This essay explores how the nursing profession has evolved since Florence Nightingale and how any change in the direction of n

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This essay explores how the nursing profession has evolved since Nightingale and to understand how quality patient care today, requires effective leadership rather than autocratic management.  Nurse managers still perform a valuable function; however, management activities are thought to compliment rather than replace the leadership role.  As the nursing profession has evolved, nurses have adapted and developed skills that are complimentary for the society and times they are functioning in.  One example of this has been the development of competency standards for the registered nurse [Australian Nursing Council (ANC) 2002].  Modern health care settings are complex and the registered nurse’s ability to perform a multitude of roles and responsibilities requires highly developed skills in decision making, critical thinking, and adherence to professional, ethical, moral and legal standards.  In addition to these skills, leadership and management abilities are considered essential for professional practice; all are included in the ANC National Competency Standards (ANC 2002) and are required for competent practice.  The ability of registered nurses to be effective leaders will impact on staff, resources, and the setting and achieving of goals.  This will, in turn, have implications for the quality of patient care.  

I examined the role of the registered nurse to understand how practise and client safety can be maintained by adhering to competency standards.  In addition, transformational leadership was examined to understand how this style of leadership functions and to determine how it could benefit the nursing profession.  Professional competencies and transformational leadership theories were then combined to reflect on a scenario to see how, when used together, an improved outcome could be achieved for all involved, especially the client.


 Transformational Leadership could be one answer to the question; How do you transform organisations or the staff within them to work in a more effective or efficient fashion? Those who support transformational leadership believe it to be much more than a passing fad. Embracing this style of Leadership has been described as ‘the key to future nursing development’ (Cook 2001:41) Covey (1992, cited in Wieck&Evans 2003:22), describes the goal of the transformational leader as:

   …to transform people and organisations in a literal sense, to change them in  mind and heart; enlarge vision, insight and understanding; clarify purposes; make  behaviour congruent with beliefs, principles or values; and bring about changes that  are permanent, self perpetuating and momentum building.

The five principles of transformational leadership include;

  1. Challenging the process
  2. Inspiring a vision
  3. Enabling others to act
  4. Modelling the way
  5. Encouraging the heart

 Used together these principles can help to develop trust and communication between staff (Kouzesand Posner (1997,cited in Weick & Evans 2003:22)

From this exploration I concluded that patients, staff and organisations could all benefit if a transformational leadership approach were to be introduced into healthcare situations. Communication, trust between staff, stress levels, absenteeism and staff turnover levels could all be improved and if that were the outcome the primary goal of quality patient care would also benefit greatly.

What is Transformational Leadership?

Nightingale nurses of the 19th Century were managed by experienced nurses ‘who were usually used to managing servants’ (Fedoruk 2000:16) Todays nurses are graduates who have been described as knowledge workers who want to be led not managed (Drucker1999, cited in Weick& Evans 2003) Transformational leadership has the potential to transform the nursing profession so that it is up to date with the needs of the current society and in order for nurses to have a stimulating and rewarding professional career. (Weick & Evans 2003)

The role of management in the time of Nightingale was authoritarian and focused on rules, control, hierarchy and systems of punishment or reward to motivate workers (McCallin 2003). This role to oversee working conditions may have been appropriate for directing servants, nurses and factory workers in the 19th century but today it no longer reflects the needs or values of professional nurses. Nurses who are managers have a vital function in the nursing profession. Nursing managers perform duties that are necessary, such as the organisation of staff rosters, looking after budgets, ensuring the safety of the work environment and the organising of materials and resources. These duties ensure the smooth operation of the nursing environment. This role is described by Huber (2000:77) as: ‘the coordination and integration of nursing resources by applying the management process to accomplish nursing care and service goals and objectives’. Modern nurse managers are integrators and facilitators, not watchdogs and interventionists’ (Huber 2000:19)

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It is desirable that nurse managers are leaders but this is not always necessary or achievable. (Weick & Evans 2003). Effective leaders are important to the profession as they set the tone of the working environment and inspire others to perform at their highest level (Weick & Evans 2003). Bowles and Bowles (200:70) define leadership as:

‘…an interpersonal relationship of influence, the product of personal characteristics rather than mere occupation of managerial positions. It is these personal characteristics which attract, enthuse and motivate followers towards organizational goals…’

Various leadership styles have been discussed and debated over time. The ...

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