Theory and leadership in the Emergency room Essay

Theory and leadership in the Emergency room Essay

Please complete the following steps for your initial discussion post:
• Complete a library search for a peer-reviewed journal article that integrates nursing theory and nursing management.
• Present the article and discuss the nursing theory used, the benefits of nursing theory in management and any weaknesses you
identify in the article.
• Responses should be at least 500 words, integrate key concepts from the weekly readings and include specific examples of how the concepts can be applied to your work environment.Theory and leadership in the Emergency room Essay.
• Attach a copy of the article, or e-mail your article to the instructor for posting.
• Be sure to supplement your discussion with personal and professional experiences.
Responses need to address all components of the question, demonstrate critical thinking and analysis, and include peer reviewed journal evidence to support the student’s position.Theory and leadership in the Emergency room Essay.
Please be sure to validate your opinions and ideas with citations and references in APA format.
Sources must be less than 5 years old
I have an article that I will attach for you to use

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Describe the elements of a comprehensive health assessment of a geriatric patient.Theory and leadership in the Emergency room Essay. What special considerations should the nurse keep in mind while performing this assessment?
- Transformtional_Leadership_Practices

JONA
Volume 44, Number 4, pp 201-206
Copyright B 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
THE JOUR N A L O F NUR S I N G A D M I N I S T R A T I O N
Transformational Leadership Practices
of Nurse Leaders in Professional
Nursing Associations
Erin J. Ross, DNP, ANP-BC, CORLN
Joyce J. Fitzpatrick, PhD, RN, FAAN
Elizabeth R. Click, ND, RN, CWP
Helene J. Krouse, PhD, RN
Joanne T. Clavelle, DNP, RN, NEA-BC, FACHE
OBJECTIVE: This study describes the transformational
leadership (TL) practices of nurse leaders in
professional nursing associations (PNAs).
BACKGROUND: Professional nursing associations
are vehicles to provide educational opportunities for
nurses as well as leadership opportunities formembers.
Little has been published about the leadership practices
of PNA members.
METHOD: E-mail surveys of 448 nurse leaders in
PNAs were conducted in 2013 using the Leadership
Practices Inventory (LPI)Theory and leadership in the Emergency room Essay.
RESULTS: The top 2 TL practices of these nurse
leaders were enabling others to act and encouraging
the heart. Respondents with more leadership training
reported higher TL practices.
CONCLUSION: This is the 1st study to describe
TL practices of nurse leaders in PNAs. Results of this
study show that nurse leaders of PNAs emulate practices
of TL. Transformational leaders can mobilize
and direct association members in reaching shared
values, objectives, and outcomes. Understanding TL
practices of nurse leaders in PNAs are important to
the future of nursing in order to enable nurses to lead
change and advance health through these organizations.
The nursing profession is the largest segment of the
US healthcare workforce with more than 3 million
members.1 The 2010 Institute ofMedicine’s (IOM’s)1
Future of Nursing report identifies a need for resilient
and proficient nursing leadership.Theory and leadership in the Emergency room Essay. Professional nursing
associations (PNAs) provide leadership development
through mentoring and best practice opportunities
formembers. The goals of PNAs include education of
members, other professional health providers, and the
public about the nursing specialty. Professional nursing
associations provide a means for obtaining continuing
education, establish standards of practice and ethics,
and provide a culture that promotes leadership among
members to further serve the profession. Being amember
of a professional association demonstrates dedication
and commitment to the profession and to professional
growth on behalf of the members.2Theory and leadership in the Emergency room Essay.
Transformational Leadership
Transformational leadership (TL) is a form of social
influence that has broad applicability in nursing.
Transformational leadership is a leadership style that
inspires and empowers followers to achieve extraordinary
outcomes while transcending individual selfinterests,
aligning objectives and goals of the followers,
the leader, groups, and the organization.3 Transformational
leadership is a distinct model that provides an
empirically supported approach to foster organizational
JONA Vol. 44, No. 4 April 2014 201
Author Affiliations: Doctor of Nursing Practice and Certified
Adult Nurse Practitioner (Dr Ross), Head&Neck Institute,
ClevelandClinic, Beachwood, Ohio; Elizabeth Brooks Ford Professor
of Nursing (Dr Fitzpatrick); Assistant Professor (Dr Click), Francis
Payne Bolton School of Nursing, Case Western Reserve University,
Cleveland, Ohio; Medical Director (Dr Click), Case Western Reserve
University,Cleveland,Ohio; Professor ofNursing (DrKrouse),College
of Nursing, Wayne State University, Detroit, Michigan; Senior Vice
President and ChiefClinical Officer (DrClavelle)Theory and leadership in the Emergency room Essay, Scottsdale Healthcare,
Arizona.
