DOS: Leadership 3514

WEEK 1:

Lesson 1.1: Part 1

–        Canadian health care system

o   Deficits and inequalities exist

o   Need to build on the…

§  Canada Health Act

·        5 criteria of health standard delivery (public administration, comprehensiveness, universality, portability, accessibility)

§  Social determinants of health

·  Education, justice, housing, transit

§  Eradicate social exclusion

·  Indigenous, refugees

o   Nursing constitutes the backbone of the health care system

§  Bare responsibility of safe quality care

§  Innovative and engaging

–        Nursing in Canada

o   A Nursing Call to Action: The health of our nation, the future of our health care system (CNA, 2012)

o   Direct care nurses are informal leaders

–        Strength based nursing leadership

o   Advocating and leading change requires strengths-based leadership ->

§  Using positive feedback instead of negative criticism

o   Effective leaders build on their own and others’ strengths ->

o   Essential change agents

o    What does strength based nursing look like?

§  Positive patient / organization outcomes

§  Complex settings

§  Critical thinking

o   Leadership is not just for those in leadership positions

o   It’s for all nurses image depends equally of independent decision making and ability to engage and collab with others

–        The ways nurses lead, manage and follow has changed over time.

–        21st century nursing… are you ready?

o   Autonomous practice and shared decision making

o   Patient acuity

o   Direct care nurses have much more control over practice thank they think

o   Technology (more information and tools, reach beyond physical findings), ICT, Informatics

o   Study of leadership, management, and followership so important

–        Calling on all nurses …

o   Accountable for

§  Organization’s mission and goals

§  Manage limited health care resources

§  Avoid mistakes

§  Achieve patient satisfaction

§  Ensure positive patient outcomes

o   A lot of responsibility

o   Organizations expect nurses to reduce costs, contribute to improvement, and interact with other to solve clinical/organizational problems

–        Must engage in strength-based leading, managing and following

o   These concepts are integrated, which means that nurses lead, manage, and follow concurrently.

o   All nurses lead, manage, and follow.

–        Leadership

o   The process of engaging and influencing others

o   Nurse leaders who can positively influence patient care and organizational outcomes are especially valued

§  Approachable an inspiring and empathetic; text control is powerful and influential; someone who is self-aware and focuses on self-development in developing others; inspires individuals through their own actions

o   Any nurse can be a nurse leader

–        Managing

o   Is about ensuring that people have the necessary resources to get the job done

o   Key management competencies – i.e.: deciding how to allocate scarce resources

o   Timelines, budgets, authority positions

o   Effective managers focus efficiently on objectives, tasks, procedures, and policies

o   A person who assigns duties, supervises their team members, and keeps the work environment organized also facilitates communication in practice development

–        Followership

o   Involves engaging with others who are leading or managing, by contributing to the work that needs to be done

o   someone who supports admired others and contribute to the work

o   Find out what’s expected, take imitative to deal with problems, show appreciation, provide recognition when appropriate, change flawed plans and proposals

o   Followership guidelines

–        Why is the leader follower relationship important?

o   Their needs to be a form of trust, in the relationship

o   Helps get them to the mutual goal, 2 leaders can have different goals, and miscommunication can occurs

–        Nursing position

o   Formal: nurse managers, nurse directors

o   Informal: direct care nurses, frontline clinical nurse leaders – change between managers, leading, and following

Lesson 1.1: Part 2

–        This lesson will review thePersonal Attributes and Behaviours Needed to Lead, Manage, and Follow. We will discuss ethics, emotional intelligence, appreciative inquiry, resilience, and mindfulness

1.     Ethical individuals

o   Ethical individuals are not coercive or manipulative, and they collaborate with others.

o   Nurses need to value fundamental ethical principles such as beneficence, autonomy, truthfulness, confidentiality, justice, and integrity. although members of the health care organizations must always consider clinical and organizational goals and priorities, the underlying philosophy associated with excellent health care delivery is patient centred/ focused or person-centre care.

o   Ethical leadership is based on willingness to identify an act on complex problems in an ethical manner. leadership can be misused when coercive relationships form and information and true world are withheld

2.     Emotional intelligence (EI)

o   Emotionally Intelligent individuals are aware of their own emotions and can regulate and control their emotions, particularly in response to stressful or challenging situations. individuals with EI are also aware of others emotions and can assist others with understanding and controlling their emotions

o   is considered a stressful profession because of nurses regular exposure to emotionally charged the situation where they are expected to respond to an emotional needs of their patients and families

o   nurses with a higher level of EI are associated with more effective nurse leadership because EI leaders are able to build positive and constructive relationships with their staff

3.     Appreciative inquiry

o   which is associated with how we question and problem solve.

o   Appreciative inquiry is a strengths-based strategy from positive psychology. AI is used at all levels (e.g., individual, group, and organizational) to engage people in identifying and accentuating positives within a context, such as a practice environment. Specifically, instead of focusing on the negative (i.e., seeing the glass as half empty), AI emphasizes the positive (i.e., seeing the glass as half full)

o   The following questions can be asked when following AI

§  What does a supportive clinical learning environment look like to you?

§  What is working well for us in our clinical learning environments?

§  What can each of us do better to contribute to an excellent clinical learning environment?

§  What can we do together to contribute to an excellent clinical learning environment?

4.     Resilience

o   is an attribute associated with surviving or thriving in the aftermath of an adverse or tragic event. Resilient individuals are able to bounce back after crisis and adversity. Resilience has been linked to other characteristics such as self-efficacy (i.e., the belief you can succeed), optimism, and hope.

o   A number of strategies associated with personal resilience-building in nurses are:

§  establishing positive professional support networks

§  maintaining a positive attitude (e.g., using AI strategies to approach problems in the workplace)

§  using reflection (e.g., journaling).

o   NOTE: Think about your own resilience and the resilience of other nurses as you move through the aftermath of the COVID-19 pandemic.

5.     Mindfulness

–        The latest addition of attributes and behaviours that support effective leadership, management and followership is mindfulness . A mindful person has increased awareness of what is happening in the present. Our attention often drifts to past or future events over which we have no current control. Mindfulness buffers against mental drift and it can also guard against knee-jerk reactions. Rather than immediately evaluating and labeling emotions in a situation, the mindful person creates a neutral space for reflection.

Mindfulness prompts individuals to stop and reflect before responding to a situation. Before you do or say anything, ask yourself: “Are my words and actions going to be the best reflection of my core values and beliefs?” A short reflective pause for deeper processing can result in more genuine, authentic responses to others’ words and actions—versus a reactive, potentially damaging response.

Lesson 1.2: Theory Development for Leading, Managing, and Following

Leadership theories – first 3 task focused, last two relational

–        Trait leadership

–        Style leadership

–        Situational-contingency leadership

–        Transformational leadership

–        Authentic leadership

–        Transactional

o   Task-oriented leadership style

o   Followers know what to expect of themselves from leaders

–   Defined roles and accountabilities

–   Receive support/ resources

–   Reward for work well done

o   Need to be present

More like nurse manager role

Theory/ContributorKey IdeaApplication to Practice
Trait Theories Trait theories were studied from 1900 to 1950. These theories are sometimes referred to as the Great Man Theory, from Aristotle’s philosophy extolling the virtue of being “born” with leadership traits.Leaders have a certain set of physical and emotional characteristics that are crucial for inspiring others toward a common goal Some theories believe that traits are innate and cannot be learned; others believe that leadership traits can be developed in each individual.Self-awareness of traits is useful for assessing personal strengths (such as drive, motivation, integrity, confidence, cognitive ability) and matching those strengths to types of employment.
Style Theories Instead of focusing on traits, style theories consider how leaders behave.All style theories are based on two types of behaviour: task and relationship behaviours. The combination of these two types of behaviours has been extensively studied to determine the most effective leadership staples. The assumption that styles can be learned and cultivated.High concern for accomplishing task objectives and high concern for building and maintaining collaborative relationships. Leaders need to develop both types of competencies.
Situational-Contingency Theories Situational-contingency theory emerged in the 1960s and 1970s. It proposed that leadership effectiveness depends on any given situation. Situational variables are research-tested variables related to leadership effectiveness in different situations. Outcomes are contingent on situational factors.Path-goal theory: There are four types of leader behaviours: supportive, directive, participative, and achievement-oriented. Leader behaviour should be contingent on task and follower characteristics. Stressful tasks, for instance, require supportive leaders to lower follower anxiety. Situational leadership theory: The level of follower maturity influences the appropriate mix of task characteristics and leader behaviour. With novice followers (those who are new at a task), leaders should be directive.Nurses and leaders must assess each situation as unique and determine appropriate actions accordingly. Leaders must adapt their styles to complement the specific issue faced.
Transformational Theories Transactional leadership is based on a leader-follower exchange, where the follower expects rewards in exchange for effect. Transactional leaders are similar to managers: they manage the status quo or day-to-day operations. Transformational leadership is a process whereby leaders and followers set higher goals and work together to achieve them. This type of leadership is connected with higher moral values. Full range leadership theory has three types: transformational, transactional, and laissez faire.Transformational leaders are known for the four I’s: idealized influence, intellectual stimulation, individual consideration, and inspirational motivation. There are three types of transactional leaders: contingent reward leaders focus on role clarification and ensuring followers receive appropriate supports to do their work; management-by exception active leaders are vigilant and only intervene when a problem starts to airse; management-by exception passive leaders only intervene after mistakes have occurred. Laissez-faire leaders avoid making decisions and abdicate responsibility.Transformational nurse leaders were associated with positive outcomes wish as nurse retention, group cohesion, role clarity, and effectiveness. Research has demonstrated significant positive association between relations; leadership styles, such as transformational leadership, and patient outcomes, such as lower morbidity and mortality rates and greater patient satisfaction reports.   Lots of trust Followers will go above and beyond for them
Authentic Leadership Authentic Leadership arised from the positive psychology tradition. Authentic leaders are aware of their own values and moral convictions and are constantly realigning their actions to match their values.Authentic leaders are characterized by balanced processing (objectively weighing the evidence); an internalized moral perspective or internal moral compass; genuine, open transparency about one’s feelings and thoughts’ heightening awareness of self, others and the context.Authentic leadership is strongly, positively associated with followers’ trust in their leaders and with followers’ positive emotions. Some evidence suggests that authentic leaders’ values-based moral perspective has the biggest influence on followers’ emotions. Followers are inspired by these leaders and trust them based on perceived congruence between their values and the leaders’ values.

Management theories

–        Taylor (1947): the founder of “scientific management” and the “efficiency movement”

–        Mintzberg (1990): organizational structures and processes

–        Followership theories

Followership theories

–        “Team” vs follower terms

–        Self-enhancement / self-protection

–        Contribution to organizational success – actively contributing

–        A role rather than a person

–        Inherent characteristics

Complexity science

–        The study of complex systems: “the patterns of relationships within them, how they are sustained, how they self-organize, and how outcomes emerge.”

–        Nurses must be flexible and dynamic to keep up with the ever-changing systems of people, health care, public policy, and human relationships.

