-
mal leader is fully committed to both the patient and the
unit they are often asked to work extra. Managers
should be mindful not to overuse their informal leaders.
To prevent burnout, managers should carefully choose
projects for their informal leaders [American Associa-
tion of Critical-Care Nurses (AACN) (2009)].
Nurse managers have the ability to assist informal
leaders in creating a positive and motivating environ-
ment. This can be done by encouragement and support
to create informal task forces to look at problematic
issues; give them opportunities to show how they help
solve current problems. Engaging nurses with diverse
backgrounds creates synergy and a greater commitment
to goals (Tornabeni & Miller 2008). Motivate the INLs
to get excited about the issues at hand as they are crea-
tive thinkers, and also look at creating a more formalized
way to tap into their knowledge and willingness to serve.
In instances of complaints regarding staff–patient-
relationships, low morale in nursing units or patient-
care complaints, nurse managers can leverage the
activist which is a vital quality of informal leaders.
Remember, informal leaders are typically your advo-
cates and are vested in the success of the unit. Their
power and influence is translated into nurse leaders who
are cheerleaders, motivators and problem solvers of the
unit (Grabowski & Logan 2009).
Informal leaders need to know that their positive
attitude and creative contributions are of great value to
you and the unit. Let them know that they are a moti-
vating force in the unit and that their efforts are making
a difference. Simple day-to-day recognition efforts can
be one of the most highly valued forms of rewarding
your nurses (Chambers & Mazzei 2008). Retreats or
gift cards may be simple means of encouragement.
After discovering the INL, the nurse managers and
leaders may find the best means to support the INL is
through mentorship. Mentoring the INL begins by
understanding the qualities discussed previously. For-
mal or informal mentorship programmes might be
developed to encourage the INL to continue their role.
Benefits of informal leaders to health care management
The benefits of informal leaders to formal leaders and
organizations are numerous. Giving staff the freedom to
innovate and learn from their mistakes is at the heart of
good healthcare services (Clark 2008). Informal nurse
leaders have an impact on the quality of services as well
as the level of patient and staff satisfaction (Domm
et al. 2007). They influence the culture through their
overall enthusiastic involvement, freely sharing their
knowledge and expertise, team orientation and genuine
caring approach towards patients, staff.
As one nurse manager stated, managing informal
leader nurses is �painless� because they complete what- ever is asked of them. Informal leaders are high per-
formers who are experts at doing more with less,
effectively using limited resources to their maximum
(Smart 2010). Because they always keep the broader
picture of the unit in mind, they can usually anticipate
the needs of other staff, physicians and patients. Infor-
mal leader nurses tend to feel a strong sense of owner-
ship and responsibility for the outcomes of the unit.
Most notably, they embrace the profession of nursing
(Grabowski & Logan 2009).
Conclusion
�Informal leadership is about heart�
Informal leaders are an essential component to meet the
current challenges of today�s health care environment. In discussing nurses as informal leaders we have identified
who they are, the roles they play, how they impact the unit
and how they shape the organization. Collaboration, trust
M. Downey et al.
520 ª 2011 The Authors. Journal compilation ª 2011 Blackwell Publishing Ltd, Journal of Nursing Management, 19, 517–521
and a high level of management support would definitely
contribute to nurses abilities to exercise informal lead-
ership (Resha 2006). Informal nurse leaders are an un-
derutilized asset in health care. These nurses can be
developed and empowered to impact unit performance,
efficiency and culture in a positive manner. When prop-
erly mentored, nurse leaders will find the informal nurse
leader is truly a �hidden treasure�.
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