Performance potential
Leadership by design: Creating successful “TEEAMS” By Paul LeBlanc, MSN, RN ransformational leadership is a term used to describe successful leaders in business, technology, industry, and healthcare. Transformational leaders aspire to be motivators, using innovative ideas and practices to entice and encourage their teams to move forward with meeting the goals of the organization, the profession, and themselves. Leaders know the term and understand what it means to transform, but how do we take this concept of transformational leadership and operationalize it on the ground level? How do we teach and mentor new and current nurse leaders about the concepts of transformational leadership, including a team philosophy that captures the emotional will to work toward common goals and outcomes? The teeams approach is one solution to creating a successful team because it provides an overview of strategies that can positively impact nursing satisfaction. This approach focuses on some of the core components of transformational leadership: time, enthusiasm, engagement, appreciation, management, and support.
T
There’s a direct relationship between nursing team satisfaction and intent to stay, and the nurse manager’s leadership style and perceived abilities. A high degree of nurse satisfaction has been linked with positive patient outcomes and improved safety, quality, and patient satisfaction. A satisfied nursing workforce has been attributed to a reduction in patient mortality, fewer medication errors, and a decrease in patient falls. In contrast, nurses who are highly dissatisfied are often disengaged within their work environment and have difficulty with working relationships. Dissatisfied nurses have higher rates of tardiness and absenteeism, and are at increased risk for carelessness, poor performance of duties, medication errors, and poor patient outcomes.1 Transformational leadership focuses on change and innovation by connecting with individuals and teams. The leader supports and guides the team to be creative and empowered to invoke change. Creative thinking is encouraged, and challenging the status quo is expected. Approaching problems in a new way directed by the individual and the team benefits the nurses, the teams, and the organization. Engagement, empowerment, and having the team own its outcomes, successful or not, are the drivers of team dynamics. This behavior improves performance and the willingness of a team to adapt to change.2,3
The format The role of the nurse manager is critical to the development of satisfied and successful work teams. Nurses are often placed in positions of leadership due to their clinical abilities, which don’t necessarily translate into successful leadership abilities. Moving into a leadership role, nurses often have little or no formal leadership training. The availability of leadership education is limited, tools may be sparse, and effective mentorship is often unavailable due to the time constraints and other responsibilities of their nurse manager colleagues.
Breaking into TEEAMS Time The first component of the teeams concept is time. Nurse managers must recognize the significance and importance of spending adequate and quality time with their teams to communicate, share ideas, and be present on the nursing unit. In our hectic healthcare environment, we’re all pressed for time, but there are simple steps to increase face time with the team. Schedule team meetings on the calendar every day. One hour of free time provides the opportunity for you to round on the team and connect with healthcare providers in their environment.
www.nursingmanagement.com
Nursing Management • March 2014 49
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Performance potential This is a commitment to reserve and hold this time exclusively for the purpose of rounding, meeting, engaging in conversation, and getting to know the team. This time to connect provides the opportunity to build the emotional bridge that’s necessary to successfully deploy the strategies of transformational leadership. The transformational leader is an effective communicator, defined as being interactive, ongoing, and inclusive.4 This style of communication can only be provided if the necessary amount of time is available to the team member free of distractions, and in an environment that’s safe and welcoming. Nurses with limited access to their manager or those who feel that the manager doesn’t have an open and effective communication style are more likely to leave their jobs. Empowerment Productive teams are empowered teams! This is important to understand if you want to build strong teams. Empowering the team doesn’t mean that you’re giving up authority or control. Rather, it proves that you trust the team to make appropriate decisions with minimal intervention. Clearly state the organizational goals and expectations and act as a facilitator, providing support and resources to meet these goals. The provision and access to information is important for staff. The team needs information to make informed and appropriate decisions. Sharing information about the current and upcoming actions and decisions of the organization is necessary for the team to clearly understand its trajectory. This access to information includes knowledge about organizational decisions, policies and procedures, and the ability of clinical nurses to make informed decisions based on this knowledge.2,5
Access to organizational information provides nurses with a sense of belonging; there’s a feeling of value, purpose, and trust because information is power. With this sense of empowerment comes a sense of ownership and autonomy of practice. After the team feels empowered, managers must allow the team to do something with this information and sense of empowerment. Suggestions to operationalize empowerment include establishing team-driven governance and clinical practice councils. Allowing the team to own the issues, provide solutions, and initiate and evaluate the outcomes is possible through collaboration between yourself and the team. Enthusiasm Nurse managers, in a sense, are cheerleaders on the unit. The successful nurse manager must believe in the team and be committed to its success. Your enthusiasm builds on the emotional drive of the team. Enthusiasm becomes infectious and entices the team, as individuals or as a cohesive unit, to seek opportunities to enhance the team, learn new skills, and be excited about the work that’s being done. Enthusiasm isn’t related to a specific event or moment. It’s a reaction to all successes and attempts to tackle the issues that arise. It’s a willingness to celebrate the commitment of the team to work together to meet organizational goals, patient needs, and unit outcomes. In addition, part of building a successful team is celebrating the personal milestones of the team and individual members, such as birthdays, the addition of new family members, graduations, and other life events. Team members must also learn how to support one another during times of sorrow, grief, and disappointment.