–        Holistic complex system

–        World is full of many systems and systems and relationships and patterns occur over time

–        Humans adapt well to complex situations

–        Health care systems are complex adaptive systems, and individuals are interconnected, complex and ever changing

–        It really is in contrast to the traditional systems thinking (elaborate plans, specific details) in complex science (decision making distributed across organization; HCP loosen control over patients and family)

Lesson 1.3: Leading, Following, and Managing Competencies

–        Competencies comprise knowledge, skills, and attitudes, and they are often arranged in checklists or frameworks for self-assessment. Competencies are influenced by the practice setting and the level of authority (e.g., front-line nurse leader, departmental manager, and executive director).

1.     Leading and Managing

–        Leadership and management are closely intertwined. The figure below illustrates how leadership-management domains influence each other. You will observe the overlap among three competency domains: leading within, leading people, and managing the business.

–        Leadership development always receives the most attention in the literature: the reason is related to the critical importance of beginning with your own leadership development. Leading from within is something each of us can do at any point along our nursing career trajectory. More complex competencies related to leading people and managing the business take time, practice, and effort.

–        Strengths-based leadership therefore begins with knowing yourself—your core values and ethics. This domain requires self-reflection practice anddevelopment of emotional intelligence (i.e., self-awareness, emotional self-regulation, other-awareness, and interpersonal skills).

–        Managing the business includes the followingcore competencies: human resource management, financial accountability, critical thinking, clinical practice knowledge, performance management, strategic planning, and technology use.

o   Human resource management entails having the right numbers and types of staff available to meet patient needs.

o   Clinical practice knowledge is a related competency, because managers must know their patient populations to make effective staffing decisions.

o   Other competencies include critical thinking skills associated with the constant monitoring of patients’ status, including patient discharges, transfers, and admissions.

o   In addition, managers need to understand the big picture of patient movement within their hospital or facility—not just what is happening in their unit or department. Managers attend meetings daily to plan strategies for patient management throughout their hospital or facility.

o   Managers are also responsible for overseeing staff performance and providing constructive feedback and supports, particularly for newer nurses.

–        With the advent of technology for communications and documentation, managers must know how to use data, generated by technology, to inform their critical decisions. An over-arching concern for managers is safe, quality care that is cost effective. When scheduling staff and ordering supplies, managers are held financially accountable for their decisions.

–        The third domain of leading people includes relationship-building and use of influence tactics to promote best practices. A key competency is knowing how to engage others in solving problems and making decisions. Promoting collaboration is particularly important for ensuring effective teamwork.

2.     Following

–        Typically, followers are considered to be passive, uninspired, and waiting for direction. However, just the opposite is true. Followership is an understudied area in the leadership literature, but interest is growing in the ways in which members of a group or team organize themselves into leader–follower relationships that synergize outcomes for the group or team.

–        In effective leader–follower relationships, followers play an important role in sharing and discussing relevant information that informs the leader’s decisions. Proactive followers versus passive followers are associated with better leader–follower communications and outcomes when leaders acknowledge and support followers’ efforts to speak up and engage in finding collaborative solutions.

–        Proactive or strengths-based follower competencies include rational, positive influence tactics and constructive feedback seeking.

o   Rational persuasion where the follower shares their evidence-based observations and concerns with a leader to avert problems and contribute to a better outcome.

o   Rational evidence-based influence tactics are more effective than negative tactics, such as complaining and pressuring.

o   Constructive feedback-seeking is another, positive way for followers to establish effective working relationships between leaders and followers, particularly when using an approach such as appreciative inquiry. Rather than waiting for a leader’s response, a follower can ask: What went well of us? How can we do better next time?

–        During your clinical practicum, observe leader-follower interactions during change of shift. Change of  shift is a time when the clinical nurse leader and staff will often negotiate assignments based on patient needs and nurse competencies. Think about….

o   Are there discussions between the leader and staff about patient needs?

o   Is the leader soliciting staff ideas?

o   Is the staff offering information and advice?

–        The change-of-shift observation is an example of just one leader–follower exchange. Based on what you have learned about leaders and followers from this week, critique the quality of leader–follower relationship. Would you want to work on this unit? Why or why not?

Solutions for Terry’s Challenge

After Terry graduated from her nursing program, she was hired for a full-time position on a medical-surgical unit. Terry had completed the final clinical practicum on this unit, and the management there felt it was important to start Terry’s career on a unit where she knew about the patients and the unit policies and procedures. In her interview, Terry liked the nurse manager; she also liked the nurse preceptor who worked with them during her practicum. Terry, however, focused on her clinical skills during her practicum, and she did not do a thorough evaluation of the presence (or absence) of important leadership and followership behaviours. Was the clinical nurse leader available and supportive? Were the nurses and leader positive and supportive of each other? In addition, Terry did not inquire about transition-to-practice opportunities at this hospital or the possibility of having a nurse act as a preceptor and/or mentor to her during her transition period.

Unfortunately, Terry received a very short orientation and little mentorship support from the staff. Although the clinical nurse leader and staff were welcoming on her first day on the unit, they were busy with their own work, and Terry realized that as a staff person, it was “business as usual.” She particularly had trouble keeping up with the workload, and no one was available to answer her questions. The nurse leader, in particular, was seldom available because of her own responsibilities. Terry began to develop different perceptions of her workplace. She began to wonder if this was the right start to her nursing career.

During her clinical practicum, Terry had an opportunity to observe interactions between the clinical nurse leader and staff. What positive leader and follower behaviours should Terry have watched for? During her interview with the manager, what questions could Terry have asked to gain an understanding of leadership within the context of the unit?

Solutions

What positive leader and follower behaviours should Terry have watched for?Collaboration between team members and managers Use of evidence or data to solve problems Open communication between team members Awareness of others emotions and how they control/understand their emotions in critical situations Creating an environment that supports positive feedback rather than criticism Opportunities to share concerns as well as seek feedback Positive relationships where strengths and weaknesses are examined and used as a means of problem solving and not blame High emotional intelligence (EI) & appreciative inquiry (AI) Interprofessional and intraprofessional skills
During her interview with the manager, what questions could Terry have asked to gain an understanding of leadership within the context of the unit?Who can I go/speak to if I am having difficulties managing my tasks? Are there opportunities for continuing education, such as seminars or in-service presentations? What criteria should I be aware of to ensure I am performing well on the job? How often is a job performance check done? What is the management/leadership style? What support is available to me during and after my orientation? Do you have a mentorship program on the unit? When changing shift, what is included in a usual handoff report?

Summary – Need to Know

–        Grow your emotional intelligence (EI). Know your own values (EI self-awareness). Practice self-reflection and control (EI regulation) of your own emotions.

–        Be positive. Strengths-based leadership begins with a positive attitude—of looking for ways to build on positives. Practice positive psychology strategies, such as appreciative inquiry.

–        Develop your leadership competencies. In addition to leading from within, leading others depends on relational skills or knowing how to develop and maintain positive relationships with your peers, other health care professionals, patients, and their families.

–        Develop your followership competencies. Practice speaking up and using effective communications in interactions with your team and leadership. Effective followership depends on your proactive efforts to support your leader and team whenever possible.

–        Seek out strong leader role models and formal leadership development opportunities: they are important components to becoming a strengths-based leader.

WEEK 2

The Importance of Nursing Leadership

A Challenge

Lauren is team leader on her unit and has been in this role for less than 2 years. Her manager has been tasked to lead the implementation of nursing huddles as a way of improving nursing team communication. The nursing team is quite diverse in terms of age, years of experience, and areas of expertise. When the nursing huddles were initially introduced, there was a mixed reaction from the staff, with some quite opposed to the idea. Lauren is now faced with the challenge of introducing this change to her colleagues. As the team leader, how should Lauren deal with this situation?

This lesson focus on the importance of leadership in nursing. We will review a different definition of leadership, why nurses are expected to be leaders, and where nursing leadership occurs within the healthcare system. We will also review the essential skills for nurse leaders and the challenges described by novice leaders and the concept of “imposter syndrome.

Leaders must be able to cast a vision before followers to lead effectively…remember the transformational leader theory from Week 1 and the importance of the Leader/Follower relationship?  What is your vision of nursing in the year 2021? What strategies would you employ to engage your followers in working with you to reach that vision? What barriers do you anticipate? How would you approach and overcome the barriers? How would you measure success in achieving your vision?

The new College of Nurses Entry to Practice Competencies (2019) highlight the role of nurses as leaders and advocates.

“Registered nurses are LEADERS who influence and inspire others to achieve optimal health outcomes for all.

Registered nurses are ADVOCATES who support clients to voice their needs to achieve optimal health outcomes.

Nurses are expected to be strong advocates for patients, families, communities, and social issues.

 (CNO, 2019, p.7)

Health care is also changing globally. Some of these challenges include: climate change and environmental issues; technological and scientific advances; labour market expectations; migration; differing disease trends and changes to the burden of disease; antimicrobial resistance, demographic shifts (aging population); and the commodification and prioritization of health (All-Party Parliamentary Group on Global Health, 2016 ).

As such, nursing leadership must occur at all levels in the system, from clinical practice, education and administration to research and policy development. The Canadian Nurses Association (2009) in their position statement on nursing leadership identified the importance of effective leadership in affecting nurses’ quality of work life, but also its impact on the entire health system.

Nursing is a practice discipline and a political act (CNA, 2009, p.1)

On October 15, 2020, the International Council of Nurses (ICN) announced the theme for International Nurses Day 2021 (#IND2021). Note: International Nurses Day is celebrated around the world every May 12, the anniversary of Florence Nightingale’s birth.

“COVID-19 has changed our lives, deeply affecting those who have been infected and those who have lost loved ones as a result of this devastating virus. The pandemic greatly impacted the lives of nurses and the health systems they serve. Although daily life may have changed, the core character of nursing has not. Now more than ever, health, economies and societies are heavily influenced by nurses who are on the frontlines battling COVID-19 whilst continuing to improve access to quality and affordable healthcare. As a result of COVID, health systems and healthcare are under enormous strain. However, in response to this pressure, healthcare is on the brink of large-scale disruption and innovation. As the largest provider of healthcare services, nurses are leading this revolution of the healthcare system (ICN, n.d.)”

#IND2021, Nurses: A Voice to Lead – A vision for future healthcare, looks at the challenges nursing faces and how the profession will transform the next stage of healthcare. Are you ready as a 21st century nurse? What leadership competencies do you need? What followership competencies do you need

Lesson Presentation – The New Competencies for Nursing Leaders (Part 2)

As we move forward in 2021, effective leadership is paramount. Effective leadership is known to be a prime determinant of work satisfaction. The presence of strong leadership sets the tone for achievement in the work environment.

Strategies: Nurses must develop new competencies and leadership skills both within areas of nursing practice and in collaboration with other health partners and consumers. Remember from Week 1 we discussed personal attributes and behaviours needed to lead, manage, and follow: ethics, emotional intelligence (EI), appreciative inquiry (AI), resilience, and mindfulness. Additional essential skills of nurse leaders in the 21st century include judgement and decision making, negotiation, critical thinking, people management, complex problem-solving, data management, competence in technology, and political acuity.

New leaders will need to be adaptive and creative and bring stakeholders from many fields together to solve the “wicked problems” facing health care today. Identifying and testing new approaches will begin to address the complex challenges that will continue to arise in health care.

