The New Leadership Challenge Creating The Future of Nursing 5th Edition
The New Leadership Challenge Creating The Future of Nursing 5th Edition
The New Leadership Challenge Creating The Future of Nursing 5th Edition
All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored
in a retrieval system, or transmitted in any form or by any means, electronic, mechanical,
photocopying, recording, or otherwise, without written permission from the publisher.
Printed in the United States of America
As new scientific information becomes available through basic and clinical research,
recommended treatments and drug therapies undergo changes. The author(s) and publisher
have done everything possible to make this book accurate, up to date, and in accord with
accepted standards at the time of publication. The author(s), editors, and publisher are not
responsible for errors or omissions or for consequences from application of the book, and
make no warranty, expressed or implied, in regard to the contents of the book. Any practice
described in this book should be applied by the reader in accordance with professional
standards of care used in regard to the unique circumstances that may apply in each situation.
The reader is advised always to check product information (package inserts) for changes and
new information regarding dose and contraindications before administering any drug. Caution
is especially urged when using new or infrequently ordered drugs.
Authorization to photocopy items for internal or personal use, or the internal or personal use
of specific clients, is granted by F. A. Davis Company for users registered with the Copyright
Clearance Center (CCC) Transactional Reporting Service, provided that the fee of $.25 per copy
is paid directly to CCC, 222 Rosewood Drive, Danvers, MA 01923. For those organizations
that have been granted a photocopy license by CCC, a separate system of payment has been
arranged. The fee code for users of the Transactional Reporting Service is: 978-0-8036-5766-
3/16 1 $.25.
This book is dedicated to the many faculty and other professional colleagues, as
well as the hundreds of students I have known who have helped me crystallize my
thinking about leadership and who, themselves, have taken on the challenge of
providing leadership. Through dialogues in the classroom and online environ-
ments, papers that have been written, conversations in each other’s offices, sharing
of resources and ideas, and observing these individuals functioning as leaders, I
have come to understand more fully the true meaning of what it means to be a
leader. I also dedicate this book to my husband, Bob, who continues to support
me in all my professional pursuits and whose patience and understanding have
meant the world to me. This book also is dedicated to my sister, Diane Czere-
puszko, a nurse, a leader, a friend. Finally, I dedicate this book to my mother and
father. Although neither of them is here to see its publication, they were a tremen-
dous influence in my development as a professional and, hopefully, a leader; for
that and for all they have given me, I will be forever grateful.
TMV
Theresa M. “Terry” Valiga, EdD, RN, CNE, ANEF, FAAN, received her bachelor’s
degree in nursing from Trenton State College (now The College of New Jersey)
and her master’s and doctoral degrees, both in nursing education, from Teachers
College, Columbia University. She has been a faculty member at Trenton State
College, Georgetown University, Seton Hall University, Villanova University, and
Fairfield University, where she served as dean of the School of Nursing. At present,
she is a professor, chair of the Division of Clinical Systems and Analytics, and
director of the Institute for Educational Excellence in the School of Nursing at
Duke University. Before this position, Dr. Valiga served for 9 years as the chief
program officer at the National League for Nursing. Dr. Valiga’s primary research
interests relate to students’ cognitive and intellectual development, critical think-
ing, and leadership development. Her publications, presentations, and consulta-
tions center around these topics, as well as curriculum development, creative
teaching strategies, and various professional issues. She is the author of numerous
articles and book chapters and has coauthored four other books: The Nurse Educa-
tor in Academe: Strategies for Success, Using the Arts and Humanities to Teach Nursing:
A Creative Approach, Achieving Excellence in Nursing Education, and Clinical Nursing
Education: Current Reflections. She has served as vice president of Sigma Theta Tau
International and national vice president of the Interdisciplinary Honor Society of
Phi Kappa Phi, and she has held numerous leadership positions in nursing
throughout her career. Dr. Valiga also is the recipient of several prestigious national
awards, including the Elizabeth Russell Belford Founders Award for Excellence in
Education and two from the National League for Nursing: the Isabel Stewart Award
for Excellence in Nursing Education and the Outstanding Leadership in Nursing
Education Award. Additionally, she is a fellow in the American Academy of Nursing
and the Academy of Nursing Education.
are meant to provide you with an opportunity to invest time thinking about your-
self, your leadership qualities, and how you can strengthen those abilities as you
grow as a professional.
