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Perspectives in Psychiatric Care

ISSN 0031-5990

Editorial

Nursing Leadership in the Face of Change The increasing speed of change is a driving force in all parts of our professional lives. The effects can range from learning that a beloved nursing journal will be moving to an online version, to a shift to electronic medical records that require computer knowledge, or to learning that the lengths of stay in an inpatient system will be shortened even more given fiscal concerns. Psychiatric nurses, across the world, are being faced with a tsunami of change that directly influences their practice. How do nurses deal with these changes, the effects on their practice, and, more importantly, the influence on patient care? How do they pull apart the strands of influence on their practice, picking and choosing where to focus change strategy? Or, how does an advanced practice nurse, for whatever reason, choose not to participate in the change process and conduct business as usual? Is this even possible in today’s healthcare environment? A classic paper by the esteemed change theorist, John P. Kotter, was published in 1995 and talks about “Leading Change: Why Transformation Efforts Fail.” Reprinted in his book published in 2012, Kotter maintains that his change theories are even more relevant in today’s society. As I read the original publication, I realized that so much of this information has applicability to advanced practice psychiatric nursing and our ongoing efforts as clinicians, educators, researchers, and administrators to facilitate change. Kotter’s premise is written predominantly for a business model but has implications for health care at all levels. He speaks of success being based on the following eight steps to transforming an organization. They are: 1. Establishing a sense of urgency 2. Creating the guiding coalition 3. Developing a vision and strategy 4. Communicating the change vision 5. Empowering broad-based action 6. Generating short-term wins 7. Consolidating gains and producing more change 8. Anchoring new approaches in the culture (Kotter, 2012, p. 23) Kotter (2012) emphasizes that transformation is a process rather than an event. Each building stage takes time, that no change occurs quickly and that skipping steps is likely to result in failure. He also notes that even the most capable and inspired leader can make errors. He also emphasizes the need for a team, for a group, for a plan, for a vision. His change

doi: 10.1111/ppc.12075

Perspectives in Psychiatric Care 50 (2014) 147–148 © 2014 Wiley Periodicals, Inc.

process takes years of effort, hard work, diligence, and a constant evaluation of progress. McCabe and Sambrook (2014) note that nurses and nurse managers must develop trust in the leadership in order for any change to occur within a healthcare system. The line manager is key to the development of trust, which in turn results in change within a resource-impaired and fiscally challenged healthcare environment. Trust at the level of nurse and nurse manager must occur at individual, interpersonal, and organizational levels. Lyon (2014) speaks of the clinical nurse specialist providing transformational leadership to deal with system-level problems that adversely influence effective patient care. In the nursing literature, for several decades, transformational leadership encompasses concepts of belief in a better vision, ability to take risks (Gillespie & Mann, 2004), and commitment to the change (George, 2003). Leadership by nurses is relationship-oriented, relies on evidence-based practice, and encompasses the capacity to lead. Lyon notes that “the capacity to lead is a complex quality that encompasses particular personal and relationship-focused attributes, the ability to earn and effectively use interpersonal power, and the judicious use of the principles of influence” (2014, p. 163). The context of change has been dramatically influenced by the speed of change, the increased connectivity of people, the common need to search for meaning, and the global economy (Kouzes & Posner, 2012). Nursing leaders are challenged to model practice, inspire a shared vision, and lead with the heart (Lyon, 2014). This defines transformational leadership. Acknowledging that transformational leadership seems like a concept applicable to those in charge of large organizations, how does it have meaning for the advanced practice nurse treating patients, or teaching graduate nursing students, or conducting clinical research? How do advanced practice nurses who have done this work for 20, 30, or 40 years manage the changes occurring constantly in their healthcare world? I don’t think the answer is easy. Kotter talks about leaders who allow too much complacency to undermine their plans for change. He also writes that no individual can manage organizational change without a shared vision and goal. Over and over he emphasizes the concept of the team, of shared vision. Many of the pitfalls in the process occur because this shared vision is not adequately communicated or emphasized with the individuals doing the work of the organization. The task for all nurses is figuring out what aspect of their work life they can transform, what they can implement and absorb, and what they might choose to leave. They need to 147

Editorial

figure out what is essential to doing the job and what can be passed on to someone else. Nurses have to continually ask themselves the question of whether they are part of the organizational solution or part of the problem. And when nurses honestly find they are the problem and perhaps find it intolerable to participate in organizational change going on around them, they need to bravely ask if it is time to move on emotionally and perhaps physically. The speed of change is not going to alter anytime in the future. If anything, the complexity will increase, the distress and psychiatric needs of our patients will deepen, and the demands of us will increase. Kotter would emphasize the need to plan and understand your role in the change process, whether you are the managerial leader or the provider or both. He also writes about the process of lifelong learning as a means of dealing with change. This involves “risk-taking, humble self-reflection, solicitation of opinions, careful listening, and an openness to new ideas” (Kotter, 2012, p. 191). Finally, he speaks of not fearing change, of moving boldly into the future, and always growing. This is the task facing all psychiatric nurses as they continue to cope with increasing change while moving forward, providing high-quality patient care, and valuing lifelong learning.

References George, B. (2003). Authentic leadership: Rediscovering the secrets to creating lasting value. San Francisco, CA: Jossey-Bass. Gillespie, N., & Mann, L. (2004). Transformational leadership and shared values: The building blocks of trust. Journal of Healthcare Management, 19, 588–607. Kotter, J. P. (1995). Leading change: Why transformation efforts fail. Harvard Business Review, 73, 59–67. Kotter, J. P. (2012). Leading change (reprinted from 1996). Boston, MA: Harvard Business Review Press. Kouzes, J. M., & Posner, B. Z. (2012). The leadership challenge: How to make extraordinary things happen in organizations (5th ed.). San Francisco, CA: Jossey-Bass. Lyon, B. L. (2014). Transformational leadership as the clinical nurse specialist’s capacity to influence. In J. S. Fulton, B. L. Lyon, & K. A. Goudreau (Eds.), Foundations of clinical nurse specialist practice (2nd ed., pp. 163–172). New York, NY: Springer. McCabe, T. J., & Sambrook, S. (2014). The antecedents, attributes and consequences of trust among nurses and nurse managers: A concept analysis. International Journal of Nursing Studies, 51, 815–827.

Geraldine S. Pearson, PHD, PMH-CNS, FAAN [email protected]

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Perspectives in Psychiatric Care 50 (2014) 147–148 © 2014 Wiley Periodicals, Inc.

Nursing leadership in the face of change.

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