Courage to Lead: Transformational Nurse Leadership for a Healthy Work Environment June Marshall, DNP, RN, NEA-BC Mano y Corazón Binational Conference of Multicultural Health Care Solutions, El Paso, Texas, September 27-28, 2013

2. • Describe transformational leadership qualities necessary
for creating and sustaining healthy work environments.
• Define components and characteristics of healthy nursing
work environments.
• Identify strategies for mitigating nurses’ workplace stress.

3. • Effective communicator
• Charismatic
• Inspirational
• Individual consideration
• Intellectual stimulation
• Empower others

4. • Servant leader
• Humble
• Ethical
• Transparent
• Empathetic
• Compassionate/Caring
• Authentic

5. • Strategic
• Visionary
• Committed to
EXCELLENCE
• Passionate
• Trustworthy

6. •COACH
•MENTOR

7. Florence Nightingale –
Transformational Leader & Role Model
• Self-knowledge
• Authenticity
• Expertise
• Vision
• Flexibility
• Shared leadership
• Influence
• Inspiring others

8. Florence Nightingale –
• Innovator
• Change agent
• Advocate
• Reformer

9. Ildauro Murillo-Rohde, PhD,
RN, FAAN –
• Innovator
• Change agent
• Advocate
• Reformer
• Visionary
• Instrumental in
founding NAHN

10. Henrieta Villaescusa,
MPH, RN, FAAN –
• Mentor
• Role Model
• Trailblazer
• Advocate for Social
Justice

11. Mary Lou de Leon Siantz,
PhD, RN, FAAN –
• Interdisciplinary,
Multicultural Educator
• Researcher &
Translationalist
• Legislative Advocate

12. • What do YOU
see in the
mirror?

13. • Skilled communication
• True collaboration
• Effective decision making
• Appropriate staffing
• Meaningful recognition
• Authentic leadership
(AACN, 2005)

14. http://ajcc.aacnjournals.org/content/14/3/187/F1.expansion
Interdependence
of healthy work
environment,
clinical
excellence,
and optimal
patient outcomes

15. High-quality, patient-
centered health care for all
will require a
transformation of the
health care delivery
system
One of the most-viewed
online reports in IOM history
AJN Book of the Year Award

16. 1) Remove scope-of-practice barriers
2) Expand opportunities for nurses to lead and diffuse
collaborative improvement efforts
3) Implement nurse residency programs
4) Increase the proportion of nurses with a BSN degree to
80% by 2020
5) Double the number of nurses with a doctorates by 2020
6) Ensure that nurses engage in lifelong learning
7) Prepare and enable nurses to lead change to advance
health
8) Build an infrastructure for the collection and analysis of
interprofessional health care workforce data

17. Campaign for Action
Education Practice Collaboration Leadership Data
Diversity

19. Ergonomics and Safety
Intergenerational Workforce
Just Culture
Mind, Body, Spirit Healing
Moral Courage/Distress

20. Structural Empowerment
Evidence and Outcomes
Transformational Leadership
Modeling the Way

21. • Complexity of nursing work environments
• Workplace stressors – patient acuity, technology,
rapid cycle change, ethical dilemmas and
bullying/violence
• Stress responses produce adverse physiologic,
social, emotional, and behavioral reactions

22. • Key to recruiting and retaining “best talent” and
providing care for patients
• “Feeling physically and emotionally safe”
• Culture with a sense of belonging and positive team
relationships
Shirey (2006)

23. • Critical Incident Stress Management
• Psychological Debriefing
• Peer Support
• Ethics Consultation
• Employee Assistance Programs
• The Nurse Advocate Role

24. • One Size Does
NOT Fit All!