The New Leadership Challenge: Creating the Future of Nursing gives you, the reader,
a glimpse into the world of knowledge and skills needed to be a leader—it is not
“a state of mind,” nor is it something that just happens. This book provides a core
foundation for you to think about the important question: “What does leadership
have to do with me?” In the chapter on followership, it becomes clear that all of
us are leaders in some situations and followers at other times. In fact, engaged
followers are critical to the success of any organization! Students and experienced
nurses alike will likely find the self-assessments offered throughout this book to
be very interesting and informative. Use every opportunity you have within these
pages to spend time assessing the experiences you have had in health care and
reflecting on your own strengths as an emerging leader. These reflections will build
your inner strength and widen your repertoire of skills for working in challenging
situations throughout your career.
As someone who will shape the future of nursing you may actually envision
yourself as having many years before you take that big step into a leadership posi-
tion. The reality is that you are already there! As someone studying to be or prac-
ticing as a professional nurse, you are part of the most well-respected profession
(Riffkin, 2014). With that respect comes high expectations for leading those who
understand less about health and illness—at the bedside, on a unit, in the com-
munity—and for leading our colleagues in other health professions to work as a
team to ensure the best possible care delivery. After you read about the theories,
and “try on” the leadership exemplars and activities in this book, you will be
armed with new knowledge and a sense of comfort about yourself that will help
you to accept this responsibility, and you will be prepared to make a difference.
Go forth and do great things!
Institute of Medicine (2010). The future of nursing: Leading change, advancing health.
Washington, D.C.: National Academics Health.
Riffkin, R. (2014). Americans rate nurses highest on honesty, ethical standards.
Gallup Poll. Retrieved July 13, 2015, from http://www.gallup.com/poll/180260/
americans-rate-nurses-highest-honesty-ethical-standards.aspx.
Sheila C. Grossman
Theresa M. “Terry” Valiga
xiii
SCG
TMV
xv
Index 281
The Phenomenon
of Leadership
Classic/Historical and Contemporary
Leadership Theories
LEARNING OBJECTIVES
• Examine the multiple aspects of the phenomenon of leadership.
• Describe how leadership ability is a vital component of success for an individual;
a unit, department, or practice; and an organization, particularly in nursing.
• Compare and contrast major theoretical ideas about leadership from classic/
historical and contemporary perspectives.
• Analyze how nurses can use a combination of classic and contemporary theories
of leadership to strengthen their success as leaders of the health-care team,
within institutions, and for the profession.
INTRODUCTION
Chaos. Uncertainty. Unpredictability. Constant change. These are all characteristics
of the world in which we now live, and all indications are that the world of
the future will be even more chaotic, more uncertain, more unpredictable, and in
even greater states of constant and unprecedented change and flux. Such circum-
stances desperately call for new leaders even though “being an effective leader
in today’s tumultuous world is almost impossible” (Tetenbaum & Laurence, 2011,
p. 48). Indeed, “if there was ever a moment in history when a comprehensive
1
strategic view of leadership was needed, . . . this is certainly it” (Bennis & Nanus,
2003, p. 2).
Defining just what leadership is, who leaders are, what leaders do, and how
leadership is different from management—a phenomenon with which it often is
confused—is no easy task. This chapter is intended to address these questions and
help the reader understand the complex, multidimensional concept we refer to as
leadership. It is also intended to challenge readers to consider the leadership
we need in nursing today, to think about themselves as leaders, and to reflect on
how leadership responsibilities can be integrated into their roles as professional
nurses.
For almost a century, writers have attempted to describe leadership, and
researchers have attempted to identify the defining characteristics of leaders. The
outcome has been one very clear conclusion: “Leadership is one of the most
observed and least understood phenomena on earth” (Burns, 1978, p. 2). It is
multidimensional and multifaceted—a universal human phenomenon that many
know when they see it but few can define clearly.
