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Chapter 1
A New Landscape for Leadership: Changing the Health Script in an Age of Value
Case Study 1-1
Transforming Leaders
Cameryn is the vice president for professional development at a large metropolitan hospital in the Midwest. She has been in her role for 6 years and has accepted new responsibilities over the years, widening her scope of work to include the direction of all of the clinical nurse specialists (CNSs), the new graduate residency program, and the research- and evidence-based practice initiatives. She also oversees the Magnet program, which strives for continual readiness for redesignation.
Cameryn and some of the other leaders in the organization have become concerned about the competence level of some nurse managers and their assistant managers, clinical leads, and shift supervisors. The managers and others “get the job done,” but they do not seem to be focused on inspiring the workforce to achieve excellence in their work or preparing potential leaders for succession. In fact, some managers seem to be threatened by informal leaders who excel in the clinical setting; they fail to encourage them to develop their skills and competencies to assume direct leadership roles in the future.
For all in manager and supervisory roles, the hospital provides a quarterly leadership educational event with motivational speakers. The feedback regarding the leadership event is positive, and managers are expected to share with their staff the new knowledge gained from the motivational speakers and presentations. How this new knowledge is shared and disseminated is not assessed. Cameryn wonders whether it is shared at all and questions how well the leadership messages are integrated into the daily behaviors and activities of the managers.
Cameryn has been reading about transformational leadership and how one of the characteristics of a transformational leader is to inspire others to achieve what they previously thought was impossible. Cameryn reflects on those in her own career who inspired her to return to school for further education and ultimately to seek roles where she could influence nursing practice and patient care. In her heart, she wants to provide the same experience for all developing nurse leaders in the clinical setting and also in beginning-level management positions. She believes that management is far more than “getting the job done and completing tasks” and needs to include behaviors that transform individuals into those who have a thirst for new knowledge and quest to constantly change the status quo to achieve excellence in their work.
Cameryn is inspired to do something about the development of the nurse managers. She realizes that the first step would be to inspire her colleagues to embrace the same vision for nursing leadership at all levels within the organization, especially with their focus on managing budgets and meeting organizational priorities. Cameryn is convinced that with better prepared frontline managers, many of the organizational priorities could be achieved more expediently. She wants the group to examine the current roles expected of clinical leads, shift supervisors, nurse managers, and their assistants and the personal and experience requirements for the roles. She also wants to impress upon her colleagues that their own behaviors strongly influence those who are watching their interactions with others and daily behaviors in their roles. She realizes that this is a sensitive subject, and she decides to develop a strategy to informally lead her colleagues on a journey for their own improvement and to influence them to improve the experience of their direct reports. She realizes that the interconnection between her colleagues and their direct reports is critical for the changes that she envisions to transform every nurse manager and supervisor into true inspirational leaders.
Cameryn decides to move beyond the occasional inspirational speaker and elects to empower the management team at all levels with as much information as possible about transformational leadership, workplace empowerment, healthy work environment, and nursing excellence. She works with the Collaborative Governance Council for Professional Development to initiate a leadership journal club for clinical leaders and all levels of management. The journal club is led by the members of the Professional Development Council who choose the journal articles to read and review. The council also establishes group meeting norms, leads the discussions about the articles, and creates a short summary of the articles for all of the nursing staff to read in the Magnet Nursing Newsletter.
Cameryn also decides that it is important to determine the actual learning needs of those in management positions, so she develops a self-assessment tool using the leadership domains outlined by the American Organization of Nurse Executives and the Benner levels of competency as the response set. The new assessment tool provides information as to how each manager, assistant manager, clinical lead, and shift supervisor perceives his or her level of competence in each of the leadership domains. From that information, Cameryn plans to ­develop educational content and experiences that are targeted to areas where managers perceive themselves to be least competent. She also meets with those who are more expert in the leadership domains and discusses their mentoring those who are less experienced and competent and presenting some of the formal content needed for development of the frontline ­leadership team.
Recognizing that professional development is a very complex and multileveled task, Cameryn also plans to develop educational content and experiences for the more expert group to teach them how to mentor others and how to prepare and present educational content using teaching methods that are innovative, engaging, and inspiring to the learners. Cameryn realizes how interconnected each level of the plan is and how necessary it is to create a fluid and adaptable project management plan to guide the various stages of development to transform nurse managers into true leaders.
She soon realizes that in her work with the collaborative governance councils to develop an educational intervention for the frontline managers she has forgotten to engage the Human Resources department, which is also responsible for leadership development. There are many indications of their discontent with her new leadership development program. When Cameryn recognizes their concern, she meets with them to discuss ways that Human Resources could be instrumental in the assessment and development of frontline managers.
Needless to say, not all of her colleagues embrace her vision to transform the leaders in the organization. Many barriers emerge that would dissuade most from continuing to achieve their vision, and Cameryn is disappointed at times and must continually refocus her energies to remain on course despite the barriers. When she recognizes that one of her colleagues or one of the nurse managers is not “on board,” she spends personal time talking with that person and helping to translate the vision so that it could become his or her reality as well. She is continually engaged in dialogue with others to support the change effort, and she formally recognizes the actions and efforts of those who are involved in mentoring less experienced nurse leaders and those who are involved in the educational activities.
The transformational process has taken several years, but reflecting on the progress, Cameryn and her colleagues believe that significant changes have occurred in the organization and that nurse leaders at every level have benefited from the efforts to enhance the competencies and skills of the frontline managers. The benefits of the program are validated with significant improvements in employee opinion surveys and in surveys to assess healthy work environment.
Questions
How do you think that complexity science and quantum leadership systems thinking provide a framework for an initiative to advance the competencies and skills of frontline managers and to change the management culture to a leadership culture in an organization?
How effective do you think Cameryn was in transforming the leadership culture in her organization? What might she have done differently to facilitate the change process?
One of the roles of the quantum leader is to read the signposts that give direction and feedback regarding the change process. What were some of the signposts that Cameryn encountered during the development of the frontline manager group, interactions with her colleagues, and the encounter with the Human Resources department?
In your opinion, what effect will advancing the frontline managers, her own colleagues’ competence, and transformational leadership culture have on the organizational climate, nursing satisfaction, and even patient outcomes?

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