25. Stabilization &
Acknowledgement of
Events & Reactions
(Everly, 2001)
Critical Incident
Impacting a Group
of RNs Initiate
CISM Program
Defusing in Small Groups –
Including Introduction,
Exploration, & Information
(Mitchell, 2006)
Successful
Work Reentry
Facilitation of
Normal
Recovery
(Mitchell, 2006)
If Stress Responses
Unresolved, Refer to
Formal Individual or
Group CISM Program
Stress Responses
Completely Resolved
Without Need for Ongoing
Follow-up
Professional
Practice-related
Critical Incident
Initiates Referral
to Nurse
Advocate (TNA,
2010)
Individual and Group Workplace Critical Incident Stress Management (CISM) for
Registered Nurses (RNs) – Marshall (2010)
Critical Incident
Impacts Individual RN
– Initiate CISM
Program
Assist RN to
Understand &
Normalize Events
(Everly, 2001)
Encourage
Actions to
Facilitate
Effective Coping
(Everly, 2001)
If Stress Responses
Resolve, Provide
Periodic Follow-up as
Needed for Problems
If Stress Responses
Continue, Refer for
Follow-up Assessment
& Interventions (Everly,
2001)
Stressful Workplace
Incident Occurs &
Individual or Group Peer
Support Session Initiated

26. • Stress Support Work at UT
Southwestern
• Staff Survey and Involvement in the
Work
• EAP, Chaplain Support
• Lessons Learned
• Accomplishments
• Next Steps

27. • Ergonomics
• Quiet Environments
• Cultures of Safety
• “Zero Tolerance” Policies for Abusive
Behavior
• Healthy Work/Life Balance

28. • Support for education
• Working with clinically competent
nurses
• Collegial and collaborative
interdisciplinary relationships
• Autonomous nursing practice
• Control over nursing practice
• Supportive nurse managers
• Perceived adequacy of staffing
• Culture in which concern for the
patient is paramount
http://www.amsn.org/practice-resources/healthy-work-environment

29. • What will YOU
agree to DO?

30. GOALS
ACTIONS
OUTCOMES

32. HEALTH WHOLENESS

33. GOOD GREAT

34. MIND
BODY
SPIRIT

35. Mission
Vision
Values

36. • What brought you
to this work?
• What sustains your
commitment?
• What is your vision
for the future?

38. AACN (2005). AACN Standards for Establishing and Sustaining Healthy Work
Environments: A Journey to Excellence. Aliso Viejo, CA: American Association of
Critical-Care Nurses.
ANCC (2013). 2014 Magnet® Application Manual. Silver Spring, MD: American Nurses
Credentialing Center.
Bowles, A. & Bowles, N.B. (2000). A comparative study of transformational
leadership in nursing development units and conventional clinical settings.
Journal of Nursing Management, (8), 69-76.
Clements, P.T. & Averill, J.B. (2006). Finding patterns of knowing in the work of
Florence Nightingale. Nursing Outlook, 54, 268-274.
http://dx.doi.org/10.1016/j.outlook.2006.06.003
Dossey, B.M., Selanders, L.C., Beck, D-M., Attewell, A. (2005). Florence Nightingale
Today: Healing Leadership Global Action. Silver Spring, MD: American Nurses
Association.

39. Everly, G.S., Flannery, R.B. & Mitchell, J.T. (2000). Critical incident stress
management: A review of the literature. Aggression and Violent Behavior, 5(1),
23-40.
Florence Nightingale. (2012). Biography.com. Retrieved 12:01, May 09, 2012 from
http://www.biography.com/people/florence-nightingale-9423539
Govier, I. & Nash, S. (2009). Examining transformational approaches to effective
leadership in healthcare settings. Nursing Times, (105), 18.
Hutchison, M. & Jackson, D. (2013). Transformational leadership in nursing: Towards
a more critical interpretation. Nursing Inquiry, 20(1), 11-22.
Maloney, C. (2012). Critical incident stress debriefing and pediatric nurses. Pediatric
Nursing, 38(2), 110-113.
Marshall, J. & Zolnierek, C. (2012). Supporting nurses through critical practice
incidents: The nurse advocate role. Nurse Leader, 10(2), 34-36,44.

40. McDonald, L. (2001). Florence Nightingale and the early origins of evidence-based
nursing. Evidence Based Nursing, 4, 68-69. doi:10.1136/ebn.4.3.68 .
Swanson, K.M. & Wojnar, D.M. (2004). Optimal healing environments in nursing. The
Journal of Alternative and Complementary Medicine, 10(1), S-43-S-48.
Sherman, R.O. (2012). What followers want in their nurse leaders. American Nurse
Today, 7(9).
Smith, M.A. (2011). Are you a transformational leader? Nursing Management, 26(8),
44-47.