50 March 2014 • Nursing Management
Appreciation Transformational leaders are committed to broadening the awareness of their teams. The transformational leader is one who’s able to move the individual beyond his or her own self-interests and create genuine excitement for the team to meet organizational goals. You must take the lead on being appreciative of the contributions of the individual and the team. This is a key factor in the development of successful teams.2 Appreciation has also been called meaningful recognition. Team members need to know that they’re appreciated. Acknowledge the positive behaviors demonstrated by your team members. This positive feedback is crucial as a means of validating the work and value of the team and its individual members. Remember that meaningful recognition is different than positive feedback. Providing the individual with examples of how his or her positive behavior has impacted performance and the contribution to the team is a powerful tool that permits the team member to continue to grow and develop over the lifetime of his or her career.6 How can you demonstrate your appreciation to the individual and team? Take the time to send a quick e-mail to your team members. Short, handwritten notes provide a personal touch of recognition that’s sometimes lost in our fast-paced world. Post general e-mails to let the team know of the successes of individuals. Listing accomplishments in the honor section of your unit newsletter is another way of recognizing the team. Staff meetings can have a dedicated time to recognize work, accomplishments, and other milestones. Keeping these tied with enthusiasm continues to build the team on an emotional level. Appreciating and acknowledging the contributions of the individual and team has the effect of boosting www.nursingmanagement.com
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Performance potential self-esteem and is associated with enhanced self-image. The impact of improved self-esteem and selfimage is often translated into improved patient care; increased communication among team members, patients, and their families; and a willingness to continue to strive to meet organizational goals. Management Managing teams is the most obvious role for nurse managers, and part of this is holding them accountable, especially when using the teeams approach. To hold team members accountable, first be certain that team members understand the expectations of their jobs, as well as their professional practice. You’re responsible for providing the tools necessary for your team to do the job and understand practice parameters. Job expectations and performance information should first be provided during organizational and unit orientation, and should then become an ongoing process through the life of the nurse’s career. Clear communication about expectations and the ramifications of failure to follow practice or unit standards must also be part of this discussion. There will be times when you’ll be required to coach and discipline clinical nurses for poor performance. Nurse managers must receive the appropriate training and guidance regarding the necessary steps in the disciplinary process when workplace rules have been violated. Team accountability and ongoing reinforcement of workplace rules and expectations is necessary for adherence. Early intervention when team members are drifting from accepted norms of unit behavior may prevent issues from becoming complex problems that could impact the team and patient outcomes. Consistency in the application of the standards and disciplinary action is www.nursingmanagement.com
important for the team to build trust and an awareness of role delineation. Support Support is the last component of the teeams approach and is quite possibly one of the most important. Nurses work in an intense environment. There are increasing pressures to meet the demands of regulatory bodies, increased patient acuities, and ever-changing technologies. The demand for services often outpaces supply. Your support for your team members encompasses personal, professional, and organizational needs. In order to support your team, you must be visible. Daily rounding is necessary. Easy access to the manager by the charge nurse, supervisor, or team leader(s) is also a key component. Keep the door to your office open for visibility and access. Return calls and pages promptly. When it’s necessary to leave for a business meeting, touch base with the charge nurse to make him or her aware of your appointment, so he or she can communicate to the rest of the team about any delays in responding to a request. The key to supporting the team also includes creating an atmosphere that encourages work engagement. This is described as a persistent and positive state of internalizing self-fulfillment through the work that we do. The provision of support is integral to achieving the components of work engagement, including vigor, a high level of resilience, and a high level of work commitment even when the work is difficult and challenging.7 A group effort The teeams approach is intended to provide a roadmap for implementing effective leadership strategies to help improve nurse satisfaction and retention. Nurse managers can