LEADERSHIP MUST HAPPEN AT EVERY LEVEL SO THAT NURSES CAN PROVIDE QUALITY CARE AND POSITIVE OUTCOMES IN EVERY PRACTICE AREA WHERE THEY WORK.

Nurses at every level must develop these competencies to achieve excellent health outcomes . Nursing research proposes that a new agenda on leadership in health should encompass the following:

  • Interactive leadership, which includes different actors within the health system
  • Empowerment of operational leaders to look at new mechanisms and build a learning health system
  • Involvement of communities, patients, and families in the heath dialogue
  • Increasing evidence and research to understand leadership in different health systems.

Nurses must lead to improve work processes at the point of care, create new practice models, collaborate with stakeholders to develop policy and legislation that allow nurses to work to full capacity, lead nursing curricula to prepare nurses, translate and apply research and best practice, develop new and innovative models of care, and, finally, have a role on institutional and policy boards where critical health decisions are made. WOW that’s a lot to do….. We will work through all these strategies during this semester

What about YOU…the new nursing graduate?

Ekstom and Idvall (2015) describe how new registered nurses experience their leadership role within the care team. Being a team leader is challenging for novice leaders who described feeling inadequate and lacking the necessary experience to lead and not having access to the necessary supports or mentors to assist in their development as leaders. Yet, they also identified the importance of being self-aware, learning from personal experience and the value of team work and effective collaboration in their leadership roles supporting patient care.

Novice leaders may also experience the “imposter phenomenon,” self-doubt in one’s ability to function adequately in one’s role. This may prevent nurses from taking advantage of leadership opportunities because of feelings of inadequacy. Christensen et al. (2016) found that nursing students experienced mild to moderate feelings of imposter phenomenon despite the number of clinical practice hours and amount of preparation. Aubeeluck et al. (2016) suggest that all nurses may experience imposter phenomenon at various stages of their career and this may be a typical reaction in transitioning from student to registered nurse or from one role to another.

To support leadership at all levels of the organization, it is important that student and early-career nurses determine their unique leadership goals and that they also be afforded the support and opportunities to develop leadership competencies.

What will you do as a new graduate to support your leadership role?

Required Reading / Viewings

Canadian Nurses Association (2012). Position Statement – Nursing Leadership

Cummings, G. (2012). Editorial: Your leadership style – how are you working to achieve a preferred future? Journal of Clinical Nursing,21(23-24), 3325-3327.

International Council of Nurses (ICN) – ICN Voice to Lead-Landing Page. (n.d.). Retrieved from https://www.icnvoicetolead.com/

Reference List:

Aubeeluck, S. (2016). Do graduate entry nursing student’s experience “Imposter Phenomenon”?: An issue for debate. Nurse Education in Practice, 19, 104–106. https://doi.org/10.1016/j.nepr.2016.06.003

Ekström, I. (2015). Being a team leader: newly registered nurses relate their experiences. Journal of Nursing Management, 23(1), 75–86. https://doi.org/10.1111/jonm.12085

Christensen, A. (2016). Do student nurses experience Imposter Phenomenon? An international comparison of Final Year Undergraduate Nursing Students readiness for registration. Journal of Advanced Nursing, 72(11), 2784–2793. https://doi.org/10.1111/jan.13034

Lessons in this Section

Lesson 2.2 Leadership Styles for Today

Overview Lesson Overview

This lesson will focus on the importance of informatics competencies for nurses including the 6 “P”s of social media use. In addition, a more in depth look at leadership styles specifically how leadership styles evolve as nurses develop from novice to expert, and depending on their area of practice and practice setting.

Presentation Icons - Download Free Vector Icons | Noun Project Lesson Presentation – Leadership, Health Informatics and Social Media (Part 1)

Health Informatics and social media are two areas in which nurses must take a leadership role to build knowledge and skills. Research suggests that nursing informatics competencies is one method to support nurses globally in addressing the new health challenges of the future. At a basic level this means having the ability to retrieve the best available evidence, use communication and other technology effectively, and understand information management. The Canadian Association of Schools of Nursing (CASN) published Nursing Informatics – Entry to Practice Competencies for Registered Nurses. CASN has defined three entry-to-practice nursing informatics competencies with the following overarching competency – Uses information and communication technologies (ICTs) to support information synthesis in accordance with professional and regulatory standards in the delivery of patient/client care. The three entry to practice nursing informatics competencies include:

  1. Information and Knowledge Management Competency: Uses relevant information and knowledge to support the delivery of evidence- informed patient care.
  2. Professional and Regulatory Accountability Competency: Uses ICTs in accordance with professional and regulatory standards and workplace policies.
  3. Information and Communication Technologies Competency:  Uses information and communication technologies in the delivery of patient/ client care.

The International Nurse Regulator Collaborative is used by the College of Nurses of Ontario to identify common expectations for nurses when using social media and provides six “P”s of social media use.

Social media has the potential to become a useful tool for contemporary nurse leaders. The rise of digital literacy, including social media literacy, has exploded with most people using computer platforms and smart mobile devices to connect to Twitter, Facebook, Instagram, YouTube, LinkedIn, and the like. It is a space where you can participate at the individual micro level, or on a much larger macro scale through monitoring tools, data exploration and crowd sourcing.

Social media is allowing more engagement between nurses, patients and other health care providers, as it facilitates engagement of ideas and allows evidence, opinions, expertise, and resources to be shared globally. It is important that student and registered nurses alike focus on developing their digital and interpersonal skills to become social media leaders. Through the use of data and social media listening tools, nurses can begin to understand and gain insight into a variety of issues. By using social media, nurses become visible and accessible role models ( Moorley & Chin, 2016 – See Required Reading below). This idea of being a social media leader is the premise of the Change Initiative and Presentation Assignment due Week 10. You will research how to create a professional social media platform, develop a change initiative, and then use social media to implement your change initiative strategy

Leadership styles will evolve as you develop from a novice to expert nurse and may change based on your area of practice and practice setting (e.g., research, education, policy, administration). Therefore, it is important to be aware of the various leadership styles that you can draw upon.

The nursing literature identifies many leadership styles, which have been categorized by Cummings (2012 – see Lesson 2.1) as either task-focused or relational. The task-focused style includes autocratic, transactional, instrumental, and laissez-faire leadership, while relational leadership centres more on people and relationships and includes transformational, emotionally intelligent, resonant and participatory leadership. Refer to Week 1 for a description of leadership theories such as transformational and transactional leadership.

Read Cope, V. & Murray, M. (2017) found below in Required Readings. Also use this chart to help guide your reading and viewing of the following video lecture. Please click

Required Reading / Viewings

Moorley C, Chinn T.  Developing nursing leadership in social media .  Journal of Advanced Nursing . 2016;72(3):514–520. doi:  10.1111/jan.12870 .

Cope, V. & Murray, M. (2017). Leadership styles in nursing. Nursing Standard, 31(43), 61-69. https://search-proquest-com.ezproxy.library.yorku.ca/docview/1953961371/fulltextPDF/F993D70F94854B84PQ/47?accountid=15182

Additional Resource

Hooijberg R.  Instrumental Leadership: the Nuts and Bolts of Leadership . Lausanne, Switzerland: International Institute for Management Development; 2014 Retrieved from:.

https://www.imd.org/research-knowledge/articles/instrumental-leadership-the-nuts-and-bolts-of-leadership/

Lesson 2.3 Leadership Impact, Development and Challenges

Lesson Overview

This lesson will focus on the importance of how leadership impacts patient outcomes, nurse outcomes and practice setting related outcomes. We will discuss how nursing leaders are developed through self-development, as well as support from their organization and mentorship. Lastly, we will investigate the five practices included in The Leadership Challenge framework.

Reflecting on our Leadership Challenge Workshop | The Marketing Squad

Lesson Presentation – The Impact of Leadership (Part 1)

Nursing leadership is essential for improving and sustaining outcomes at the patient, professional, and organizational levels. Nurse researchers have provided a wealth of evidence that supports the impact of leadership.

1.  Patient Outcomes

Wong et al. (2013) conducted a systematic review (see below – Research Perspective) to examine the relationship between nursing leadership practices and patient outcomes. In this study, a leader was defined as a nurse in a formal leadership role at any level of the organization who is involved in the direct supervision of other nurses. Twenty studies were included in the review, which identified a variety of patient satisfaction and patient safety outcomes associated with various leadership styles.

Patient Satisfaction: Leadership was positively associated with patient satisfaction in seven studies. Both relational and transactional leadership styles had a positive association with patient, resident, and/or family satisfaction. Transactional leadership in nursing homes was positively associated with family satisfaction with resident care, in that transactional leaders may provide more direction and clear work expectations regarding care. Makes sense!!

Patient Safety Outcomes:  Four studies identified the link between transformational and resonant leadership styles and decreased patient mortality. Decreased medication errors, patient falls, incidence of pressure ulcers, and infection rates were associated with positive leadership styles, with a transformational leadership style being the most frequently described.

These findings support the idea that relational leadership styles are associated with positive patient outcomes. The positive relationship between both relational and transactional styles may indicates the benefits of a leadership practices that include elements of different styles in achieving desired outcomes.

Research Perspective: Wong, et al. The relationship between nursing leadership and patient outcomes: a systematic review update. Journal of Nursing Management , 2013; 21(5); 709–724. This systematic review included 20 studies that examined the relationship between nursing leadership practices and patient outcomes. The results of the systematic review documented the evidence of a relationship between relational leadership and a variety of positive patient outcomes, although future testing of leadership models that examine the mechanisms of influence on outcomes is warranted.

Implications for Practice: Efforts by organizations and individuals to develop transformational and relational leadership reinforces organizational strategies to improve patient outcomes.

 2.  Nurse Outcomes

A systematic review conducted by Cummings et al. (2010) included 53 studies that demonstrated the relationship between leadership and nurse-related outcomes within five distinct categories of satisfaction, such as work, role, relationships, health and wellbeing, work environment and effectiveness.

Relational focused leadership styles, such as resonant and transformational, were associated with higher nurse satisfaction and higher satisfaction with their leader.

Transformational leader styles were associated with higher degrees of organizational commitment and intent to stay, higher overall staff health, and lower reported levels of anxiety, emotional exhaustion, job tension, and stress.

Transformation and resonant leadership styles were also associated with higher levels of role clarity, team functioning, and nurse–physician collaboration.

 Hmmm…..What type of leadership would you want???

 3.  Practice Setting Related Outcomes

Nursing leadership is critical to the ability to deliver high quality patient outcomes, to overall unit effectiveness and organizational sustainability.

Leadership at all levels of the organization plays a key role in the creation and sustainability of healthy work environments.

Shirey (2017) described leadership practices for creating and sustaining healthy work environments as four themes:

  • Quality leadership (e.g., people-focused rather than task-focused styles)
  • Relational exchanges (e.g., quality of the relationship between managers and staff)
  • Environmental elements (e.g., supportive structures and access to resources), and
  • Contextual factors (e.g., organizational culture and climate).

Lesson Presentation – Developing Future Leaders (Part 2)

As you can see, the knowledge, skills and attributes required for effective leadership are multi-faceted and complex. As such, leadership is a skill that does not simply involve formal education, but is developed over time.