In fact, there are almost as many different definitions of leadership as there are
people who write about it. According to Bennis and Nanus (2003)
Decades of academic analysis have given us more than 850 definitions
of leadership. Literally thousands of empirical investigations of leaders
have been conducted in the last seventy-five years alone, but no clear and
unequivocal understanding exists as to what distinguishes leaders from
non-leaders, and perhaps more important, what distinguishes effective
leaders from ineffective leaders. (p. 4)
The lack of a “clear and unequivocal understanding” of leadership has led these
experts on the subject to assert that “never have so many labored so long to say
so little” (Bennis & Nanus, 2013, p. 4). Despite this situation, however, there is
increasing clarity about what true leadership is and how it is different from the
related concept of management.
Trait Theories
Personal trait theories of leadership attempted to distinguish leaders from other
people and identify the universal characteristics of leadership. Not surprisingly, no
qualities were found that were universal to all leaders, although a number of traits
did seem to correlate with leadership (Bass, 2008): above average height and
weight, an abundant reserve of energy, an ability to maintain a high level of activ-
ity, better education, superior judgment, decisiveness, a breadth of knowledge, a
high degree of verbal facility, good interpersonal skills, self-confidence, and creativ-
ity. In addition to the fact that these theories revealed no universal traits among
leaders, they also failed to acknowledge the importance of the situation in which
leadership occurred.
Situational Theories
Situational theories, in comparison, gave clear recognition to the significance of
the environment and the particular situation as factors in the effectiveness of a
leader. They asserted that the leader was the individual who was in a position to
institute change when a situation was ready for change. In other words, the leader
did not plan for a change, nor was the leader chosen by a group of followers; he
or she just “happened to be in the right place at the right time” and took the action
that was needed to resolve a crisis or manage a problem. Although this view of
leadership was broader than merely looking at one’s heritage or specific traits, it
still did not capture the complexity of the phenomenon and failed to acknowledge
one very important element in a leadership “event”—the followers.
Transformational Leadership
This theory was first introduced by Burns (1978), who described it as being context
based, a process for motivating followers believing in similar internal values
directed toward the “greater good,” and having an emphasis for leaders and fol-
lowers to enjoy a close bond. Bass (1985) expanded the work of Burns to explain
how transformational leadership could be measured in terms of the leader’s influ-
ence on followers and how followers could be motivated via transformational
leadership to include four processes: (1) idealized influence, (2) inspirational
motivation, (3) individualized consideration, and (4) intellectual stimulation. By
idealized influence, the leader assists the follower to increase confidence, respect,
and trust. Inspirational motivation involves teaching the follower to be empowering,
goal oriented, and responsible. Individualized consideration includes assisting the
follower to increases self-esteem, continue working hard, and self-actualize. Last,
Authentic Leadership
This theory is often associated with the perception of morality and may be con-
fused with ethical leadership, but it differs in that authentic leaders also have a
strong component of good communication skills and self-awareness. According to
Gardner et al (2005), this leadership model’s underpinnings include (1) self-
awareness, an understanding of each individual’s strengths and weaknesses; (2)
relational transparency that encompasses honest two-way communication; (3) bal-
anced information processing, which is defined as taking the time to explore other
options before making a decision; and (4) internalized moral perspective or the
individual’s moral compass. Kernis (2003) further expands on the first component
of authentic leadership by emphasizing the importance of self-reflection, a concept
that may be particularly important for nurses who, in many instances, do not
engage in reflection because of the fast pace of their work environment and the
many immediate and pressing demands with which they must deal.
Adaptive Leadership
Heifetz, Grashow, and Linsky (2009) created the adaptation leadership model in
1994, defining it as “the practice of mobilizing people to tackle tough challenges
and thrive” (p. 13). At the same time Heifetz et al proposed this model, Schore
(1994), a prestigious neuropsychologist, suggested that the evolution of any system
generates greater complexity, stability, and adaptability. Just as any living system
evolves, so does the health-care delivery system, and those who are part of that
system must be able to relate to the context of what is happening in it and adapt
to the continuous changes that occur.