develop strategies for effective communication and leadership styles through evidence-based practice and research. The process of team engagement in decision making and the creation of an empowered workforce can begin immediately. Effective leadership enhances job satisfaction and promotes staff retention. Be committed to maintaining a high level of staff involvement while holding the team accountable to unit and organizational standards. And positively influence nurse satisfaction through open discussions and serious consideration of team member input. The teeams approach provides the opportunity for team cohesion, greater nurse satisfaction, and higher nurse retention. NM
REFERENCES 1. Brunetto Y, Farr-Wharton R, Shacklock K. Supervisor-subordinate communication relationships, role ambiguity, autonomy and affective commitment for nurses. Contemp Nurse. 2011;39(2):227-239. 2. Doody O, Doody CM. Transformational leadership in nursing practice. Br J Nurs. 2012;21(20):1212-1218. 3. Lobo VM. Transformational leadership to promote cross-generational retention. Nurs Leadersh (Tor Ont). 2010;23(2):21-31. 4. Kash BA, Naufal GS, Dagher RK, Johnson CE. Individual factors associated with intentions to leave among directors of nursing in nursing homes. Health Care Manage Rev. 2010;35(3):246-255. 5. Casey M, Saunders J, O'Hara T. Impact of critical social empowerment on psychological empowerment and job satisfaction in nursing and midwifery settings. J Nurs Manag. 2010;18(1):24-34. 6. Duffield CM, Roche MA, Blay N, Stasa H. Nursing unit managers, staff retention and the work environment. J Clin Nurs. 2011;20(1-2):23-33. 7. Halfer D. Job embeddedness factors and retention of nurses with 1 to 3 years of experience. J Contin Educ Nurs. 2011;42(10):468-476. Paul LeBlanc is a nurse manager of Operations at Duke University Hospital in Durham, N.C. The author has disclosed that he has no financial relationships related to this article. DOI-10.1097/01.NUMA.0000443950.21970.a9
Nursing Management • March 2014 51
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Leadership by design: Creating successful “TEEAMS” By Paul LeBlanc, MSN, RN ransformational leadership is a term used to describe successful leaders in business, technology, industry, and healthcare. Transformational leaders aspire to be motivators, using innovative ideas and practices to entice and encourage their teams to move forward with meeting the goals of the organization, the profession, and themselves. Leaders know the term and understand what it means to transform, but how do we take this concept of transformational leadership and operationalize it on the ground level? How do we teach and mentor new and current nurse leaders about the concepts of transformational leadership, including a team philosophy that captures the emotional will to work toward common goals and outcomes? The teeams approach is one solution to creating a successful team because it provides an overview of strategies that can positively impact nursing satisfaction. This approach focuses on some of the core components of transformational leadership: time, enthusiasm, engagement, appreciation, management, and support.
T
There’s a direct relationship between nursing team satisfaction and intent to stay, and the nurse manager’s leadership style and perceived abilities. A high degree of nurse satisfaction has been linked with positive patient outcomes and improved safety, quality, and patient satisfaction. A satisfied nursing workforce has been attributed to a reduction in patient mortality, fewer medication errors, and a decrease in patient falls. In contrast, nurses who are highly dissatisfied are often disengaged within their work environment and have difficulty with working relationships. Dissatisfied nurses have higher rates of tardiness and absenteeism, and are at increased risk for carelessness, poor performance of duties, medication errors, and poor patient outcomes.1 Transformational leadership focuses on change and innovation by connecting with individuals and teams. The leader supports and guides the team to be creative and empowered to invoke change. Creative thinking is encouraged, and challenging the status quo is expected. Approaching problems in a new way directed by the individual and the team benefits the nurses, the teams, and the organization. Engagement, empowerment, and having the team own its outcomes, successful or not, are the drivers of team dynamics. This behavior improves performance and the willingness of a team to adapt to change.2,3
The format The role of the nurse manager is critical to the development of satisfied and successful work teams. Nurses are often placed in positions of leadership due to their clinical abilities, which don’t necessarily translate into successful leadership abilities. Moving into a leadership role, nurses often have little or no formal leadership training. The availability of leadership education is limited, tools may be sparse, and effective mentorship is often unavailable due to the time constraints and other responsibilities of their nurse manager colleagues.