Nursing students have the opportunity within and outside their nursing education to articulate and identify those skills that will enable them to become nursing leaders of the future. Organizations also have a role to play in identifying and developing potential future leaders.

1.  Role of the Emerging Leader – What’s your role??

Individuals who aspire to become nursing leaders need to assume responsibility for their own learning and development through identifying those competencies they require to embark on this leadership journey. Person Walking Icon Free Vector Art - (600 Free Downloads)

Simpson et al., (2011) encourage individuals to engage in reflective learning practices, including journaling, coaching conversations, use of assessment tools (e.g., 360-degree feedback), and building an individualized leadership plan. Emerging leaders can seek out mentors who are themselves established leaders, and who can be extremely valuable in assisting the future leader to develop their values and learn how to integrate their own personal style into the culture of the workplace or, more broadly, the whole profession. They can also help the future leader begin to develop a stronger sense of self ( Simpson et al., 2011 ).

What is 360 Degree Feedback? 360 Degree Feedback is a system or process in which employees receive confidential, anonymous feedback from the people who work around them. This typically includes the employee’s manager, peers, and direct reports.

360 Degree Feedback – Definition, Benefits, Process and Examples

There are other ways for individuals to enhance their leadership journey. A tangible way is for nurses to develop an action plan for career advancement. This may mean engaging more intentionally in their nursing education through career planning and development, or, if already a registered nurse, looking at higher education courses, such as a masters or doctoral degree program. Leaders may also consider earning certificates in a nursing specialty area. Attending courses, workshops and conferences (e.g., CNSA or other professional conferences) is another way of enhancing your leadership abilities. Did you know the Canadian Nurses Association offers specialization in 22 nursing practice specialties?? Check it out and become a leader in your specialty after your graduate. In the meantime, start building your transformational leadership behaviour by reviewing the picture below.

START BUILDING – Transformational Leadership Behaviours

2.  Role of the Organization

Organizations must also recognize and nurture the development of future nurse leaders. By doing so, they will be rewarded with leaders who can motivate, inspire change, and work with interprofessional colleagues in a shared vision of an environment of empowerment. As we have read above, clinical leaders are crucial to the success of patient care initiatives: good leaders produce good care. If organizations identity and nurture future leaders, excellence in patient and family-centred care can be achieved. Health care organizations are now specifically incorporate leadership expectations in every job description, from front-line practitioner to senior management.

Health care organizations can also recruit and retain leaders to achieve their strategic priorities. Ongoing support in the area of leadership development is vital to organizational effectiveness ( Cummings et al., 2010 ). Organizations that celebrate and communicate leadership accomplishments recognize leadership as a core function of the organization. Projects and accountability for results demonstrates commitment to building internal leadership capacity ( Simpson, 2011 ).

Organizations can also provide education focused on how to foster innovation, creativity and change by developing new leader competencies, including building coalitions, developing intra-and inter-organizational partnerships and networks, and measuring system outcomes.

    Learning Activity 2.3

Reflecting upon the leadership qualities and competencies you identified in Exercise 2.2:

1. Examine the website of one of your practice placements to see what professional development resources and opportunities are available to help nurses build up their leadership competencies.

2. Examine the website of a provincial or national nursing professional association to see what resources they offer for leadership development of their members.

Lesson Presentation – The Leadership Challenge ™ (Part 3)

Kouzes and Posner (2012) developed The Leadership Challenge as a framework of easily applied, measurable and teachable leadership behaviours. Known worldwide as the most practical model of leadership development, the five leadership practices enable the development of leadership potential in all formal or informal leaders, at any level of an organization (http://www.leadershipchallenge.com/about.aspx ). Note we touched on this in the required reading for Week 1.

The five practices included in the framework are:

  1. Model the way.
  2. Inspire a shared vision.
  3. Challenge the process.
  4. Enable others to act.
  5. Encourage the heart.

Pullen (2016) applied these leadership practices when describing leadership in nursing practice.The table below provides exemplars of each of the leadership practices in action that can be used by students and novice nurses as they further develop their leadership practices.

Let’s think about it….How have you, or how have you seen others, enact each leadership practice below.

Lessons in this section

Lesson 4.1 – Current Theories of Change and Perspective

A Challenge

A student group is taking an undergraduate course on Health and Healing Promoting Community and Societal Health. Of interest to the group is the health inequities experienced by immigrant and refugee groups in their local community. The group wants to develop a health promotion initiative aimed at increasing health care access. Amy, one of the students, had done some research in this area and found out that social determinants of health, for example, health literacy, gender, local geography, and social support networks, are playing an increasing role in primary health care accessibility. Amy asks: “How could the local primary health care team increase accessibility to health services for refugees?” and “What needs to be in place for newcomer families to utilize a primary health clinic?” Amy is also wondering about how they could develop an initiative that promotes accessible primary health care for newcomers. If you were Amy, what community engagement strategies could you initiate to promote change?

By the end of this lesson, you will be able to provide Amy with strategies to promote change. smile

Yoder-Wise, Patricia S.,Waddell, Janice,Walton, Nancy. Leading and Managing in Canadian Nursing E-Book (Kindle Locations 15181-15188). Elsevier Health Sciences. Kindle Edition.

Overview Lesson Overview

RECAP: The first two weeks of Nurse as Leader and Agent of Change outlined the importance of Bachelor of Science in Nursing (BScN) prepared registered nurses being READY TO LEAD CHANGE in the workplace and in everyday practice. In week 3, we discussed the importance of certain competencies, such as self-awareness, critical thinking and self-reflexivity, as required for nurse leaders.

In Part 1 of this lesson, we review the most common change theories or framework on planned change. Nursing students are typically introduced to the following change theories:

  1. Lewin’s 3-stage Model of Change: Unfreezing, Changing & Refreezing
  2. Kotter’s 8-Step Change Model
  3. Diffusion of Innovation Theory

In Part 2 of this lesson, we will critique these current theories as to whether they are useful in nursing leadership whereby highly complex, accelerated, and unpredictable change situations of contemporary everyday nursing practice requires a contextualized, relational and strengths based approach.

For this lesson, I will be using Study.com to teach the different theories of change. Study.com is the largest, most extensive website for educators and students. Study.com is an online learning platform that offers MOOCs (massive open online courses). I have registered for a teaching plan with Study.com  There is no cost to students, however you will be directed to create an account to see the material. I am choosing to use Study.com for this lesson as the change theory lessons have been developed by professors, curriculum developers and subject matter experts in the field of business management.

One Decision to Make Change Exciting - BayToday.ca

Lesson Presentation – Theories of Change (Part 1)

1.  Lewin’s 3-stage Model of Change: Unfreezing, Changing & Refreezing

Lesson Objective: After watching this lesson, you should be able to summarize the three steps of Kurt Lewin’s change model and explain how to apply them in the workplace (total 8:06 min)

Please use this link to access the course information on Lewin’s theory

Let’s think about it….think of an example of how you could apply Lewin’s 3-stage model of change as a nurse leader.

Do you think this statement from the lesson applies to healthcare? “Some argue that the refreezing step is outdated in contemporary business due to the continuous need for change. They find it unnecessary to spend time freezing a new state when chances are it will need to be reevaluated and possibly changed again in the immediate future.”

2. Kotter’s 8-Step Change Model

Lesson Objective: After watching this lesson, you should be able to identify and paraphrase the steps of John Kotter’s eight-step change model (Total time: 10:45 min)

Please use this link to access the course information on Kotter’s 8-Step Change Model

 Let’s think about it…. Apply Kotter’s 8-Step Change Model to a nursing issue such as improving ‘bedside handoff”.  Read Using Kotter’s Change Model for Implementing Bedside Handoff and use this guided note to outline Kotter’s 8-Steps in implementing this quality improvement project.

3.  Diffusion of Innovation Theory

Lesson Objective: After watching this lesson, you should be able to identify and paraphrase the steps of Diffusion of Innovation Theory (Total time: 6:45 min)

Please use this link to access the course information on the Diffusion of Innovation Theory.

 Let’s think about it.. Diffusion of Innovation Theory has been widely applied to public health in achieving effective disease prevention. Check out this editorial on how the Diffusion of Innovation Theory was applied to diabetes care.

 Lesson Presentation – Critiquing Current Perspectives (Part 2)

The change theories identified above focus on PLANNED CHANGE. These theories can be helpful in stable situations in which one is trying to make an incremental change, for example, applying Kotter’s 8-Step Change Model to a nursing issue such as improving ‘bedside handoff’.  As such, these planned linear change theories are useful in somewhat stable (low-complexity change) contexts. However, the highly complex, accelerated, and unpredictable change situations of contemporary everyday nursing require a different approach.

Flag of Canada Maple leaf Canada Day - Canada png download - 1024*1024 -  Free Transparent Canada Day png Download. - Clip Art LibraryHealth care in Canada is in the midst of unprecedented change.

A COVID-19 pandemic, shrinking health care dollars, the increasing demand for services, human resources shortages, health care reform, increased complex health care needs of individuals and groups, and a growing body of research on the need for innovation mean that the health care system is unpredictable and chaotic. To address this complexity, nurses leading change can no longer ONLY rely on the typical planned change theories or frameworks. This is where Complexity Theory can guide us.

Complexity theory (or complexity science) is the study of complexity and of complex systems. Complexity theory allows us to better understand organizational systems, organizational change, and leadership. Complexity theory can offer insights into how organizations can become more sustainable, adaptive, and innovative.

Watch the video below to understand the key concepts related to complexity theory. What benefit does understanding complex systems offer you as a nurse leader?

Think about it…Let’s consider complexity theory in relation to the COVID-19 pandemic. Could complexity thinking help us understand and identify strategies for the COVID-19 pandemic?

Along with understanding complex systems, nurse leaders need to lead change by aligning it with the relational values of nursing. In Lesson 2.2, we discussed the different styles of nursing leadership. Remember, relational leadership centres on people and relationships and includes transformational, emotionally intelligent, resonant and participatory leadership.

Doane & Varcoe (2016) state, “from a relational perspective, leadership is understood to be a relational process that occurs and is enacted among people and within contexts . . . it is understood that the influence of both formal and informal leaders is shaped by the specific contexts within which they are working, the people with whom they work, and the relationships among them” (p. 426). I’ve included a required reading below that explains relational practice.

Lastly, don’t forget about using a strengths -based leadership approach to make change (Remember from Lesson 1.1 & Gottlieb, 2012). Many planned change theories focus on the ‘deficits’ and so ‘deficit approaches’ remain the dominant perspective in health care to make change. In another article by Gottlieb (2013), the author further explains, “The deficit approach has yielded short term solutions that often have been proven to be unsustainable in the long term. People have difficulty maintaining change when motivated by fear and when reminded of their weaknesses, what they are missing, what is malfunctioning or dysfunctional”. Gottlieb (2013) calls for a profound shift in our thinking that moves from a narrow focus on a problem or deficit to a wider perspective. She argues, “The person, family, and community are situated in their context and history of their lives with their many facets, layers and complexities” Similarly, leading change draws on multiple forms of knowledge without privileging a leadership position or status.

