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AT THE FOUNDATION of understanding and applying any new skill is a basic understanding of its core concepts and often its history. Every acquired discipline, from architecture to the practice of law, requires attention to elementary principles. Emotional skill, specifically as it relates to nursing leadership, is no exception. In fact, emotionally intelligent nurse leaders have the opportunity to hone three skills: nursing, leadership, and emotional ability. In the pages that follow, we will explore the foundations of emotional intelligence and set the stage for applying emotional skill to effective leadership in nursing.
The Nurse as Caregiver
Since the dawn of the nursing profession, nurses have been viewed as caretakers or caregivers. A late nineteenth-century description of the nursing role includes the following:
Every physician recognizes the importance of good nursing. In the treatment of disease medicinal agents are necessary to combat the various symptoms as they arise, but it is equally important that the surroundings of the patient should be so arranged that he may be supported and tided over the critical period of his illness. It is not too much to say that in many illnesses good nursing is more than half the battle. When a man is seriously ill he is practically as helpless as a child, and canneither think nor act for himself. He is fortunate should there be some friend or relative who will take the initiative for him, but there are many people-often men in good social position-who have no one about them whom they would care to trust. The sick man sends for his doctor, and nurses are provided on whom rests the responsibility of seeing that he is properly cared for, and that no advantage is taken of his helplessness. The trust is a sacred one, and for the honour of the nursing community is rarely or never abused [Ambulance Work and Nursing, c. 1898].
Caregiving defines nursing even to the present day. Despite the increasingly technical and knowledge-rich nature of nursing, the expansion of nurses into significant health care leadership positions, and the growing number of nursing professionals who hold master's or doctoral degrees, the patient-nurse relationship still involves giving and receiving care. Highly qualified through certification, advanced learning, and experience, the nurse combines skilled medical administration with the roles of teacher, minister, and friend.
The "sacred trust" formed between nurse and patient is built on more than medical skill. It contains elements that are inevitably social and emotional. As nurses administer metered doses of potent medications, they assess patients for signs of depression and fear. As they explain treatment options to patients, they calm fears and anxieties by means that cannot be ascribed to procedural knowledge. Fundamentally, nursing involves a complex blend of accuracy and intuition, reason and emotion.
Emotion and Reason: The Traditional Dichotomy
The relationship between the rational and the emotional, then, must be explored. Traditionally, the two represent opposite poles of a dichotomy. Most people may be able to recall how emotions were viewed during their childhood, but in order to advance in emotional aptitude, it is helpful to first understand exactly how one was taught to perceive, manage, and express emotion in everyday life. Many people were taught that there was no way for emotion and reason to peacefully coexist and that the two must by nature be at odds with each other. Many were taught the necessity of leaving emotions out of decision making.
Emotion and Reason: Their Interdependency
The emotional and rational realms overlap, interact with, and affect each other. Despite notions of the desirability of separating emotions and reason, both realms must be acknowledged in order to provide quality health care, especially as medicine becomes more technical. Understanding how the two realms overlap is becoming ever more important as medicine presents us with issues such as life support decisions and genetics counseling. Such decisions as opting for elective oophorectomy or mastectomy to avert cancer (Dimond, Calzone, Davis, and Jenkins, 1998) or remaining childless because of genetic test results highlight the impossibility of ignoring the emotional component in rational health care decision making. Nurses especially, as patients' lifelines, need to understand the emotional dimensions in such clinical situations. Recognizing emotions and facilitating the transition from one to another are skills of emotional intelligence that serve nurses in such settings.
Emotion and Nursing Leadership
Increasingly, leaders in all fields acknowledge emotional processing, which was once left to instinct and intuition, as a vital component of executive ability. Without this skill, health care managers in hospitals, home care, outpatient care, nursing facilities, and other settings may face the challenge of rectifying the wrongs that result when emotions are handled ineffectively. Managers may be less able to communicate optimally with clients, families, or other health care professionals than they would be with better emotional skills. Important gains can be made in health care leadership by giving attention to the significant and critical emotional element present in every health care situation and by ensuring that nursing leaders develop their emotional potential, especially now that these competencies are recognized as skills that can be developed rather than less malleable personality traits (Freshman and Rubino, 2002).
