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TRANSFORMATIONAL
Elaine Sorensen Marshall
LEADERSHIP IN NURSING
TRANSFORMATIONAL
From Expert Clinician to Influential Leader
Elaine Sorensen Marshall, PhD, RN
LEADERSHIP
he ultimate goal for Doctor of Nursing Practice (DNP) leaders is to develop skills
that wil support their ability to lead efectively through complex chalenges— IN
Tsuch as working within the constraints of tight budgets, initiating health care
policy change to eliminate health disparities, and improving health care outcomes at all
levels of care.
This text is an invaluable instructional guide for nursing graduate students who are NURSING
developing the skills needed to fulfill this new and emerging role of clinical leadership.
With this book, nurses can develop leadership skills that will ultimately transform health
care practice by incorporating innovative professional models of care. It provides critical
information and practical tools to enhance leadership, drawing from the works of experts
in business and health care leadership. This book is an important resource for DNP students,
nurse practitioners, and current clinical leaders dealing with the challenges of health care
for the next generation.
KEY TOPICS:
• Cultivating the characteristics of a transformational leader: charisma, innovation,
inspiration, intellect, and more
• Developing the role of the DNP within complex organizational systems
• Incorporating new care delivery, practice, and management models through leadership
• Navigating power, politics, and policy: building the team, understanding economics
and finance, and more
From Expert Clinician to
Influential Leader
11 W. 42nd Street
New York, NY 10036-8002
www.springerpub.com
Marshall TRANSFORMATIONAL LEADERSHIP IN NURSING
TRANSFORMATIONAL
LEADERSHIP IN NURSING
Elaine Sorensen Marshall, PhD, RN, is currently professor and Bulloch Healthcare Foundation
Endowed Chair at the School of Nursing at Georgia Southern University. She served as dean of the
College of Nursing at Brigham Young University and as a member of the Board of Trustees of
Intermountain Healthcare in Utah. She has served in national elected and appointed leadership
positions for the American Association of Colleges of Nursing (AACN), the American Association for
the History of Nursing (AAHN), and the Western Institute of Nursing. She has published two books
and more than 50 professional and public articles and book chapters. Her work has been noted by
the New Professional Book Award from the National Council on Family Relations, the Lavinia Dock
Award from the American Association for the History of Nursing, and the Jo Eleanor Elliott
Leadership Award from the Western Institute of Nursing.
TRANSFORMATIONAL
LEADERSHIP IN NURSING
From Expert Clinician to Infuential Leader
Elaine Sorensen Marshall, RN, PhD
Copyright © 2011 Springer Publishing Company, LLC
All rights reserved.
No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or
by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission
of Springer Publishing Company, LLC, or authorization through payment of the appropriate fees to the
Copyright Clearance Center, Inc., 222 Rosewood Drive, Danvers, MA 01923; 978-750-8400; fax 978-646-8600;
The true professional is one
Who does not obscure grace
With illusions of technical prowess,
The true professional is one
Who strips away all illusions to reveal
A reliable truth in which
The human heart can rest.
Margaret Wheatley
Contents
Foreword ix
Preface xi
Acknowledgments xiii
Part I: BecomIng the transformatIonal leader
1. E xpert Clinician to Transformational Leader
in a Complex Healthcare Organization 1
2. Characteristics of a Transformational Leader 27
3. Cultivating the Habits of a Transformational Leader 51
Part II: contexts for transformatIonal leadershIP
4. Understanding Contexts for Transformational Leadership 79
5. Leading Among Leaders 101
6. Current Challenges in Health Care: The Role of the Leader 127
Part III: desIgnIng new care delIvery models
7. Practice Design and Management 155
8. Culture and Practice Environments 181
Part Iv: Power, PolItIcs, and PolIcy
9. Building the Team 201
10. Economics and Finance 225
11. Fluency in the System 245
Appendix: Classic Books for the Library of the Transformational Leader 263
Index 271
vii
Foreword
What would you do in the next three to fve years if you absolutely know that you can-
not fail? If you cannot answer that question spontaneously, you have probably let your
dreams sit on the back burner for way too long. Throughout my career journey, I have
had the privilege of assuming multiple leadership roles in healthcare systems, profes-
sional organizations, and academia. In those roles as well as through reading the biog-
raphies of many leaders who have made a phenomenal impact in the world, one of the
most important things I have learned is that to be a transformational leader, you need to
have a big dream or vision for what you want to accomplish and an ability to inspire that
vision in others. Any successful initiative needs to begin with the end or dream in mind.
However, there are far too many leaders who do not realize the importance of the team
vision or dream and, instead, are overly focused on processes instead of outcomes. These
types of extreme “process-driven” leaders have a challenging time keeping people mo-
tivated, especially when the going gets tough. Although process is important, it should
never be the main driving force in realizing a vision.
When individuals are inspired with a common vision by a transformational leader,
they are intrinsically motivated to accomplish that vision instead of satisfed with the
status quo. Transformational leaders recognize that a clear consistent focus on the vision
by the team and an ability to keep the dream bigger than any fears are a key ingredient
to success, especially when the journey gets tough or “character-building.” However,
having a dream and inspiring it in others is not enough by itself. Transformational lead-
ers must believe in their abilities to accomplish their dreams and enhance that belief in
others. They also must provide ongoing support and encouragement to others through-
out the journey.
Transformational leaders are innovators, positive deviants, and “movers and shak-
ers.” They typically see things before others, use creative strategies to problem-solve
challenges, and are not afraid to take risks in order to accomplish their dreams. These
types of leaders also have the ability to anticipate and overcome barriers as well as
mobilize resources and people to accomplish the vision. They are comfortable with un-
certainty and thrive on change. Transformational leaders also have high integrity; their
followers trust them, and they invest in the people on their team, especially through
mentorship and encouragement. They strive for continuous quality improvement by
using and generating evidence to inform best practice and organizational policies as
well as use evidence to infuence health policy. Finally and very importantly, trans-
formational leaders persist through the “character-builders” until their dreams are
realized in contrast to many individuals who give up on their dreams, right before
they would have come to fruition. Transformational leaders go from one failure to the
next with enthusiasm, knowing that they are one step closer to the realization of their
dreams.
ix