Required Reading

The alternative model that I will describing in Lesson 4.2 is a Relational change framework. It is important that you understand what relational practice is with respect to you a nurse leader.

Doane, V. (2007). Relational practice and nursing obligations. Advances in Nursing Science, 30(3), 192–205. https://doi.org/10.1097/01.ANS.0000286619.31398.fc

References:

Small, G. (2016). Using Kotter’s Change Model for Implementing Bedside Handoff: A Quality Improvement Project. Journal of Nursing Care Quality, 31(4), 304–309. https://doi.org/10.1097/NCQ.0000000000000212

Doane G, Varcoe C.  How to nurse: Relational inquiry with individuals and families in changing health and health care contexts . Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins; 2016.

Dyess, S. (2013). Gottlieb, L. (2013). Strengths-based nursing care: Health and healing for person and family. New York: Springer Publishing: Book Review. Nursing Forum (Hillsdale), 48(1), 2–2. https://doi.org/10.1111/nuf.12011

Systems Innovation (Producer). (2019, September 27). Complexity Theory – Key Concepts[Video file]. Retrieved January 28, 2021, from https://youtu.be/hLXIJF5ytpM27

Lewin’s 3-Stage Model of Change: Unfreezing, Changing & Refreezing. (2012, September 11). Retrieved from https://study.com/academy/lesson/lewins-3-stage-model-of-change-unfreezing-changing-refreezing.html.

Applying Kotter’s 8-Step Change Model. (2012, October 4). Retrieved from https://study.com/academy/lesson/applying-kotters-8-step-change-model.html.

Diffusion of Innovation: Theory, History & Examples. (2015, October 30). Retrieved from https://study.com/academy/lesson/diffusion-of-innovation-theory-history-examples.html.

Lessons in this section

Lesson 4.2 – Presenting An Alternative Relational Change Framework

Lesson Overview

Lesson 4.2 and Lesson 4.3 offer an alternative approach to leadership for nurses leading change. This alternative framework includes three general phases: Creating Collaborative Relationships; Engaging in Critical Dialogue; and Reflection in Action (Praxis). It is proposed that the change process is fluid and contextual and dependent upon collective engagement and integration of multiple ways of knowing, i.e., all voices.

Lesson 4.2 describes the WHAT of the change process. Lesson 4.3 will describe the HOW of leading effective change.

Let’s think about it…. What are the conditions that must be present for change to occur?

The authors (Hills, Clark, & Simon, 2020) propose a change framework comprised of three interrelated components that are necessary and sufficient and that act in synergy to bring about change:

  1. Creating collaborative relationships
  2. Engaging in critical dialogue
  3. Reflection-in-action.

Lesson Presentation – Creating Collaborative Relationships (Part 1)

Let’s start here….what is collaboration?

Before detailing the first component, creating collaborative relationships, it is important to consider what we mean by collaboration .

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The process of nurses leading change should arguably always be collaborative, involving the change leader working together with stakeholders who are interested in bringing about the desired change and vice versa. We call this concept leading from beside ( Hills, 2016 ). Others have described this process as shared governance.

The following definition best captures the collaboration that is needed to lead the change process in this way.

 Collaboration is the creation of a synergistic alliance that honours and utilizes each person’s contribution to create collective wisdom and collective action.

 Collaboration is not synonymous with cooperation, partnership, participation, or compromise. Those words do not convey the fundamental importance of being in a relationship or the depth of caring and commitment needed to create the kind of reciprocity that is collaboration.

 Collaborators are committed to, care about, and trust in each other. They recognize that, despite their differences, each has a unique and valuable knowledge, perspectives, and experiences to contribute to the collaboration.In creating collaborative relationships as part of a change process, all participants are viewed as contributing partners. The leader and the participants share responsibility and joint decision making. This type of collaboration demands that leaders relate person to person with all team members.

It is not possible to develop a collaborative relationship with someone who assumes all responsibility and power , as with some traditional styles of team leadership.

 Leading change requires a facilitation process that supports equitable power relations and community building of these relationships. All participants fully engage in the process to build their capacity and feel a sense of ownership that moves the change process forward.

Let’s think about it….How do we create COLLABORATIVE RELATIONSHIPS?

#1: Developing Partnerships

The first element is creating collaborative relationships is developing partnerships. How often have you encountered someone’s decision to change things up by engaging the boss, choosing a charismatic leader, or securing the money without any consideration of who they will need to work with to get things changed?

The first element in creating collaborative relationships is to identify allies across and within groups who may have an interest in the proposed change, and to engage them as partners in the change process. Think about these questions….Is there anyone else that should be at the table with us? Whose voices matter and need to be represented, and is anyone being excluded? How can we work through tensions and differences?

#2: Negotiating Power

The second element of creating collaborative relationships is negotiating power. It is not possible to talk about leading change without talking about power. Power dynamics exist in all relationships, organizations, and health and social structures. Nurses leading a change process need to be aware of power dynamics, understand how they operate, and know how to negotiate power effectively for inclusivity and positive social change to occur.

Power can be an inherent attribute in many leadership positions, such as being a team leader or a nurse manager or leader on a project. However, leaders always have a choice of how they negotiate power: they can choose to have power over others or to have power with others, and to use power for a social good. In this alternative change framework, power is a relational process, negotiated through dialogue, reflexivity, and mutual interests. Negotiating power this way results in distributed leadership.

Power lies at the centre of emPOWERment and empowering behaviours of nurses leading change can be of paramount importance to the way that staff nurses react to their work environment and to the change.

Power is often correlated with a leadership role, as though leaders inherently have power and knowledge over health interventions and/or others. Leaders always have a choice on how to use power.

What strategies could you use to operationalize power for the purpose of leading change? What strategies in working with people can reduce power imbalances to promote meaningful social inclusion?

#3: Participation

The third element of creating collaborative relationships is participation. Without participation there can be no partnerships, no negotiation of power or relationships. Participation requires a commitment that is not necessarily present when you are merely involved in or associated with an activity or project. Participation is a conscious choice to commit time, resources, and energy to a change project. Participation demands engagement. In every change project, it is critical to make the process for discussion and decision making transparent and participatory.

Lesson Presentation – Engaging in Critical Dialogue (Part 2)

The second component of this alternative change framework—engaging in critical dialogue—is the backbone of this change framework. Critical dialogue encourages change agents to stay in a state of not knowing, to question taken-for-granted assumptions and habits, and to ask the unaskable..

Let’s think about it….How can we engage in CRITICAL DIALOGUE?

#1: AUTHENTIC LISTENING AND RESPONDING

Authentic listening and responding is the heart of critical dialogue. Being able to understand and to demonstrate that we understand another’s issues, concerns, and interpretations is a precious gift that nurses leading change can develop. It means listening not only to the words of another but also to the meaning that is conveyed between the words, the feelings and experiences that are not expressed, and what remains to be known.

When we are able to respond authentically in a way that the other feels understood, it allows change to occur. Authentic listening and responding requires that we suspend our judgements, assumptions, prejudices, and responses and hold space for the other’s story and perspective.

TRY IT OUT….In discussing a change initiative, you find yourself disagreeing with your collaborator as you are trying to put forward your opinion. You realize that in this situation the collaborator does not share your point of view. You shift your stance and decide to fully listen and engage with your collaborator through authentic listening. In this case, how could you demonstrate understanding of the other collaborator’s perspective?

Click here to provide one or two examples of a response that would effectively demonstrate authentic listening.

#2 CRITICAL THINKING

Hills and Watson (2011) argue that “critical thinking is a process that requires that we consistently and critically question our assumptions that underlie our customary, habitual ways of being, thinking and acting in everyday life and work” (p. 100). SOUND FAMILIAR from Week 3 when you completed your “Who Am I?”  Developing Self-Awareness Assignment

Critical thinking requires the ability to identify and challenge assumptions as they are enacted in our daily lives. Questioning our assumptions or raising our awareness about the assumptions we are making can be challenging because it implies that our personal and/or political existence might rest upon faulty foundations. Asking questions such as What constitutes a given reality? How do you know that? or Why must this be so? begins to uncover our taken-for-granted ideas and assumptions about the world.

Critical thinkers are aware that practices, structures, and actions are contextual. They are tuned in to the nuances of a given situation and they understand the dynamics that occur because of the context. “Because they understand the complexity of context, they can respond instantaneously to a given situation even though they may have never previously been in such a situation” ( Hills & Watson, 2011 , p. 103).

Critical thinkers can imagine and explore alternatives because they are aware that there are many possible ways to act other than the one that seems obvious. They are open and flexible and are willing to try different alternatives. Critical thinkers are wary of quick-fix solutions and have a healthy scepticism of situations that appear too easily remedied. Critical thinkers like to raise questions and are not intimidated, even when others’ views may differ. Importantly, critical thinking is a developmental process that requires culturally safe strategies for leading change. Remember from Lesson 3.2 the importance of cultural competence in being a nurse leader.

How You Can Improve Your Critical Thinking Skills - Australian Institute of  Business

Presentation Icons - Download Free Vector Icons | Noun Project Lesson Presentation – Reflection-in-Action (Praxis) Part 3

The third and final framework component is reflection-in-action. Put simply, reflection-in-action is the relationship between experience, theory, reflection, and action (Hills & Watson, 2011). Schon (1993) would call this the ability to “think on your feet” and learn to be a ‘reflective practitioner”.

References

Hills, M. D., Clark, N., & Carroll, S. (2020). Nurses Leading Change – A Relational Emancipatory Framework for Health and Social Action. In Yoder-Wise’s Leading and Managing in Canadian Nursing(pp. 15153-15738). Toronto, ON: Elsevier Canada. Retrieved January 28, 2021.

Lesson 4.3: The Change Process – A Relational Framework

◄ Week 3 Zoom Slides

Lessons in this section

Lesson 4.3: The Change Process – A Relational Framework

Overview Lesson Overview

The previous section describes the WHAT of the change process. In the following section, the HOW of leading effective change will be explored.

Nurses leading change using this relational change framework create and implement change through cycles of reflecting, planning, and acting that are based upon relational values. Through this process change is planned and operationalized. This process cycles through six phases: Initiation; Reflection and Planning; Action; Critiquing, Reflection and Planning; Follow-up Action; and Subsequent Cycles (see figure below).

Lesson Presentation – The Change Process: A Relational Framework

The following lecture will guide you through the HOW of the change process. Please click HERE for lecture slides.

Let’s think about it….Below is an example of Student Nurses Leading Change Using a Relational Change Framework

This section describes how an undergraduate nursing student group applied the relational framework for leading change in a community health course at the University of Victoria, British Columbia.

For the purpose of the student assignment, the student group applied a relational framework to evaluate their health promotion initiative, which examines the relationship between social media and student mental health on a university campus. Their assignment was to theorize how a relational framework could promote change for a social good and/or community development project.

In part one of this student assignment, students collected data from observation, windshield surveys, publicly accessible information on the University of Victoria (UVic) website, and the lived experiences of student members of the impact of social media and their mental health and well-being.