Tetenbaum and Laurence (2011) acknowledged that there has been little change
in leadership styles and practices despite the current paradigm of chaos, disequi-
librium, and change in organizational structures. They endorsed the model of
leadership proposed by Heifetz et al (2009) that outlines the role of the leader as
one who disturbs equilibrium and engages followers in solving an organization’s
problems, a theory, they assert, that is useful in the face of chaos, ambiguity, and
rapid change. None of the common theories of leadership—trait, skills, style, situ-
ational, leader—member exchange, contingency, and even transformational—“is
sufficiently rigorous to address today’s volatile environment” (p. 48), they note,
and more modern theories must be relevant for today’s world. Successful adaptable
leaders, therefore, must:
• Demonstrate integrity and follow their heart.
• Surround themselves by people who are different than them.
• Be flexible but not always willing to compromise.
• Be able to stand up for their vision(s).
• Learn from the past.
• Enjoy the present.
• Keep aware of having a stake in one’s future by continuously gathering
data from all sources (Galuska, 2014).
Innovative Leadership
Johnson (2014) describes how innovation over the years has generated historical
consequences and how unexpected connections have yielded successes in far-
reaching ways. Reading How We Got to Now: Six Innovations that Made the Modern
World can assist nurses to follow the entrepreneurs of yesterday in being more
innovative with how we provide, document, and evaluate care. Some examples of
health-care inventions, best practices of care delivery, and employee engagement
techniques are emerging at some of the Magnet-recognized hospitals and health-
care delivery centers, both serendipitously and as a result of planned initiatives.
Canton (2015) says future-smart leaders must be more innovative than they are
now, and the paradigm of having one individual leader must change to having a
leader force. The leaders must “inspire greatness in others and evangelize the future
vision” and develop “a new set of values that embrace purpose, sustainability and
innovation” (p. 47). Perhaps Max Mckeown’s definition (2014) will serve to better
explain what this innovation leadership is; it is about practical creativity and
making new ideas useful to solve problems and make something better plus creat-
ing new opportunities. He recommends that innovation + strategy about shaping the
future = adaptability.
If nurses aspire to become more innovative leaders, they will need to acquire
specific behaviors. Some examples of such behaviors were found by Zenger and
Folkman (2014), who studied 33 individuals employed in a large telecommunica-
tion industry who scored in greater than the 99th percentile on an Innovative
Leadership Inventory. These researchers identified the following 10 characteristics
that characterized these innovative individuals: excellent strategic vision, a strong
customer focus, a strong trust with customers, fierce organization loyalty, faith in
I see increasing reason to believe that the view formed some time
back as to the origin of the Makonde bush is the correct one. I have
no doubt that it is not a natural product, but the result of human
occupation. Those parts of the high country where man—as a very
slight amount of practice enables the eye to perceive at once—has not
yet penetrated with axe and hoe, are still occupied by a splendid
timber forest quite able to sustain a comparison with our mixed
forests in Germany. But wherever man has once built his hut or tilled
his field, this horrible bush springs up. Every phase of this process
may be seen in the course of a couple of hours’ walk along the main
road. From the bush to right or left, one hears the sound of the axe—
not from one spot only, but from several directions at once. A few
steps further on, we can see what is taking place. The brush has been
cut down and piled up in heaps to the height of a yard or more,
between which the trunks of the large trees stand up like the last
pillars of a magnificent ruined building. These, too, present a
melancholy spectacle: the destructive Makonde have ringed them—
cut a broad strip of bark all round to ensure their dying off—and also
piled up pyramids of brush round them. Father and son, mother and
son-in-law, are chopping away perseveringly in the background—too
busy, almost, to look round at the white stranger, who usually excites
so much interest. If you pass by the same place a week later, the piles
of brushwood have disappeared and a thick layer of ashes has taken
the place of the green forest. The large trees stretch their
smouldering trunks and branches in dumb accusation to heaven—if
they have not already fallen and been more or less reduced to ashes,
perhaps only showing as a white stripe on the dark ground.