Breaking into TEEAMS Time The first component of the teeams concept is time. Nurse managers must recognize the significance and importance of spending adequate and quality time with their teams to communicate, share ideas, and be present on the nursing unit. In our hectic healthcare environment, we’re all pressed for time, but there are simple steps to increase face time with the team. Schedule team meetings on the calendar every day. One hour of free time provides the opportunity for you to round on the team and connect with healthcare providers in their environment.
www.nursingmanagement.com
Nursing Management • March 2014 49
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Performance potential This is a commitment to reserve and hold this time exclusively for the purpose of rounding, meeting, engaging in conversation, and getting to know the team. This time to connect provides the opportunity to build the emotional bridge that’s necessary to successfully deploy the strategies of transformational leadership. The transformational leader is an effective communicator, defined as being interactive, ongoing, and inclusive.4 This style of communication can only be provided if the necessary amount of time is available to the team member free of distractions, and in an environment that’s safe and welcoming. Nurses with limited access to their manager or those who feel that the manager doesn’t have an open and effective communication style are more likely to leave their jobs. Empowerment Productive teams are empowered teams! This is important to understand if you want to build strong teams. Empowering the team doesn’t mean that you’re giving up authority or control. Rather, it proves that you trust the team to make appropriate decisions with minimal intervention. Clearly state the organizational goals and expectations and act as a facilitator, providing support and resources to meet these goals. The provision and access to information is important for staff. The team needs information to make informed and appropriate decisions. Sharing information about the current and upcoming actions and decisions of the organization is necessary for the team to clearly understand its trajectory. This access to information includes knowledge about organizational decisions, policies and procedures, and the ability of clinical nurses to make informed decisions based on this knowledge.2,5
Access to organizational information provides nurses with a sense of belonging; there’s a feeling of value, purpose, and trust because information is power. With this sense of empowerment comes a sense of ownership and autonomy of practice. After the team feels empowered, managers must allow the team to do something with this information and sense of empowerment. Suggestions to operationalize empowerment include establishing team-driven governance and clinical practice councils. Allowing the team to own the issues, provide solutions, and initiate and evaluate the outcomes is possible through collaboration between yourself and the team. Enthusiasm Nurse managers, in a sense, are cheerleaders on the unit. The successful nurse manager must believe in the team and be committed to its success. Your enthusiasm builds on the emotional drive of the team. Enthusiasm becomes infectious and entices the team, as individuals or as a cohesive unit, to seek opportunities to enhance the team, learn new skills, and be excited about the work that’s being done. Enthusiasm isn’t related to a specific event or moment. It’s a reaction to all successes and attempts to tackle the issues that arise. It’s a willingness to celebrate the commitment of the team to work together to meet organizational goals, patient needs, and unit outcomes. In addition, part of building a successful team is celebrating the personal milestones of the team and individual members, such as birthdays, the addition of new family members, graduations, and other life events. Team members must also learn how to support one another during times of sorrow, grief, and disappointment.
50 March 2014 • Nursing Management
Appreciation Transformational leaders are committed to broadening the awareness of their teams. The transformational leader is one who’s able to move the individual beyond his or her own self-interests and create genuine excitement for the team to meet organizational goals. You must take the lead on being appreciative of the contributions of the individual and the team. This is a key factor in the development of successful teams.2 Appreciation has also been called meaningful recognition. Team members need to know that they’re appreciated. Acknowledge the positive behaviors demonstrated by your team members. This positive feedback is crucial as a means of validating the work and value of the team and its individual members. Remember that meaningful recognition is different than positive feedback. Providing the individual with examples of how his or her positive behavior has impacted performance and the contribution to the team is a powerful tool that permits the team member to continue to grow and develop over the lifetime of his or her career.6 How can you demonstrate your appreciation to the individual and team? Take the time to send a quick e-mail to your team members. Short, handwritten notes provide a personal touch of recognition that’s sometimes lost in our fast-paced world. Post general e-mails to let the team know of the successes of individuals. Listing accomplishments in the honor section of your unit newsletter is another way of recognizing the team. Staff meetings can have a dedicated time to recognize work, accomplishments, and other milestones. Keeping these tied with enthusiasm continues to build the team on an emotional level. Appreciating and acknowledging the contributions of the individual and team has the effect of boosting www.nursingmanagement.com