In Phase 1: Initiation, students proposed to implement an interpersonal workshop to identify the community of interest and key stakeholders. Once students identified key stakeholders (e.g., members of the university residence, University of Victoria [UVic] Residence Services, UVic Counselling Services, and the UVic faculty orientation team), they discussed how developing a plan of action (Phase 2) would start with establishing an inquiry group as a way to foster trust and promote equitable power relations and confidence within the group. Initiation and developing a plan of action included diverse faculty and student voices to examine how they would develop a health promotion initiative that would promote mental health and use of social media.

In Phase 3, students identified how they would act upon the model: in other words, how they would put a relational model into action. In this phase, the students outlined the specific workshop activities that would be inclusive and sensitive to a variety of different learning styles and knowledges. Students noted that evaluation began with Phase 1 of the proposed project where stakeholders could evaluate what they would like to have addressed throughout the plan of action. Students noted that it is important to address values and link values throughout planning and evaluation. In this context, the use of social media may have either negative or positive impacts upon students’ mental health. Through this process students described the cyclical nature of applying a relational framework through “reflecting and planning”, “action”, “analyzing, reflecting, and planning”, and “follow-up action” (Phase 4,5,6)

In traditional approaches to leadership, evaluation usually comes after a change initiative has been implemented and may not include the experience of all participants in the process, including those impacted by the change. The student group described above applied a relational framework to their evaluation process. In a relational process for leading change, this student group discussed that stakeholder collaboration includes and involves community-in-partnership in all phases of evaluation. Students argued that to have buy-in and action, program intervention must be continuous and collaborative, and that evaluation must also be participatory.

References

Yoder-Wise, Patricia S.,Waddell, Janice,Walton, Nancy. Leading and Managing in Canadian Nursing E-Book (Kindle Locations 15514-15515). Elsevier Health Sciences. Kindle Edition.

Summary and Conclusion

Lessons in this section

Conclusion and Solution

Conclusion

Now, more than ever, to make a positive impact in our discipline and across health care contexts, nurses have a moral responsibility to lead change that is both visionary and empowering. Given the complexity of the social world and its impact on everyday nursing work, it is argued that leadership must be transformative, attend to equitable power relations, be reflexive of theory and action, and engage in critical consciousness to uphold nursing’s commitment toward social justice.

The Week 4 module offered a relational framework as an alternative approach to leadership for nurses leading change . This framework includes three general phases: Creating Collaborative Relationships; Engaging in Critical Dialogue; and Reflection in Action (Praxis). It is proposed that the change process is fluid and contextual and dependent upon collective engagement and integration of multiple ways of knowing, i.e., all voices.

The BSN-student-led example demonstrates action and potential learnings from implementation of a relational framework.

A Solution

Go back Lesson 4.1 and review Amy’s challenge and the questions asked.

Amy and the group decided to use a relational framework and work through the six phases to bring about the desired change. In this context, to make change happen, they engaged not only key stakeholders, such as nurse practitioners, registered nurses, and physicians, but also settlement workers, child and youth workers, and local immigrant support workers. The student group realized that to support primary health care access and integration of Social Determinants of Health (SDOH) they would have to include wider community members. This team of stakeholders developed a conceptual model through a brainstorming activity by asking: What it would look like if the access needs of newcomer families were met? The team identified the need to have a greeter, translation services, patient navigator, linkages to settlement support, literacy resources, local social support networks, and resources available. The team decided to monitor the implementation of the change by collecting community stories from service users as well as service providers.

This approach helped nurses evaluate the impact of the change initiative. They learned that having a greeter made them feel comfortable and welcomed. Consequently, the number of people accessing the primary health care clinic increased. Having a translations service also reduced language barriers. The families found that in-person translators worked more effectively than translators over the phone, whereas health care providers preferred phone interpretation because of its efficiency. In the next iteration of the planned change process, the team decided to adjust the conceptual model to provide in-person services for lower-literacy newcomers. Although several challenges remain, other primary health care centres have decided to integrate SDOH into their delivery of primary health care services for newcomers. Would this process for leading change be a suitable approach in your workplace setting? Why or why not?

Required Reading

Kouzes, J. M & Posner, B. Z (2003). The five practices of exemplary leadership. http://www.ohacep.org/aws/OACEP/asset_manager/get_file/49721?ver=30

Lessons in this Section

Conclusion and Solution

Conclusion:

Health care locally and globally is changing rapidly, and nurses must be agents of change to provide leadership and direction. Nursing leadership must occur at all levels in the system from clinical and educational to administration and policy. Health informatics and social media are two areas where nurses need to assume leadership roles to build knowledge and skills. Many leadership styles are described in the literature, and nurses need to incorporate multiple styles into their own practice depending on the arena in which they are working. Nursing leadership is critical in order for good quality patient outcomes to be realized and for healthy work environments to be sustained.

Checkmark PNG Images | Vector and PSD Files | Free Download on PngtreeNeed to Know Now

  • Leadership styles vary; a combination of leadership styles is required to navigate complex environments.
  • There is a need for leaders at all levels.
  • Leadership styles have significant impact on patient, nurse, and organizational outcomes.
  • Leadership frameworks assist in the identification and development of leadership competencies.
  • Nurses need to develop leadership competencies using a great variety of strategies and resources.
  • New leadership competencies will be required for nurse to lead in the twenty-first century.
  • Students can begin their leadership development the first day of their nursing education.

Yoder-Wise, Patricia S.,Waddell, Janice,Walton, Nancy. Leading and Managing in Canadian Nursing E-Book (Kindle Locations 2248-2254). Elsevier Health Sciences. Kindle Edition.

A Solution

Go back Lesson 2.1 and review Lauren’s challenge and the questions asked.

To address this scenario, consider the following questions:

1. How can Lauren identify her own leadership style and determine what style or approach would work best to help her achieve success?

2. What leadership framework might assist Lauren in accomplishing her goal?

3. How will Lauren know what the impact this will have on staff and patient outcomes?

Welcome to Week 4 of 3514: Nurse as Leader and Agent of Change. This week will focus on nurses leading change.

This module will introduce you to a change framework for nursing that proposes three processes necessary and sufficient to bring about change. It suggests that nurses leading change engage in the change process with people rather than imposing it on or around them.

Leading change in this manner has the potential to engage nurses in an empowering transformational and relational experience. It honours each individual’s freedom of choice and multiple forms of knowledge, and therefore working with others within a context of freedom of choice and inclusivity makes this framework relational.

Leading change from this perspective is dramatically different from most other change theories or frameworks. The framework is described according to three processes: creating collaborativerelationships, engaging in critical dialogue, and reflection-in-action. This framework implements change through a series of cycles that are explored with examples.

After viewing the quick video overview below, proceed to Lessons in the Section to access your Week Four content.

Lessons in this section

Lesson 4.1 – Current Theories of Change and Perspective

Cute Minimalistic Cartoon Yellow Light Bulb Thinking Question Mark, Bulb  Clipart, Question Mark, Cartoon Minimalist Light Bulb PNG and Vector with  Transparent Background for Free Download A Challenge

A student group is taking an undergraduate course on Health and Healing Promoting Community and Societal Health. Of interest to the group is the health inequities experienced by immigrant and refugee groups in their local community. The group wants to develop a health promotion initiative aimed at increasing health care access. Amy, one of the students, had done some research in this area and found out that social determinants of health, for example, health literacy, gender, local geography, and social support networks, are playing an increasing role in primary health care accessibility. Amy asks: “How could the local primary health care team increase accessibility to health services for refugees?” and “What needs to be in place for newcomer families to utilize a primary health clinic?” Amy is also wondering about how they could develop an initiative that promotes accessible primary health care for newcomers. If you were Amy, what community engagement strategies could you initiate to promote change?

By the end of this lesson, you will be able to provide Amy with strategies to promote change. smile

Yoder-Wise, Patricia S.,Waddell, Janice,Walton, Nancy. Leading and Managing in Canadian Nursing E-Book (Kindle Locations 15181-15188). Elsevier Health Sciences. Kindle Edition.

Overview Lesson Overview

RECAP: The first two weeks of Nurse as Leader and Agent of Change outlined the importance of Bachelor of Science in Nursing (BScN) prepared registered nurses being READY TO LEAD CHANGE in the workplace and in everyday practice. In week 3, we discussed the importance of certain competencies, such as self-awareness, critical thinking and self-reflexivity, as required for nurse leaders.

In Part 1 of this lesson, we review the most common change theories or framework on planned change. Nursing students are typically introduced to the following change theories:

  1. Lewin’s 3-stage Model of Change: Unfreezing, Changing & Refreezing
  2. Kotter’s 8-Step Change Model
  3. Diffusion of Innovation Theory

In Part 2 of this lesson, we will critique these current theories as to whether they are useful in nursing leadership whereby highly complex, accelerated, and unpredictable change situations of contemporary everyday nursing practice requires a contextualized, relational and strengths based approach.

For this lesson, I will be using Study.com to teach the different theories of change. Study.com is the largest, most extensive website for educators and students. Study.com is an online learning platform that offers MOOCs (massive open online courses). I have registered for a teaching plan with Study.com  There is no cost to students, however you will be directed to create an account to see the material. I am choosing to use Study.com for this lesson as the change theory lessons have been developed by professors, curriculum developers and subject matter experts in the field of business management.

Lesson Presentation – Theories of Change (Part 1)

1.  Lewin’s 3-stage Model of Change: Unfreezing, Changing & Refreezing

Lesson Objective: After watching this lesson, you should be able to summarize the three steps of Kurt Lewin’s change model and explain how to apply them in the workplace (total 8:06 min)

Please use this link to access the course information on Lewin’s theory

Thinking İcon Png & Free Thinking İcon.png Transparent Images #64875 - PNGio Let’s think about it….think of an example of how you could apply Lewin’s 3-stage model of change as a nurse leader.

Do you think this statement from the lesson applies to healthcare? “Some argue that the refreezing step is outdated in contemporary business due to the continuous need for change. They find it unnecessary to spend time freezing a new state when chances are it will need to be reevaluated and possibly changed again in the immediate future.”

2. Kotter’s 8-Step Change Model

Lesson Objective: After watching this lesson, you should be able to identify and paraphrase the steps of John Kotter’s eight-step change model (Total time: 10:45 min)

Please use this link to access the course information on Kotter’s 8-Step Change Model

https://study.com/academy/lesson/lewins-3-stage-model-of-change-unfreezing-changing-refreezing.html

Thinking İcon Png & Free Thinking İcon.png Transparent Images #64875 - PNGio  Let’s think about it…. Apply Kotter’s 8-Step Change Model to a nursing issue such as improving ‘bedside handoff”.  Read Using Kotter’s Change Model for Implementing Bedside Handoff and use this guided note to outline Kotter’s 8-Steps in implementing this quality improvement project.

3.  Diffusion of Innovation Theory

Lesson Presentation – Critiquing Current Perspectives (Part 2)

The change theories identified above focus on PLANNED CHANGE. These theories can be helpful in stable situations in which one is trying to make an incremental change, for example, applying Kotter’s 8-Step Change Model to a nursing issue such as improving ‘bedside handoff’.  As such, these planned linear change theories are useful in somewhat stable (low-complexity change) contexts. However, the highly complex, accelerated, and unpredictable change situations of contemporary everyday nursing require a different approach.