Partial funding received to complete the project was presented
to Dr Ross in the form of nursing research grants. Grant funding
was awarded fromSigma Theta Tau International AlphaMuChapter
and the Society of Otorhinolaryngology & Head-Neck Nursing.
The authors declare no conflicts of interest.
Correspondence: Dr Ross, Cleveland Clinic Beachwood Family
Health Center, 26900 CedarRd, Suite 315 S, Beachwood,OH44122
(ejr63@case.edu).
DOI: 10.1097/NNA.0000000000000058
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
and personal change.4 Transformational leadership
has been found to be highly effective in creating a highly
engaged organizational culture.3 Transformational leaders
support excellence in practice by appealing to the
higher ideals and values of their followers. Nurse leaders
should embody these values. Transformational
leadership, compared with other forms of leadership,
is associated with lower rates of burnout,5,6 a better
sense of leader effectiveness,7 and better staff satisfaction.
6,8-10 Use of TLs can produce environments
with higher rates of employee retention, productivity,
and job satisfaction.11,12 Further TL development leads
to improved organizational strategies and better patient
outcomes.12Theory and leadership in the Emergency room Essay.
The IOM1 recognizes the need for a wide variety
of nursing bodies to focus on providing leadership
development, mentoring programs, and entrepreneurial
opportunities for nurses. Transformational leaders
have the power to develop and support future generations
of leaders with the aptitude to create effective
strategies to some of the profession’s most critical issues.11
Background of TL
Transformational leadership practices were 1st described
by Burns13 in his theory of leadership. His
theory was extended by the work of Bass,14 who defined
how TL could be measured and how it influences
follower enthusiasm and performance. Bass14 proposed
a theory that portrays how leaders affect and
move their followers and organizations by transforming
them. Influenced by Bass and Avolio’s3 transformationalmodel
of leadership, Kouzes and Posner15Theory and leadership in the Emergency room Essay.
developed a model of exemplary leadership and described
5 leadership practices: enabling others to act,
encouraging the heart, inspiring a shared vision, challenging
the process, andmodeling the way. Definitions
of these leadership practices16 are as follows:
Inspiring a shared vision: envisioning the future
by imagining exciting and ennobling possibilities;
enlisting others in common vision by appealing
to shared aspirations
Challenging the process: searching for opportunities
by seeking new ways to change, grow, and
improve; experimenting and taking risks; generating
small wins; and learning from mistakes
Enabling others to act: fostering collaboration
by promoting cooperative goals and building
trust and strengthening others by sharing
power and discretion along the way
Encouraging the heart: recognizing individual
contributions, showing appreciation for excellence,
and celebrating victories by creating a
spirit of community
Modeling theway: finding voice and clarifying
personal values by setting an example and aligning
actions with the shared values of the team
When leaders were getting extraordinary things
done in organizations, they were emulating these 5
practices.16(p27)Theory and leadership in the Emergency room Essay.
Leadership is among the most widely studied
behaviors by organizational behaviorists, psychologists,
and human resource researchers in organizations.
17,18 There is empirical research suggesting the
benefits of TL.19-21
Related Studies of TL Among Nurse Leaders
Leadership has been studied among nursing
leaders.6,8,9,14,18,21,22 There are a number of studies that
directly address TL among nurse leaders. Dunham-
Taylor23 found that as the nurse executive’s TL score
increased, the hospital organization was more participative.
Chiok Foong Loke,24 Leach,25 andMcGuire
and Kennerly26 recognized significant relationships
between TL practices and organizational commitment.
Wylie and Gallagher27 explored self-reported
TL behavior profiles; seniority and prior leadership
training were positively related to TL. Failla and
Stichler8 found a significant relationship between
nurse manager TL style and job satisfaction. Furthermore,
researchers have shown that strong leaders improve
outcomes by contributing to improved quality
and patient safety,28 lowering patient mortality,29 and
enhancing work environments.30
Transformational leadership practices of nurse
leaders have not been studied in PNAs to date, even
though these leaders have potential to shape many
others in the profession aswell as practice. This study
was designed to fill the void in our understanding of
leadership practices of leaders in professional nursing
organizations.Theory and leadership in the Emergency room Essay.