Linking Emotional Elements and Leadership Style
For emotional development to occur in leaders, the concepts of emotional intelligence and leadership must be linked in such a way as to demonstrate a relationship between aspects of emotional intelligence and facets of leadership style. Various leadership styles have been described by different theorists (Blake and Mouton, 1978; Kouzes and Posner, 1995; Covey, 1991; Yukl, 1998), and their individual characteristics and actions have been explained (Birrer, 2002; Blake and McCanse, 1997). Because these characteristics are often associated with character traits, intuitive links between types of leaders and specific emotions often derive from experience. For example, one might associate an authoritarian manager with anger or lack of compassion, and a more relaxed or personable managerial style with cheerfulness.
Linking Specific Emotional Abilities to Leadership Style
Beneath these relatively easy-to-identify traits that characterize certain types of leaders lies another aspect of emotion not as readily apparent-the ability to identify, facilitate, understand, and manage emotion (Mayer, Salovey, and Caruso, 2000, 2002). Although we may identify anger with the tyrannical boss, appropriate management of that emotion may net an entirely different leadership style that we would no longer recognize as tyrannical. The personable, cheerful manager may be perceived by colleagues as friendly but may become a more effective leader by better understanding how underlying emotions cause individuals to react to adverse situations and how to help others manage these emotions in times of conflict. One of the first to note that effective leaders tend to have more emotional competencies was David McClelland, and research on this topic continues to this day, especially since the subject was popularized by Goleman (1995) (Freshman and Rubino, 2002).
Mayer and Salovey (1997) defined emotional intelligence as "the ability to perceive accurately, appraise, and express emotion; the ability to access and/or generate feelings when they facilitate thought; the ability to understand emotion and emotional knowledge; and the ability to regulate emotions to promote emotional intellectual growth" (p. 10). Abilities on this scale may be specifically tied to practical aspects of leadership style, and development of these abilities may be tied to professional and personal growth.
It is especially important, then, to explore what it is to be an effective leader in health care and not merely to act like one-intertwining Mayer, Salovey, and Caruso's (1999, 2000, 2002) constructs of emotional ability with specific leadership traits, exploring how these abilities can be learned as part of personality (Mayer, Salovey and Caruso, 2002), and discussing examples from earlier times, before the time went away and during which emotional art was as common at the bedside as medical science. We now have a clearer, more scientific view of what this art was and how it can be applied to other forms of knowledge to synergistically meet the demands placed on nursing leaders today.
Emotionally Intelligent Leaders Create
Leaders who are emotionally literate are more willing to experiment, more willing to make mistakes, and more ready to widen the span of their employees' control. Nursing leaders face a significant challenge in these aspects of leadership. Risk taking in leadership is often associated with liability for the actions of oneself or others, and in the health care setting, this liability involves a significant human life element that is not present in other fields. Policies and procedures abound, and adherence to standards is imperative when quality of care is at stake. How, then, does the nurse leader become one who creates, one who empowers, and one who takes risks within the organization? What abilities beyond a command of clinical and administrative skills give the nurse leader an edge on effectiveness that others may not possess?
Leaders who create take their work beyond duty to inspiration. They shape an enjoyable work culture and encourage employees to shape it as well. They foster a positive emotional climate in order to encourage participation. They are not afraid of failure; instead, they use it to teach success (Farson and Keyes, 2002). Having creative leaders will lead to having creative employees, which will result in more team spirit, more employee loyalty, and better productivity (Kouzes and Posner, 1995).
Emotionally Intelligent Leaders Communicate and Share a Vision In addition, emotionally literate leaders possess and share a vision of the ideal workplace. They communicate their vision of success, and by doing so, they inspire others to collaborate with them in making the vision a reality. They are planners, developers, and motivational managers (Kouzes and Posner, 1995; Mayer, Salovey, and Caruso, 2000, 2002).