Flag of Canada Maple leaf Canada Day - Canada png download - 1024*1024 -  Free Transparent Canada Day png Download. - Clip Art LibraryHealth care in Canada is in the midst of unprecedented change.

A COVID-19 pandemic, shrinking health care dollars, the increasing demand for services, human resources shortages, health care reform, increased complex health care needs of individuals and groups, and a growing body of research on the need for innovation mean that the health care system is unpredictable and chaotic. To address this complexity, nurses leading change can no longer ONLY rely on the typical planned change theories or frameworks. This is where Complexity Theory can guide us.

Complexity theory (or complexity science) is the study of complexity and of complex systems. Complexity theory allows us to better understand organizational systems, organizational change, and leadership. Complexity theory can offer insights into how organizations can become more sustainable, adaptive, and innovative.

Watch the video below to understand the key concepts related to complexity theory. What benefit does understanding complex systems offer you as a nurse leader?

Lesson Objective: After watching this lesson, you should be able to identify and paraphrase the steps of Diffusion of Innovation Theory (Total time: 6:45 min)

Please use this link to access the course information on the Diffusion of Innovation Theory.

Thinking İcon Png & Free Thinking İcon.png Transparent Images #64875 - PNGio  Let’s think about it.. Diffusion of Innovation Theory has been widely applied to public health in achieving effective disease prevention. Check out this editorial on how the Diffusion of Innovation Theory was applied to diabetes care. Lesson Presentation – Critiquing Current Perspectives (Part 2)

The change theories identified above focus on PLANNED CHANGE. These theories can be helpful in stable situations in which one is trying to make an incremental change, for example, applying Kotter’s 8-Step Change Model to a nursing issue such as improving ‘bedside handoff’.  As such, these planned linear change theories are useful in somewhat stable (low-complexity change) contexts. However, the highly complex, accelerated, and unpredictable change situations of contemporary everyday nursing require a different approach.

Flag of Canada Maple leaf Canada Day - Canada png download - 1024*1024 -  Free Transparent Canada Day png Download. - Clip Art LibraryHealth care in Canada is in the midst of unprecedented change.

A COVID-19 pandemic, shrinking health care dollars, the increasing demand for services, human resources shortages, health care reform, increased complex health care needs of individuals and groups, and a growing body of research on the need for innovation mean that the health care system is unpredictable and chaotic. To address this complexity, nurses leading change can no longer ONLY rely on the typical planned change theories or frameworks. This is where Complexity Theory can guide us.

Complexity theory (or complexity science) is the study of complexity and of complex systems. Complexity theory allows us to better understand organizational systems, organizational change, and leadership. Complexity theory can offer insights into how organizations can become more sustainable, adaptive, and innovative.

Watch the video below to understand the key concepts related to complexity theory. What benefit does understanding complex systems offer you as a nurse leader?

Think about it…Let’s consider complexity theory in relation to the COVID-19 pandemic. Could complexity thinking help us understand and identify strategies for the COVID-19 pandemic?

Along with understanding complex systems, nurse leaders need to lead change by aligning it with the relational values of nursing. In Lesson 2.2, we discussed the different styles of nursing leadership. Remember, relational leadership centres on people and relationships and includes transformational, emotionally intelligent, resonant and participatory leadership.

Doane & Varcoe (2016) state, “from a relational perspective, leadership is understood to be a relational process that occurs and is enacted among people and within contexts . . . it is understood that the influence of both formal and informal leaders is shaped by the specific contexts within which they are working, the people with whom they work, and the relationships among them” (p. 426). I’ve included a required reading below that explains relational practice.

Lastly, don’t forget about using a strengths -based leadership approach to make change (Remember from Lesson 1.1 & Gottlieb, 2012). Many planned change theories focus on the ‘deficits’ and so ‘deficit approaches’ remain the dominant perspective in health care to make change. In another article by Gottlieb (2013), the author further explains, “The deficit approach has yielded short term solutions that often have been proven to be unsustainable in the long term. People have difficulty maintaining change when motivated by fear and when reminded of their weaknesses, what they are missing, what is malfunctioning or dysfunctional”. Gottlieb (2013) calls for a profound shift in our thinking that moves from a narrow focus on a problem or deficit to a wider perspective. She argues, “The person, family, and community are situated in their context and history of their lives with their many facets, layers and complexities” Similarly, leading change draws on multiple forms of knowledge without privileging a leadership position or status.

Reading Icon #222765 - Free Icons LibraryRequired Reading

The alternative model that I will describing in Lesson 4.2 is a Relational change framework. It is important that you understand what relational practice is with respect to you a nurse leader.

Doane, V. (2007). Relational practice and nursing obligations. Advances in Nursing Science, 30(3), 192–205. https://doi.org/10.1097/01.ANS.0000286619.31398.fc

References:

Small, G. (2016). Using Kotter’s Change Model for Implementing Bedside Handoff: A Quality Improvement Project. Journal of Nursing Care Quality, 31(4), 304–309. https://doi.org/10.1097/NCQ.0000000000000212

Doane G, Varcoe C.  How to nurse: Relational inquiry with individuals and families in changing health and health care contexts . Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins; 2016.

Dyess, S. (2013). Gottlieb, L. (2013). Strengths-based nursing care: Health and healing for person and family. New York: Springer Publishing: Book Review. Nursing Forum (Hillsdale), 48(1), 2–2. https://doi.org/10.1111/nuf.12011

Systems Innovation (Producer). (2019, September 27). Complexity Theory – Key Concepts[Video file]. Retrieved January 28, 2021, from https://youtu.be/hLXIJF5ytpM27

Lewin’s 3-Stage Model of Change: Unfreezing, Changing & Refreezing. (2012, September 11). Retrieved from https://study.com/academy/lesson/lewins-3-stage-model-of-change-unfreezing-changing-refreezing.html.

Applying Kotter’s 8-Step Change Model. (2012, October 4). Retrieved from https://study.com/academy/lesson/applying-kotters-8-step-change-model.html.

Diffusion of Innovation: Theory, History & Examples. (2015, October 30). Retrieved from https://study.com/academy/lesson/diffusion-of-innovation-theory-history-examples.html.

Lessons in this section

Lesson 4.2 – Presenting An Alternative Relational Change Framework

Overview Lesson Overview

Lesson 4.2 and Lesson 4.3 offer an alternative approach to leadership for nurses leading change. This alternative framework includes three general phases: Creating Collaborative Relationships; Engaging in Critical Dialogue; and Reflection in Action (Praxis). It is proposed that the change process is fluid and contextual and dependent upon collective engagement and integration of multiple ways of knowing, i.e., all voices.

Lesson 4.2 describes the WHAT of the change process. Lesson 4.3 will describe the HOW of leading effective change.

Let’s think about it…. What are the conditions that must be present for change to occur?

The authors (Hills, Clark, & Simon, 2020) propose a change framework comprised of three interrelated components that are necessary and sufficient and that act in synergy to bring about change:

  1. Creating collaborative relationships
  2. Engaging in critical dialogue
  3. Reflection-in-action.

Lesson Presentation – Creating Collaborative Relationships (Part 1)

Let’s start here….what is collaboration?

Before detailing the first component, creating collaborative relationships, it is important to consider what we mean by collaboration .

he process of nurses leading change should arguably always be collaborative, involving the change leader working together with stakeholders who are interested in bringing about the desired change and vice versa. We call this concept leading from beside ( Hills, 2016 ). Others have described this process as shared governance.

The following definition best captures the collaboration that is needed to lead the change process in this way.

 Collaboration is the creation of a synergistic alliance that honours and utilizes each person’s contribution to create collective wisdom and collective action.

 Collaboration is not synonymous with cooperation, partnership, participation, or compromise. Those words do not convey the fundamental importance of being in a relationship or the depth of caring and commitment needed to create the kind of reciprocity that is collaboration.

Collaborators are committed to, care about, and trust in each other. They recognize that, despite their differences, each has a unique and valuable knowledge, perspectives, and experiences to contribute to the collaboration.In creating collaborative relationships as part of a change process, all participants are viewed as contributing partners. The leader and the participants share responsibility and joint decision making. This type of collaboration demands that leaders relate person to person with all team members.

It is not possible to develop a collaborative relationship with someone who assumes all responsibility and

It is not possible to develop a collaborative relationship with someone who assumes all responsibility and power , as with some traditional styles of team leadership.

  Leading change requires a facilitation process that supports equitable power relations and community building of these relationships. All participants fully engage in the process to build their capacity and feel a sense of ownership that moves the change process forward.

Thinking İcon Png & Free Thinking İcon.png Transparent Images #64875 - PNGio Let’s think about it….How do we create COLLABORATIVE RELATIONSHIPS?

#1: Developing Partnerships

The first element is creating collaborative relationships is developing partnerships. How often have you encountered someone’s decision to change things up by engaging the boss, choosing a charismatic leader, or

securing the money without any consideration of who they will need to work with to get things changed?

The first element in creating collaborative relationships is to identify allies across and within groups who may have an interest in the proposed change, and to engage them as partners in the change process. Think about these questions….Is there anyone else that should be at the table with us? Whose voices matter and need to be represented, and is anyone being excluded? How can we work through tensions and differences?

#2: Negotiating Power

The second element of creating collaborative relationships is negotiating power. It is not possible to talk about leading change without talking about power. Power dynamics exist in all relationships, organizations, and health and social structures. Nurses leading a change process need to be aware of power dynamics, understand how they operate, and know how to negotiate power effectively for inclusivity and positive social change to occur.

Power can be an inherent attribute in many leadership positions, such as being a team leader or a nurse manager or leader on a project. However, leaders always have a choice of how they negotiate power: they can choose to have power over others or to have power with others, and to use power for a social good. In this alternative change framework, power is a relational process, negotiated through dialogue, reflexivity, and mutual interests. Negotiating power this way results in distributed leadership.

Power lies at the centre of emPOWERment and empowering behaviours of nurses leading change can be of paramount importance to the way that staff nurses react to their work environment and to the change.

Power is often correlated with a leadership role, as though leaders inherently have power and knowledge over health interventions and/or others. Leaders always have a choice on how to use power.

Question mark sign. White icon on red circle. — Stock Vector ©  Asmati1702@gmail.com #125741616 What strategies could you use to operationalize power for the purpose of leading change? What strategies in working with people can reduce power imbalances to promote meaningful social inclusion?

#3: Participation

The third element of creating collaborative relationships is participation. Without participation there can be no partnerships, no negotiation of power or relationships. Participation requires a commitment that is not necessarily present when you are merely involved in or associated with an activity or project. Participation is a conscious choice to commit time, resources, and energy to a change project. Participation demands engagement. In every change project, it is critical to make the process for discussion and decision making transparent and participatory.

Presentation Icons - Download Free Vector Icons | Noun Project Lesson Presentation – Engaging in Critical Dialogue (Part 2)

The second component of this alternative change framework—engaging in critical dialogue—is the backbone of this change framework. Critical dialogue encourages change agents to stay in a state of not knowing, to question taken-for-granted assumptions and habits, and to ask the unaskable..

 Let’s think about it….How can we engage in CRITICAL DIALOGUE?