Methods
This descriptive study included RNs in defined leadership
positions (president, vice president, past president,
and members of boards of directors) in PNAs. Prior
to data collection, institutional review board approval
was obtained. E-mail addresses (n = 448) of potential
nurse leaders participants were obtained from the
Web site of the PNAs. The nurse leaderwas invited to
a link on the SurveyMonkey Web site, where the informed
consent and survey were available. The next
contact was at 2 weeks, with an e-mail postcard
thanking those who had participated and reminding
those who had not completed the survey. The data
collection period was 6 weeks. Data were downloaded
202 JONA Vol. 44, No. 4 April 2014
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
into the Statistical Package for the Social Sciences
using IBM SPSS Statistics version 20 (Ireland).
Instrument
The Leadership Practices Inventory (LPI)YSelf is a
30-item questionnaire containing 5 subscales for each
ofThe Five Practices ofExemplary Leadership: inspiring
a shared vision, encouraging the heart, enabling
others to act, modeling the way, and challenging the
process.33 Each subscale contains 6 questions, with a
10-point Likert response scale, with 1 considered low
and 10 considered high. A high level of internal consistency
is reported in the LPI34 with Cronbach’s " scores
of .70 to .84 and high test-retest reliability of 0.93 to
0.95 with the specific subscale reliabilities as follows:
enabling others to act (0.91), encouraging the heart (0.86),
inspiring a shared vision (0.91), challenging the process
(0.86), and modeling the way (0.84). In the present
study, the Cronbach’s " scores ranged from .70 to
.88: enabling others to act (.70), encouraging the heart
(.80), inspiring a shared vision (.88), challenging the
process (.85), and modeling the way (.77)Theory and leadership in the Emergency room Essay.
The LPI has been used in 2 studies of leadership
practices among nurse leaders in MagnetA hospitals.
Porter-O’Grady31 compared 71 Magnet chief nursing
officers (CNOs) and 90 non-Magnet CNOs, with
results demonstrating no significant differences between
the 2 groups. The mean (SD) LPI scores for
Magnet CNOs were as follows: inspiring a shared
vision, 8.63 (0.77); challenging the process, 8.61
(0.79); enabling others to act, 9.16 (0.53); modeling
the way, 8.86 (0.66); and encouraging the heart, 8.71
(0.76).Clavelle et al32 provided new evidence that the
top 2 TL practices of CNOs inMagnet organizations
are enabling others to act and modeling the way. The
LPI subscale score of enabling others to act was significantly
higher than that of modeling the way (t =
6.78, P G .001), encouraging the heart (t = 8.85, P G
.001), inspiring a shared vision (t = 7.33, P G .001), and
challenging the process (t = 10.50, P G .001). According
to these researchers, as CNOs gain experience and
education, they exhibit more TL characteristics.
Demographic information obtained in the study
included gender, year born, race, education, certification,
primary nursing specialty, work status, nursing
association specialty, residing state, office held, years
in leadership, years as member of nursing association,
number of members and level of office (national,
regional or local), amount of leadership training, current
position, and title.
Result
One hundred thirty-four (n = 134) nurse leaders completed
the survey, a response rate of 30% (Table 1). Of
Table 1. Sample Characteristics (n = 134)
Variable n %
Gender
Female 113 84.3
Male 20 14.9
Missing data 1 0.7
Race
White 128 99.5Theory and leadership in the Emergency room Essay.
