What do Nurses want from their Leaders?

By Rose O. Sherman, EdD, RN, FAAN

“The proof of leadership is found in followers”. John Maxwell

Last week, I was asked to do a presentation on what nurses want from their leaders. This is a very interesting question in today’s environment. I asked the group as to whether the answer to this question could be different than it was ten years ago. Many seasoned leaders in the room seemed to feel that some things nurses want today are different than they may have wanted at another point in time. They are right about this and that is why leaders must constantly scan their environment for change — changes in reimbursement policies, changes in expectations about quality, changes in how health-care will be delivered but also changes in the needs of the workforce.

What the Evidence Tells Us

From the current research evidence on what nurses look for in their leaders, the following five conclusions can be drawn:

1. Nurses want leaders who are authentic.

Are you the read deal or are you like a chameleon who changes your viewpoints and way of relating depending on the situation. Nurses look for leaders who demonstrate integrity, speak the truth and walk their talk. That is authenticity and it is a fundamental building block of a healthy environment according to the American Association of Critical Care Nurses and their research on transformational leadership style. It is important that we stay true to ourselves as leaders. Have you adopted a style of being politically correct or hesitancy about expressing your views. Sometimes nurse leaders worry excessively about how they will be perceived when staff is really looking for authenticity. Authentic leadership can be developed if you work on it in an intentional way.

2. Nurses want leaders who are transformational in their style.

All of us have probably had a leader or coach who was able to bring out the very best of everyone on their team and achieve results that seemed impossible. If you have had this experience, you were probably witnessing transformational leadership. It is one of the key characteristics of Magnet designated organizations and is considered essential to solve some of the complex problems that we see in health care today. Nurse researchers who study transformational leadership have found that nurse leaders who use transformational leadership principles create environments that promote higher levels of job satisfaction, well being and organizational commitment. Wong & Cummings (2009) also found in their work that there were significant associations between transformational leadership practices, increased patient satisfaction and reduced adverse events.

3. Nurses want leaders who will build healthy work environments.

There is growing evidence in the nursing literature about the positive impact of healthy work environments on staff satisfaction, retention, improved patient outcomes and organizational performance. Many organizations have launched efforts to improve their work environments. The establishment of a healthy work environment requires strong nursing leadership at all levels of the organization but especially at the point of care or unit level where most front line staff work and patient care is delivered. Nurse leaders can help create a deeply satisfying organizational culture at the unit level by engaging staff in the development of shared values in their work. This entails a paradigm shift from a more traditional command and control style of staff supervision toward a more transformational and authentic style of leadership.

4. Nurses want leaders who can help frame the chaos in today’s health-care environment.

Gail Fairhurst in her book The Power of Framing: Creating the Language of Leadership, suggests that one of the most important but least talked about leadership communication skills is that of “framing”. How leaders use language to frame people, situations, and events has important consequences for the way individuals make sense of the world and their actions. Not all nurse leaders think about this when they communicate but it is important especially during turbulent times that we are now experiencing in health-care. The response of leaders to change or turbulence has a powerful effect on their staff. Leaders who remain calm, truthful and optimistic in their communications help to prevent the spread of misinformation and reduce staff anxiety. The words of leaders can be very powerful in a positive or a negative way. While the skill of framing may not be easy, it can improve our ability to be effective communicators during times when staff depend on their leaders.

5. Nurses want leaders who develop others.

Most nursing staff today look for opportunities to develop their skills and mastery at their jobs. Mastery is a desire to get better and better at something that matters. This requires opportunities to learn, practice and make mistakes. When environments or leaders don’t support this learning, research indicates that staff can disengage and lose interest in their work. If a staff member does not see future opportunities for growth, they may resist returning to school for a higher level of education or leave an organization for lack of opportunity. Great nurse leaders look for developmental opportunities for their staff. This coaching in nursing matters more now than ever. Our younger nurses seek it from their employers as their #1 criteria for job selection as Jean Meister pointed out in her book Workplace 2020.

The role of the nurse leader can be quite demanding in today’s environment. Knowing what really matters to staff and where to put your energies is an important step to setting your priorities and planning your own leadership development.

Read to Lead

American Association of Critical Care Nurses (2005). AACN Standards for Establishing and Sustaining Healthy Work Environments. AACN Healthy Work Environments

Fairhurst, G.T. (2010). The Power of Framing: Creating the lanuage of leadership. San Francisco: Jossey-Bass.

Meister, J.C. & Willyerd, K. (2010). The 2020 Workplace: How innovative companies attract, develop and keep tomorrow’s employees today. New York: Harper Business.

Shirey, M. (2006). Authentic leaders creating healthy work environments for nursing practice. American Journal of Critical Care. 15(3), 256-267.

Wong, C.A. & Cummings, G.G. (2009). The relationship between nursing leadership and patient outcomes: A systematic review. Journal of Nursing Management. 15, 508-521.