This work of destruction is carried out by the Makonde alike on the
virgin forest and on the bush which has sprung up on sites already
cultivated and deserted. In the second case they are saved the trouble
of burning the large trees, these being entirely absent in the
secondary bush.
After burning this piece of forest ground and loosening it with the
hoe, the native sows his corn and plants his vegetables. All over the
country, he goes in for bed-culture, which requires, and, in fact,
receives, the most careful attention. Weeds are nowhere tolerated in
the south of German East Africa. The crops may fail on the plains,
where droughts are frequent, but never on the plateau with its
abundant rains and heavy dews. Its fortunate inhabitants even have
the satisfaction of seeing the proud Wayao and Wamakua working
for them as labourers, driven by hunger to serve where they were
accustomed to rule.
But the light, sandy soil is soon exhausted, and would yield no
harvest the second year if cultivated twice running. This fact has
been familiar to the native for ages; consequently he provides in
time, and, while his crop is growing, prepares the next plot with axe
and firebrand. Next year he plants this with his various crops and
lets the first piece lie fallow. For a short time it remains waste and
desolate; then nature steps in to repair the destruction wrought by
man; a thousand new growths spring out of the exhausted soil, and
even the old stumps put forth fresh shoots. Next year the new growth
is up to one’s knees, and in a few years more it is that terrible,
impenetrable bush, which maintains its position till the black
occupier of the land has made the round of all the available sites and
come back to his starting point.
The Makonde are, body and soul, so to speak, one with this bush.
According to my Yao informants, indeed, their name means nothing
else but “bush people.” Their own tradition says that they have been
settled up here for a very long time, but to my surprise they laid great
stress on an original immigration. Their old homes were in the
south-east, near Mikindani and the mouth of the Rovuma, whence
their peaceful forefathers were driven by the continual raids of the
Sakalavas from Madagascar and the warlike Shirazis[47] of the coast,
to take refuge on the almost inaccessible plateau. I have studied
African ethnology for twenty years, but the fact that changes of
population in this apparently quiet and peaceable corner of the earth
could have been occasioned by outside enterprises taking place on
the high seas, was completely new to me. It is, no doubt, however,
correct.
The charming tribal legend of the Makonde—besides informing us
of other interesting matters—explains why they have to live in the
thickest of the bush and a long way from the edge of the plateau,
instead of making their permanent homes beside the purling brooks
and springs of the low country.
“The place where the tribe originated is Mahuta, on the southern
side of the plateau towards the Rovuma, where of old time there was
nothing but thick bush. Out of this bush came a man who never
washed himself or shaved his head, and who ate and drank but little.
He went out and made a human figure from the wood of a tree
growing in the open country, which he took home to his abode in the
bush and there set it upright. In the night this image came to life and
was a woman. The man and woman went down together to the
Rovuma to wash themselves. Here the woman gave birth to a still-
born child. They left that place and passed over the high land into the
valley of the Mbemkuru, where the woman had another child, which
was also born dead. Then they returned to the high bush country of
Mahuta, where the third child was born, which lived and grew up. In
course of time, the couple had many more children, and called
themselves Wamatanda. These were the ancestral stock of the
Makonde, also called Wamakonde,[48] i.e., aborigines. Their
forefather, the man from the bush, gave his children the command to
bury their dead upright, in memory of the mother of their race who
was cut out of wood and awoke to life when standing upright. He also
warned them against settling in the valleys and near large streams,
for sickness and death dwelt there. They were to make it a rule to
have their huts at least an hour’s walk from the nearest watering-
place; then their children would thrive and escape illness.”
The explanation of the name Makonde given by my informants is
somewhat different from that contained in the above legend, which I
extract from a little book (small, but packed with information), by
Pater Adams, entitled Lindi und sein Hinterland. Otherwise, my
results agree exactly with the statements of the legend. Washing?