Leaders should be the visionaries of their organizations and should understand what is needed to make them successful; this notion is very much supported in current thought. The Baldrige National Quality Program stipulates visionary leadership as an overarching critical element among performance excellence criteria for health care (Levey, Hill, and Greene, 2002). The Magnet Nursing Services Recognition Program defines and acknowledges features of hospitals that resulted in retention and recruitment of talented staff and improved patient outcomes (Aiken, Havens, and Sloane, 2000), results for which a solid vision is often at the core. Nursing team leaders should be able to communicate the possibilities of the long-term future and how present activities will translate to achieving that vision. In imagining the future, most imagine the ideal. High standards are a consequence of imagining that ideal. Part of being a leader is the ability to communicate persuasively, which includes conveying the conviction that the future will be better, even when the current situation presents a threat or major change (Bardwick, 1996). To achieve this, certain emotional tools are necessary, including the ability to recognize and manage emotions inherent in change (Mayer, Salovey, and Caruso, 2000).
Emotionally Intelligent Leaders Set an Example
Emotionally skilled leaders not only set a high standard but also set an example of excellence for others to follow. Because of their stability, they can encourage others to do as they do as well as to do what they say. They are not afraid of being wrong or admitting it, and they are ready to acknowledge credit for work well done. They operate personally, interpersonally, interdepartmentally, and organizationally in the same way, consistently representing their work and that of others. They balance their lives and expect others to do the same.
What sets these leaders apart is that they challenge the system from within while participating, while making the process better. They are not the managers who stand and criticize, failing to apply to themselves the rules they apply to others. In this way, they encourage others to act and to participate in the ongoing betterment of the work at hand.
Emotions in Organizational Teams
The preceding paragraphs point out that the emotional skills critical to effective patient care actually translate to better leadership ability. In the dual role of caregiver and leader, the nurse manager interfaces laterally with colleagues and vertically with patients, subordinates, and corporate administrators. The interfaces are no longer unilateral but are increasingly collaborative. Nurse managers find themselves not simply giving orders and taking orders but rather engaging themselves and their staff, their superiors, their colleagues, and even their patients, in participative decision making. As shared leadership becomes formalized in many organizations, its collaborative principles already typify even informal interactions in the health care team. It is becoming the norm.
It has to. Without it, patients are patients, doctors are doctors, dietary aides are dietary aides, and administrators are administrators in the senseless world of poking, prodding, and speedy discharge that patients have come to know as "the health care system." Without collaboration and team decision making, patients, nurses, aides, and even doctors may have no idea what the goals are or where they are in relation to their accomplishment.
Admittedly, not all work is done by teams, but the team concept is becoming the norm in many organizations. In health care, diagrams of teams often show interactive, interdisciplinary representation with the client in the center. Because team can be misinterpreted to mean "a group of people working on the same thing," it is important to differentiate here between work groups and teams in organizations and to realize that the two are not synonymous. Teams include an interpersonal accountability that work groups do not always have. As such, the development of a team involves an element of risk that the formation of a work group does not (Katzenbach and Smith, 1993).
Excerpted from The Emotionally Intelligent Nurse Leader by Mae Taylor Moss Excerpted by permission.
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|1||An age-old, new kind of nursing intelligence||3|
|2||Emotions in a techno-illogical age||20|
|3||Emotional intelligence and leadership||42|
|4||Leaders who create||69|
|5||Leaders who share a vision||93|
|6||Leaders who set an example||119|
|7||Downloading : honing emotional intelligence||141|
|8||Uploading : coaching emotional intelligence||163|
|9||Weathering a crash : conflict resolution in the health care environment||184|
|10||Shaping the work environment and culture||215|
|11||Rebuilding and upending the hierarchical pyramid||238|
|12||The future of emotional intelligence for nursing leadership||262|