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
Performance potential self-esteem and is associated with enhanced self-image. The impact of improved self-esteem and selfimage is often translated into improved patient care; increased communication among team members, patients, and their families; and a willingness to continue to strive to meet organizational goals. Management Managing teams is the most obvious role for nurse managers, and part of this is holding them accountable, especially when using the teeams approach. To hold team members accountable, first be certain that team members understand the expectations of their jobs, as well as their professional practice. You’re responsible for providing the tools necessary for your team to do the job and understand practice parameters. Job expectations and performance information should first be provided during organizational and unit orientation, and should then become an ongoing process through the life of the nurse’s career. Clear communication about expectations and the ramifications of failure to follow practice or unit standards must also be part of this discussion. There will be times when you’ll be required to coach and discipline clinical nurses for poor performance. Nurse managers must receive the appropriate training and guidance regarding the necessary steps in the disciplinary process when workplace rules have been violated. Team accountability and ongoing reinforcement of workplace rules and expectations is necessary for adherence. Early intervention when team members are drifting from accepted norms of unit behavior may prevent issues from becoming complex problems that could impact the team and patient outcomes. Consistency in the application of the standards and disciplinary action is www.nursingmanagement.com
important for the team to build trust and an awareness of role delineation. Support Support is the last component of the teeams approach and is quite possibly one of the most important. Nurses work in an intense environment. There are increasing pressures to meet the demands of regulatory bodies, increased patient acuities, and ever-changing technologies. The demand for services often outpaces supply. Your support for your team members encompasses personal, professional, and organizational needs. In order to support your team, you must be visible. Daily rounding is necessary. Easy access to the manager by the charge nurse, supervisor, or team leader(s) is also a key component. Keep the door to your office open for visibility and access. Return calls and pages promptly. When it’s necessary to leave for a business meeting, touch base with the charge nurse to make him or her aware of your appointment, so he or she can communicate to the rest of the team about any delays in responding to a request. The key to supporting the team also includes creating an atmosphere that encourages work engagement. This is described as a persistent and positive state of internalizing self-fulfillment through the work that we do. The provision of support is integral to achieving the components of work engagement, including vigor, a high level of resilience, and a high level of work commitment even when the work is difficult and challenging.7 A group effort The teeams approach is intended to provide a roadmap for implementing effective leadership strategies to help improve nurse satisfaction and retention. Nurse managers can
develop strategies for effective communication and leadership styles through evidence-based practice and research. The process of team engagement in decision making and the creation of an empowered workforce can begin immediately. Effective leadership enhances job satisfaction and promotes staff retention. Be committed to maintaining a high level of staff involvement while holding the team accountable to unit and organizational standards. And positively influence nurse satisfaction through open discussions and serious consideration of team member input. The teeams approach provides the opportunity for team cohesion, greater nurse satisfaction, and higher nurse retention. NM
REFERENCES 1. Brunetto Y, Farr-Wharton R, Shacklock K. Supervisor-subordinate communication relationships, role ambiguity, autonomy and affective commitment for nurses. Contemp Nurse. 2011;39(2):227-239. 2. Doody O, Doody CM. Transformational leadership in nursing practice. Br J Nurs. 2012;21(20):1212-1218. 3. Lobo VM. Transformational leadership to promote cross-generational retention. Nurs Leadersh (Tor Ont). 2010;23(2):21-31. 4. Kash BA, Naufal GS, Dagher RK, Johnson CE. Individual factors associated with intentions to leave among directors of nursing in nursing homes. Health Care Manage Rev. 2010;35(3):246-255. 5. Casey M, Saunders J, O'Hara T. Impact of critical social empowerment on psychological empowerment and job satisfaction in nursing and midwifery settings. J Nurs Manag. 2010;18(1):24-34. 6. Duffield CM, Roche MA, Blay N, Stasa H. Nursing unit managers, staff retention and the work environment. J Clin Nurs. 2011;20(1-2):23-33. 7. Halfer D. Job embeddedness factors and retention of nurses with 1 to 3 years of experience. J Contin Educ Nurs. 2011;42(10):468-476. Paul LeBlanc is a nurse manager of Operations at Duke University Hospital in Durham, N.C. The author has disclosed that he has no financial relationships related to this article. DOI-10.1097/01.NUMA.0000443950.21970.a9
Nursing Management • March 2014 51
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