Hapana—there is no such thing. Why should they do so? As it is, the
supply of water scarcely suffices for cooking and drinking; other
people do not wash, so why should the Makonde distinguish himself
by such needless eccentricity? As for shaving the head, the short,
woolly crop scarcely needs it,[49] so the second ancestral precept is
likewise easy enough to follow. Beyond this, however, there is
nothing ridiculous in the ancestor’s advice. I have obtained from
various local artists a fairly large number of figures carved in wood,
ranging from fifteen to twenty-three inches in height, and
representing women belonging to the great group of the Mavia,
Makonde, and Matambwe tribes. The carving is remarkably well
done and renders the female type with great accuracy, especially the
keloid ornamentation, to be described later on. As to the object and
meaning of their works the sculptors either could or (more probably)
would tell me nothing, and I was forced to content myself with the
scanty information vouchsafed by one man, who said that the figures
were merely intended to represent the nembo—the artificial
deformations of pelele, ear-discs, and keloids. The legend recorded
by Pater Adams places these figures in a new light. They must surely
be more than mere dolls; and we may even venture to assume that
they are—though the majority of present-day Makonde are probably
unaware of the fact—representations of the tribal ancestress.
The references in the legend to the descent from Mahuta to the
Rovuma, and to a journey across the highlands into the Mbekuru
valley, undoubtedly indicate the previous history of the tribe, the
travels of the ancestral pair typifying the migrations of their
descendants. The descent to the neighbouring Rovuma valley, with
its extraordinary fertility and great abundance of game, is intelligible
at a glance—but the crossing of the Lukuledi depression, the ascent
to the Rondo Plateau and the descent to the Mbemkuru, also lie
within the bounds of probability, for all these districts have exactly
the same character as the extreme south. Now, however, comes a
point of especial interest for our bacteriological age. The primitive
Makonde did not enjoy their lives in the marshy river-valleys.
Disease raged among them, and many died. It was only after they
had returned to their original home near Mahuta, that the health
conditions of these people improved. We are very apt to think of the
African as a stupid person whose ignorance of nature is only equalled
by his fear of it, and who looks on all mishaps as caused by evil
spirits and malignant natural powers. It is much more correct to
assume in this case that the people very early learnt to distinguish
districts infested with malaria from those where it is absent.
This knowledge is crystallized in the
ancestral warning against settling in the
valleys and near the great waters, the
dwelling-places of disease and death. At the
same time, for security against the hostile
Mavia south of the Rovuma, it was enacted
that every settlement must be not less than a
certain distance from the southern edge of the
plateau. Such in fact is their mode of life at the
present day. It is not such a bad one, and
certainly they are both safer and more
comfortable than the Makua, the recent
intruders from the south, who have made USUAL METHOD OF
good their footing on the western edge of the CLOSING HUT-DOOR
plateau, extending over a fairly wide belt of
country. Neither Makua nor Makonde show in their dwellings
anything of the size and comeliness of the Yao houses in the plain,
especially at Masasi, Chingulungulu and Zuza’s. Jumbe Chauro, a
Makonde hamlet not far from Newala, on the road to Mahuta, is the
most important settlement of the tribe I have yet seen, and has fairly
spacious huts. But how slovenly is their construction compared with
the palatial residences of the elephant-hunters living in the plain.
The roofs are still more untidy than in the general run of huts during
the dry season, the walls show here and there the scanty beginnings
or the lamentable remains of the mud plastering, and the interior is a
veritable dog-kennel; dirt, dust and disorder everywhere. A few huts
only show any attempt at division into rooms, and this consists
merely of very roughly-made bamboo partitions. In one point alone
have I noticed any indication of progress—in the method of fastening
the door. Houses all over the south are secured in a simple but
ingenious manner. The door consists of a set of stout pieces of wood
or bamboo, tied with bark-string to two cross-pieces, and moving in
two grooves round one of the door-posts, so as to open inwards. If
the owner wishes to leave home, he takes two logs as thick as a man’s
upper arm and about a yard long. One of these is placed obliquely
against the middle of the door from the inside, so as to form an angle
of from 60° to 75° with the ground. He then places the second piece
horizontally across the first, pressing it downward with all his might.
It is kept in place by two strong posts planted in the ground a few
inches inside the door. This fastening is absolutely safe, but of course
cannot be applied to both doors at once, otherwise how could the
owner leave or enter his house? I have not yet succeeded in finding
out how the back door is fastened.