#1: AUTHENTIC LISTENING AND RESPONDING

Authentic listening and responding is the heart of critical dialogue. Being able to understand and to demonstrate that we understand another’s issues, concerns, and interpretations is a precious gift that nurses leading change can develop. It means listening not only to the words of another but also to the meaning that is conveyed between the words, the feelings and experiences that are not expressed, and what remains to be known.

When we are able to respond authentically in a way that the other feels understood, it allows change to occur. Authentic listening and responding requires that we suspend our judgements, assumptions, prejudices, and responses and hold space for the other’s story and perspective.

TRY IT OUT….In discussing a change initiative, you find yourself disagreeing with your collaborator as you are trying to put forward your opinion. You realize that in this situation the collaborator does not share your point of view. You shift your stance and decide to fully listen and engage with your collaborator through authentic listening. In this case, how could you demonstrate understanding of the other collaborator’s perspective?

CRITICAL THINKING

Hills and Watson (2011) argue that “critical thinking is a process that requires that we consistently and critically question our assumptions that underlie our customary, habitual ways of being, thinking and acting in everyday life and work” (p. 100). SOUND FAMILIAR from Week 3 when you completed your “Who Am I?”  Developing Self-Awareness Assignment

Critical thinking requires the ability to identify and challenge assumptions as they are enacted in our daily lives. Questioning our assumptions or raising our awareness about the assumptions we are making can be challenging because it implies that our personal and/or political existence might rest upon faulty foundations. Asking questions such as What constitutes a given reality? How do you know that? or Why must this be so? begins to uncover our taken-for-granted ideas and assumptions about the world.

Critical thinkers are aware that practices, structures, and actions are contextual. They are tuned in to the nuances of a given situation and they understand the dynamics that occur because of the context. “Because they understand the complexity of context, they can respond instantaneously to a given situation even though they may have never previously been in such a situation” ( Hills & Watson, 2011 , p. 103).

Critical thinkers can imagine and explore alternatives because they are aware that there are many possible ways to act other than the one that seems obvious. They are open and flexible and are willing to try different alternatives. Critical thinkers are wary of quick-fix solutions and have a healthy scepticism of situations that appear too easily remedied. Critical thinkers like to raise questions and are not intimidated, even when others’ views may differ. Importantly, critical thinking is a developmental process that requires culturally safe strategies for leading change. Remember from Lesson 3.2 the importance of cultural competence in being a nurse leader.

Lesson Presentation – Reflection-in-Action (Praxis) Part 3

The third and final framework component is reflection-in-action. Put simply, reflection-in-action is the relationship between experience, theory, reflection, and action (Hills & Watson, 2011). Schon (1993) would call this the ability to “think on your feet” and learn to be a ‘reflective practitioner”.

References

Hills, M. D., Clark, N., & Carroll, S. (2020). Nurses Leading Change – A Relational Emancipatory Framework for Health and Social Action. In Yoder-Wise’s Leading and Managing in Canadian Nursing(pp. 15153-15738). Toronto, ON: Elsevier Canada. Retrieved January 28, 2021.

essons in this section

Lesson 4.3: The Change Process – A Relational Framework

Overview Lesson Overview

The previous section describes the WHAT of the change process. In the following section, the HOW of leading effective change will be explored.

Nurses leading change using this relational change framework create and implement change through cycles of reflecting, planning, and acting that are based upon relational values. Through this process change is planned and operationalized. This process cycles through six phases: Initiation; Reflection and Planning; Action; Critiquing, Reflection and Planning; Follow-up Action; and Subsequent Cycles (see figure below).

https://drive.google.com/file/d/1SKR6LEGOfHiDQJAtfEMObeFnb88ufwdW/view

Let’s think about it….Below is an example of Student Nurses Leading Change Using a Relational Change Framework

This section describes how an undergraduate nursing student group applied the relational framework for leading change in a community health course at the University of Victoria, British Columbia.

For the purpose of the student assignment, the student group applied a relational framework to evaluate their health promotion initiative, which examines the relationship between social media and student mental health on a university campus. Their assignment was to theorize how a relational framework could promote change for a social good and/or community development project.

In part one of this student assignment, students collected data from observation, windshield surveys, publicly accessible information on the University of Victoria (UVic) website, and the lived experiences of student members of the impact of social media and their mental health and well-being.

In Phase 1: Initiation, students proposed to implement an interpersonal workshop to identify the community of interest and key stakeholders. Once students identified key stakeholders (e.g., members of the university residence, University of Victoria [UVic] Residence Services, UVic Counselling Services, and the UVic faculty orientation team), they discussed how developing a plan of action (Phase 2) would start with establishing an inquiry group as a way to foster trust and promote equitable power relations and confidence within the group. Initiation and developing a plan of action included diverse faculty and student voices to examine how they would develop a health promotion initiative that would promote mental health and use of social media.

In Phase 3, students identified how they would act upon the model: in other words, how they would put a relational model into action. In this phase, the students outlined the specific workshop activities that would be inclusive and sensitive to a variety of different learning styles and knowledges. Students noted that evaluation began with Phase 1 of the proposed project where stakeholders could evaluate what they would like to have addressed throughout the plan of action. Students noted that it is important to address values and link values throughout planning and evaluation. In this context, the use of social media may have either negative or positive impacts upon students’ mental health. Through this process students described the cyclical nature of applying a relational framework through “reflecting and planning”, “action”, “analyzing, reflecting, and planning”, and “follow-up action” (Phase 4,5,6)

In traditional approaches to leadership, evaluation usually comes after a change initiative has been implemented and may not include the experience of all participants in the process, including those impacted by the change. The student group described above applied a relational framework to their evaluation process. In a relational process for leading change, this student group discussed that stakeholder collaboration includes and involves community-in-partnership in all phases of evaluation. Students argued that to have buy-in and action, program intervention must be continuous and collaborative, and that evaluation must also be participatory.

References

Yoder-Wise, Patricia S.,Waddell, Janice,Walton, Nancy. Leading and Managing in Canadian Nursing E-Book (Kindle Locations 15514-15515). Elsevier Health Sciences. Kindle Edition.

Conclusion

Now, more than ever, to make a positive impact in our discipline and across health care contexts, nurses have a moral responsibility to lead change that is both visionary and empowering. Given the complexity of the social world and its impact on everyday nursing work, it is argued that leadership must be transformative, attend to equitable power relations, be reflexive of theory and action, and engage in critical consciousness to uphold nursing’s commitment toward social justice.

The Week 4 module offered a relational framework as an alternative approach to leadership for nurses leading change . This framework includes three general phases: Creating Collaborative Relationships; Engaging in Critical Dialogue; and Reflection in Action (Praxis). It is proposed that the change process is fluid and contextual and dependent upon collective engagement and integration of multiple ways of knowing, i.e., all voices.

The BSN-student-led example demonstrates action and potential learnings from implementation of a relational framework.

Week Seven content.

Lessons in this section

Lesson 7.1 Nursing Workplace Culture: Change Begins With You

 Lesson Overview

Workplace culture in nursing and healthcare is so important to job satisfaction, staff retention, and patient outcomes. Workplace culture isn’t always talked about, but nurses are negatively and positively affected by workplace culture. The thing is, you can choose to change a workplace culture that’s dragging you down, and you always have the choice to leave if it just feels impossible.

Lesson Presentation

What’s the culture like in your workplace? Do people naturally cooperate and collaborate? Are the leadership and executive teams available and transparent? What values and principles does your organization express?

An employer’s mission looks great on their “About” page, but it takes leadership to bring those values to life — unless, of course, employees take the culture into their own hands.

If bullying is tolerated or silently condoned in your workplace, the organizational culture is toxic If leaders ignore the value and importance of individual contributions, that’s another sign of an unhealthy workplace.

This lecture provides an introduction to leadership related to organization culture and work environments.

Required Reading

Warrick, D. D. (2017). What leaders need to know about organizational culture. Business Horizons 60 (3), 395-404. https://www-sciencedirect- com.ezproxy.library.yorku.ca/science/article/pii/S0007681317300113

Lessons in this section

Lesson 7. 2 Liberating Structures

Lesson Overview

  When you feel included and engaged, do you do a better job?

  Do you think teams in which people work well together produce much better results? Have you noticed the best ideas often come from unexpected sources? 

  Do you want to work at the top of your intelligence and give the same opportunity to others?

If YES, Liberating Structures help make it happen. Read the principles below on ‘liberating principles.”

  Lesson Presentation: What are Liberating Structures?

What are Liberating Structures?

Liberating Structures are a selection of 33 alternative structures for facilitating meetings and conversations, curated by Henri Lipmanowicz and Keith McCandless.

What’s the value in them?

There are five main conventional “microstructures” that we default to in organisations and groups:

  • Presentations
  • Managed discussions
  • Status reports
  • Open discussions
  • Brainstorms

The problem with these is they are either too constraining (in the case of presentations, managed discussions and status reports) or too loose (in the case of open discussions and brainstorms).

Source: “The Surprising Power of Liberating Structures” by Henri Lipmanowicz and Keith McCandless

Liberating Structures, on the other hand, are designed to embrace distributed control and include a fairer, larger number of people in shaping the next steps.

 The benefits? Innovation, inclusion, participation, clarity, purpose, fun… you’ll see when you experience them.

  Which Liberating Structure do I start with?

It doesn’t really matter which Liberating Structure you use. Any of them will be more effective than a conventional microstructure. However, 1-2-4-ALL is a great one a new leader can start with.

1–2–4-All (12 mins)

You can integrate this into any meeting, conversation or workshop super easily. It’s a great way of easing people into participating or discussing something, especially if there are people in the group with a tendency to be quiet.

The sequence is: reflect on something (a question, a topic, an idea) for 1 minute individually in silence, then discuss it in pairs for 2 minutes, then in fours for 4 minutes, and then come together as a whole group and cherry pick some highlights from each four to share with the whole group.

Required Reading

Holskey, M., & Rivera, R. (2020). Optimizing Nurse Engagement: Using Liberating Structures for Nursing Professional Practice Model Development. The Journal of Nursing Administration, 50(9), 468–473. https://doi.org/10.1097/NNA.0000000000000918

 References

Keith McCandless, H. L. (n.d.). Liberating Structures. Retrieved from https://www.liberatingstructures.com/ls-menu/

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Our Services

No need to work on your paper at night. Sleep tight, we will cover your back. We offer all kinds of writing services.

Essays

Essay Writing Service

No matter what kind of academic paper you need and how urgent you need it, you are welcome to choose your academic level and the type of your paper at an affordable price. We take care of all your paper needs and give a 24/7 customer care support system.

Admissions

Admission Essays & Business Writing Help

An admission essay is an essay or other written statement by a candidate, often a potential student enrolling in a college, university, or graduate school. You can be rest assurred that through our service we will write the best admission essay for you.

Reviews

Editing Support

Our academic writers and editors make the necessary changes to your paper so that it is polished. We also format your document by correctly quoting the sources and creating reference lists in the formats APA, Harvard, MLA, Chicago / Turabian.

Reviews

Revision Support

If you think your paper could be improved, you can request a review. In this case, your paper will be checked by the writer or assigned to an editor. You can use this option as many times as you see fit. This is free because we want you to be completely satisfied with the service offered.

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