Black/African American 3 2.2
American Indian/Alaska Native 2 1.5
Other 1 0.7
Education
Diploma 2 1.5
Associate 5 3.7
Bachelor’s 13 9.7
Master’s 73 54.5
PhD 14 10.4
DNP 21 15.7
Missing data 6 4.5
Certification
Yes 98 73.1
No 36 26.9
Work status
Full-time 108 80.6
Part-time 15 11.2
PRN 4 3.0
Retired 4 4.5
Student 6 0.7
Office held
President 35 26.1
President-elect 7 5.2
Past president 29 21.6
Vice president 12 9.0
Board of director 40 29.9
Missing data 11 8.2
Years in leadership
G1 8 6.0
1-2 12 9.0
3-5 27 20.1
6-10 33 24.6
11-15 13 9.7
16-20 11 8.2
21-25 7 5.2
925 21 15.7
Missing data 2 1.5
No. of members
G100 16 11.9
101-250 8 6.0
251-500 15 11.2
501-750 10 7.5
751-1,000 8 6.0
1,001-5,000 47 35.1
5,001-10,000 7 5.2
910,000 21 15.7
Missing data 2 1.5
Years in PNA
1-2 3 2.2
3-5 23 17.2
6-10 33 24.6
11-15 22 16.4
16-20 9 6.7
21-25 9 6.7
925 34 25.4
Missing 1 0.7
Amount of leadership training
A great deal 29 21.6
A lot 18 13.4
A moderate amount 44 32.8
A little 29 21.6
None at all 13 9.7
Missing data 1 0.7Theory and leadership in the Emergency room Essay.
JONA Vol. 44, No. 4 April 2014 203
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
those who answered the demographic questions (n =
133), the majority was female with a graduate degree
and professional certification. Nurse leaders from
37 states participated. Office held included president,
president-elect, past president, vice president, and board
of directors.Thereweremore than 50 different nursing
specialty associations reported by the participants.
The top 2 TL practices of nurse leaders in a PNA
were enabling others to act and encouraging the heart.
Leadership Practices InventoryYSelf mean and SD results
for all subscales are reported in Table 2.
Additional Analyses
To identify relationships between means of the LPISelf
and how much leadership training was acquired,
Pearson correlations were calculated. Respondents
with more leadership training reported higher TL
practices, modeling the way (r = 0.296, P G .001),
inspiring a shared vision (r = 0.320, P G .001),
challenging the process (r = 0.240, P G.05), enabling
others to act (r = 0.193, P G .05), and encouraging
the heart (r = 0.212, P G .05)Theory and leadership in the Emergency room Essay.
To determine differences between office held and
LPI-Self, analysis of variance tests were conducted.
There were no significant differences in 5 LPI subscales
based on the office held.
Discussion
This was the 1st study to identify TL practices of
nurse leaders in PNAs. The top 2 TL practices of
nurse leaders in a PNA were enabling others to act
and encouraging the heart. Enabling others to act
relates to fostering collaboration and strengthening
others. Leaders in PNAs are in an ideal position to
promote cooperative goals and make each member
feel competent and confident. Encouraging the heart
is recognizing individual contributions and celebrating
in team accomplishments. Leaders in PNAs can
create a culture in which there is recognition of peers
and celebration of accomplishments, thus incorporating
the mission of the association.
In the present study, therewas similarity between
CNOs of Magnet hospital and nurse leaders in PNAs.
There are 2 other studies describing TL in nurse leaders
in organizations. Porter-O’Grady31 compared Magnet
CNOs and non-Magnet CNOs using the LPI and
found no statistically significant differences. Clavelle
et al32 reported that the top 2 TL practices of CNOs
in Magnet organizations were enabling others to act
and modeling the way. The LPI subscale of enabling
others to act is 1 of the top 2 reflected in the present study
as well as Clavelle and colleagues’32 study. These results
reflect that CNOs of Magnet hospitals and nursing
leaders in PNAs see themselves as enabling others to act.
Overall, Magnet CNOs and nurse leaders of
PNAs perceive themselves as transformational. The
subscale of challenge the process had the lowestmeans
for all 3 studies (Table 3)Theory and leadership in the Emergency room Essay. This is an interesting finding;
nurse leaders are less likely to view themselves
as challenging the process. Identifying effective leadership
styles and skills required by nurse leaders to evolve
and transform today’s healthcare issues, including
challenging existing processes, is necessary to reach
the transformational recommendations set in IOM’s
Future of Nursing report.1
Table 2. Descriptive Statistics of the LPI Subscales
Challenge the Process Enable Others to Act Encourage the Heart Model the Way Inspire A Shared Vision
n 134 134 134 134 134
Mean 8.1704 8.7724 8.6119 8.5037 8.2164
SD 1.09843 0.66212 0.89480 .92186 1.21017
Minimum 3.67 6.33 6.00 4.50 3.33Theory and leadership in the Emergency room Essay.
Maximum 10.0 10.0 10.0 10.0 10.0
Data in bold represent the top 2 transformational leadership practices of nurse leaders in PNAs.
Table 3. Comparison of Means of Previous Studies Using LPI in Nursing31,32
Model the
Way
Inspire a Shared
Vision
Challenge the
Process
Enable Others
to Act
Encourage
the Heart
Ross et al (current study) 8.50 (0.921) 8.21 (1.21) 8.17 (1.10) 8.77 (0.662) 8.61 (0.895)
Clavelle et al32 8.39 (0.872) 8.22 (1.05) 8.16 (0.909) 8.70 (0.674) 8.17 (1.10)
Porter-O’Grady31 8.81 (0.67) 8.51 (0.92) 8.50 (0.85) 9.17 (0.57) 8.61 (0.95
Values are mean (SD)Theory and leadership in the Emergency room Essay.
Data in bold represent that the number 1 transformational leadership practice is the same among all 3 studies compared.

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204 JONA Vol. 44, No. 4 April 2014
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Leading a PNAentails getting extraordinary things
done. It takes modeling the way, inspiring a shared vision,
challenging the process, enabling others to act,
and encouraging the heart to meet the mission and
vision of the PNA. Leaders of PNAs foster collaboration
and actively involve other members to meet the
strategic goals of the association. Leaders of PNAs
role model and open the way for leadership development
of the members.Theory and leadership in the Emergency room Essay.
Limitations
The study is limited by being the 1st to study TL in
nursing leaders of PNAs; thus, there are no studies
for comparison. The LPI was administered as selfassessment
and was not combined with an observational
360-degree data collection process (members
in the PNA). Thus, the findings are limited to how
nurse leaders of PNAs view their own leadership style.
The transformational model may have some potential
limitations so it is possible that the claim made by
participants regarding the extent of TL in nursing is
exaggerated.35
For the execution of the survey, it was difficult to
obtain the e-mail addresses of nursing leaders.Many
PNAs do not wish to share their Listserv stating privacy
reasons, so the study was limited to nurse leaders
whose e-mail addresses were publicly listed on the
organization Web site.
Recommendations for Future Research
This study should be replicated with a large sample.
Further investigation with research into leadership
development and improved outcomes is warranted.
Opportunity exists in a future research initiative to
explore the variable of the current office held and research
each office independently exploring outcomes
and implications. The IOM report1 suggests nurses
should be full partnerswith physicians and other healthcare
professionals. It would be interesting to further
research the finding of low scoring means of challenge
the process from the 3 reported studies compared in
Table 3. Understanding why leaders rate this quality
so low in themselves and changing this perception or
reality is important to transformation of practice and
healthcare in the future.Theory and leadership in the Emergency room Essay.
Conclusion
Professional nursing associations have the opportunity
to create cultures that promote and value leadership.
Transformational leadership is a model that provides
an approach to foster organizational and personal
change. Transformational leadership practices can be
learned by those seeking to strengthen their abilities
and maybe as easily adaptable to other settings36
such as PNAs. Achieving extraordinary accomplishments
in a PNA can be challenging and takes the
dedication from leaders and members.Theory and leadership in the Emergency room Essay. Professional
nursing association’s leaders must identify priorities in
support of the IOM’s report on the Future of Nursing
recommendations1 and take responsibility for executing
those recommendations on multiple levels. Professional
nursing associations and nurse leaders should
foster leadership development and mentoring programs
throughout their associations to enhance the organizational
outcomes as well as the experiences of the members.
Seasoned nurse leaders have a responsibility to
support the development of the novice nurse in multiple
settings including at the bedside, in the boardroom,
and PNAs.37Theory and leadership in the Emergency room Essay.
Leaders in PNAs can promote leadership activities
among their membership, encouraging them to
participate on committees and boards, both internal
and external to the association.Theory and leadership in the Emergency room Essay.1 The TL can mobilize
and direct the association members in reaching shared
values, objectives, and outcomes. Elected association
leaders today remain responsible to their members
and through TL practices should incorporate members’
input into advancing healthcare, thus allowing
members to contribute to the voice of the profession
through PNAs.38
Acknowledgments
The authors thank the Alpha Mu Chapter of Sigma
Theta Tau and the Society of Otorhinolaryngology
& Head-Neck Nurses for supporting this research
through educational grants.
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